Community reaction to bioterrorism: prospective study of simulated outbreak - Research

Emerging Infectious Diseases, June, 2003 by Cleto DiGiovanni, Jr., Barbara Reynolds, Robert Harwell, Elliott B. Stonecipher, Frederick M. Burkle, Jr.

To assess community needs for public information during a bioterrorism-related crisis, we simulated an intentional Rift Valley fever outbreak in a community in the southern part of the United States. We videotaped a series of simulated print and television "news reports" over a fictional 9-day crisis period and invited various groups (e.g., first-responders and their spouses or partners, journalists) within the selected community to view the videotape and respond to questions about their reactions. All responses were given anonymously. First-responders and their spouses or partners varied in their reactions about how the crisis affected family harmony and job performance. Local journalists exhibited considerable personal fear and confusion. All groups demanded, and put more trust in, information from local sources. These findings may have implications for risk communication during bioterrorism-related outbreaks.

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Human behavior during disasters (e.g., hurricanes, fires, mass shootings, airplane crashes) has been studied by historians as well as behavioral and social scientists, and disaster management teams make assumptions on the basis of these studies (1-11). However, with bioterrorism (intentional release of biological, chemical, or radiologic agents), the standard sensory cues (location, beginning and end of crisis) are not available; therefore, a different "emotional valence" may be involved. The standard models used as predictors of human behavior during crises may not be adequate. We simulated a bioterrorism-related outbreak in a U.S. community to examine (prospectively) the community's reaction to the crisis and assess the need for public information.

Methods

We simulated the intentional aerosolized release of Rift Valley fever virus (RVFV) in a semirural community (population 300,000) in the southern part of the United States. The community was selected because its mosquito population could support transmission of RVFV. We videotaped a series of simulated print and television (local, network, and cable) "news reports" over a fictional 9-day crisis period. The 83-minute videotape told the story of the intentional disease outbreak. We invited four groups (medical first-responders, medical first-responder spouses or partners, journalists, and others) within the selected community to view the videotape and answer questions about their reactions. These four groups knew that the outbreak was fictional. We then tabulated and analyzed the responses.

The Video

The story of the simulated outbreak unfolded in a series of video reports from federal and local governments and the news media (Appendix 1, online only, available from: URL: http://www.cdc.gov/ncidod/EID/vol9no6/02-0769_ app1.htm). Health agency news bulletins were provided by the Centers for Disease Control and Prevention; news reports by television reporters or news anchors; and community reports by local officials, including the mayor. The reports began with recognition in the community of an unusual infection affecting humans and certain farm animals and continued during the next 9 days with an epidemiologic investigation and the identification by federal authorities of intentional release of RVFV. Reports included a detailed press conference by federal health authorities describing routes of transmission, prevention measures, signs and symptoms of infection, and medical management of the disease. The news conference, held in the state capital the day after the presence of RVFV infection in the United States was announced, was immediately followed by a panel discussion (by nongovernment experts) on RVFV. Differences of opinion on clinical, epidemiologic, and biological issues among RVFV experts were reported.

Confusion arose in the community over disease management (e.g., the effectiveness of the antiviral drug ribavirin, the need for RVFV vaccine, and who should receive the vaccine) and over the potential for infected persons to serve as reservoirs and carriers of the virus elsewhere during the few days when viral titers are especially high. Governors of adjoining states questioned the adequacy of mosquito-control and animal quarantine measures, given the lack of a control model for the spread of RVFV infection in industrialized countries. Although official quarantine measures were not taken, final video reports showed a gradual de facto isolation of the city.

The Questionnaire

The questionnaire (Appendix 2, online only, available from: URL: http://www.cdc.gov/ncidod/EID/vol9no6/02-0769_ app2.htm), which included multiple-choice, open-ended questions, and opportunities for additional comments, was distributed to all participants. Questions addressed job abandonment, quarantine compliance, demand for drugs and vaccine, information requirements, and other issues of community interest. Six sets of questions were posed to the participants during the video presentation. Set 1 was given after a disease of unknown etiology affecting humans and some farm animals was recognized in the community. These questions focused on willingness to remain at work, the types and sources of information that influenced the decision to work or not work, and actions regarding families and loved ones. Set 2 was given after the disease was identified as RVFV infection, federal health authorities briefed the public about this infection at a press conference, and a panel of nongovernment experts discussed the disease on television. These questions tested the participants' understanding of RVFV routes of transmission and preventive measures and the participants' satisfaction with information from government and nongovernment sources. Sets 3 and 4 followed a period of growing confusion and anxiety caused by changing and sometimes conflicting "authoritative" statements and tested participants' requests for medication, including ribavirin (Set 3), and for RVFV vaccine (Set 4). Set 5, given after the participants learned that the outbreak of RVFV was intentional, reassessed decisions and actions regarding job and family concerns and information needed to make these decisions. Set 6 followed a period of increasing anxiety over a now-confirmed bioterrorism-related outbreak that could spread to humans and cattle in the state and in adjoining states, over the ability of the government to stop the spread of the infection, and over the de facto isolation of the community. These questions surveyed participants' reactions to rumors of possible quarantine and to sources of information deemed reliable and influential in decision making now that the threat had become more complicated, personal, and disruptive.