Emerging Infectious Diseases - A Whole-Community Approach

by Anthony S. Mangeri

The World Health Organization defines an emerging infectious disease as either a new disease that has not been previouslyentified or a disease that is known but increasing in frequency. Like many natural disasters, emerging infectious diseases such as Ebola virus disease (EVD) and severe acute respiratory syndrome (SARS), as well as the reemergence of tuberculosis and other diseases, require an integrated whole-community response. 

Planning, Resources & Response

Managing threats from emerging infectious diseases requires planning, as well as public and private sector resources. All facets of local government, including public safety and the community as a whole, must be part of the response. For this reason, emergency planners and mitigation officers need to consider emerging infectious diseases as part of their Threat and Hazardentification and Risk Assessment (THIRA) process.

Similar to other natural hazards, EVD is just one of many emerging infectious diseases that can potentially threaten community normalcy by disrupting day-to-day activities and business operations. This can have significant social and economic impacts. However, implementing an effective community response that is unique to each type of disease would be time consuming and expensive. Operational planners consider the three key components of personnel, time, and cost when preparing emergency operations plans. If there were little time to respond, then cost and personnel would have to increase to meet demand. If availability of response personnel were low, the response would clearly take more time and require more financial support.

According to the Centers for Disease Control and Prevention (CDC) website, during a 30-year period (1976-2006), CDC estimated that flu-associated deaths in the United States ranged from 3,000 to 49,000 people. Moreover, in the fall of 2014, CDC began an investigation of acute flaccid myelitis – inflammation of nerve cells in the spinal cord, which can be caused by viral infections – in U.S. children. Thus far, CDC hasentified 94 children in 33 states with this illness.

In reality, an emerging highly infectious disease incident: (a) can easily overwhelm a community’s emergency response and medical systems; and (b) requires a comprehensive multiagency response for all communities possibly affected by the disease.

Slow Onset Disasters

Many agencies consider communicable illnesses – including EVD, SARS, and influenza – public health incidents, rather than slow onset disasters requiring activation of emergency management systems. This leads some communities to assume that public health can address such crises without outside assistance. Community mitigation strategies for widespread pandemic incidents may include social distancing and isolation of those who may be ill. Such strategies require activation of jurisdictions’ emergency operations plans to manage isolation protocols, cancel public gatherings and events, establish points of dispensing, monitor patients, and transport patients.

For these reasons among others, it is time to integrate communicable and infectious diseases into communities’ THIRA processes as emerging natural hazards. The Federal Emergency Management Agency (FEMA) has published the second edition of the THIRA Guide in 2013. This guide provides a strategy for completing a comprehensive communitywide THIRA using a standard four-step process. At its core is the FEMA whole-community approach.

This approach defines emergency preparedness as an integrated risk that requires each community to estimate capability requirements of the whole community including residents, businesses, faith-based organizations, nonprofit groups, schools and academia, and all levels of government. The THIRA process is designed to aid communities inentifying threats they may face and tasks they must do to prepare. In addition, communities work together toentify the resources needed and determine actions that can mitigate hazards, which should include public health threats from emerging infectious diseases.

Emergency management is a system – a process designed to bring stability to a crisis and manage the impact on a community. The role of emergency managers is to ensure that all partners in the community can effectively respond to, recover from, and mitigate the potential effects of known hazards and their threat assessments should include risks of emerging infectious disease.


Anthony S. Mangeri, MPA, CPM, CEM, is the director of strategic relations for fire services and emergency management and is on the faculty of the American Public University System’s School of Security and Global Studies. He has more than 30 years of experience in emergency management and public safety. He also has spent much of his career integrating public health and community emergency management systems. During the terrorist attacks of 11 September 2001, he served as operations chief at the New Jersey Emergency Operations Center, coordinating that state’s response to the passenger-aircraft crashes into the World Trade Center.