Pandemics threaten the fabric of the global community and represent one of the greatest challenges to any disaster response organization.
Over the past 20 years, my work in global health security has primarily focused on trauma preparedness, terrorism and responding to natural disasters. But, as an emergency medicine physician, I have also been actively involved in helping large health systems prepare for, and respond to, emerging infectious disease threats for more than a decade. As the Medical Director of Emergency Management for Atrium Health’s Carolina Medical Center-Main I have helped lead teams during the MERS, Ebola, and now COVID-19 responses.
Dr. David Callaway (r)
Today, I am also the Chief Medical Officer for Team Rubicon, a veteran-led disaster relief organization. In this role, I oversee all of Team Rubicon’s international medical missions, work to build future response capabilities, and provide medical guidance for domestic missions. Part of that means helping Team Rubicon understand how to deploy its vast stores of human capital to serve international and domestic communities impacted by the novel coronavirus, COVID-19.
For any organization deploying during an infectious disease epidemic, there’s a lot more to think about than simply whether the organization has the medical personnel needed. When your organization is composed of volunteers, those estimations are even more complex and must consider things like the ripple effects on the donor community medical systems, nuanced communication, differences in duty to care, and an understanding of the volunteer base.
Consider the Ripple Effect on the Medical Industry
There’s a significant operational difference between deploying medical relief for a natural disaster and deploying medical relief in response to an epidemic. When emergency medical relief personnel are sent out in response to natural disasters, like earthquakes and typhoons, they are able to return to work in their home hospitals or medical centers immediately post-deployment. However, during highly infectious disease outbreaks such as the coronavirus, employers often impose very strict quarantines—usually 14-21 days—on individuals who may have had moderate- to high–risk exposures. From a planning standpoint, that means every doctor, nurse or medic we deploy for two weeks may functionally be out of capacity in their home community for four weeks.
Adding an additional 14 days of sick or vacation leave to the end of a multi-week volunteer deployment can be hard on any employed person; for the medical industry, if not done correctly, it can be a deal breaker. It’s not an easy decision, but a volunteer disaster relief organization may have to prioritize the ripple effects and long-term impacts on their own communities and infrastructure over deploying medical disaster relief volunteers for an epidemic elsewhere.
There are a few strategies that organizations can use to attack this complex problem. First, find a partner (unless you have the in–house capability) who can build predictive models of disease spread, health system impact, and projected recovery. For example, there are groups that have taken the data from China, South Korea, and Italy and built models to predict local, regional and national spread of the coronavirus based upon current infection rates. Acknowledging modeling gaps, national organizations like Team Rubicon can use this information to mobilize resources from less affected to more affected regions, while remaining sensitive to the operations of all health systems.
Second, partner with local and regional health systems to develop forward leaning return–to–work policies. As we have all seen during this pandemic, the recommendations for testing, personal protective equipment, quarantine, and when health care workers can return to seeing patients changes, quite literally, every day. Anticipate where we will be in 2-4 weeks, get agreements in place with the employers of your volunteer base, and get people to where they are needed. Finally, organizations can develop aggressive scope–of–practice guidelines to ensure that all staff are working at the top of their credentialing or licensure. This means taking on some additional risk, but if done properly, can expand your capability.
Consider Non-Medical Responses to Medical Humanitarian Crises
On any mission there’s never a shortage of work. Medical personnel who do deploy may be tasked with non-medical work in order to serve the greater good. For doctors, this sometimes means not providing direct patient care, but instead taking out the garbage and filling out paperwork—doing whatever needs to be done. As a doctor, you may have to be willing to set down the stethoscope and put up a tent instead.
The health system and community response to a pandemic is labor–intensive; think things like setting up mobile testing sites, establishing shelter health, mitigating the consequences of quarantine, and more. To that end, sometimes the biggest assets to a medical mission are non-medical volunteers. There are ways that we can assist local public health, and even provide local health management, without providing clinical care. This may mean anything from delivering food to at-risk populations to building medical tents. As the coronavirus evolves, we’ll see where those opportunities present themselves. But, we know, there will be a need. And we know, we will serve.
To Deploy Non-Medical Volunteers for the Coronavirus, Know Your Volunteer Base
Some of the nation’s best disaster relief volunteers are retired veterans, nurses, doctors, and other civilians. These are people with the time and availability to help, and a lifetime of invaluable skills and experience to bring with them.
Unfortunately, in the case of an infectious disease or epidemic such as COVID-19, a nonprofit’s biggest asset may not be deployable. With the coronavirus, it is known that people over age *60, and those with underlying conditions such as heart disease, emphysema, COPD, and diabetes, are at the highest risk of negative health outcomes. It’s not that those top boomer volunteers are more likely to get the coronavirus than millennials, but that the risks of complications are far greater. The vast majority of people—people with low-risk factors—who contract COVID-19 feel like they have the common cold. But, for those who are older, or with underlying conditions, COVID-19 can occasionally progress to pneumonia, cause buildup of fluid in the lungs, and kill. So, if you’re going to deploy a volunteer army, you need to know that army and be willing to make some tough decisions about which volunteers you will, and will not, deploy.
The Tricky Business of Responding to Non-Medical Disaster During an Epidemic
Team Rubicon doesn’t only provide medical relief: the majority of its work is boots-on-the-ground cleaning up and helping out after natural disasters, such as recent mudslides in Washington and Oregon, and the tornadoes in Nashville and Tennessee.
During an epidemic, there are other ramifications that have to be considered when deploying on nonmedical missions. Any operation in a COVID-19 affected region—especially the close-quarters, high-impact Team Rubicon ops—becomes more hazardous. The risk of COIVD-19 impacts each core component of an operation—mobilization, berthing, daily operations, security, sustainment, health and wellness, and post-deployment recovery. For example, the daily cadence may now include an extended safety brief, volunteer symptom screening (e.g for fever, cough or other symptoms of COVID-19), social distancing in the berthing space, enhanced environmental precautions in the work and living areas, more frequent wellness checks, and mandated symptom reporting. For a team leader with 30 volunteers, mucking out tornado-ravaged homes and returning to sleep in a local church auditorium, attention to these details is critical.
COVID-19 will challenge the historical operating principles or many volunteer organizations. A strong organizational culture is critical. If you don’t have one, take a strategic pause, and use this opportunity to examine how this crisis can help you build one.
How To Utilize Volunteers During an Epidemic
There are, and will be, massive needs. Many disaster relief organizations can serve during the coronavirus without putting their volunteers or their local communities at risk. They might set up freestanding clinics for people who believe they may have the coronavirus, or establish drive through testing areas, as many health systems, including Atrium Health are doing. Organizations can assist with food, water and sheltering needs: They can deliver meals and supplies to people in need as Team Rubicon is beginning to do in Milwaukee, WI and Albuquerque, NM.  
Even when they aren’t directly patient related, these are medically adjacent services disaster relief organizations can deliver during a pandemic. Be smart. Find work. Be part of the community. And, continue to serve.
*Editor’s Note: In late March, the CDC raised its age for high risk from 60 to 65.
