Transcript Alamosa Salmonella Outbreak

Alamosa Salmonella Outbreak
Colorado Department of Public Health and Environment Response
It’s In The Water!
Next Steps
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Bottled water order for customers who pay water bill to the
City of Alamosa (East Alamosa Water NOT affected)
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Drain and patch holding tank
3.
Decontaminate (super-chlorinate) tanks and water distribution
system
4.
Test water for chlorine levels during super-chlorination
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Test water for bacteria and arsenic/heavy metal levels
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Continue to monitor illness patterns
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Assist businesses, food facilities, schools, daycare facilities to
return to water system
Timeline (cont)
March 19: CDPHE issues bottled water order to City of Alamosa
– residents/visitors to stop using tap water
Alamosa declares city/county emergency
COHELP Line activated: 1-877-452-2911
CDPHE WQCD issues request for assistance via
CoWARN mutual aid network
Denver Water and CDPHE Water Quality arrive
March 20: 3 water distribution centers established – bulk/bottle
American Red Cross volunteers staff distribution sites
CDPHE, Denver Water, Alamosa develop a strategy
to disinfect/flush Alamosa’s water distribution system
Timeline (cont)
March 21: Governor declares state public health emergency
Colorado National Guard arrives
Alamosa signed mutual aid agreement, establishing
formal/legal relationship between city and other mutual
aid partners
March 22: Governor Ritter and Senator Salazar arrive for tour
March 23: Jefferson County Incident Management Team (IMT)
arrives
Over 170 volunteers distribute over 5,000 flyers
March 24 : Alamosa water samples test positive for salmonella
First press conference in Alamosa
Request assistance from HHS:
environmental
epidemiology
risk communication
water quality
Develop color code phases for system flushing
System Flushing Process
• System Flushing – water disinfected with chlorine in 3-stage process
• Color-coded safety notices delivered to residences at each stage
STAGE 1 – Red
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High concentration of chlorine - 25 ppm
Can NOT use water for anything other than flushing toilets
Possible skin, eye, or other irritation from water exposure
STAGE 2 - Yellow
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Chlorine decreases to 10 ppm (slightly above swimming pool)
Water CAN be used to bathe and wash laundry
Can NOT consume water
STAGE 3 - Green
• Chlorine decreases to 1-2mg per liter
• Normal drinking, bathing, and other water uses can be resumed
Timeline (cont)
March 25: Alamosa public schools close
“Red” high chlorination process begins
5 FDA consumer personnel arrive
March 26: Entire city in “Red”
5 water samples test positive by PCR
for Salmonella – of 5 PCR-positive
samples, 4 grew in culture
Adams State College classes canceled
CDPHE updates Alamosa City Council
5 CDC personnel arrive
Mayor starts daily televised statements
on channel 10
March 27: Denver Salvation Army provides
vouchers for paper products
NW Colorado IMT assumes authority
Timeline
March 28: City completes “Red” phase, goes to
“Yellow”
Consumer protection inspectors reach out
to all regulated food service/institutional
facilities -89% remain open
Grocery store ensures produce
not harmed by contaminated
water
March 30: Alamosa receives memo from CDPHE
outlining how to go to “Green” status
CO-HELP line open over the weekend
March 31: Schools reopen
All city in “Yellow” stage
News conference with Colorado media
Eastern Colorado IMT assumes authority
CDC epidemiology staff demobilized
Water shares front stage
during Easter services
Timeline
April 3: City goes to “Boil Water” Order
April 4: CDPHE meets with Alamosa City Officials in Pueblo to
discuss ongoing investigation of the cause of the Salmonella water
contamination
April 8: CDC water samples show presence of Giardia and Cryptosporidium
(samples taken before system was flushed/disinfected).
April 9: CDPHE takes water samples to confirm Giardia and
been eliminated
April 10:
Crypto have
Total Cases = 424
Hospitalizations = 22
Deaths = 1
April 11: Boil Water Order rescinded – Alamosa goes to “green” status,
residents can consume water
CDPHE Response
CPD
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Provide guidance/assistance to restaurants, food manufacturers, childcare centers, and schools
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Conduct inspections of restaurants, food manufacturers, childcare centers, and schools
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Track facility closures for restaurants, schools and daycare centers
Communications
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Work with joint information center (JIC) partners and CDPHE divisions to draft public
communications as needed
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Press releases
Flyers
Reverse 911
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COHELP hotline
CDPHE website
DCEED
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Provide assistance in conducting disease surveillance, including case interviews/phone survey/etc
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Track number of cases and hospitalizations
EPRD
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Coordinate information and response activities from CDPHE divisions
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Monitor and provide staffing replacements for local/state public health staff
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Update messages on COHELP hotline and on CDPHE website
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Track COHELP reports, including homebound residents
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Track KRONOS records and other CDPHE fiscal costs related to the incident
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Provide ESF #8 support to Colorado Division of Emergency Management (CDEM)
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Assist CDEM in getting water, personnel, equipment and other resources to Alamosa as needed
CDPHE Response
HFEMSD
• Contact/provide assistance to hospitals, clinics, and long-term care facilities
Lab
• Conduct sampling for salmonella, total coliform and heavy metals
PSD
• Provide assistance to Alamosa WIC Director to find supplies of “ready to feed” formula
Sustainability Program/Waste Facilities
• Ensure recycling facilities in Alamosa are ramped up
WQCD
• Coordinate with city to develop and implement plan for flushing city municipal water
system
• Conduct water sampling for bacteria and heavy metals before/during/after flush
• Work COWARN to provide personnel and equipment mutual aid resources to Alamosa
• Provide guidance for water use during each stage during system flush
Online Situational Awareness Tool
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Secure, web-based system
Critical information specific to incident
Contact information
Real time status updates and info sharing
Media reports, links to related stories
Media & Public Information
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Joint Information Center (JIC) established
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CDPHE provided technical guidance, fact sheets, through JIC
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Current information provided to media/public as it was made available
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Having one point of contact for media inquires ensured accurate
messages delivered
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Consistent information provided by various methods (in English and
Spanish):
– Flyers delivered door-to-door Local/State media releases
– COHELP Line
– County website - www.CityofAlamosa.org
– CDPHE website - www.cdphe.state.co.us/epr/Alamosa.html
– Local cable channel 10
COHELP Line
• Staffed with information specialists from the Rocky Mountain
Poison & Drug Center (RMPDC)
• Developed to provide consistent, accurate and up-to-date
information to the public
• Telephony, integrated voice response unit (IVR), and webbased technology
• Operates daily - topics, hours, staffing adjusted to meet public
need
• Can take up to 1,000 calls per hour
• Voice recording and option to speak to live person
• Situational Awareness - data collection on dead bird/squirrel
reports, zip code geocoding of public concern trends
• Monthly reports on call volume and public concern trends
COHELP – Alamosa Response
• Total Calls = 2,544 in 14 days
• Notification to Activation Time = 3 hours
• Heaviest call volume hour = 90 call in one hour
• Heaviest call day = 486 calls
• Daily reports = call volume, top 5 FAQ’s, call trend analysis, real
time reporting of emergency requests
• Weekend coverage—calls transferred to registered nurses at
RMPDC for medical support
CoWARN Mutual Aid
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Colorado’s Water/Wastewater Agency Response Network
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47 public and private water and wastewater utilities, industry
support organizations and government members
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Can provide immediate assistance to members in emergency
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Participation is voluntary
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Signed “Mutual Aid Agreements” in place allow for quick response
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Colorado one of only 6 states that has web-based mutual aid
system like this
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Member website provides forum for establishing/maintaining
emergency contacts and communicating needs/resources in real
time
CoWARN – Alamosa Response
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Provided technical expertise, equipment and supplies to Alamosa
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23 water and wastewater utilities, industry support organizations and State of
Nebraska assisted
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CoWARN coordinators from CDPHE, Denver Water, and Aurora Water operated
through the CDPHE DOC.
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communication with City and CDPHE personnel onsite
maintained the CoWARN website
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Tracked donations of supplies/assistance from private businesses in network
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Crews worked 12 hour shifts, around the clock, with Alamosa and CDPHE
personnel onsite
CDEM Response
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Colorado Division of Emergency
Management
– Opened State Emergency
Operations Center (SEOC)
– Coordinated multiple state
agencies, volunteer
organizations and business
donations
– Status reports via emails
and 209 reports
– Coordinated IMTs sent to
manage the incident onsite
– As of 4/2, 812 volunteers
provided over 3,447 hours
of assistance
Incident Command
• ICS used among all response partners
ESF#8 - CDPHE Organization List
Incident Commander
Chris Lindley
PIO
Mark Salley
Rachel Coles
Talking Points
Nancy Enyart
Liaison/COHELP
Jackie N-W.
Translation/Education Contact
Koral O'Brien
Safety Officer
Operations
Planning
Logistics
Finance
Water Quality Division
Steve Gunderson
Section Chief- Dana Erpelding
Section Chief - Gerrit Bakker
Section Chief - Tanya S.
Consumer Protection
Barbara Hruska
Disease Control Division
Ken Gershman
Health Facilities Division
John Schlue
ESF8 Liasion at CDEM
Natalya V.
Staffing- Tracy C.
Deputy
Diana H.
External Agencies
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Local Public Health Agencies
Alamosa Fire Department
Alamosa County Nursing
Alamosa County Sheriff’s Office
Alamosa County and City Management
Alamosa County Road and Bridge
Alamosa County Emergency Management
Alamosa Water Department
Alamosa Police Department
City of Durango
City of Ft. Collins
Denver Environmental Health
Denver Water
Aurora Water
Pueblo Water
Boulder Water
Colorado Rural Water Association
East Cherry Creek Village
San Luis Valley Regional EMS/RETAC
San Luis Valley Mental Health
Denver Department of Local Affairs
Costilla County
Rio Grande County
Saquache County
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Jefferson County Incident Management Team
Northwest Colorado Incident Management Team
Division of Emergency Management
Department of Transportation
Department of Human Services- Mental Health
Department of Corrections
Colorado National Guard
Governor Ritter’s Office
State Senator Ken Salazar's Office
Congressman John Salazar's Office
Rocky Mountain Poison and Drug Center (COHELP)
American Red Cross
FEMA Region VIII
U.S. Dept. of Health and Human Services
Centers for Disease Control and Prevention (CDC)
U.S. Forest Service
Food and Drug Administration
Homeland Security