Whether it be a disease outbreak, a natural disaster or a devastating lung condition, regular, responsive communication drives response to public health emergencies. In the summer of 2019, with cases of E-cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI) steadily rising, partners at federal, state and local health agencies, health associations, hospitals, poison control centers and other players were in constant contact.
APHL Director of Environmental Health Julianne Nassif recalls, “At the height of the EVALI response, I spent most of my day on conference calls with [the US Centers for Disease Control and Prevention (CDC), US Food and Drug Association, Council of State and Territorial Epidemiologists] and member labs. It was many long hours fortified by a lot of caffeine, but these calls kept us up-to-date and on-task in a rapidly evolving situation.”
EVALI Community Links Members, Partners
APHL facilitated the exchange of time-sensitive information by creating an EVALI community of practice, linking member laboratories, federal agencies and others working on the issue. Building upon relationships developed through various laboratory networks, the group held conference calls to brainstorm ideas and discuss surveillance reports, testing methodology and legal considerations. Experts in testing for e-liquids in vaporized products joined the calls to explain methods unfamiliar to many public health laboratories. The community also served as a nexus for rapid distribution of sampling guidance and analytical methods to scientists working on analysis of EVALI case-related specimens and products. For example, CDC deployed standards for collection of bronchial lavage specimens through the EVALI community. The community continues to hold routine conference calls to exchange notes on recent findings.
APHL also polled member laboratories to solicit their advice on resources and services needed for EVALI response. They returned six recommendations:
- Elevation of the EVALI response to an agency-wide level
- Addition of experts in environmental and occupational medicine and in epidemiology
- Guidance for specimen collection and storage
- A template for submitting data to CDC
- Extending the time allotted for collection of samples
- Building non-targeted testing capability for 1000s of chemicals and providing technical support to assist states with chemical analysis
When APHL forwarded these recommendations to CDC’s Emergency Operations Center, the response was prompt: CDC would provide almost all that APHL had requested.
Existing Relationships Facilitate Response
So why did APHL laboratories and partners communicate so well during the peak of the EVALI outbreak? In short, because they knew each other. By participating in the Laboratory Response Network for Chemical Threats (LRN-C), the National Biomonitoring Network, Opioid Biosurveillance and the APHL Community of Practice for Cannabis Testing, they knew each other personally and trusted one another. Through these same networks, they had also built relationships with hospital staff, poison control specialists, epidemiologists and forensics scientists. In an emergency, these connections proved invaluable.
A plenary session about how strong communications enhanced the laboratory response to the EVALI outbreak had been planned for the APHL 2020 Annual Conference, which unfortunately has been canceled due to the COVID-19 pandemic. There are plans underway to turn the session into a webinar, so keep an eye out on the APHL Webinars page for more information.