Remain Calm

Photo: Susan Wides; Title: Mobile Views FK7-1, Copyright 2002/2003; Courtesy of Kim Foster Gallery of New York

On an early-winter Monday morning in Hong Kong, a businessman boards a plane for New York. The man, who’d spent a few days touring the Chinese countryside during his trip, is not feeling great. He’s tired and achy. He can’t decide if it’s the wear and tear of his travels or the beginning of a cold, but after coughing and sneezing throughout his sixteen-hour flight, he’s certain he’s getting sick.

By the time he goes through Customs at JFK, gets his bags, and finds a cab, he has only enough energy left to check into his midtown hotel and collapse on the bed in his room. The next day, feeling even sicker, he heads to the nearest emergency room. By now, he’s got a high fever and he’s coughing up blood. Given his robust flulike symptoms and his international travel, alarm bells go off in the ER.

Though word hasn’t yet reached the U.S., there have been several dozen confirmed cases of human-to-human transmission of the H5N1 virus—better known as avian flu—in the Chinese countryside and several other spots in Asia. But even without the new information, the ER doctors, who’ve been drilled on what to watch for, are convinced it’s avian flu. Taking no chances, they isolate the patient. But the damage has been done—the businessman has infected people on the plane, at JFK, in his hotel, and even in the hospital’s waiting room.

The city’s ability to deal with the pandemic is severely hampered by three problems. There is no vaccine and won’t be for months. Tamiflu, an anti-viral drug that is the principal form of treatment, is in shockingly short supply. And people are now getting sick in other cities as well.

The city’s hospitals are unprepared to deal with the large number of incoming patients flooding the system. More than 2 million people will be infected over the course of the six-to-seven-month flu season. Of these, 10 percent, or 200,000 people, will need to be hospitalized. That’s 1,000 admissions a day. The fatality rate will be about 2 percent, which translates to 40,000 dead, many of them children and healthy people between the ages of 18 and 50.

The social fabric begins to fray. As in New Orleans, there is a disparity between the white community and the nonwhite community, between richer neighborhoods and poorer neighborhoods. The mayor has to take draconian measures, practically instituting martial law, to contain the spread of the disease. Public gatherings are forbidden. Movie theaters, Broadway shows, concerts, and sporting events are all suspended. Even the subway is shut down.

Is New York ready? With the growing fear of an avian-flu pandemic, and in the aftermath of Katrina, that’s the most pressing question in the city right now. Hurricane Katrina showed that logistics aren’t mere details; they can mean the difference between life and death. And it furthermore showed (as if New York needed more convincing) that the federal government can’t be counted on to secure our safety.

“Four years after 9/11, we are, as a nation, extraordinarily, inexplicably unprepared to deal with a major catastrophic event,” says Dr. Irwin Redlener, the head of the National Center for Disaster Preparedness at Columbia.

Redlener, who is also the president of the Children’s Health Fund, traveled to the Gulf in the immediate aftermath of Katrina with several mobile medical units to assist in the recovery effort. I talked to him the evening he returned from Mississippi; what he saw there made him angry. “We’ve had terrible leadership in Washington. We have less accountability in place on the issue of preparedness than we have for making ice cream. We’ve spent tens of billions of dollars,” he says, exasperated, “and I challenge anyone to find a person or even an agency in Washington that knows what we’ve purchased. What we have are random acts of preparedness with no overall strategic plan.”

The city itself gets a much better grade. “There’s no question,” says Dr. Shelley Hearne, executive director of Trust for America’s Health, “that New York is far more advanced in its preparedness than any other city.”

Redlener concurs. Though most of his blistering criticism is directed at federal authorities, he says the city has shown too little foresight. To illustrate his point, he uses decontamination facilities, which a handful of concerned New York hospitals rushed to put in after 9/11. He argues that even though the hospitals are proud of these facilities and it makes them feel like they’re doing something, no one really knows how many decon showers New York City needs to effectively deal with a major event. Is it 500 or 5,000? Maybe it’s 10,000.

“I spoke to the head of infection control at one of the major medical centers in New York recently,” Redlener says, “and I asked her how many SARS patients her hospital could accommodate in isolation. She said, ‘We’re in pretty good shape. We can handle five.’ And I said five—what? Five hundred? And she said, ‘No, five.’ The degree to which we can’t get this together from an overall strategic point of view is almost surreal. We still don’t even have a definition of what preparedness is.”

The problem with disaster preparedness is that it all too often involves fighting the last war. In New York, of course, that means 9/11. Redlener contends that though some progress has been made, disaster planning on the whole remains hampered by a kind of first-wave mentality. That is to say, too many people are still stuck in the same mind-set they were in immediately after 9/11.

“We started backwards,” he says. “We put the money first and told people to go buy things, and now we’re struggling to define what it is we wanted them to achieve with that money.”

Even more problematic is the alarming lack of creativity. After 9/11, everyone focused on planes and airline security. When Richard Reid, the shoe bomber, was caught, suddenly there was great urgency about having everyone remove their shoes at the airport-security checkpoints. Everything is always reactive.

“Now the focus will undoubtedly be on hurricane planning,” Redlener says. “We’re always playing catch-up. We’ve got to get over this disaster-du jour mentality and develop the ability to take a broader, overall view, or we will continue to get blindsided.”

In fact, there is a new way of looking at things, a view that does reflect the reality that everyone has had four years since the initial shock of 9/11 to think about readiness. Rather than all terrorism all the time, planners have begun to focus on a more sophisticated, more adaptable strategy called the “all hazards” approach.

The idea is simple. When dealing with the impact of a catastrophe, the cause (terrorism or Mother Nature), at least as far as recovery and rescue are concerned, is almost irrelevant. People have to be evacuated, the wounded have to be treated, the displaced have to be sheltered, order has to be maintained, and so on. In other words, much of what composes an effective response is largely the same in every emergency situation.

Even the feckless Department of Homeland Security has recognized the need for this approach, issuing a list of fifteen possible disaster scenarios that it has urged every state to prepare for. New York City’s Office of Emergency Management switched to an all-hazards strategy nearly two years ago.

State Assemblyman Richard Brodsky, who recently completed a highly critical study of New York’s hurricane evacuation plans, argues, however, that the city’s stated change in approach is little more than lip service. “All they’re thinking about is terrorism,” Brodsky says. “And the net result is that the hurricane plan is embarrassing. The city is as unprepared as FEMA.”

And Redlener argues that even the all-hazards approach is not enough. There must be a distinction in planning between calamities that are manageable in scope and what he calls mass events. He believes, for example, a suicide bomber in the subway would be a completely manageable event. Horrific and disruptive, no doubt, but manageable.

“But a nuclear explosion, a flu pandemic, an earthquake, or a major hurricane would be something else entirely,” Redlener says. “These kinds of events, where the number of casualties exceed the ability of our health-care system to respond and where you’re likely to have a breakdown of essential systems, are another matter. This is where our planning and our imagination fail to meet the reality.”

To virologists and infectious-disease experts, the flu scenario presented above is all too real. “When those of us in public health think about the terrible things that could happen,” says Dr. Thomas Frieden, New York City’s health commissioner, “pandemic influenza is right there at the top. And we’re clearly in a situation now that’s different from where we were ten years ago. It’s estimated that 150 million birds have died from avian flu.”

A pandemic would affect virtually every aspect of life in the city. Consequently, Frieden and members of his staff have been meeting with leaders from all sectors across New York to make sure everyone understands that a pandemic would be more than just a health crisis.

As much as 30 percent of the workforce may not show up owing to illness or fear of getting sick. This could result in disruptions in power and phone service. Fewer deliveries could produce food shortages, and maintaining sufficient Police and Fire Department manpower could cause problems in protecting the city.

In a pandemic, the first line of defense is the hospitals. Several weeks ago, the Health Department ran a tabletop exercise with hospital executives, simulating a pandemic to try to identify weaknesses in the system. Frieden says that despite worries about surge capacity, the overall number of beds was not an issue.

“We’re most concerned about respirator capacity and ICU beds. That’s the bottleneck in the models we’ve run,” he says. The department is currently evaluating low-cost portable ventilators. He’s also working with the hospitals to run crash courses for respiratory technicians and nurses.

Tamiflu, the anti-viral drug touted for its ability to mitigate the impact of avian flu, however, is another matter. “The data on Tamiflu is really weak,” Frieden says. “I don’t think we should stockpile it. It would cost more than $100 million, which is a lot of money for something that might not be needed and, if it is needed, might not work.”

Frieden believes that buying the hard-to-get Tamiflu is, in any event, a federal responsibility. Last week, in an attempt to try to get out in front of a potential crisis, President Bush announced he would ask Congress for $1 billion to stockpile Tamiflu. Even if approved, those funds will not pay for nearly enough doses of the drug if there is a pandemic. Frieden, however, may have an ace in the hole. He spent five years in India as a medical officer for the World Health Organization, and during that time he developed relationships with health officials and the pharmaceutical companies. He has already been in touch with drug manufacturers in India about their plans to make Tamiflu. “If we have a crisis,” he says, “we’ll get it through any safe source we can.”

There are also experimental vaccines. They are not commercially available, and no one knows if they will work once the flu virus mutates to enable easy person-to-person transmission. But the federal government has bought 2.3 million doses of one of them. Distributing anti-viral medicines, if they’re available, and vaccinating millions of people, if there’s a vaccine that works, would be a logistical nightmare—so the Health Department has been doing distribution drills.

But there is an even more vexing problem: What if there are only limited supplies of lifesaving medicine? Who will get it? “It would be unethical to use Tamiflu for prevention when people who are sick can’t get enough of it,” Frieden says. “It should go first to those most likely to die if they don’t get it.”

Ironically, all the media coverage of avian flu has begun to produce a backlash among some in the medical community. There are experts who say all this attention is creating unnecessary panic.

“This is a dangerous attitude,” Redlener says. “This country doesn’t respond well to carefully worded warnings. Look at New Orleans. Civil engineers were saying for years that the levees were too fragile. We need to amp up the message, not throttle back.”

The storm is named Rudy. When it reaches the coast of the Carolinas, it is a Category 2 hurricane with winds in the 96-to-110-mile-an-hour range. Rather than turn inland, as expected, it suddenly heads north, making its way up the East Coast toward New York. If it continues on its present path, it will hit the city in 48 hours.

The mayor has decided to wait another 24 hours before taking any drastic action. There is still a chance that Rudy will head out to sea before reaching the metropolitan area.

A day later, with the storm moving at an incredibly fast 34 miles an hour (triple the speed of the average southern storm), it appears to be headed straight for the city. Acting quickly now, the mayor orders the evacuation of lower Manhattan, as well as much of coastal Brooklyn, Queens, and Staten Island.

Extra subway and bus service is added, but the systems quickly become overwhelmed. Roads out of town are immediately clogged. In all, more than 2 million people need to get to higher ground. With the storm now only hours away, the Verrazano-Narrows and George Washington Bridges are closed owing to the danger from high winds, which are now well over 100 miles an hour.

Panic begins to take hold when many people realize they won’t make it out of the city. Some just leave their cars and head on foot for one of the reception centers spread across the five boroughs. There is plenty of chaos, but despite scattered pockets of hysteria and violence, the cops remain in overall control.

The power of the storm is intensified by what is known as the “New York Bight.” The narrow mouth of the harbor and the land formation create a natural chute to direct and focus the hurricane on the city. When the 30-foot storm surge hits the coast, the thunderous wall of water is, as a 1998 Army Corps of Engineers report predicted, “like a giant bulldozer sweeping away everything in its path.” Cars are overturned and tossed like toys, windows are blown out, small buildings and storefronts are completely destroyed. The most vulnerable areas near the coastline, including Wall Street, are left under nearly ten feet of water.

Weather trackers still talk about 1938, when a Category 3 hurricane with sustained winds of more than 100 miles an hour tore through parts of the city and Long Island. The storm knocked out all power above 59th Street, including the entire Bronx, destroyed more than 100 large trees in Central Park, and shut down the new IND subway line. But Long Island bore the brunt of it. There were 32 deaths in Westhampton alone. During an 1821 hurricane, the East River and the Hudson both overflowed their banks and were connected along Canal Street, which was under water from one edge of Manhattan to the other.

“We did a review of the city’s weather-related evacuation plan,” says Assemblyman Brodsky, “and drew the conclusion that the city’s completely unprepared and relying on an outdated, unworkable plan.”

Brodsky claims the mayor’s office stonewalled him at every turn. Repeated attempts to question Office of Emergency Management commissioner Joseph Bruno were thwarted. “I believe Joe Bruno is an honest professional,” Brodsky says. “Joe said our review ‘lit a fire under our rear end.’ But the mayor’s office refused to cooperate.”

Using subpoenas, Brodsky has now begun to get access to critical documents and Bruno has testified at two hearings, one held last week. “It’s fairly clear that no one has looked at the evacuation plan since the year 2000,” Brodsky says. OEM says the plan is a work in progress and they are updating it.

A mass vaccination is “something we’re constantly working on,” says Weisfuse. “If we had to do it, we could.”

The principal problem, according to Brodsky’s review, is the two-tiered system to provide refuge. First, evacuees will have to go to one of 23 reception centers, then they will be directed to a shelter. Brodsky believes this is a ridiculous setup that will only double the traffic.

“OEM says they did it this way because people won’t want to leave their cars behind and there isn’t sufficient parking at the shelters,” Brodsky says. “Well, guess what? Over half the reception centers have no parking either.”

The city has also underestimated by more than half, according to the assemblyman, the number of people who’ll have to be sheltered and evacuated. “But the most damning thing is they don’t even have a computer model for evacuation,” Brodsky says.

“It’s like they’re playing Sink the Bismarck and pushing plastic pieces around a tabletop rather than running the various scenarios through a computer to determine how many people they can get out in how many hours.”

The evacuation plan also relies heavily on the use of mass transit, but the system’s workers have received no training. Since many of these employees live in evacuation zones, they may be faced with an unfortunate choice between evacuating their families or going to work to evacuate strangers.

The lack of training is a critical issue when it comes to terrorism as well. During last summer’s subway bombings in London, the actions taken by train crews in the first five minutes—before the first-responders arrived—are recognized as having saved a lot of people. Workers in London’s Underground are all trained in first aid. New York transit workers have received no such training.

Hospitals and nursing homes are not part of OEM’s plan—they fall under state jurisdiction—and are essentially left to their own devices for evacuation. No one currently knows which facilities actually have plans or if they’d work. One city insider told me that after Katrina, Mayor Bloomberg put the state on notice about this, and the State Department of Health has now begun to step up to the plate. It is possible to get a sense of what New York’s officials are worried about by looking at the kinds of drills that have taken place recently. One of the more interesting and complex recent exercises began with the simulated release of anthrax during a concert in Flushing Meadows–Corona Park. Called POD-X (points-of-distribution exercise), the goal of the run-through was to test the city’s ability to amass and distribute medicine to perhaps millions of people.

New York is the only city with “green status” (green as in go) to receive immediate access to the strategic national stockpile. The stockpile is actually several shipping containers placed in key locations around the country filled with emergency medical supplies, like Cipro for anthrax exposure.

“New York has a system in place to mass-medicate,” says Ed Gabriel, deputy commissioner for planning and preparedness at OEM. “Once we call in the federal supplies, we have a plan that includes opening and staffing distribution centers around the city, getting the word out to the public, and implementing security. Cops have to guard the stockpile, accompany shipments to locations around the city, and maintain order at the centers.”

Calling it a “system” is probably overstating the case at this point. More than 200 sites—not hospitals, to avoid having them overrun—have been chosen in neighborhoods across the city to distribute medicine and, if necessary, vaccinate people.

“We’ve written protocols for setup and procedures,” says Dr. Isaac Weisfuse, the Health Department’s deputy commissioner for disease control. “In drills, the highest rate at which we’ve dispensed antibiotics is 1,400 people an hour at each POD. Vaccination takes more time. It’s something we’re constantly working on. It’s an immense task, and we’ve made a lot of progress. If we had to do it, we could.”

Again, while experts say New York is light-years ahead of everyone else on this—the NYPD even has a fully formed plan to quickly medicate its own officers at the start of a crisis so they won’t lose any time on the street—the city is still not quite there yet on a practical, finished plan.

There was a proposal put forward to use letter carriers to deliver antibiotics as a kind of stopgap measure. But the union balked, citing issues of protection and security. In a life-or-death situation, when who lives and who dies may depend on access to pills, the social order can quickly break down. No matter how many drills you run, it is impossible to predict what will actually take place in the frenzy of a real disaster. In Baton Rouge, 6,000 beds were successfully set up in Pete Maravich Arena, and the national stockpile of medicine did arrive. As it turned out, however, it contained the wrong drugs for the situation. There were plenty of medications for bio- and chemical terrorism, but what was needed were drugs like insulin for chronic illnesses.

Several years ago, I interviewed the head of emergency medicine at NYU Downtown Hospital, which, only a few blocks from the World Trade Center, treated more than 1,200 people in the first couple of hours after the attack.

“We learned that nothing works the way it works in theory,” he told me. On 9/11, as ambulances were screaming into the hospital’s receiving bay filled with ten and twelve people each, even the simplest things became difficult. It was impossible to handle the standard triage tags that have a place to write a patient’s name and a colored tear-off strip to identify the patient’s condition (from green, which is not urgent, to black, which is dead or beyond saving).

The tags have a little string that is used to tie it around a toe or a finger. “It doesn’t get any more basic than this,” the doctor said. “But when we were outside triaging patients, we just didn’t have the time to do it. And some of the strings were tearing as we fumbled in a rush to get them on.”

It may even be too much to count on health-care workers—not to mention other critical public-service employees like cops, firemen, and the people who keep public transportation running—to show up for work during a crisis. According to a study just released by the Mailman School of Public Health at Columbia, only 48 percent of the more than 6,000 health-care workers surveyed said they would go to work during a SARS outbreak, 57 percent during a radiological event, and 61 percent during a smallpox epidemic.

“Staffing during a crisis is a concern,” says the Health Department’s Weisfuse. “We’ve created a little institute at NYU Bellevue to educate hospital staff and help remove their fears. We’ve also worked to make sure hospitals provide staff with personal protective equipment. And emergencies do bring out the best in people sometimes.”

Though it is true that firemen and cops and health-care workers rushed to the scene downtown on 9/11 without regard for their own safety, there is no reason to assume this would happen again. As devastating as the 9/11 attacks were, it was still what experts refer to as a traditional explosive event. It was localized, it was visible. Everyone thought they knew what they were dealing with.

Today, people have a better idea of what there is to fear. “The truth is,” says Redlener, “in a major disaster, we just don’t know who will and who won’t show up for work.”

On a hot August afternoon two summers ago, when the Northeast power grid failed, plunging New York and much of the East Coast into a blackout, Phil Pulaski, the NYPD’s assistant chief in charge of preparedness, was driving on Ocean Parkway in Brooklyn. Pulaski, who may be the most credentialed cop in the history of the department (next to Commissioner Ray Kelly)—he has run the Counter Terrorism Bureau, the Joint Terrorism Task Force, the Bomb Squad, and the police lab, and he has two engineering degrees and a law degree—was on his way back to One Police Plaza from the Counter Terrorism Bureau.

When he saw the traffic signals go out, he radioed headquarters and was told the problem was citywide. Pulaski knew immediately where to go. “We have a continuity-of-command plan,” he says, “that tells everyone where they need to be and what their function is in a crisis.”

During any crisis in the city, from a terrorist attack to a severe storm, the Police Department has what it calls five centers of gravity: the police commissioner, the chief of department, the emergency operations center, the backup operations center (everyone learned on 9/11 that redundancy is critical), and the Patrol Borough Stand Alone Plan.

The emergency operations center, located at One Police Plaza (the backup center is at another location), is designed to coordinate the response to an emergency through a single clearinghouse for all information. Every commander in every corner of the city reports into the operations center.

The Patrol Borough Stand Alone Plan identifies one ranking officer in each borough who serves as incident commander for his area, and it puts all the cops in that borough, regardless of their normal jobs, under his control. The concept is that there are huge numbers of cops spread across each borough ready to be deployed in a crisis. And since they don’t have to get from point A to point B, they’re not affected by the emergency.

“You can’t overlay New Orleans on New York City,” says Pulaski. “We’ve had 9/11, anthrax, blackouts, mass-transit strikes. We have a hierarchal system in the NYPD that’s proved itself in disasters. We really believe we can handle anything. But I don’t have to talk about how well I hit, I can just show you the back of my baseball card. Me, being the New York City Police Department.”

The City uses an all-Hazards plan, adaptable to whatever disaster occurs.

Pulaski says the city never waits for the Feds in an emergency situation. “Either we do it with them, or we do it ourselves. But we never wait for the Feds to take the lead.”

He points to the department’s performance during the blackout as evidence of its ability to deal with a major surprise event. “There was no warning on the blackout, and yet we got people over the bridges and safely out of the city. Without the subway. We established and manned ingress and egress routes and successfully stopped traffic from coming into the city. We created routes for emergency vehicles.”

It did not happen by accident. The cops have drawn up and drilled on—and in the case of the blackout, actually implemented—very specific emergency plans. Pulaski says that every precinct commander knows exactly what his responsibilities are. If, for example, an evacuation is called for, the city is divided into 150 evacuation zones.

“If I’m responsible for Zone One East, which covers Wall Street,” says Pulaski, “I know which pedestrian evacuation routes must be staffed. Traffic control knows where to stage their tow trucks and other equipment that may be needed to keep critical roadways clear. And I know the Williamsburg Bridge has to have the south roadway open for pedestrians, the north roadway open for emergency-responder vehicles, and there has to be one lane incoming and one lane outgoing. I know what my primary and alternate transit hubs are, and where I’m trying to move people because I’m in contact with the MTA and I know where the trains are.”

The planning is done under the all-hazards approach so that, at least theoretically, with minor alterations and tweaks, it is adaptable to whatever the crisis turns out to be. “As a precinct commander, I have one plan, not fifteen, that I have to memorize,” Pulaski says. “I just activate those elements I need. So if it’s a chemical attack, I know which bulbs to light up. If it’s a hurricane, I know my coastal flooding zones, so I light up a few different bulbs. When you’re a commander, the basic rule is, ‘Keep it simple, stupid.’ That’s the key to success.”

The cops automatically assume that, until it is proved otherwise, every crisis involves terrorism. So, appropriate force protection measures must be taken. In the case of the blackout, their immediate concern was protecting the bridges, where thousands of people were headed on foot to get out of Manhattan. A second attack is now always a significant worry.

“Depending on what the first hit was, we’ll know what the most likely subsequent targets would be,” Pulaski says. “At this point, our intelligence division stands up what’s called the Fusion Cell. It’s basically a joint-operations intelligence center with the FBI that’ll have a classified-information channel. Our air assets go up, and we’ll have direct downlinks from the air into our Fusion Cell. Lines of contact will be open with the MTA, OEM, Port Authority, and Fire Department so there’s coordination between agencies. That’s how it would play out.”

Despite Pulaski’s confidence, few people believe a full-scale evacuation of New York would be anything other than an interminable, nightmarish logjam. “You look at New York City and you know you’ll never be able to evacuate all of it,” Assemblyman Brodsky admits.

When I ask Pulaski about this, he takes an uncharacteristic pause. Then he answers with a question.

“What would happen that would require the entire city to be evacuated? I can’t think of anything.”

Unlike New Orleans and its levees, New York has no single point of failure, and it is difficult to imagine a situation in which the entire city would have to be evacuated. Except for one. A nuclear explosion.

It’s a little before nine on a beautiful morning with a slight breeze. The kind of morning that dawned on 9/11. Downtown, in the financial district, there is an explosion that essentially blows out the front of one building and damages several surrounding ones.

First-responders rush to the scene to treat the wounded, evacuate everyone else, and secure the area. It takes somewhere between ten and fifteen minutes for the first-responders to recognize there is radioactive contamination at the site. Using cesium 137 stolen from a medical facility and a detonator cord taken from a mining operation, terrorists had constructed a dirty bomb.

A couple of hundred people are killed in the initial blast. Several hundred more are injured, and there are perhaps as many as 20,000 contaminations. Radioactive material is spread for 36 blocks, all the way up through Chinatown, Little Italy, Soho, and the Village. City Hall, the courthouses, and the federal buildings are all affected by the fallout. There is a panicked rush to flee Manhattan. Roads, bridges, and tunnels are all hopelessly clogged with traffic, and train service is suspended.

Cesium 137, a fine, light powder, binds to concrete and stone, making cleanup a nightmare. Several buildings near the blast will have to be demolished and rebuilt owing to contamination. The financial markets are closed for days, and lower Manhattan is completely deserted for months. Checkpoints are set up to control traffic in and out of Manhattan and to check for possible contamination.

A dirty bomb is one thing, but an actual nuclear event, as it’s often innocuously referred to (it makes it sound like something you don’t want to miss, like the “movie or concert event of the season”), is the mother of all disaster scenarios. And it is the Rubik’s Cube of preparedness planning. How do you prepare for something so overwhelming?

To the extent that the city has plans for this kind of catastrophe, it will not give anything away because of security concerns. “No local jurisdiction has the capability to deal with this on its own,” says Jarrod Bernstein, an OEM spokesman.

The hospitals have installed decon showers and negative-pressure isolation rooms. They have purchased hazmat gear and once-exotic items like Geiger counters, chemical-weapons detectors, and nerve-gas and chemical-weapons antidote kits.

In some cases, they have even installed security gates that can shut down general hospital access as well as access to ambulance bays and emergency rooms. In a nuclear, chemical, or biological incident, or during a pandemic, hospitals must make sure their facilities are not compromised. This means controlling who gets in and out. Quarantine may also be necessary. Commissioner Frieden says they’re ready. Last year, during the sars scare, there were several patients who were kept in the hospital against their will as a public-safety measure.

The Health Department, working with hospitals and the OEM, has developed what is called a syndromic surveillance system. Every day, the department collects data from emergency rooms, ambulance services, 911 calls, and pharmacies, in order to watch for clusters of unusual symptoms: unexplained fevers, outbreaks of diarrhea, multiple flulike cases.

Still, there are holes. Four years after 9/11, the Police and Fire Departments still have difficulty communicating with one another by radio. A satellite scheduled to go up in January is supposed to alleviate this problem once and for all. (It was a serious issue in New Orleans during Hurricane Katrina.)

In the end, some of the most important things to manage are expectations. “There is this notion,” Brodsky says, “that we can take care of everybody. Well, the truth is we can’t take care of everybody.”

HOW TO PLAN FOR DISASTERCase-by-Case Scenarios
Nine disasters to worry about—and what you can do about them. Preparing For Avian Flu
How New Yorkers are handling the fear du jour. Geography of Disaster
Flood zones, escape routes, and more.

See also
When Bad Things Happen
Nine things to worry about - and what you can do.
Bird Watching
How New Yorkers are coping with the Avian flu scare.
Geography of Disaster
The City’s fault lines, flood zones, escape routes, and trauma centers.

Remain Calm