>> Good afternoon, everyone.  I'm Jonathan Lynch, a Health Communication Specialist in CDC's Center for Preparedness and Response, Division of Emergency Operations.  Thank you for joining us for today's EPIC webinar on the 2020 hurricane season.  Today, we're going to hear from Bill Rich, Vivi Siegel, and Mollie Mahany.  If you do not wish for your participation to be recorded, please exit at this time.  You can earn continuing education by completing this webinar.  Instructions on how to earn continuing education can be found on your, on our website, emergency.cdc.gov/epic.  The course access code is EPIC0527 with all letters capitalized.  To repeat, the course access code to receive continuing education is, in all caps, EPIC0527.  Today's webinar is interactive.  To make a comment, click the chat button on your screen and then enter your thoughts.  To ask a question, please use the Q&A button.  The Q&A session will begin after our presenters have finished.  Closed captions are available for this webinar.  So, a few bios for our presenters.  Let's see.  Bill Rich serves as an Emergency Management Specialist and Disaster Planner.  He helped found the National Disaster Medical System.  While at CDC, Bill has taught disaster management classes in 12 countries and many domestic locations and has completed numerous deployments to disaster areas.  Vivi Siegel is a Senior Health Communication Specialist for CDC's Division of Environmental Health Science and Practice.  Vivi has a background in public health and journalism and helps lead communication activities for natural, chemical, and radiological disasters, including the hurricane responses for 2017 and 2018.  Mollie Mahany is a Senior Public Health Advisor at the National Center for Environmental Health at CDC.  She has over 20 years of experience working in disaster management, both domestically and abroad, including disaster risk reduction, emergency management, and disaster recovery and mitigation.  So, thank you, everyone.  First, we're going to go to Bill.  Bill, please begin. 
>> Okay.  This is Bill Rich.  Am I coming through, Jonathan? 
>> We hear you. 
>> Good.  We'll be talking about health impacts of hurricanes and the fact that they are, indeed, more than just property damage.  Next slide, please. 
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While technically the hurricane season for 2020 begins next Monday on June 1st, or even later than that, anyway, we are already looking at the second named storm of the year working its way into South Carolina at this moment, Tropical Storm Bertha, still at 45 knots, so it's still a tropical storm, even though it's been on the beach for over an hour.  Predicted activity this year is a little higher than what we had in 2019, looking at a total predicted of 14 named storms, 8 hurricanes, and at least 4 major hurricanes.  This is what's expected for the Colorado State University Prediction Center.  Big thing here.  Just like the two named storms we've already had prior to the season starting, don't count on the weather reading predictions or memos.  They don't care.  They don't read the prediction models.  They don't read the SLOSH models.  The storm is whatever it is.  Prepare for the worst, and you will only have good surprises, not bad ones.  Next slide. 
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Don't rely on the warning models.  At close of business yesterday, we had a storm area that had a 20% chance of strengthening in the next five days.  At 8:00 this morning, we had a tropical storm named Bertha.  There was no 120hour warning.  There was no 48hour warning.  If you see anything that could potentially affect your area, get ready now.  If you prepare yourself and your family, this will free you up to prepare for your job.  You can't do a good thing on your job if you're worried about your home, if you're worried about your home, if you're worried about your family.  They come first.  Direct storm impact is not required to have personal and professional impacts from a hurricane.  Look at all the folks that were hundreds of miles away from the actual impacted area, the directed impacted area, that are still having financial effects all the way from two years ago.  Some of the worst historical damage is from slowmoving or stalled tropical storms, not hurricanes.  The huge amounts are plain and impact to infrastructure and impact to evacuations have come from tropical storms, not just hurricanes.  Next slide, please.  Some of the medical services are pretty easy to impact when a storm comes ashore, or even makes a near pass offshore if you're near the beach.  Dialysis clinics especially have to have power and secure water supplies.  People that are on oxygen concentrators require power.  Home IV therapy, same deal.  They have to have power.  And if there's any compromise to their IV sites, you have to have a technician that can come out.  And you can't do that during the storm.  Power loss at the medical service company, same deal.  Hospitals, they do have generators, but they have a finite supply of fuel, and sometimes that fuel is not stored in the best possible place, especially if that hospital hasn't been stormimpacted for quite a few years.  Radio communications can be impacted, because the antennas can be impacted on top of the hospital or out wherever the tower is.  Plus, power drop and other things.  Medical refrigeration is a big issue, because if you lose power, you don't have backup power, the clock is ticking on a medication shelflife.  Once it reaches or exceeds a certain temperature, it's no longer a drug.  Can't be used for humans.  So, there is, indeed, a stopwatch ticking as soon as the power drops.  Plan B, plan C.  If you have a hospital, a clinic, a pharmacy, or if you have medications at home that require temperature stabilization.  And security systems and lighting at most facilities, if you lose power and you lose those systems, the facilities will have to close.  They're required to, by their legal situation, their risk management will require them to close and no longer provide service until they can get those systems back up.  This can be a problem if that location is a hotel, for instance, with evacuees in it.  Some of the hotel policies require that if the power drops and they can't provide fire alarms, they have to evacuate that facility even if it's into the yard.  Next slide, please. 
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Direct citizen impacts.  Loss of home lighting and refrigeration.  We already talked about the medication angle of that.  Sitting in the dark is rough on morale.  Well, we have numerous plan B, C, D and E at our house.  And I recommend that everybody take at least a look at plan B and C for their own situation.  Loss of news sources.  Any information is highvalue in the wake of a storm impact, or during the storm impact.  And people will search out whatever information they can find.  And if you're, you as a manager are not providing news or updates, they'll get them from somewhere else.  God save us if it's from the internet, because there's no way to validate that.  Outages will impact eventually landlines.  Cell phones.  They're great.  They often are the only communications during and after a storm.  But they have to be charged.  If you don't have power to run a charger, you have to do it in a vehicle if you have a vehicle and a vehicle charger and fuel to run the vehicle.  Losing thermostability due to heating and air conditioning, this is the thermostability for humans, not just the medicine.  If people get too warm or too cold, they have issues, and this can easily happen if you take away heat and their air.  And we already discussed the hotel policies that could be challenging.  And this did happen during Hurricane Ike, especially in Texas.  Next slide.
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Electric shock.  This claims victim every single time.  The basics are real easy.  Stay clear of a fallen power line.  Don't step on it.  Don't drive on it.  Don't go near it.  If you don't know if it's live, it's live.  Okay?  That's your default.  Watch out for overhead power lines, because they may not be as far overhead as they were before the storm.  They may be drooping down and your vehicle can be touched by it, or they could be in a tree branch lower than normal and you could be impacted.  Flooded homes.  If you can stand in a dry place, turn off power to the home if it's flooded.  Otherwise, it takes an electrician to do that.  Here's the big one.  Never turn power on or off or use an electric tool or appliance while standing in water.  I, honest to God, had to say that.  Okay?  By looking at ER admission logs, there are people who will use electric tools while they're standing in water.  Once.  Water damage power tools.  If it got wet, it's not safe.  Don't plug it in until it's absolutely known to be dry.  If it's still plugged in, leave it plugged in.  Turn off the main breaker.  And wait for an electrician to check things before you reengage with them.  Next slide, please.  Food.  In a survival hierarchy, most people most days most places can last three minutes without air, three hours without some form of shelter, three days without water and three weeks without food.  Obviously not everybody fits that profile.  But food is not an immediate issue, but if you ask somebody to make preparations because the storm is coming right at their town, what they'll do is run out and buy milk and bread and other foods, frozen food.  They'll stockpile food before they do other more critical items.  If it's bad, it can get you sick.  If you get sick and you have limited access to medical care because of the impacts, this is not a good day.  Encourage folks in your area, your jurisdictions, stockpile canned or dry food ahead of time and keep them clean and dry, so that tells you how to stockpile it of a flooded area or rain impact.  Keep food fresh.  If it's spoiled or you can't be sure it's not spoiled, get rid of it.  Clean off canned food.  You might, just to kill time while the storm's coming in, you might want to write on the end of the can what it is.  Because once the label gets wet and comes off, now you're looking, wondering, is this canned beets or canned peaches?  Use bottled water if possible. 
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And typically in a storm area, there will be tons of bottled water available, although it may take a while to get there.  So, the first couple of days are on you.  If you're going to have to mix up infant formula, only use treated or purified water if bottled water is not available.  And treat, ways to treat water are, the directions are everywhere.  Look on CDC's website just as a start.  FEMA website, Red Cross website [inaudible] water into drinking water.  Next slide, please. 
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Don't use gas or coalburning equipment inside your home, basement, garage, whatever.  Keep it outside and away from windows and vents.  Don't fire up the charcoal grill in the garage.  Do notcarbon monoxide will infiltrate the house, and it will be a problem for you.  Use a carbon monoxide detector any time you use a generator or, pardon me, anything else that burns fuel.  Never run a car or a truck inside the garage attached to your home, even with the garage door open.  Direction of the wind and so forth can infiltrate carbon monoxide into a house, even with the big door open.  Don't heat your home with a gas oven.  It's not meant to do that.  And if you have a carbon monoxide detector and it starts beeping, leave the house.  This will take a decision tree.  If the storm is happening, you may need to have that gamed out already.  Where would you go if that alarm goes off and it's still storming?  What would you do?  Next slide. 
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Other health risks.  Driving through floodwaters.  The number one people, way people die in a hurricane is they drown.  The number one cause of drowning in a hurricane is driving into or through floodwaters.  If you can't see the road through the water, don't go there.  You don't know if the road's even still there.  You don't know what else is still there.  Broken bottles, dead dogs, trees, whatever.  If you can't see through it, you can't drive there.  Don't, don't drive into the water, folks.  Animals and pests.  Their normal territories are disturbed.  Their normal housing is disturbed.  They will be looking for high ground.  And they will be looking to reestablish territory.  Dogs will often stop barking and just start biting if they're trying to reestablish.  Psychological harm.  Watching everything you have ever owned floating downstream from flooding is terrifying and will often require psychological help, psychological intervention.  Again, this can be gamed out ahead.  If you're a planner or provider in your area, game this out.  Right now, before we deeply get into the hurricane season for this year, because it's going to be more active, there will be more people at risk, injuries during cleanup are bad because not only are you injured, you're usually at a higher risk for infection.  Every injury must be claimed.  And if it's anything bigger than a bandaid can fix, you need medical help on it.  Mold, especially when you go to reoccupy a flooded or moistureimpacted structure, can be a very serious health problem, or it just be a scary thing out there that you're worried about.  There's plenty of information on how to reoccupy a structure and how to deal with potential mold.  Hyperthermia and hypothermia.  Humans live really well when their body temperature's around 98.6 degrees Fahrenheit.  You get them too cool, the chemical reactions in their brain and their heart don't work as well.  Same thing for getting them too warm.  Work out how you're going to provide that to atrisk people in your zone.  How are you going to take care of homeless?  How are you going to take care of nursing home patients?  How are you going to take care of indigent and old people that are sitting in a oneroom apartment?  Do your planning now.  And really, folks, we're into the storms already, so your planning time is just about at an end.  Best get on it.  Next slide, please. 
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And resources.  I work for CDC.  So, naturally, we've got webpages on lots and lots of stuff, folks.  Come to see us.  Look us up on the web.  Call somebody that has an internet connection if you don't.  NOAA, great source.  Ready.gov, Red Cross.  They've been doing this forever.  Talk to the folks who do this a lot, and they'll have better information than somebody that just makes stuff up.  And one website I use every single day in my job, spaghettimodels.com, also called Mike's Weather Page dot com or something of that nature, but spaghettimodels works.  It puts all of the trace maps and radar screens and Saharan Dust Layer predictions and everything on one page where you can select what you need to know.  Next page. 
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And that's it for me.  So, there will be a time for questions at the end of our presentations today.  Thank you for listening. 
>> Hi, everyone.  Thank you, Bill.  Thank you, Jonathan, and the EPIC team for having us.  And thank you, everyone, who is here participating today in this webinar.  We really appreciate you taking the time to sit with us for an hour and talk about the 2020 hurricane season.  My name is Vivi Siegel.  As Jonathan mentioned, I've been working as a Health and Risk Communicator at CDC for a while, including on hurricanes and disasters for the past decade or so.  And so I've had the privilege of working with a lot of you at the federal level, at the state level, at the local level, both governmental and nongovernmental organizations.  And I know that we're stronger when we all work together.  Next slide, please.  So, I'm going to talk to you today about how we at CDC are adjusting our public messaging for hurricanes this year in light of the COVID pandemic.  So, and I'm just going to be talking about public messaging.  I'm not going to be talking about our messaging for healthcare providers or hospital systems or things like that.  Mollie Mahany, who will be talking after me, will be talking more about shelter operations from the shelter operator point of view.  But I'm going to basically be focusing on what we're talking to the public about this year.  Next slide, please.  So, our hurricane messaging, like all of our messaging at CDC, the goal is to use crisis and emergency risk communication principles, which are principles developed by CDC to help speak with people in a disastrous situation, knowing that during a disaster, people are thinking differently about things.  They have a lot on their minds.  They're worried about protecting themselves and their family.  It's important to be direct, to speak clearly, to be first as much as possible, as Bill mentioned, if they don't get the news from us, people will find a way to get the news, and it may not be as accurate as we'd like it to be.  And, of course, to use empathy and know who we're speaking with.  It's important to understand who our audiences are, audiences plural.  That should say, have an S on it, knowing that not everyone is approaching the situation from the same way.  Next slide, please. 
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So, with that in mind, when we started thinking about hurricane season a few months ago and preparing for hurricane season for 2020, some of our earliest conversations were how can we ask people to prepare for hurricanes now?  We are having a pandemic.  Everyone is, lives look very different this year than they did last year.  And they've already got a lot on their minds.  People are dealing with health impacts and economic impacts and social impacts.  How can we add one more stressful thing to this burden that they're already carrying?  And with that in mind, you know, I just, you know, we knew we had to say something, as Bill mentioned, this is going to be a really difficult hurricane season because more storms than usual are predicted.  So, we can't just ignore it.  It's going to happen, whether or not we're prepared for it.  So, we need to be prepared.  But we need to acknowledge in words that this is a lot harder than usual.  This, this is a difficult thing that we're asking of people.  It is another heavy lift to have to think about a second kind of disaster when we're all dealing with the pandemic.  So, one of the first things that I just want everyone to think about is how we can acknowledge in words the difficulty of dealing with multiple disasters and the difficult things that we're asking people to do with regard to preparing for hurricane season.  And we know that acknowledging that helps people understand that we understand what we're asking, and that it's hard.  Acknowledging the difficulty also helps people kind of put that aside and move forward to what they need to do.  And taking care of your emotional health will help you think more clearly and react to situations in the way that you need to.  CDC does have some advice and guidance and fact sheets on taking care of emotional health.  We always promote the SAMHSA Disaster Distress Helpline, which is staffed with people to support those who are going through disaster situations, including this one.  So, next slide, please. 
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So, then we started thinking about, well, what actually is different this year?  And how will our messages change?  You know, we want people to prepare for hurricanes, bullet we want them to do it in a way that is protecting themselves and others from COVID19.  So, how can people do that?  So, we started thinking about like anticipating all of the things that might be different this year.  For example, it may be harder for people to get items for their emergency kits to replenish them.  Sometimes the items are out of stock.  Sometimes people don't feel comfortable going to a grocery store and they're having trouble or unable to get items delivered.  So, one message that we have is for people to start thinking about that earlier than they might have, and to give themselves more time to pull supplies together, including prescription medicines that they might need.  We also think it's important as people are out running errands to get their prescriptions, to get their items for their emergency kit, to continue to take, take cautions and take protective actions to protect themselves and others from COVID.  And CDC does have a website on how to safely run essential errands during the COVID pandemic.  And that's that link there that you see on running essential errands.  We also are thinking forward to what might be different about sheltering this year.  And, again, Mollie will get a lot more detailed into sheltering in her presentation.  But one thing we want to forecast for people is that it's probably not going to be the same as last year.  If you went to a public shelter last year, you may be going to somewhere different this year if you need to evacuate.  I know that this is something that cities and counties are working very closely with the Red Cross and with FEMA and other partners to figure out right now.  There's a lot of thought and a lot of work going into, you know, backup plans and alternative plans in case people need to evacuate and shelter this year, and how we can do that safely.  But I think for the public, one thing to know right now is to just be aware that it might be different and be aware that you'll need to pay attention very closely to what your local authorities are saying about shelters, including potential locations for pet shelters this year.  We want people to think about what they're bringing with them in their go kits in case they do have to evacuate to think about taking items that will help protect them from COVID19, including cloth face coverings, which, of course, help protect other people, hand sanitizer and soap.  So, think about packing those things in advance so that if you do need to evacuate, you'll already have it ready.  And then, of course, one of the things that we ask people to do before hurricane season is to check on their friends and family, make sure they've got everything they need, check on your neighbors, see if they need help with their storm windows.  We have a lot of people who really want to help others, which, of course, is wonderful, and we just want to make sure that people are doing that in a safe way.  So, you can find these recommendations for preparing for a hurricane during the COVID19 pandemic at the link at the bottom.  And that's also where we have information about staying safe after a hurricane.  So, we'll go into that now in the next slide. 
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So, we're coming back from our shelter, or we're waking up the next day, looking out at our front yard and thinking about all of the things we need to do to clean up our homes.  We need to remind people, even though we're dealing with all of this, even though it's really tough and we have a lot to think about with regard to cleanup, it's still important to use preventive actions.  Washing hands, using face coverings in public, using social distancing or staying six feet from one another when we can to, to protect ourselves and others from COVID19 while we're in the cleanup process.  We also, and this is something that I don't know, you know, will happen in all instances, but it may be possible that this year it's going to be more difficult for services to get turned back on, power, water, medical care.  It might be harder than in previous years because of the additional burdens that all of those utilities and providers are facing with the COVID pandemic.  So, this is not to say that this will definitely happen.  But I think it's one of the things we can do to help people mentally prepare is to set expectations, that things may not be as happening as quickly as they normally would after a hurricane.  That may also mean that we, we end up with people who have power outages for a longer time.  And so carbon monoxide poisoning prevention messaging becomes even more important.  You know, another thing to think about after a hurricane is there may not be personal protective equipment available as easily as in other years if you were trying to clean mold out of your house.  So, we really want to push the message to prevent mold, to get wet things out of your homes as quickly as possible.  And finally, like I said before, we need to acknowledge and remind people that it's natural to feel anxiety, to feel grief, to worry, and that it's important to get help when you need it, both for your own peace of mind and so that you can help your families.  And that goes not only for people who are experiencing the hurricane, but also for those who are helping them through it, our first responders.  Next slide, please. 
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So, I'm going to talk a little bit about what we're telling the public when it comes to disaster shelters this year.  And Mollie will go into it more from the shelter operator perspective.  So, we want people to know that if they need to go to a disaster shelter, they should still go.  You know, it's important to follow the recommendations of your local authorities about if you need to evacuate.  And we don't want people to, you know, not take that action if they need to take it because they're worried about COVID19.  So, we want people to know that there is a lot of thought going into how to safely shelter people during this pandemic.  So, one of the things is just to remind people, again, that your shelter location may be different this year to bring items to help you stay protected from COVID19 while you're there, to practice social distancing in the shelter and help your children do the same.  And I think this is probably the hardest thing on there, because I can just imagine, you know, trying to keep your kids away from other families.  This is something that, you know, folks are thinking about, thinking about what areas might make the safest shelters this year.  And it may not be, you know, the big gymnasiums that were used in previous years in some instances.  And then, you know, if you do feel sick when you arrive at the shelter, just tell shelter staff immediately so that they can segregate people who are feeling sick from those who are not.  Next slide, please.  Oh, and this, this is all, you can find all of this information at the link below. 
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So, I'll just share with you really briefly some of the educational materials that CDC has that you can use in helping to prepare folks for hurricane season this year.  Next slide, please.  So, we have on our, on the link below, you'll see we have a link to hurricane educational materials.  And they're sortable by topic and by language.  And so we've tried to preposition materials as much as we can in different languages on a variety of topics that we know will be issues.  These are things that Bill Rich mentioned in his presentation.  Carbon monoxide poisoning prevention, safe mold cleanup, water disinfection, food and water safety, and mental health.  Next slide, please. 
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And on this slide, you'll see we have also a lot of educational materials about COVID19 that can be used in shelters or to share with people as you're, as you're doing your preparation messaging.  And these also, we've worked to make sure that they're available in multiple languages, that they are as much as possible using language that is clear for most people to read and understand.  And we also have information in sign language.  And so at that link below, you'll see a lot of our printable and shareable COVID19 communications resources.  Next slide, please. 
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And finally, we've been working with our partners to create messaging that acknowledges COVID19 and hurricane season.  And you see some of this here from CDC, the tweet from CDC Environment.  From FEMA, the ready.gov site.  And from NOAA and the National Weather Service, that while we want people to prepare for hurricane season, we want them to do it while keeping themselves and others safe from COVID19.  Next slide, please.  So, coordinating messaging.  So, this is going to be I think even more important this year.  And it's always important every year.  But this year, probably going to be a few more people to coordinate with.  And you may not be coordinating with the same people.  Let's say you have the health department hurricane person that you normally work with.  Now you may also need to coordinate with the health department COVID folks.  Same goes with the other emergency organizations.  There's just, there are more people.  So, next slide, please.  One thing that we found really helps with this coordination is preparing as much messaging as we can in advance.  So, CDC uses the phasebased system for communicating about hurricanes that you see on the left, anticipating that the messages that you share just before a hurricane hits are going to be different than the ones that you share just after the storm, and that changes again as you go, you know, half a week down the line, a week down the line, or a month down the line.  And if we know what these messages will be, and we do because we've seen these issues come up year after year, we can plan for them and we can circulate and clear them and review them with all of our partners, knowing that everyone is on the same page with, you know, at this time, we're going to be pushing these messages.  And you'll see on the right that we have put all of our hurricane flooding and natural disaster messaging into this booklet that is downloadable at the link.  And we are working on adding a COVID19 annex to this book.  It's not ready yet.  But it will contain, you know, the information that I've been sharing in this presentation and the information that was on the links earlier about COVID19 and hurricanes to have it easily accessible for health departments and other partners who may be looking for quick, easytofind public messaging on a variety of different disaster topics.  Next slide, please. 
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Thank you very much.  So, as part of coordination, you know, it's important to make sure we understand what the disagreements might be before we get to them, and let people have these conversations now.  You know, we're having these conversations now.  Well, what else do people need to think of this year?  It's going to be different.  Making sure that we are clearing messages in advance as much as we can.  And then during a response, staying in very close contact with our partners.  And also knowing that who leads on every type of message, whether that's on a specific topic or whether it's for a specific audience.  Thank you very much.  That's the end of my presentation now.  And I'll turn it over to Mollie Mahany to speak about shelters this year.  Thanks for your attention. 
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>> Good afternoon.  Thank you, Vivi.  I was asked to join the webinar and talk a little bit about something that I think is probably on a lot of people's minds involving thinking about this as hurricane season, you know, when does it start, next week.  So, CDC has been in a lot of conversations with various stakeholders over the last couple of months, whether it be state and local, Red Cross, a huge range of federal partners, including, you know, FEMA, ASPR, you know, NIH, a whole, a whole range of other, other partners.  And we've been talking about what do we need to do, how do we modify our planning for preparedness in our response for all disasters during the COVID19 pandemic.  And, of course, one of the first specific items that come up for discussion is the issue about sheltering.  You know, we're telling people to stay home and stay away from one another, and now we, now we want to ask them to come into a shelter.  So, let's talk about that a little bit.  Next slide, please.  So, what is it about hurricane season 2020?  As Bill said, the forecasting the National Weather Service does say that we expect this season to be a bit more active than average.  And in spite of stayathome orders or individuals' decisions to stay at home, it might become necessary for people to seek safety in shelters.  And we hope that they do, as Vivi will say, if they need to.  We know that shelters are, you know, often crowded spaces with a lot of shared space and shared areas for services such as meal service and other things, and so this is going to require some modifications to the standard shelter operations.  And as mentioned, CDC developed recommendations.  Mentors says shelter staff for reducing the possibility of introduction or transmission of COVID19 among all people who would be in the shelter, be it staff or volunteers, residents, and visitors.  Next slide, please.  So, this picture is just to illustrate the problem that we're talking about.  Right?  So, you take a look at this.  You know, clearly this is a situation where, you know, you have a lot of people in a shared indoor space.  We don't know about the ventilation system here.  This is actually the Houston Astrodome, September of 2005.  And these are evacuees from the New Orleans area following Katrina.  But, you know, you take a look, and you can see it's impossible probably to stay six feet away from others under these circumstances.  And so this is just, we're going to take a look at this.  We understand that Katrina was somewhat unusual.  And we certainly have learned a lot since then about a lot of things.  But it is possible that another slowmoving large hurricane might result in us once again having to shelter hundreds, if not thousands, of people.  Next slide, please.  So, this is another example of a shelter.  Looks pretty different from the previous slide.  Maybe a little bit more typical.  Fairly orderly.  But, again, you know, the cots are very close together, and people are in a shared space, probably food services, you know, you know, cafeteria, buffetstyle, something along those lines, you know, so this, this gives us an opportunity to kind of think about what the issues are.  When we look at this, this is just my opinion, I don't know, but this looks to me like it may be fairly early after this shelter opened.  And the reason I say that is because it really is quite tidy, right?  And there are some empty cots here.  Not so many people.  It might be daytime and people are elsewhere.  But it's not unusual in shelter environments for people to sort of reconfigure their cots and families to move things around and do a bit of, you know, nesting in the shelter if they're there for any length of time.  Maybe putting some blankets on the floor so the babies and the kids can play and so forth.  And so the reality of what a shelter looks like is probably something between the two photos that I've just shared.  Next slide, please. 
^M00:39:47
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So, what are some of the questions?  What do we need to ask and what do we need to answer?  And so we look at these questions, you know, how do we, how do we lower the risk of transition, what do we need to do to make sure that people can maintain their physical or social distancing?  Do we have enough space in these facilities that we've selected to do this?  It will take more space to provide all the services in a shelter that are normally provided.  What do we do if somebody gets sick?  How do we monitor people getting sick?  What do people need to bring to the shelter?  Do we have special considerations for people who are at a higher risk for getting severe illness from COVID19?  What about children?  What about pets?  So, a lot to think about when we're looking at this.  And the important thing is here that not only do we ask these questions and answer them to the best of our ability, but that we share with the public, we effectively communicate with the public that these questions are being asked, and that shelter managers and health officials and emergency management are all putting policies and procedures into place to make these shelters as safe as they possibly can be, to make them as safe as another public area outside one's home.  And if you need to go there, hopefully people will be willing to do so.  Next slide, please.  So, one of the first considerations, and Vivi mentioned this a little bit, one of the first considerations is the types of facilities that we use for sheltering.  Pretty typical in the U.S. and other places to use schools.  Schools have made good shelters.  They have separate rooms that can be used for providing services.  They have, you know, bathrooms and kitchens.  Sometimes they have showers.  So, that's fairly common.  And then sometimes we do wind up with these very large mega sheltering situations, such as the photos we saw before.  And now with the COVID19 pandemic, you know, there's a little built of a change in thinking, not that these options weren't considered before, but they have become more of a priority now to sort of change what we're doing.  Next slide, please.  So, the preferred option really is to use something like a hotel or a dormitory.  This provides obviously the best way to keep families together, or households together, while keeping them as far away as possible from other evacuees in the same facility.  And, again, you know, they have areas for feeding and laundry and others.  So, this is, hotels are ideal because they also have, you know, a separate bathroom in each room for, you know, bathing and showering and so forth, may have televisions or phones or Wi-Fi if it's up and running.  May even have housekeeping.  So, that would be, that would be ideal.  And then just to mention, this, these priorities, facilities selected as shelters, these are the same, the same priorities that are used by Red Cross and FEMA and the National Mass Care Strategy groups.  So, it's, it's consistent with that.  Next slide, please. 
^M00:42:59
^M00:43:01
Another option would be to use campgrounds, whether people are in tents, cabins, trailer, RVs, again, they have the same kind of, you know, facilities might be available, bathrooms, laundry, that sort of thing.  If those places are shared facilities, which they often are, you may need to put something in place like a schedule for, you know, laundry or scheduling for showering or something, just so we can limit the number of people in an area at a time.  But, again, these, this kind of facility does allow for a nice separation from one household to another.  We need to check sometime if they are accessible.  That would need to be checked in advance.  And, of course, unless we can absolutely be sure that this selected campground is well outside the area likely to be impacted by a hurricane, this would only be useful as a shelter as opposed to a hurricane event, right, for people who have lost their homes.  Otherwise, you would not want to be here in one of these facilities during a hurricane, of course.  Next slide. 
^M00:44:08
^M00:44:11
And sort of the last option, option sort of three and four, are these congregate shelters.  So, option three would be to have smaller shelters, whether they were, you know, 50 residents or clients or fewer.  You may need to have a larger number of smaller shelters.  So, that may be a little complicated possibly.  But they are easier to run than the mega shelters are.  And there are oftentimes these kinds of facilities can be found, you know, a suitable facility can be found closer to the homes of the evacuees, and that's, that's always advantageous.  And very last option would be the large shelter that has 50 or more, perhaps 100, perhaps thousands of people.  This would be a last resort.  We would want people to safely be out of those shelters as soon as possible, to demobilize these large shelters, have people moved into the smaller shelters that we prioritized, or to make use of any of the FEMA housing options that might be available.  The picture on the left, the bottom there, I'm sorry, on the right bottom, is the setup for City of Dallas, City of Houston, excuse me, I guess had a mega shelter set up, and it was open for 26 days.  And at its peak, it was serving 3,500 people.  So, you know, that's what we want to try to avoid now, if possible.  Next slide.  So, I'm going to talk a little bit about the guidance that we've been talking about, the general population guidance for shelters during the pandemic.  I'm not going to go line by line, and we're not going to read every recommendation here.  We are going to talk a little bit about some of the sort of big issues that rose to the top are things that were either a little, you know, we felt needed to be discussed in more detail.  The guidance, of course, is available on the CDC website.  And this guidance, along with the others, will be updated or revised if we get new information that would change any of the recommendations within.  But it's important also for shelter managers to pay attention to state and local officials' recommendations and information specific to their location.  Next slide, please. 
^M00:46:30
^M00:46:32
So, the guidance covers these following topics.  And, again, as I said, we're not going to go into one of these.  However, you can see that they fall into a couple different areas.  One might be, you know, specific area in the shelter, whether it's an intake area or food service.  It could be a specific process, such as monitoring or cleaning and disinfection.  And it might also be information recommendations about specific populations, people who need extra precautions, children, something along those lines.  The document does have a lot of links to additional resources and guidance to information as well.  Next slide, please.  So, the next couple of slides just have some of these sort of key points that we thought were important to sort of bring up and make us a little extra, extra point about rather than, you know, just saying we want people to stay six feet apart from one another, I think you would guess that.  So, what I want to talk about here is this was one that says if your local and state officials believe and recommend to you that it's safe to shelter in place, that should be considered.  That would be a good way, if it's going to be safe to stay at home, that, that really should be considered.  A second thing that we're talking about is that everyone in the shelter should wear a cloth face covering at all times, exempt when it's not practical, of course, when, you know, eating or showering.  And I should have a little footnote there that says, and most of you have heard this before probably, babies and children under two should not be wearing these face coverings, and nor should anyone else who has trouble breathing, who's incapacitated in some way, or unable to remove the face covering without assistance.  The third bullet is really quite important.  You know, in the event that we have a big hurricane coming down, access to the shelter is critical.  And shelters should not exclude anyone who has some symptoms or who has tested positive for COVID19.  These should be allowed into the shelter and immediately directed to a separate area where they can, you know, be separate from the rest of the population and monitored.  It's important to mention here that we're not talking about people with severe symptoms.  Right?  If there's anyone who stays in a sort of an isolated area within the shelter, it would only be for very mild symptoms.  And they would be monitored.  And if these people develop more serious symptoms, such as shortness of breath, or, you know, high striking fever or any other number of symptoms, but, you know, they should be contacting, you know, letting the shelter know, and seeking appropriate medical care elsewhere.  Next slide, please.  So, here we say the staff should be monitoring for signs of COVID19, as well as other concerns.  You know, shelter surveillance is normally conducted.  And that this information should be provided to a health department or whoever the local appropriate authority is.  And this helps with two things.  It helps the health department of course know what's happening in the community.  But it also provides information to the shelter.  I mean, if the shelter starts to see, you know, additional cases, or, you know, something of that sort, then maybe they need to look at their policies and procedures to pry to figure out where they can make modifications.  Sounds like something's not working, you know, if they have an unusual number of cases starting to develop.  Again, we did say all of the shelters that, during this pandemic, should have an area where people can, anyone with symptoms can remove themselves from the rest of the general population.  And if testing is available, then the staff, volunteers and residents should be tested according with the state and local health department guidelines.  If the testing is available, but limited, then we would, we would like to see that the folks at higher risk for severe illness from COVID19 would be prioritized for testing.  Next slide. 
^M00:50:53
^M00:50:56
And it's important here to note that some, many shelters will either provide an area for animals that's either in or located near the human sheltering area.  And while there's little, there has been some documentation of transmission between humans and animals, it's more between the human to the animal transmission.  The opposite isn't really clearly, clearly documented.  The transmission from animals to human remains unclear at this time.  Nonetheless, CTC does recommend that all of those same protective measures that you use in any other part of the shelter would also be maintained in an area for animals.  And that's including the recommendation that one family member be designated to care for the animal.  Partly this is just to lower the number of people who would be in that area at any one time, because still the highest risk is a humantohuman transmission.  And so we're trying to lower that as much as possible.  And lastly, we do just want to say that in accordance with the Americans with Disabilities Act, service animals must be allowed to stay with their handlers unless the animal is out of control or poses some sort of a threat to health and safety.  So, these animals could very well be in the, in the general population with the rest of the people in the shelter.  Next slide, please.  You can go to the next slide.  Thank you.  So, just, just sort of briefly here, there are some situations that we've been thinking about, some things that we see as challenges, or maybe problems that may come up.  I want to talk a little bit about these, because we don't necessarily have the answers to all of these questions.  The one that concerns me probably the most is that there may be people who need to go to a shelter who are afraid to do so.  So, we've talked about that some over and over.  So, again, we need to clearly communicate to people, you know, we need to say, listen, if there is a, you know, an evacuation order issued in your area that we need to provide enough information to hopefully people will comply, and that there are certain things that they can do, such as, you know, bringing their own, you know, hand sanitizers and face masks and complying with the rules within the shelter that are put in place.  You know, there may not be enough masks and face covering or testing.  People may not comply with what we're asking them to do when they're in the shelter.  And, you know, what we do about that is not entirely clear at this point.  Maybe a heightened level of anxiety just in general.  You know, we have this hybrid disaster.  Right?  So, people are already fearful of COVID19.  And now they're fearful, you know, for their homes and their livelihoods and their families and so on and so forth due to a hurricane.  I've heard some discussions about the issue of actually transporting people during, you know, an evacuation.  The CDC guidance document is not that, it's discussing the operation of the shelter itself.  But there are some options.  But what we've done in the past may not, you know, we won't be able to do it that way again now, right, so we've put a bunch of people on public transportation or buses, there needs to be some, some modifications.  And, again, CDC does have guidance and information and recommendations on public transport and so forth that can be found on the website.  And, you know, one of the final issues is that staff and volunteers in these shelters may be unwilling or unable to assist.  And many of them are in the higherrisk categories simply by being over 65 years old, even if they don't have any other, you know, coexisting issues. 
^M00:54:49
And so when we look at all these challenges, you know, it's not a perfect solution.  We don't yet know the answer to all these questions.  And we actually don't know all the questions yet probably.  And so we're, you know, in this situation.  And so even though we do have, you know, federal guidelines from CDC or from FEMA and we have the National Mass Care Strategy, and we have, you know, Red Cross, it's really many of you here on the phone that will be in the field.  And you will be some of the people who will come up with and think about new ideas and new strategies for protecting our families and our communities.  And so we look forward to hearing what other, you know, what other solutions and strategies you come up with, and being able to share it with others who may be able to use what you've found out.  So, with that, I will thank you, and I will turn this back over to Jonathan. 
^M00:55:44
^M00:55:46
>> Okay.  Hi, everyone.  I just want to say that we're running a little bit long here, and so I apologize for that, but we will have the recording up on our website in two days.  And we'll just keep going with some Q&A for now.  But our apologies for running long.  So, let's start with a question for, that I want to direct to Bill.  Bill, how can people still wash their hands if the water is knocked out? 
>> Okay, several options.  One, where are you talking about?  If it's at home, if it's at your residence, you have the option of stored water, of contaminated water that you make clean, of not using water, of using hand gel, alcohol, one of the other options that folks have talked about over the last couple of months.  Here at my house, we have a certain amount of stored water for drinking purposes.  We have some other water stored for toilet and cleaning.  And then I have, because I'm a disaster guy, I have filters, I have alternative filters, I have bleach to sanitize water with, and I have alcohol and other items to wash with when I can't use water at all.  I hope that answers it. 
>> An emphasis there on preparing ahead of time, because you need those [inaudible]. 
>> And this beats response every time. 
>> Okay, the next question, looks like there's a little bit of out of sync between Bill's audio and video there.  So, apologies for that.  The next question is going to go to Mollie.  If everyone in the room or shelter is wearing a mask and washing their hands, is there still a need for the sixfoot rule? 
>> You know, I think the answer is that we would still recommend that people do stay at least six feet apart from one another.  None of these, none of these options are necessarily 100%, providing 100% protection.  And so what we want to do is if you use all of these protective actions together, then you certainly increase the chance of not getting exposed or coming down with COVID19.
>> The next question from Arthur.  What would you say regarding the need to wear masks while sleeping in a shelter? 
>> I'm guessing that's for me as well. 
>> Yes, please. 
>> So, the recommendation does say at all times, other than when it's not practical, such as, you know, showering or eating, we have had some discussion about that question.  And I think it's a good question.  You know, we would like to see as much as possible that people are wearing these masks.  We also understand that, you know, people may take them off in their sleep without even being aware of it, or that you roll over and now the mask isn't really on correctly.  So, again, it's sort of an aspirational recommendation that people wear these as much as they can, with recognition that, you know, there are some, there are some, you know, there are some times when that won't be practical.
>> And Mollie,  another question regarding the shelters.  Is there any guidance on how to handle special needs shelters? 
>> There, there are other guidance documents on the website.  And, again, this one, like I said, is [inaudible] used for those situations.  But if you go onto the CDC website, and you'll see the COVID19 page, if you scroll down, there's a link, and we can provide that, I guess, there's a link to all the guidance documents that are available.  And you can search them by topic and key words and so forth.  So, you would find it there. 
>> Great.  Thank you.  I'm not sure which of you should field this question, but we received a question about medical staff who have to stay in place in the storm zone and can't evacuate.  Are there any special considerations for those personnel? 
>> That's not addressed in this document.  And I do not, I haven't been involved in that particular discussion, but I believe that NIOSH and some of the others are looking that.  I know that we've had conversations with FEMA and ASPR and some others about the thing about [inaudible] about these issues and what can we do to help protect these folks.  But I'm not aware of any published guidance document at this point. 
>> Pretty much, guys, if you're going to be, if you know you're preparing in this direction, if you're designating people to write it out in place, plan for them, stock for them, do the very best you can, and then solve the problems when they crop up later.  That's all we do.  Okay, I'm going to direct this next question to Vivi.  What they asked was is there an image or video to share that shows the what now of packing a go kit.  And I'd like to expand that question, because the go kit might look a little different this year. 
>> Sure, yeah, that's a great question.  We do have some images about a traditional go kit, I believe, on our preparedness website.  But we're working on updating things for this year.  So, I think that's a great idea, and we'll take that into consideration as we're doing more graphics and social media regarding COVID19 and hurricanes to update those images.  Thank you. 
>> Great.  Thank you. 
^M01:01:51
^M01:01:54
So, is there any possible transmission concerns if there's a mosquito bloom after a storm? 
^M01:02:04
^M01:02:07
And I guess that question should probably go to Mollie.  Mollie?
>> Yeah, are we talking about, if we're talking about COVID19, or if we're talking about other mosquitoborne, you know, illnesses.  So, what these are for other illnesses that are mosquitoborne.  But I'm not aware that there would be a concern related to COVID19 and mosquitos. 
>> Thank you.  And we're running close on here.  We'll answer a couple more questions.  Do you foresee bringing telehealth services to shelters to relieve patient transport concerns, or even tele mental health services? 
>> I have had conversations with Red Cross and otherthey are planning for and considering providing [inaudible] services as possible virtually.  I don't know about the telehealth [inaudible].  My conversations would be that somebody required, you know, much medical care that they would not stay in a general public shelter.  But having said that, yes, the Red Cross is certainly doing as much as possible virtually. 
>> Great.  Okay, I'm going to direct this next question to Vivi.  I'm going to kind of summarize the question a little bit.  Where should people go to find information for cleaning shelters, especially like if it needs to be done daily, and if they have concerns about the chemicals maybe being toxic to the residents? 
>> So, I'm not sure, Mollie, how much the shelter guidance gets into disinfection.  Do you want to address that one? 
>> Sure.  I mean, there is a section on cleaning and disinfection in the shelter guidance.  And it also provides additional resources back to more specific information in more detail from additional CDC resources.  So, yeah, there is a link in the section on cleaning and disinfection. 
>> Thank you.  And you can also go to the CDC COVID19 website and search for disinfection and come up with a lot of different disinfection guidance for different situations. 
>> Okay, guys, we're over time here.  And I apologize for everyone that we made stay a little built longer.  But I see we have over 2,000 people who did stick it out over time.  So, thank you very much for coming.  I'm going to real quick read my goodbye script here.  Thank you for joining us today.  If you have additional questions, please email them to epic@cdc.gov.  I apologize that we couldn't get to everyone's questions today.  There were many good questions.  As a reminder, today's presentation has been recorded, and you can turn, you can earn continuing education for your participation.  Please follow the instructions found on emergency.cdc.gov/epic.  The course access code is EPIC0527 with all letters capitalized.  So, thank you, everyone.  Good luck.  Stay safe.