CERC Transcript 05 17 2016

Zika CERC Discussion: Uncertainty

Presenters: Barbara Reynolds, PhD

Date/Time: May 17, 2016 1:00 pm ET

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Operator:

Welcome and thank you for standing by. At this time all participants are in a listen-only mode. After the presentation we will conduct a question and answer session.

To ask a question please press the Star 1 and please record your name. Today's conference is being recorded. If you have any objections you may disconnect at this time.

I would like to introduce your host for today's conference Ms. Barbara Reynolds. You may begin. Ms. Reynolds?

Barbara Reynolds:

Thank you Kathy and welcome everyone. This is a first in a series of Webinars that we're going to be doing on Crisis and Emergency Risk Communication (CERC) as it relates to Zika issues. We're excited to have an opportunity to not only share a single concept perhaps each week related to CERC but then have a robust discussion with the people who are on the call and get their perspectives and questions along the way. So let me tell you a little bit about how we're planning to do this. We're looking at a weekly Webinar hosted by CDC where you can use slides to follow along. And you can find those slides by going to CDC's website at emergency.cdc.gov. Click on the CERC/Zika teleconference CERC discussion, Zika CERC discussions at the top of the CERC page and you should be able to find the slides there.

I do want you to know that all of these calls will be recorded and posted for future access. Of course I prefer that people were able to listen in real-time but I realize how busy we are. We chose Tuesdays at 1 o'clock as the time, set time for these Webinars, and until someone tells us that no one can show up for it we'll probably stick to Tuesdays at 1 o'clock.

So there's a certain level of certainty in when you can look for it if you want to participate live. If not we hope that you can take advantage of listening to the audio. We recognize that sometimes people call in on calls like this and won't be able to see the slides. To the extent that I think the slides inform the discussion I may do a little bit more reading of slides than I normally would. And I'll try very hard to remember to say next slide when it does when it's time.

It's an hour long Webinar. I am not going to talk for an hour on crisis and emergency risk communication. I will talk maybe 20 minutes give or take on a topic and then open it up to discussion which Kathy our operator will moderate for us so that we do get an opportunity for everyone to join in. We're doing it this way as a response to some really smart people out there in the state and local public health community who said that really what we need is a discussion and bring CERC into that discussion.

It's not us just telling you something about CERC and Zika. It's us having a discussion among all of us professionals about CERC and Zika. So I'm really looking forward to it.

It's important to know that when we're talking to people about a new threat -- and in this case we are talking about Zika in the United States as a new threat -- that we have a tendency to want to tell people what we know. But we often forget that we may need to start talking about what we don't know. I was on a call with a number of experts last week and one of the scientists said, "This virus repeatedly surprises us."

And I've been in the infectious disease arena for a quarter century and have a scientist, a subject matter expert, say something like that set me back a little bit. And that's one of the reasons why in this first of a series of Webinars on CERC and Zika I wanted to talk about uncertainty because frankly uncertainty is not uncommon at the beginning of a new or emerging infectious disease situation that we all have to face.

But what we tend to do is like I said fall back on the comfortable, telling people what we know but forgetting to tell people what we don't know. And there are some reasons why it's valuable to talk to people about what we don't know.

So I'm going to give you my signature slide next which is the right message at the right time from the right person can save lives. I say that as a mantra because I truly do believe that it's on all of us, the subject matter experts, the leaders who may be delivering these messages, the communications professionals are going to help the leaders and the experts talk about these things. It's all of us need to recognize how important it is that we get it right.

And getting it right doesn't just mean giving people the facts. Getting it right means putting the facts in a context that others can find useful. And more than anything it's making sure that what we do we do in a credible and trustworthy way.

I was explaining to someone this morning that I talk a lot about trust and I talk about credibility and that some people may think those are the same thing, trust and credibility so we make - we use them interchangeably. Well trust is sort of that gut feeling that there's somebody there who also has our best interest at heart. That's a trust situation. Credibility is where you take trust and expertise and put it together.

So you become credible when not only do you have expertise but you're also trusted with that expertise to be doing something with the public's best interest at heart, with the person's best interest at heart. So credibility is really important. And it is the credible person who has to have the right message at the right time to be able to save lives.

And credibility goes beyond just giving people the facts. If all it took to be a credible spokesperson or a credible place for information we would, you know, we could just have computers throw out factual information and not think about it. But to become credible means that you also have to have trust in there and trust means providing for people a context where they feel comfortable getting the information from you.

So the right person at the right time with the right message can save lives and I'm going to repeat that as often as I get the opportunity to do so.

In the next slide we're talking about what does the public need from our communication? And like I said we're pretty good at giving people the facts. But we also need to be able to empower decision-making. And that's where the issue of uncertainty comes into play. Facts can be facts but if we stick only to the facts especially early on in a crisis situation and we don't acknowledge the context or the uncertainty around those facts we may put ourselves in a situation where people are going to start seeking information from other places.

One of the things I learned a long time ago is that you do need to give people information. But when the answer doesn't exist yet by ignoring this you're ignoring the possibility that someone may fill the void who doesn't have the public's best interest at heart.

And so a stronger message if you're applying crisis and emergency risk communication to a situation especially initially in a new and emerging public health threat situation, the right way to go about doing it is to also acknowledge what we don't know. And an example of how this comes into play, if I were to a press conference and I was going to have an expert up to talk at that press conference and I told that expert, "Never talk about anything you - about the things that you don't know. Only talk about what you know." Well that sounds like sound advice right, just tell people what you know.

And here I am telling you that you also need to talk about what you don't know. And what I mean is you don't make it up. What you do is you acknowledge what you don't know because invariably there's going to be a difficult question that isn't yet answered early on in a public health emergency situation.

And if you ignore that the question exists and you just stand up in the press conference and you give your facts well what happens when the reporter, the first reporter out of the gate gets to ask a question at your press conference that reporter's going to ask that really important question, the one that you didn't address because you don't have the answer to it.

Well in that moment who's got the most trust from the people listening? It might very well be the reporter becomes trusted in that moment because well gosh yes, that reporter knows the big question that we're all wondering. And that expert up there he talks about what he knew but he didn't get to the crux of it. He didn't get to the question that we most have on our minds.

And so I think we really want to be a trusted credible expert or leader we need to tell people what we know and we need to tell them what we don't know. And then we have to explain when there is a degree of uncertainty the idea that perhaps things may change in the situation. And the Zika Summit that we held on the 1st of April I was talking to leaders there and I said, "I'm going to share with you some of the best lessons learned I can think of from experience with leaders across many situations and that there are six words that you need to learn. And that is these six words, based on what we know now."

Now you could say that other ways but it's the concept that I want people to start to think about as it relates to credibility in the concept of crisis and emergency risk communication. Be prepared to say based on what we know now. That allows us to let people know we're doing research, we're learning more every day. And that same scientist who said last week, "This virus repeatedly surprises us," went on to say, "And we're learning more every day about Zika." And I think that that's important.

And early on in the initial phase of a response to an emerging health threat, we need to let people know we're not just sitting around twiddling our thumbs. We're doing a lot of research and we're doing it as quickly as we can and we're bringing together all kinds of forces and we're working collaboratively to try to get the best answer. But let's talk about the context of uncertainty today because frankly in the years that I have been involved in public health emergencies I will tell you that there are some things that are going to make it easier for us to talk to the public and gain their trust and credibility and there are some things that are going to make it more difficult.

And one of the things I think makes it more difficult is that we actually have in real-time peer review publishing going on which means that as experts are looking at and asking important questions about this virus they may be starting to publish and they're publishing in real-time. And it means that we're trying to have that scientific higher-level research discussion at the same time that the public is looking for guidance and that makes it hard.

It used to be we'd, you know, work through a crisis situation and scientists might be talking to themselves in some form but the - but they wouldn't be published. It wouldn't go out into an electronic journal of some prestige. And so the differences in what we were finding and the results of our research and that is cumulative oftentimes when we get to the facts. It's because we're looking at something over time, there was time for that to be worked out after the crisis response to get to the absolute facts of a situation.

And in this case - it's a bit of a roller coaster. We're going to tell people what we know to be a fact. We're going to have to talk to people about what we're learning but leave some variation, some possibility that things could change based on new information or as we move forward. So there's a lot for us to do initially in this.

And I think more than anything we have to be comfortable with the flexibility that is required in a situation is evolving in real-time. It's frustrating. It's going to be frustrating for the public. It's frustrating for those of us who are trying to communicate this to the public because right now as we - as we're talking about this even in the few weeks or months we've been looking at Zika and what it is doing, we have had to moderate some of our messaging early on somewhere along the way we were talking about Zika and that most people who were infected were asymptomatic, a big word for saying they didn't have symptoms.

But what did we do? We went in it there and we started looking at this and we found out no it's not so much that they're asymptomatic as much as they just have mild symptoms that weren't being reported. And in some cases they attributed it to some other illness or they noted it but it didn't mean anything to them at the time and they went on.

So what we're saying instead of most people are asymptomatic what we're saying is the majority of people who are infected will have mild or no illness. And that's a minor change but it's an important one to help us recognize that we have to deal with some uncertainty and the idea that we'll provide information and guidance as we go along.

Does that mean we were all in error if we said something like that? No I'm not saying that. What I'm saying is that we're refining what we know along the way. And that means we have to refine our messages. And that is why I think it's so important that we understand some of the crisis and emergency risk communication principles and work toward them in our messaging. And based on what we know now is a reasonable approach to a situation that has a great deal of uncertainty. Let's go to the next slide.

Under promise and over delivery, over deliver. What am I saying there? What I'm saying is that early on in crisis situations that because we want things to turn out well for people we may start to talk about the steps that we're taking in our response to that problem in a way that's going to guarantee an outcome. And that's where absolutes get us in trouble. We have a number of different components to our response to Zika. And one of those is mosquito or vector control as some people refer to it, so mosquito control.

So as a jurisdiction starts to work on controlling mosquitoes what we don't want to do is imply that somehow by taking certain steps whatever steps we can to try to control mosquitoes in an area that that will guarantee that no one becomes ill. And that is true for all kinds of mosquito borne illnesses, not just Zika. But it's important that we manage expectation and understand that trust is built on promises fulfilled and it could include implied promises.

So be careful about working to encourage people to accept the idea perhaps of using insecticides in the area and doing this kind of vector control and then implying that there's a promise that therefore something won't happen. When we're talking about what we're doing and talking about potential outcomes we have to recognize that that's what we're working towards not what we can guarantee along the way. That's also an expectation around uncertainty that we can't be certain of an outcome. We can be certain that we are working towards an outcome. The next slide.

Well we were going straight into my six principles of crisis and emergency risk communication. I think sometimes it's easy to get distracted by these because we've heard it many times. I think some of us have heard it many times. And what we need to know is that being first doesn't necessarily mean answering everything. It just means being certain that we have given people the information that we should when we should.

We have to recognize that in being first that there are certain questions that the public will ask. And we need to know that those questions will be asked by the public each time that they're facing a new threat. They want to know if they're going to be safe. They want to know will this affect them, think about that, and what can they do to protect themselves and their family and whose - what caused it and can they fix it? These are all reasonable questions that we can expect people will be asking. And if we follow the six principles of crisis and emergency communication these are questions we should be prepared to answer along the way.

I just want to talk a little bit about Zika and some of the uncertainties that exist out there. So we may have some general answers to questions around Zika but as you get into a particular location the question could still exist there. So even though we're answering questions at the international or national level at a local jurisdiction there may still be questions.

So a question might be whether the mosquitoes that are circulating in your local jurisdiction are resistant to insecticides and if so to which insecticides? That's a big uncertainty that we can't necessarily answer here and you are going to have to be prepared to answer within your jurisdiction.

Without question one of the uncertainty questions that will come up -- I said that in a funny way didn't I -- is when and where? We can ask that question but we don't have any way of predicting necessarily when and where. We have to be prepared for that question. We have to be prepared for the uncertainty of that which means that before Zika is circulating or you're dealing with it in terms of preparedness and vector control, mosquito control you need to be cognizant of the fact that people will be alert to that question and think about how you might answer it.

There are so many things about the virus itself and the way it interacts with the body that we don't know everything yet. We don't know for example in different body fluids what's the utmost time that it might still be present in semen or blood or other things.

We also have a lot of questions as it relates to pregnancy and does the timeframe in which a woman is exposed to Zika in relationship to her pregnancy have a difference in pregnancy outcomes? There are some questions about vector control, what will be the best approach. And those things might not be one-size-fits-all. So there's a lot of uncertainty.

And being first doesn't necessarily mean having the answers to all the questions. Being first may mean that you are going to acknowledge for people the uncertainty of the situation and do it with the level of empathy.

So if I go on to the next slide of the six principles of CERC we talked about empathy - empathy is just acknowledging that it's not fun to have a situation that is uncertain that as human beings -- and this is universal -- there is no society and very few individuals that love to exist in a state of uncertainty. Most of us are looking to make order or sense of our world and we do that by answering questions that we have. And when people are feeling threatened by something it's even more important for us to settle those uncertainties and gain information.

As the threat becomes more real to people in a community they're going to do more information seeking. It's really important before the threat is real to them that they at least know where to go to get that information. So you can reduce uncertainty by at least letting them know there's a place to ask their questions. And then in those places where they'll be getting answers we need to acknowledge when you don't have that answer to something. And by doing that we help to reduce the potential of people taking advantage of them who don't have their best interests at heart.

There isn't a new or emerging public health emergency where there are still questions about treatment and there isn't a vaccine that you may not have someone out there who wants to take advantage of that uncertainty. And they'll do so by promoting ideas or products that will give people some level of certainty. So we have to be aware of that and guard - help guard people from those opportunists who don't have their best interests at heart. There's a lot to be done there.

What I'd like to do now I talked about trust and mistrust already. So I think we can go on from those slides. What I'd like to do is to talk a little bit about beyond dealing with uncertainty, what we can do to act trustworthy. And one of those things is to share information early. And when I say that I don't mean share just the facts. What I mean is share the context of the facts that we're talking about.

I have some resource slides here also that I'll talk to in a minute. But I'd really like to do is to ask Kathy our operator if she would please give you directions on how to go about asking a question. And let's see if we've got some discussions, a potential for a little discussion. It doesn't mean I have to answer all the questions because there are some things I won't know but it will get us talking about things that we think are important in this setting. So Kathy could you let everyone know how they could get into this discussion through lining up on the phone?

Operator:

All right, thank you. At this time we're ready to begin the question and answer session. If you would like to ask question please press the Star 1 and please record your name. To withdraw your question press Star 2. Once again Star 1 to ask a question. One moment please.

Barbara Reynolds:

So while we're waiting for people to either think of or be brave enough to share a question along the way I thought it'd be useful for us to talk about some of the questions that we could anticipate. And I talk about unpacking a question which I think is really important. When someone asks you a question if you have the luxury of time it might be worthwhile to find - to think about what is it this person is asking behind the questions. That's why sometimes the facts aren't enough. It's important to get a sense of the context. What are people seeking by asking the question that they're asking? And I'll give you an example.

I think we would expect that someone might ask the question, are the steps you're taking going to protect us or not? How can you be certain that we, those living in the 48 states won't see an explosion of Zika this year? Well now let's unpack that question. What do you think the person is really seeking in that question? I'm thinking perhaps a little reassurance. They may even be asking for a promise, a level of certainty that you can't give or they may be looking to find out just how bad is this? They're probing a little bit to kind of get a sense of where you're going. Is this as bad as I think it could be?

They might be looking to reduce uncertainty. And if that's not possible then I think what's important is explain the process. What steps are being taken to reduce the risk? So if I were asked, "Are the steps you're taking going to protect us or not. How can you be certain that we those in the 48 states won't see an explosion of Zika of this year," I might answer with something like this. "Like you were concerned about Zika being introduced here." Okay if you're into crisis and emergency risk communication you know I just used an empathy statement. And there's nothing wrong with using a little empathy when you're talking to people about things that are uncertain.

I might go on and say, "There are some things we can do right now to help our community, things we can do together." Always nice to speak to people's higher selves and to give them things to do. So what are some things we might ask? How about tip and toss standing water, wear bug repellent, follow guidance from mosquito control experts, join your neighbors in eliminating standing water, follow CDC's guidance preventing sexual transmission to pregnant women. These are all things that people can do. And what we know is that when people are allowed to act on a concern or a threat that they're more apt to feel a sense of restored self-control. And all of that is important in helping people help themselves in a crisis situation. So Kathy do we have any questions?

Operator:

Yes we do. And the first one is from Nicole Tyson.

Nicole Tyson:

Hi. Good afternoon.

Barbara Reynolds:

Hi Nicole.

Nicole Tyson:

Hi. Thank you for having the call. I just basically missed the Web site that you initially mentioned and how to find the slide that you…

Barbara Reynolds:

Sure. And I think I kind of mumbled my way through that anyway. So if you go to cdc.gov you can go to emergency preparedness or I'll give you the actual URL. It's https://emergency.cdc.gov/cerc. And then if you get on to that page at the very top in bold it says Zika CERC Discussion. Click on that. It will give you the telephone number, the time, the topic for the Webinar and if you scroll down the slides are right there. And that is also the place where we'll be putting the audio recording of each of these. So we'll archive it. Any other question Nicole?

Nicole Tyson:

No that's all for right now. Thank you so much.

Barbara Reynolds:

Okay let me know if you can't find it.

Nicole Tyson:

Okay thanks.

Barbara Reynolds:

Any other questions Kathy?

Operator:

Yes. We have one from John Hanlin.

Barbara Reynolds:

Hi John.

John Hanlin:

Hi. Good afternoon. This is John Hanlin with Ecolab. And really what I wanted to say was really more a comment. And it was just to really applaud the CDC for what I would say are Herculean efforts over the last several months to continually provide basically state of the knowledge with respect to Zika and strategies to reduce risk, dutifully respect that it is a very fluid very dynamic situation. But I think CDC has done a phenomenal job in terms of this is what we know, this is what we don't know and our guidance may change based on new insights. So that's my comment. Thank you.

Barbara Reynolds:

Thanks John. I really appreciate that insight. And it's important for all of us to continue to talk to each other and make sure that the efforts that we are making are going in the right direction that we're giving people what they need when they need it along the way and if we can't then explain why there's some barrier to that. Any other questions Kathy or comments? And I love comments because this is a discussion. It's not a Q&A.

Operator:

Yes from Charla Haley.

Charla Haley:

Hi Barb. It's Charla from the Utah Department of Health. I wanted to pick your brain for a minute because we had a concern yesterday as we had a meeting talking about our Zika messaging trying to figure out how to message about Zika and also message about West Nile virus without running the risk of message fatigue. Would you suggest combining the two?

Barbara Reynolds:

That's a good question Charla. And I think that it depends on the community whether I would do that or not. For those of us who started with West Nile way back in 1999 in New York City I will tell you I was rather surprised as West Nile marched across the country state by state jurisdiction by jurisdiction how much it captured the imagination of people along the way. I just don't know if people are paying attention to West Nile the way they once did and if they will be confused by the two other than that we need to indicate that there is a difference in the mosquito in the mosquito behaviors that could make a difference.

I don't think it would be inappropriate to acknowledge the differences in the communication around Zika. It also depends on which threat is most prominent in your area which one I would focus the most on. So if you have a much greater risk for West Nile to deal with then I would talk West Nile and mention Zika and the other way around depending on the jurisdiction I was in.

Charla Haley:

Okay thanks Barbara. That helps.

Barbara Reynolds:

Good I hope so. That's off the top of my head. I'd love to hear what other people might think about that too or what they might be doing. And that's what's exciting about having a conversation is that other people can jump in and share some ideas too so exactly what I'm hoping for. Any other comments or questions Kathy?

Operator:

We have one from Jane Lux.

Barbara Reynolds:

Hi Jane.

Jane Lux:

Hi Barbara. Thank you. We're in Illinois and so there's already a lot of discussion I think in the public about, you know, whether the mosquito that carries Zika will make it up far this north because you hear a lot in the public already about the southern states being concerned. And so I realize that's one of the areas of uncertainty right now. But how would you handle that kind of question at this point?

Barbara Reynolds:

Sure. So in any population we have some people who have a lower threshold of risk than others. And they're probably the people who were hearing about Zika and beginning to question and wonder about it. And the fact is that is a big area of uncertainty. You may want explain that depending on the jurisdiction there may or may not be as reliable of surveillance for mosquitoes that carry Zika and so especially for the southern part of Illinois. And I don't have the map in front of me. I can't remember exactly how it goes but the albopictus may go up into that area and there is the possibility that that mosquito could carry Zika.

If nothing else if people are interested in the topic of Zika you should certainly help to educate them about it so that they are prepared. And frankly some of the things that we want people to do, we would want them to do even in relationship to nuisance mosquitoes. So it's kind of a win-win if we're asking people to do things like tip and toss and eliminate standing water. And so there's still something that people could do. And then the other thing that I would do if I were doing public health messaging in the state where it's the talk of whether it will make it that far up and if it will now or later because we do have a certain how can I say transition in relation to weather and climate. And so it may not be this year but that doesn't mean it won't in the future.

What I would want to do is to help people know that we're looking at it and that we'll share what we know when we know it and I think that if nothing else just reassure them that there are some things they can do right now to whether it's Zika or some other disease that is carried by mosquitoes they could help avoid and then tell them, you know, in this case make a pact with them that if you learn something different if you learn something that's important to them to help protect them from it that you'll share it along the way and get them used to the idea.

I would start talking and I don't care what jurisdiction I was in right now I would be talking Zika right now so that people get used to the idea and that they know that we're on it and that we're thinking about it and if they want to come in and participate with us which is often what people want is they don't want to be just spectators that they can by doing some of these things even now.

Jane Lux:

Thank you.

Operator:

All right our next is from Kim Junius.

Kim Junius:

Hi Barbara. This is Kim Junius from Cook County Department of Public Health in Illinois.

Barbara Reynolds:

Hi.

Kim Junius:

Hi. How are you?

Barbara Reynolds:

Good. How about you?

Kim Junius:

I'm good thank you. So I - this is great. I think that might have been one of my colleagues from Northern Illinois that was just talking from another of our regional health departments. So I just wanted to share what my health department is planning and just kind of get your feedback kind of similar to what you're suggesting.

We're planning some general mosquito bite prevention messaging. We're going to convert what was our West Nile virus page to a landing page with basic the three hours of remove, repel, repair mosquito bite prevention and then have links to separate pages one up about West Nile virus and one about Zika where we can talk about - I was thinking we could do something where we would talk about the sort of the risks as they relate to each of those diseases so that people can see, you know, West Nile virus is something that is more of concern in this jurisdiction.

And then we could use some of the tactics that you've talked about in terms of talking about the risk for Zika not being a major concern but, you know, that there is uncertainty and will keep people informed as the situation evolves.

Barbara Reynolds:

Yes that sounds excellent. And I want to make the point if we look at the Zika case map that most states in the United States are shaded light blue on that map which means they at least have travelers who have been infected with Zika and have returned. And so even though we may not need to heavily move on messaging around the mosquitoes themselves in some of the northern states we sure have to be talking to travelers and to pregnant women or women who may become pregnant. And as we know in the United States about half of pregnancies are unplanned so there's still a lot of messaging that needs to go on even though if it isn't directly related to mosquito transmission.

And just as a preview so a great conversation that we're having, next week we're going to talk specifically about basically the roulette of who's going to within the continental United States what jurisdictions going to have our first case or cases of Zika related to mosquito transmission. So it's our first introduced by mosquito cases within the continental US. So all of those efforts that you're doing are going to work ultimately towards those kinds of concerns so I think it's great.

Kim Junius:

Great. Thank you.

Operator:

All right our next one is from Clark.

Barbara Reynolds:

Hi Clark.

Clark:

Hello. How's everybody today?

Barbara Reynolds:

Good on our end.

Clark:

Good. Clark with a company called Phagevax. That's spelled P-H-A-G-E-V as in Victor A-X.com. Earlier on FBO, Federal Biz Ops, Federal Business Opportunities CDC had put something out saying, "Okay who are the manufacturers of DEET, D-E-E-T, you know the chemical used to repel…

Barbara Reynolds:

Yes.

Clark:

…mosquitoes. So I did a Google search and found some people in Europe that have a six-hour repellent. And it's a new molecule. And it's a young PhD who's from France. And I talked with him one time and I haven't heard from him. And I think that US government should certainly consider this molecule as a sole source for six-hour repellent. What say you about that?

Barbara Reynolds:

Well what I think Clark is that one thing I'm certain of is what I know and what I don't know. And I am not an insect repellent expert so I don't have an opinion on that.

Clark:

So what I'm saying is this…

Barbara Reynolds:

But if you do want to share about insight or perspective with CDC you can do it by emailing CDC info.

Clark:

Now what I'm going to do is I'm going to give you our phone number. And when we get off this conference call you can call me. You ready for the phone number? Area code (phone number). I'll repeat…

Barbara Reynolds:

I've got it Clark. Thank you.

Clark:

…(phone number). Next topic, Wolbachia...

Barbara Reynolds:

Okay Clark, Kathy I think it's time that we move on to our next question. Clark we'll talk to you. Thank you.

Operator:

And again if you do have a question please press the Star, 1 otherwise that was our last question. One moment.

Barbara Reynolds:

Good because I have a little bit more that I want to share with all of you. We were talking about deciding when and how to talk to people about the viruses that may carry Zika coming to your jurisdiction, your area. And what I'd like to do and I want you guys to think about this too is we have an email address.

And I want you to email us with ideas and I also want you to email me with insights, tidbits, tips, cool things that we can share with each other along the way. And that email address is cercrequest@cdc.gov. It's also on the slide for those of you who can call up the slides either now or later.

But I was thinking what is it that I have learned about Zika and those mosquitoes that is interesting that I think might help inform your community as you start to talk to them about it. And there are two things that I want to make sure you know. And I'm not saying they're not in the key messages if you do get those on a regular basis.

But one is that and I frankly do not know how you refer to mosquitoes if you say they're hatched or they're born but whenever mosquitoes become mosquitoes that the Aedes Egypti mosquito that carries Zika usually doesn't travel more than 150 yards from the place where it hatches. And the lifespan of a mosquito is 30 days.

Now I'll leave it all to you all to think about what that means in context of talking about people - talking to people about vector control. We'll talk a little bit more about this next week when we talk about how to do the messaging for the first mosquito locally transmitted case of Zika. But it's those kinds of things that are interesting.

And if you missed that along the way I know a little bit about mosquitoes but I don't know everything about mosquitoes but that's something that I think is useful. And when I heard 150 yards and I heard 30 days that changes the dynamic. And as we go through these weekly discussions I think you'll see how that will inform some of the decisions that might be made by vector control people, some of the decisions that might be made related to warnings to women who are pregnant about where to travel or not travel here within the continental United States. So I'm looking forward to that and I just think it's worthwhile to ask the question. So I invite all of you to do the same to share what you know along the way.

Oh gosh. What I'd like to do since we don't have any more questions is go back to my slide and talk about some of the resources. I really do invite you to actually go to the slides to get some of this because I'm not the best person in the world to get your URL from. But I do want you to know that we do have - some of you already plugged into our Zika Web site at CDC. There's a lot of information there.

There are also Zika communications resources that you can get off from that page. You can go to emergency.cdc.gov/cerc. That's where you're going to get your information about these Webinars. And there are number of CERC resources there. I want to tell you about a training that's going on here in Atlanta August 10 through the 12th. We're going to be talking about crisis and emergency risk communication in a global context which people are invited to come to if they'd like.

And there will be more information available to you on that by emailing cercrequest@cdc.gov. And then some of you may have learned about today's Webinar by receiving the emergency partner's newsletter. If you found it out about it through some other means and it might be useful for you to sign up for the emergency partners newsletter. And you can do that through these slides also.

If you go to the communications resources at CDC you will find that there are a number of different products that can be used that will help you inform people about Zika and what they can do about it. And what I thought was really important is that we give that information for specific groups. So as you're trying to talk to pregnant women or travelers information for healthcare providers, mosquito control professionals or even the media.

Workers, I thought it was interesting as we were talking about the things related to Zika last week someone mentioned that we'll be in mosquito season which will include those mosquitoes that may carry Zika at the same time we're in hurricane season and what will happen for people workers or responders if they have to respond to a place where there's a hurricane.

And there are some concerns, you know, frankly that the mosquitoes - people who may not be used to thinking about mosquitoes because they don't live in that area will have to start thinking about thinking about mosquitoes in a different way. So there's just so many different ways to think about Zika and its relationship to people and people's health. And it's worthwhile to work through that along the way. I would have to say that we should close up today since we don't have any other questions. We'll be back…

Operator:

We do have two more questions.

Barbara Reynolds:

Okay great Kathy. Thanks for keeping track of them. Go ahead.

Operator:

All right, Care Mae Wooledge.

Barbara Reynolds:

Hi Cara.

Cara Mae Wooledge:

Hi. This is Cara Mae Wooledge. I'm with Napa County Public Health in California. And so my question sort of comment is that at this point we've really been focusing and targeting our large Latino and Hispanic population because we know that summer is coming up and there's a lot of travel to the countries that do have the Zika virus.

So we've been specifically working with people that with their OB/GYNs and our local clinic to ensure that the families that may travel there or if a woman has a partner who travels there back and forth for work the risk of, you know, exposure and then exposure during pregnancy and then after returns. So that's really been our focus so far and we've been working with local promotoras or promotores and community health workers. I was just curious if anyone else in the United States had been focusing on that or has had experience or successes with that. I'd love to hear stories of success or just lessons learned in that sense.

Barbara Reynolds:

Great. So although I really probably can't add anything else myself on the topic I would invite you to look at what we're suggesting and doing on our Resource page. And then we've thrown it out there and if somebody has something they'd like to add, there's no reason why we can't get a little bit of a forum going.

And the best way to do that is if someone has something they'd like to share on that topic to go to cercrequest@cdc.gov and plug it in. And to the extent that we can match people up to talk about these topics either separately or on a future call like today's we'll do that so thanks for the shout out. We'll see what happens.

Operator:

All right...

Barbara Reynolds:

And Kathy next question.

Operator:

Okay Barbara?

Barbara Reynolds:

Hi.

Barbara Cole:

This is Barbara Cole, Riverside County California, just more of a general question. So principles, the six principles. Do you see that they apply in terms of interaction with the media versus the general public?

Barbara Reynolds:

Okay so these principles are important in terms of building trust and credibility when you're talking to people. And I jokingly remind people that media are people too. So I do think that they're useful, not only that but, you know, you can apply them when talking to the media but you can also teach the media about these principles. And it may affect the way they talk about a health subject to the public when they understand what you're trying to do.

One of the things I've learned over the years working with the media is that they believe and often act as a marker for the public. So they're asking the questions that they believe the public would be asking of you. They're holding you accountable on behalf of the public.

So to exercise these principles talking to the media is a very good thing. But also educating them about these principles so that they know you're that you're approaching the communication from a genuine honest and open way is a good thing too. So I vote yes, be interesting to see if other people have other perspectives on it. Good question Barbara. Thank you.

Barbara Cole:

Thank you.

Operator:

We do have one more question.

Barbara Reynolds:

Sure.

Operator:

Monique Davis go ahead.

Monique Davis:

Hi Barbara, Monique Davis from Hudson County, New Jersey and two comments. One was to go back to the commenter two comments ago regarding some other ways that they're reaching out to the community. And I can share what we're doing here in New Jersey. We're working heavily with our women, infant, and children's groups whether that's through the local health departments or through Federally Qualified Health Centers.

Those at least in our community that is a great way to reach out to folks, you know, the target audiences is through the Federally Qualified Health Center. So we're partnering with them to make sure this information is given out as well as the healthcare professionals to make sure that they updated on the clinical guidance et cetera.

Barbara Reynolds:

How are the healthcare providers reacting to your offer of support and checking in them around a Zika? How are they responding?

Monique Davis:

We've gotten a lot of requests from our hospitals. I've actually gone out and done what - their grand rounds presentation. And I've partnered with the medical director of our communicable disease service. So I go when I do the overview about Zika and he addresses the clinical portion of it, you know, the testing…

Barbara Reynolds:

Right.

Monique Davis:

…the case definition, the testing guidance and all of that. And that's been quite well received and it's actually something that we modeled after the way we worked with our hospitals for Ebola.

Barbara Reynolds:

Great. So how many of them have you done?

Monique Davis:

I think out of six we've done all but one…

Barbara Reynolds:

Great.

Monique Davis:

…full process.

Barbara Reynolds:

And did you - have you seen a trend in terms of a misunderstanding or a misperception around Zika? Is there anything that surprised you as far as their reaction?

Monique Davis:

No. And I will preface that with the fact that the clinical parts of it they're working directly with either the regional epidemiologists or the state. So they're not asking us for questions, you know, coming to us for actual questions, probably nothing more to us than, "Hey can I have a copy of the latest guidance," because we are the HAN agency for our county.

Barbara Reynolds:

Right, right.

Monique Davis:

So as far as…

Barbara Reynolds:

And because…

((Crosstalk))

Monique Davis:

So as far as assumptions and things that's something I really can't answer because they're not directing the questions to us. They are very grateful for the information. They're grateful for the opportunity to kind of review it because it's coming down the pipeline but they don't always have time to read up on it in a timely fashion.

So that's probably one of the strengths that we can bring to them is to remind them what the newest and greatest information is and where to get it. And they do look to us as a resource for that.

Barbara Reynolds:

Well it sounds like a really good program and perhaps one that others can use because that is a - an audience group that's really important especially when we're talking about outcomes for pregnant women so or women who could become pregnant.

Monique Davis:

Yes we've been fortunate. Some of the hospitals have residency programs so we're not only getting, you know, their regular staff positions but we're getting the up and coming, you know, the students. And I think that that's important. So that's worked well. We're we reaching out, want to reach out more to faith-based organizations because for many of the people in the target audience their faith, you know, their church is where they're going for their information. So that's something that we want to expand a little more.

And then we also have maternal and child health consortiums, consortia so that we - we're trying to work with because they - that is what they do is pregnancy outreach. So those are just some of the folks that we're trying to work with on this. We have a very, very diverse community here in Hudson but many, many of the folks have family either in the Caribbean Island nations or in Latin America so we're really trying hard to get out there and get the information out.

Barbara Reynolds:

Yes. I think that when you're dealing with new emerging infectious disease like Zika that it brings to home quite clearly how diverse so many of our communities are and that we sometimes don't think about those connections along the way. And it's worthwhile and of course so valuable to have good communication professionals like you and others out there knowing your community, knowing the needs of your community in terms of the information and sharing it in ways that is useful to them.

And basic good old health education there's nothing wrong with it when you're looking at a situation like this. It's just a little more urgency for some jurisdictions where the possibility of Zika or another illness related to these mosquitoes is more prominent, more likely I guess. But it's still important for all of us to think about it.

I think what I'll do is go ahead and close it out here for today. Again this is more than I had hoped for for the first Webinar/discussion whatever it is that we have. But this is exactly what I hope we could do in the future, just a little bit of discussion on a topic, you know, quote lecture from me or another one of our communications professionals here at CDC and then open it up and start to hear what other people are thinking about or talking about.

So as something strikes you as interesting or you do have a question along the way of course you can always reach us through cerc preparedness - I mean I'm sorry cercrequest@cdc.gov. But if you want to save it for the Webinar for the next week, go ahead and do that too.

So with that'll sign off and I look forward to talking to you all next Tuesday 1 o'clock Eastern Time and know that the slides and the call in information will be on our Web site. Take care everyone. Kathy we're closing it out.

Operator:

All right thank you. This completes today's conference. You may disconnect at this time.