Ebola’s appearance in the United States — first in Dallas and now in New York City — raises questions about how prepared local public-health authorities are to respond to the virus. For more than a decade, the Centers for Disease Control and Prevention (CDC) has been measuring just that, though the results have limited use.
The CDC collects preparedness metrics for all 50 states and four major urban areas — Washington, D.C., Los Angeles County, Chicago and New York City. Of the 15 “capabilities” it tracks, the CDC has released recent data on only three: laboratory testing, emergency operations coordinating and emergency public information and warning. And only the latter two shed any light on Ebola preparedness, since the CDC’s data on lab testing only covers the labs that test for food-borne illnesses or chemical and biological agents in the event of a terrorist attack.
The CDC also publishes annual scores on the ability to distribute vaccines, antibiotics and other medical supplies. These metrics, found in the 2013-2014 National Snapshot of Public Health Preparedness, are shown in the table below for the four major localities, along with the 50-state average.
According to these metrics, the Big Apple is about average in responsiveness. But New York rates well above average in its ability to distribute supplies in the event of an outbreak. We can’t say where New York ranks in its ability to warn and inform the public, since the city did not submit results for 2012, the latest year of available data.
Let’s break down what these metrics mean, as described in the CDC’s data appendix :
- Emergency Operations Coordination: This measures, in minutes, how quickly authorities respond in case of an emergency. One hour is the target. New York City responders have taken, on average over the last three years, about 38 minutes — better than Chicago and LA County, but behind responders in D.C. and most states.
- Emergency Public Information and Warning: This metric awards a simple “Yes” or “No” grade on whether the state or locality issues a “risk communication” during a real or simulated emergency. New York City did not submit data in 2012 for this capability, making it the only major city not to get a grade.
- Technical Assistance Review: During a public-health emergency, the CDC relies on vaccines, antibiotics and other medical resources from the strategic national stockpile. The CDC places SNS assets strategically throughout the country. To test states’ and cities’ ability to “receive, distribute, and dispense medical assets from the SNS,” the CDC devised a test: the technical assistance review, which assigns scores from 0 to 100. In 2009-10 and 2010-11, a score of 79 or higher was acceptable. In 2011-12, the threshold was moved up to 89. New York City received TAR scores of 100, 97, and 100 in the last three years of available data. This was better than Washington, D.C., and LA County, but slightly behind Chicago. New York City does, however, score well above the average state.
These metrics are imperfect and incomplete. We don’t know how New York City (or anywhere else) ranks on the 12 measures the CDC tracks but doesn’t report. And even the full CDC set doesn’t capture all the things that would go into a response to a wider Ebola outbreak. The CDC doesn’t measure community engagement and coordination, the quality of the health care system (including hospital preparedness) or other important factors.
Even a measure of general hospital preparedness would only go so far. What really matters is how the hospital designated to treat Ebola patients performs.