	Background

Infectious diseases include naturally occurring outbreaks, such as SARS,  as well as diseases from biological agents that are intentionally released by  a terrorist, such as smallpox. Health care providers would report any  illness patterns or diagnostic clues that might indicate an unusual  infectious disease outbreak associated with the intentional release of a  biologic agent to their state or local health departments. In order to be adequately prepared for emerging infectious diseases in the  United States, state and local public health agencies need to have several  basic capabilities, whether they possess them directly or have access to  them through regional agreements. The federal government also has a role in preparedness for and response  to major public health threats. Despite Improvements, Gaps Remain in Disease Surveillance Capabilities of State and Local Public Health Agencies

In the cities we visited, state and local officials reported varying levels of  public health preparedness to respond to outbreaks of emerging infectious  diseases such as SARS. They recognized gaps in preparedness elements  that have been difficult to address, including the disease surveillance and  laboratory systems and the response capacity of the workforce. We found that planning for regional coordination was  lacking between states. States and  local areas were addressing gaps in communication. In addition, state and local health agencies were working with  CDC to build the Health Alert Network (HAN), an information and  communication system. Some State and Local Contingency Planning Underway, but Regional Coordination Is Lacking

As part of the effort to prepare for a possible outbreak of an infectious  disease, there is contingency planning at the state and local levels. Hospital Preparedness Improved, but Limitations in Response Capacity Remain

Because those with symptoms of an infectious disease might go to  emergency departments for treatment, hospital personnel would likely be  some of the first healthcare workers with the opportunity to identify an  emerging infectious disease outbreak. Most hospitals reported  training their staff and planning coordination efforts with other public  health entities. However, even with these preparations in place, hospitals  lacked the capacity to respond to large-scale infectious disease outbreaks. Hospitals Provide Vital Disease Surveillance Capacity

The disease surveillance capacities of many state and local public health  systems may depend, in part, on the surveillance capabilities of hospitals. Concluding Observations

Efforts at the state and local level have improved the ability to identify and  respond to infectious disease outbreaks and bioterrorism. These  improvements have included upgrades to laboratory facilities and  communication systems. We found that some  disease surveillance systems may be inadequate, that there are shortages  of key personnel in some localities, and that most hospital emergency  departments across the country have experienced some degree of  overcrowding, which could be exacerbated during a disease outbreak. Hospital Emergency Departments: Crowded Conditions Vary among  Hospitals and Communities. Bioterrorism: Coordination and Preparedness.
Why GAO Did This Study

Recent challenges, such as the SARS outbreak and the anthrax incidents in the fall of 2001, have raised concerns about the nation's preparedness for a large-scale infectious disease outbreak or bioterrorism event. In order to be adequately prepared for such a major public health threat, state and local public health agencies need to have several basic capabilities, including disease surveillance systems, laboratory facilities, communication systems and a sufficient workforce. GAO was asked to examine the capacity of state and local public health agencies and hospitals to detect and report illnesses or conditions that may result from a large-scale infectious disease outbreak or bioterrorism event. This testimony is based largely on recent work, including a report on state and local preparedness for a bioterrorist attack; preliminary findings from current work on updates of bioterrorism preparedness at the state and local levels; and findings from a survey GAO conducted on hospital emergency department capacity and emergency preparedness.

What GAO Found

The efforts of public health agencies and health care organizations to increase their preparedness for infectious disease outbreaks and bioterrorism have improved the nation's ability to recognize such events. However, gaps remain in state and local disease surveillance systems, which are essential to public health efforts to respond to disease outbreaks or bioterrorist attacks. Other essential elements of preparedness include laboratory facilities, workforce, and communication systems. State and local officials report that they are addressing gaps in communication systems. However, there are still significant workforce shortages in state and local health departments. GAO also found that while contingency plans are being developed at the state and local levels, planning for regional coordination for disease outbreaks or bioterrorist events was lacking between states. The disease surveillance capacities of many state and local pubic health systems depend, in part, on the surveillance capabilities of hospitals. Whether a disease outbreak occurs naturally or due to the intentional release of a harmful biological agent by a terrorist, much of the initial response would occur at the local level, particularly at hospitals and their emergency departments. Therefore, hospital personnel would be some of the first healthcare workers with the opportunity to identify an infectious disease outbreak or a bioterrorist event. Most hospitals reported training their staff on biological agents and planning coordination efforts with public health entities; however, preparedness limitations may impact hospitals' ability to conduct disease surveillance. In addition, hospitals still lack the capacity to respond to large-scale infectious disease outbreaks. Also, most emergency departments across the country have experienced some degree of overcrowding, which could be exacerbated during a disease outbreak or bioterrorist event if persons with symptoms go to emergency departments for treatment.