He had, of course, heard reports of the devastation, but as Thomas Glass drove a rented convertible through the flooded Florida streets and toward the center of destruction, he was still awestruck by the sight greeting him on the horizon.
“It looked like someone had literally shaved the whole town, because everything was snapped off at the same height,” he recalls. A few of the region’s hospitals had been hit so hard they had to be closed when people needed them most.
Such are Glass’s first eye-witness accounts of damage done by Hurricane Andrew in 1992, the hurricane most synonymous with ruin in modern America before Katrina ravaged the Gulf Coast last August. Two days after Andrew wiped out more than 25,000 houses and caused $26.5 billion in damage, rumors spread about large-scale fatalities.
As Glass interviewed storm survivors and medical workers to see how they had reacted and how emergency plans held up, a clearer picture began to emerge: Andrew took 61 lives in all. Tens of thousands remained in Homestead when the epicenter, so powerful that it destroyed wind-measuring instruments across the region, swept through, yet the death toll was substantially less than that from plane crashes in the preceding weeks.
As Glass interviewed storm survivors and medical workers to see how they had reacted and how emergency plans held up, a clearer picture began to emerge: Andrew took 61 lives in all. Tens of thousands remained in Homestead when the epicenter, so powerful that it destroyed wind-measuring instruments across the region, swept through, yet the death toll was substantially less than that from plane crashes in the preceding weeks.
“As demonstrated by community reactions to the terrorist attacks in New York and Washington, the power of the public to respond effectively to disasters should not be underestimated,” he wrote in “Bioterrorism and the People: How to Vaccinate a City against Panic,” an article for the Infectious Diseases Society of America.
As an epidemiologist, Glass studies how catastrophes—including natural disasters, human attacks and, as his title suggests, diseases—affect populations. The Denison sociology/anthropology major is especially interested in how the “rules that govern ordinary behavior are suspended and new rules emerge” in a catastrophic situation.
Glass became involved in disaster response research in the early ’90s after earning his doctorate in medical sociology from Duke University. His first job in the field was at the Texas A&M University Hazard Reduction and Recovery Center, where he studied survival factors from nine disasters in the U.S. and one in Mexico. Although not all of his peers agree with him, years of fieldwork and research have convinced Glass that we tend to devalue the importance of the people most affected by disasters as a response factor.
Ideally, he would like to see his findings incorporated into emergency response programs, and he and his colleagues have been getting more attention since September 11 and Katrina; Homeland Security Secretary Michael Chertoff announced in December that Johns Hopkins will receive $15 million in funding for an emergency response center. That’s a good thing, because Glass believes there is much work to be done.
While he feels it’s impossible to completely prepare for unforeseen disasters, Glass does believe preparation, in a variety of forms, is important. Taking into account medical staffers’ personal lives, for example, is a tactic he feels would help. Since many nurses are single parents, setting up a network to care for their children would increase the number who show up to work in the critical period immediately after a disaster and allow them to better focus on the task at hand. “Instead of planning for what people should do, we should plan for what people do do,” he says. Emergency drills are important as well; even though they do not duplicate actual disaster responses, Glass finds them valuable because they help teach responders how to improvise.
Whenever research grants allow, he travels to disaster areas within 30 days of the event, when survivor and responder recollections are freshest. Gathering information in these situations is an arduous task; record-keeping goes out the window, he says, as responders have more pressing concerns, and he must battle the media for access. Still, he finds that people typically want to tell their stories, even if their memories are put on standby as all mental aspects go to survival. He has to carefully structure his questions to get an idea of panic levels and the effectiveness of response efforts. His experience tells that the most accurate accounts come from those on the front lines; he has had particularly good luck with emergency room nurses. Authorities, on the other hand, generally report what was supposed to happen.
This work has helped Glass and his colleagues identify five guidelines that they believe should be followed in disasters: treat the public as a capable ally; enlist civic organizations in health activities; anticipate the need for medical care away from hospitals; invest in public communication strategies; and ensure that planning reflects the values of affected populations.
He points out that these guidelines were not met in the aftermath of Katrina, particularly in New Orleans. It was the slow response and bad communication to help poor minorities that caused civil unrest, not the hurricane itself, he says. This inadequacy led to what he calls a “dissensus” crisis—one in which people participate in unlawful behavior because they feel wronged. On the other end of the spectrum lies the more cooperative behavior of a “consensus” crisis—a prominent example being the public’s willingness to participate in search and rescue operations after the World Trade Center towers were toppled.
“It’s the social and cultural context around an event that determines whether behavior is going to be prosocial or violent,” he says. After government help failed to reach Katrina victims for days, it was primarily a sense of isolation that created a dissensus crisis. “That in-the-same-boat feeling that promotes cooperation and resourcefulness was replaced by a feeling that one group had been abandoned and was left to fend for itself,” he wrote in an article for The Baltimore Sun.
“People want to say this shows the real human nature,” the philosophy minor says, referencing the “nasty, brutish and short” depiction that Thomas Hobbes applied to life in the natural condition. “Yet people don’t say that 9/11 proves [Jean-Jacques] Rousseau right” in claiming that man is inherently good, Glass points out.
The horrors of Katrina seem to reinforce the importance of working with the public as well as Glass’ survival circuit theory. Louisiana authorities reported having 25,000 body bags on hand in her wake, yet as of February, the official death toll stood at slightly more than 1,400.
What we should take from Katrina, Glass says, is that “poverty is a national security threat,” as poor social conditions are more likely to lead to a dissensus crisis. “That, to me, is the real lesson of Katrina,” he says. “We need to develop and practice workable disaster plans to provide early evacuation and swift assistance to the poorest of our fellow citizens,” he wrote for the Sun. “If we fail, the extreme and widening gaps in our society between the haves and the have-nots are sure to present a clear and present danger to the national security our president has vowed to defend.”
As horrible as she was, Katrina was not the “big one” that Glass often contemplates. Much of his interest in epidemiology comes from “the good possibility that in my lifetime there will be some massive disaster event [in America] where large numbers will die,” he says, meaning tens of thousands or more. It likely will not come in the form of a natural disaster because a number of public safety measures in the U.S., like building codes, limit casualties relative to similar situations in undeveloped nations. And while he is concerned about terrorism, that is not his largest worry either. Rather, he mostly fears a pandemic flu. After spending some time studying bioterrorism, he has recently focused on infectious diseases. “We know that these pandemics occur in cycles, and we know we’re overdue,” he says, adding that a sense of urgency now exists at Hopkins to help control an outbreak. Pandemic flu typically surfaces about every 30 years or so, with the latest coming in 1968, when the “Hong Kong flu” killed 34,000 Americans. That death toll pales in comparison to the 1918 “Spanish flu,” which claimed more than half a million American lives and between 20 and 100 million worldwide.
The next pandemic could be the much-publicized H5N1 strain of bird flu, or it could be another flu form that spontaneously mutates, which would pose an even larger threat. While scientists are working to develop vaccines and medicines to combat known strains, “we can’t invent a vaccine for something that doesn’t exist yet,” Glass says. We may not be able to control something unforeseen, but our reaction to it will determine how widespread it will be, and Glass feels we are inadequately prepared. Doctors believe we will only have a three- to five-day window to react to an outbreak, regardless of its location, because of today’s global society. And despite the attention Katrina placed on public health services, Glass notes, they remain under-funded.
He also finds fault with the government’s pandemic plan, which calls for quarantine. “Unless you’re willing to permit Draconian measures to prevent people from escaping, quarantine doesn’t work,” he says. Some of the healthier people will invariably escape, and ironically, they’re the ones who pose the greatest risk. Since viral illnesses can have a several-day-long incubation period when they’re most contagious, we often get sick from people with no symptoms.
The picture Glass paints based on past occurrences is not at all pleasant. When a pandemic strikes, he says, about half of the hospital staff will be sick themselves, and up to half of the healthy staff will not show up. The hospitals will be filled to capacity, with people infecting each other at the very places they go to receive treatment—places that are also less capable of housing the sick than in the past. Mergers, downsizing, workforce shortages, and the shift toward outpatient services have significantly reduced the number of hospital beds, especially within the last decade.
“If there’s a massive outbreak, having everybody rush to the hospital is the worst thing you can do,” he says. “We need to think beyond the hospital.” Developing a sheltering approach—getting people to stay home and providing them with information there—will be key, he says. Every family should also have an infection control kit, containing goods such as face masks and latex gloves.
Even with all the problems, Glass says that discussions about public health services’ failings is at least a step in the right direction. Public health funding was cut in the ’90s, and he feels it was dealt a further blow when the Federal Emergency Management Agency was merged into the Department of Homeland Security, shifting its focus to attacks. “The crippled public health infrastructure is amazing in an industrial society that spends so much money on health,” he says.
If the “next big one” hits before America develops better disaster response planning, it would likely put Glass’ survival circuit theory to the ultimate test. Would people remain “amazingly good at getting out of harm’s way,” even under the most dire of situations, or would real life follow the story line of a Hollywood blockbuster? Glass hopes our renewed interest in the subject means we will never find out.
Having obtained a master’s in journalism last year at the Northwestern University Medill School of Journalism, Stephen Nery is now a newspaper reporter in Easton, Md. He wrote about squash pro Conor O’Malley ’02 in the Spring 2005 issue of this magazine.