Angela Blanchard, president emerita of BakerRipley, is one of Houston’s leading experts on disasters. She has been a player in helping Houston recover from multiple disasters, and at Brown University now teaches graduate-level public-policy courses on Disaster and Displacement.

We asked her about the Houston area’s response to COVID-19, the novel coronavirus. Shortly after the Q&A originally published, the city of Houston issued a emergency health declaration.

Here's why she thinks that was the right thing to do.

What does the Houston area need most right now?

Put simply, we need health officials in our region to declare a public health emergency, and the sooner the better. Our region can’t escape this virus. As a population, we can’t flee it. It has already landed here, and it’s already silently spreading.

Right now I prefer to assume that I will get this virus, and that everyone else will, too. We are not an exception to the projected spread of an epidemic, and it can be useful to work on the assumption that the spread here will resemble the one in Italy. While we don’t have recent experience with pandemic scenarios, we can — up to a point — draw on our experience with hurricanes to prepare.

The difference is that while we don’t like a slow hurricane that parks over the Gulf, we should love a slower-spreading virus that gives our health system time to catch up, and allows us time to prepare. Right now, it’s time that we need more than anything.

In Houston, we’re accustomed to preparing for hurricanes and managing emergency response in times of natural disaster. I have worked long-term recovery after Allison, Katrina, Rita, Ike and Harvey, and I know the value of preparation and planning. We start recovery at the moment of declaration.

When Houston faces a hurricane, there’s a regional “hurricane playbook” that lets people know who’s coordinating the response. At the moment, we don’t have an epidemic playbook. What does that mean for our response to this kind of disaster?

During a natural disaster, we know the speed of a hurricane, and we’ve learned to move at the speed of wind and water in our decision-making.

But the big question we need to ask now is "How quickly and how widely can the COVID-19 virus spread?" For that insight, might we look at Italy. There, the virus moved quickly and silently, and much faster than their preparedness and containment decisions. Unlike a natural disaster, we can’t see the virus that has already made landfall in our region, but it’s here already, and we should be hunkering down. Those leaders who are already stepping forward to implement containment measures we will view in the coming months as having acted responsibly.

Our local city and county health departments are in charge of health emergency declarations, and it’s up to them to announce a health emergency. I don’t think we know what their criteria will be for this declaration, but we need to know. We need the guidance. We need the declaration now, and there’s a very simple reason for that.

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At the moment, leaders in every individual institution and entity are making their own assessments on their own. University presidents, CEOs and nonprofit directors, superintendents and hospital administrators are all trying to determine the responsibilities and risks associated with the virus. Should they hold the event? Should they cancel the event? Should they close enrollment, keep the center open, or close the school?

Alone with their boards, they are making calls impacting the health and pocketbooks of thousands of people. And they’re doing it without the guidance of the authorities. While we have great leaders, they don’t deserve to be saddled with these decisions alone. We need official guidance. At the least, we need an announced set of recommendations for the whole region regarding public gatherings, large group activities, schools, preparation and supplies, and so on, before the crisis escalates.

Why is it important for our region to plan for disasters — as opposed to the wider federal government, or on a smaller scale, such as individual counties, cities, schools and hospitals?

While the federal agencies — Centers for Disease Control, and Health and Human Services — have declared a public health emergency for the nation, our local officials remain in charge here. The City of Houston Health Department and Harris County Health Department each have the power and authority independently to declare a health emergency, and to issue recommendations and/or rules regarding the spread of a dangerous virus. As do the health departments of surrounding counties and cities. Their declaration can lead to other voluntary and mandatory measures being implemented and enforced. Put simply, we need them to provide a “lane of action” to guide other institutions.

We also need to establish a regional unified command structure that mimics the one we use for hurricanes. This is the structure we use to gather and distribute insight and resources from government, business, and nonprofits so that we act in concert. In any other disaster scenario, we implement these measures so that we are all using the same set of tracking data and weather information. We need that structure now — and data that tells us about the size and “windspeed” of this storm.

What is important for everyday Houstonians to understand?

We need officials to get us up to speed on terms like “R౦” or “R-naught,” that relate to how “spreadable” the virus is. And we need to understand the “bell curve” of disease contraction and recovery from the virus. We are fluent in hurricane data terms. Now we need a quick primer on virus spread terms, and a daily briefing on what these mean for us here.

So, here goes an amateur explanation:

R౦, pronounced R-naught. If you have the "ordinary flu" you may (and will likely) spread it to 1.3 other people. With COVID-19, you will likely spread it to two to three other people, and they will, too. The problem is, that although this seems like a very small difference, in practical terms with no containment, the rate of infection is vast. Imagine, for instance, that each virus is a slot machine. In the first machine, you get a double coin for every coin you put in. So you start with a nickel, you get a dime, and then you put the dime back in, and so on. Maybe you can imagine how much that turns out to be. That’s the flu.

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In the second machine, however, when you put in a nickel, you get a quarter, and then you put in a quarter, and get a dollar — over and over again. The “normal flu” is the first machine. COVID-19 is the second machine. “R౦,” then, is the measure of how well the virus machine pays off in terms of spread, and that’s a number we need to understand, just as well as we already understand hurricane paths and trajectories.

At the moment, the simple fact is that we don’t understand it. This virus is new to us. This is a new threat, and we don’t yet have the common language that we need to get all of our response agencies on the same page. This is why we need experts to step up to the mic daily, until we all understand the threat, and our role in slowing the progress of this virus. We don’t have to put quarters into the machines at all. If we know how, we can slow the roll of this storm.

What we do know, is that quarantines and containment slow the spread and eventually stop the contagion. Right now in China, after all the containment measures, one new case now means one case. There, one new diagnosis isn’t an indication of 400 more still undiscovered. This is the highly desirable result we all need to be working toward here.

If you assume that everyone will get the virus, why does slowing the spread matter?

You have to visualize two bell curves — one that looks like Mount Everest, and another one that looks like a Hill Country “peak.” Our health system capacity is the clouds above. If we have a curve that looks like Mount Everest, the peak reaches above the clouds and, at that point, beyond the capacity of the system to care for seriously ill people. This is the case already in Italy.

If the curve looks like a Hill Country peak, gradual slow rise and slower spread over time, then it doesn’t exceed the capacity of our systems, so we can better care for the people who are more seriously ill. If I’m going to contract the virus, with the severity that older people are more likely to experience, then I want to contract it when there is a bed in the hospital and a respirator available. For this, we need to stretch the spread out over time — remembering that the emergency ceases with the availability of the vaccine. Optimistically, we want to slow this sucker down, so that we can spread new and severe cases over the longest possible period, until we reach the vaccine development.

How do you expect the Houston area’s response to COVID-19 to be different from what we’ve seen from China?

Command and control methods are extremely effective in the acute phase of any emergency. Swift decision making, controlling the disaster arena, and enforcing rules and policies are all features of the acute urgent phase of containment. In the U.S., while we like the heroics of rescue and the drama of immediate action by uniformed responders, we largely rely on a voluntary spirit of compliance and cooperation for longer term efforts. This is the case even in the matter of “local control” over what happens in this COVID-19 scenario, which is a clearly global event.

Since declaration authority belongs to local health departments, it is fair to ask them about how they are making decisions right now. How can we have a nationally declared public health emergency (since January) in the country, but not have one in the fourth largest — and most globally-connected — city in the country?

U.S. citizens are individualistic in our thinking, and we often insist upon making our own decisions. In hurricanes we see people ignore mandatory evacuations. But, now we are seeing people here already doing voluntarily what China mandated. Until we have tests, and know what we are dealing with, taking every action we can take, matters.

Our individualists attitudes and tendency toward independent action will not serve us as well in an epidemic as they do in a hurricane. While we have a tendency in a hurricane to come together, we will need to keep our distance for an epidemic. If we are strong and able-bodied in a hurricane, we can pursue our own efforts to help our neighbors. No patience necessary. Will we have the generosity and grace to comply with a longterm quarantine? Will we take the right steps to protect vulnerable people if we ourselves are feeling fine and healthy? Will we suck up the financial hardships and setbacks in the interest of collective well-being? Fostering attitudes of “collective action” requires strong leadership. We need leaders that will err on the side of extreme protection, while constantly reminding and encouraging us to understand that collective well-being is the only well-being available to us.

The nightmare scenario is that Houston might struggle not just with an outbreak, but with one or more other disasters — say, a hurricane and a major water-main break — all at the same time. How much harder could that make things? How can we plan for that?

This worst-case scenario is what keeps me up at night. With our elaborately interconnected system of resources and supports, we are sitting atop a complex Rube Goldberg machine. When the ball bearing drops, that triggers the seesaw board which flips the marble into the cup which sets off the dominoes, and so on. In a disaster scenario, that machine is the scary structure of nightmares. In Houston, we remember 2001, with Tropical Storm Allison, followed by 9/11 and then the fall of Enron — and the dominoes that followed. Empty buildings, gutted pensions, and fear and dread of what would come next. We made it through. Now we have oil falling, stocks dropping, a virus spreading — and it’s global.

I worry about the hurricane that arrives just as we reach the peak of COVID-19 disease cases. Shelters are most needed by the most vulnerable people in a storm, and these are the very people we would least want to expose. Mass shelters don’t make sense in an epidemic. We must assume that we will have a storm, or a “flood event” and we will need a true Texas-sized version of “hunker down.” A full-blown staycation at home. Adequately supplied. So it’s time to whip out the hurricane list and prepare to get really close to the people we live with.

We live in a vulnerable region. Oil, water and viruses are a bad mix. But what does work in all scenarios is our shared understanding, our concern and generosity toward one another, and our willingness to face reality, together. We “prepare” for the unthinkable by building a united command structure, by bringing leaders together, and by providing information, not superficial reassurance. We need to deal transparently with our people. We need our leaders to step up and declare this a health emergency, provide direction and guidance so that we can all get on the same page, and together, slow this storm down.

What should individuals do to prepare?

Treat COVID-19 like a hurricane: Supply your homes with at least a one month supply of everything the members of your household use daily, including your pets. Make sure you prepare to help people in your family who aren’t able to prepare.

There are differences from your hurricane-prep list, though. Pay less attention to the water and power-related items, and more to first aid, prescriptions and food.

The biggest challenge will be spending 24 hours a day with your family members. After the hurricanes in Puerto Rico, people there told me of all the new wonderful traditions that were rebooted by the isolation after the storms had passed. This will be a long “after.” Make plans for family members to have spaces to work and play — together and apart. Don’t forget entertainment.

As the virus spreads, most hospitals will be filled with people who are seriously ill, and you must consider that our health system may have little capacity for other emergencies and ailments. Maintain your health. Don’t have an accident. Try not to fall off a ladder. Use common sense, and weather the storm.