Since its inception following the events of September 11, 2001, the US Centers for Disease Control and Prevention (CDC) Division of State and Local Readiness (DSLR) has supported the development and sustainability of response-ready state, tribal, local, and territorial (STLT) public health departments through the Public Health Emergency Preparedness (PHEP) program.1,2 The program's cooperative agreements provide guidance, funding, field staff, technical assistance, and resources to 62 response-ready public health departments across the nation. The program is grounded in the 15 public health emergency preparedness and response capabilities, outlined in Public Health Emergency Preparedness and Response Capabilities: National Standards for State, Local Tribal, and Territorial Public Health,3 which serve as national standards for public health readiness and provide a blueprint that guides the development of STLT preparedness programs nationwide. | | Recipients of the cooperative agreements have credited these preparedness and response capabilities and the dedicated PHEP program funding with creating a strong foundation that readies jurisdictions for all types of public health emergencies, from localized events, such as small-scale disease outbreaks, weather-related events, and environmental hazards, to large-scale catastrophic events such as global pandemics.4 The scale, scope, and complexity of the COVID-19 pandemic challenged even the most prepared jurisdictions.

This article summarizes what is currently known about the 2019 novel coronavirus and offers interim guidance.

In spring 2011, the Centers for Disease Control and Prevention (CDC) released Public Health Preparedness Capabilities: National Standards for State and Local Planning. The capability standards provide a framework that supports state, local, tribal, and territorial public health agency preparedness planning and response to public health threats and emergencies. In 2017, a project team at the CDC Division of State and Local Readiness incorporated input from subject matter experts, national partners, and stakeholders to update the 2011 capability standards. As a result, CDC released the updated capability standards in October 2018, which were amended in January 2019. The original structure of the 15 capability standards remained unchanged, but updates were made to capability functions, tasks, and resource elements to reflect advances in public health emergency preparedness and response practices since 2011. When the number of functions and tasks in the 2018 capability standards were compared to those in the 2011 capabilities, only 20% (3/15) of the capabilities had a decrease in function number. The majority of changes were at the task level (task numbers changed in 80%, or 12/15, capabilities) in the 2018 version. The capability standards provide public health agencies with a practical framework, informed by updated science and tools, which can guide prioritization of limited resources to strengthen public health agency emergency preparedness and response capacities.

Although there are a number of definitions of “community preparedness,” we conceptualize it as the ability of communities to prepare for, withstand, and recover from natural or human-made disasters.1 Community preparedness has no bounds; a crisis, whether contained at the local level or as far reaching as a pandemic, will affect diverse community populations. Preparedness planning must account for and use the multitude of complex organizational and socioeconomic components that contribute to building community resilience following a large-scale tragedy. This supplement samples the broad-ranging topics that comprise the body of scientific and programmatic information available on the subject.

Communities are societal extensions of family. Since early times, humans banded together for mutual aid, companionship, and protection from threats.1 Communities were forged by people living in the same geographic area with shared attitudes, interests, and goals for cultures, religions, and occupations.1 However, social scientists expressed concerns during the Industrial Revolution about changes observed in the human experience as populations retreated from rural areas and close-knit family units in favor of big cities and life among strangers.1 | | Sometime in the latter part of the 20th century, the way people interacted began to shift dramatically.2 In the United States, a decline in marriage and birthrates changed family dynamics and increased the number of adults living alone.2 In 2018, there were 35.7 million single-person households, composing 28% of all United States households—a significant increase from 13% in 1960.3 Social isolation is becoming more acute, with less community engagement as people rely on advances in technology to feel connected.2

What makes a community ready to respond to the ever-expanding number and complexity of human-caused and natural disasters posing public health risks? Community preparedness is complex and involves multiple stakeholders and crosscutting sectors such as state and local governments; public health departments and agencies; law enforcement, fire, and rescue organizations; social service and faith-based organizations; and ordinary citizens from varied communities. How does community preparedness work? Community preparedness works when organizational and individual-level stakeholders collaborate.

On March 20, 1995, Sarin gas was released during morning rush hour in the Tokyo, Japan, subway system, killing 13 individuals and causing illness among thousands.1 The event received significant media coverage and signaled a call for action among officials in charge of national security. As a component of preparedness efforts against acts of bioterrorism, then President Clinton launched the first national biological weapons defense initiative, and in 1999, Congress appropriated $50 million dollars for the Department of Health and Humans Services, Centers for Disease Control and Prevention (CDC) to mobilize the public health system for protection against harmful biological agents.2 Ensuring safety of the public’s health led to the development of the National Pharmaceutical Stockpile, a repository of pharmaceuticals and medical supplies available for rapid deployment, and provision of direct support to local, state, and territorial health departments in the event of a large-scale public health emergency.3

Medical countermeasures (MCMs) are critical for minimizing morbidity and mortality in the event of a large-scale public health emergency. MCMs involve a broad spectrum of medical assets, including biological products and personal protective equipment. Whether the emergency results from a chemical, biological, radiological, or natural disaster or from widespread infectious disease and contagions, a well-prepared public health community will readily access and deploy lifesaving MCMs. Ensuring appropriate distribution and dispensing of MCMs can be logistically complex, but coordinated planning between local, state, and federal agencies facilitates an efficient public health response.

Imagine this fictional scenario: an airline passenger returning to the United States after working in a foreign country suddenly develops chills, headache, muscle pains, and a high fever in flight. Seeking immediate medical attention after landing, the index patient discovers she has a novel strain of influenza. Meanwhile, the virus is transmitted in flight by the recirculated air on-board, exposure to coughing, touching contaminated bathroom door knobs, and at least 180 other passengers. The disease continues to spread as the other infected passengers encounter more people after disembarking.

The events of September 11, 2001, forever altered how disaster preparedness was perceived and understood in the United States.1 Rapidly evolving technology, increasing globalization, social and economic crises, and the natural evolution of infectious diseases increased the complexity of public health preparedness and emergency response.2 In 2011, the Centers for Disease Control and Prevention (CDC) published the Public Health Capabilities: National Standards for State and Local Planning3 as the foundation for successful public health preparedness programs. The articles in this volume of AJPH provide detailed accounts of preparedness in action, showcasing competencies in 15 capabilities that are summarized across six domains: biosurveillance, incident management, community resilience, information management, countermeasures and mitigation, and surge management.

Whether natural, accidental, or intentional, public health threats are ever present and can lead to national emergencies. Before our current understanding of catastrophic events, and as early as 1930, AJPH published an article on predisaster preparedness (http://bit.ly/2tDkhTO) highlighting many points that are still relevant today. Even then, the authors recognized that disasters were “no longer minor or chance occurrences but each year they are more widespread, more devastating and more demanding of harmonious assistance”—a sentiment that still resonates. Furthermore, the authors professed a need for dedicated funds for staffing, equipment, and resources that are necessary to advance predisaster emergency work. | Our current frame of reference is shaped by the events of September 11, 2001. In response to the terrorist attack, the US Congress set up appropriations to support state, local, tribal, and territorial public health departments nationwide; these funds are administered through a cooperative agreement from the Centers for Disease Control and Prevention (CDC) to fortify national security. The Public Health Emergency Preparedness (PHEP) cooperative agreement helps health departments strengthen their abilities to effectively respond to a range of public health threats, including infectious diseases; natural disasters; and biological, chemical, nuclear, and radiological events.

In response to the 2014-2016 Ebola virus disease (Ebola) epidemic in West Africa, CDC prepared for the potential introduction of Ebola into the United States. The immediate goals were to rapidly identify and isolate any cases of Ebola, prevent transmission, and promote timely treatment of affected patients. CDC's technical expertise and the collaboration of multiple partners in state, local, and municipal public health departments; health care facilities; emergency medical services; and U.S. government agencies were essential to the domestic preparedness and response to the Ebola epidemic and relied on longstanding partnerships. CDC established a comprehensive response that included two new strategies: 1) active monitoring of travelers arriving from countries affected by Ebola and other persons at risk for Ebola and 2) a tiered system of hospital facility preparedness that enabled prioritization of training. CDC rapidly deployed a diagnostic assay for Ebola virus (EBOV) to public health laboratories. Guidance was developed to assist in evaluation of patients possibly infected with EBOV, for appropriate infection control, to support emergency responders, and for handling of infectious waste. CDC rapid response teams were formed to provide assistance within 24 hours to a health care facility managing a patient with Ebola. As a result of the collaborations to rapidly identify, isolate, and manage Ebola patients and the extensive preparations to prevent spread of EBOV, the United States is now better prepared to address the next global infectious disease threat.The activities summarized in this report would not have been possible without collaboration with many U.S. and international partners (http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/partners.html).

By December 31, 2014, the Ebola epidemic in West Africa had resulted in treatment of 10 Ebola case-patients in the United States; a maximum of 4 patients received treatment at any one time (1). Four of these 10 persons became clinically ill in the United States (2 infected outside the United States and 2 infected in the United States), and 6 were clinically ill persons medically evacuated from West Africa (Technical Appendix 1 Table 6). | To plan for possible future cases in the United States, policy makers requested we produce a tool to estimate future numbers of Ebola case-patients needing treatment at any one time in the United States. Gomes et al. previously estimated the potential size of outbreaks in the United States and other countries for 2 different dates in September 2014 (2). Another study considered the overall risk for exportation of Ebola from West Africa but did not estimate the number of potential cases in the United States at any one time (3).

The U.S. Department of Health and Human Services (HHS), CDC, other U.S. government agencies, the World Health Organization (WHO), and international partners are taking multiple steps to respond to the current Ebola virus disease (Ebola) outbreak in West Africa to reduce its toll there and to reduce the chances of international spread. At the same time, CDC and HHS are working to ensure that persons who have a risk factor for exposure to Ebola and who develop symptoms while in the United States are rapidly identified and isolated, and safely receive treatment. HHS and CDC have actively worked with state and local public health authorities and other partners to accelerate health care preparedness to care for persons under investigation (PUI) for Ebola or with confirmed Ebola. This report describes some of these efforts and their impact.

The 2009 H1N1 influenza pandemic was the longest and most intense public health response since the improvements in public health preparedness were initiated in the years after the 2001 World Trade Center and anthrax attacks. In addition to this general preparedness and response work, more focused preparations for an influenza pandemic were begun in 2005 with additional resources and focus as the H5N1 virus emerged in Asia and policymakers recognized its potential to cause a catastrophic public health emergency. These preparations undoubtedly set the stage for the work undertaken to respond to the H1N1 pandemic.1 In looking back on the H1N1 pandemic, it is vital that we work to understand what elements of our preparation were most effective and how our response might have been improved, so that we can prepare and respond more effectively in the future. The research reported in this issue of the Journal by Chamberlain and colleagues is an important contribution to what we must learn from the experiences of the H1N1 pandemic.2 The work was conducted by 1 of 9 CDC-funded Preparedness and Emergency Response Research Centers; each pursues multidisciplinary public health systems research aimed at improving the nation's public health system preparedness and response capabilities. | With the aim of improving emergency immunization efforts, the Chamberlain et al article offers insights into the perspectives of immunization program managers on work done before and during the H1N1 immunization program. Although conditions differed in states, there are at least 3 general lessons. The first is that the routine, everyday public health systems are the foundation for public health responses. The second lesson is that an effective planning process must delineate how those everyday systems will be adapted to create a unified response system, where capabilities from multiple public health areas must work together. And third, an exercise and training program is necessary to assure that the people who will be staffing the response understand and have practiced their roles as envisioned in the response plan. We briefly review these 3 lessons and what the Chamberlain et al article teaches us about the collaboration between state preparedness directors and immunization program managers.