6.2 Support the Affected Community Through Recovery Support Functions

Establishing how the recovery effort will be organized, including who and what organizational structure will be used to lead it and which players will be involved, is critical to community recovery from a biological incident. The recovery phase may involve agencies and organizations that did not play a major role in the response phase, such as mental health services, small business associations, planning commissions, etc., as well as additional voluntary and private organizations may not have participated in response efforts. Recovery after a biological incident may involve ongoing healthcare worker burnout and attrition issues, long-term health effects among the affected population, challenges related to childcare centers and schools reopening, ongoing economic losses for families whose primary income earner passed away or became unable to work, persistent business and facility closures, continuing supply chain logistics interruptions, movement of hazardous waste containing infectious substances, and, following a large event, potentially major reorganizations of entire sectors.

RSFs aid SLTT governments by facilitating problem solving, improving access to resources, and fostering coordination among multiple agencies and stakeholder organizations. During planning, RSFs can be used to organize recovery considerations into six key areas as detailed in the National Disaster Recovery Framework (NDRF). Following a biological incident, some RSFs (i.e., health and social services, economic recovery, infrastructure systems) are more likely to be affected than others (i.e., housing, community planning and capacity building, natural and cultural resources). It will be critical to determine which RSFs have been impacted by a biological incident and where vulnerabilities lie within an affected community. Depending on the specific characteristics of the biological agent, such as contagious nature or wide-area impact of the incident, some services provided to affected populations during response and early recovery may need to be continued long-term (e.g., health monitoring, economic support, safe and affordable, housing, etc.)

Table 4: Recovery Objectives by Recovery Support Function

Recovery Support Function (RSF)	Recovery Outcome
Health and Social Services	Sustainable and resilient health, education, and social services systems
Economic	Sustainable, diversified, and resilient economy
Infrastructure Systems	Restored, modernized, hardened and resilient systems
Housing	Adequate, resilient, and affordable housing
Community Planning and Capacity Building (CPCB)	Resilient recovery of SLTT communities
Natural and Cultural Resources (NCR)	Restored, preserved, risk-resistant and resilient systems

6.2.1 Health and Social Services Recovery

A community recovering from a biological incident may face long-term public health and healthcare challenges. Recovery may include providing long-term care for individuals with medical complications or chronic conditions caused by the biological agent and associated incident. Certain impacted populations and responders (e.g., law enforcement, EMS, hospital staff) may require long-term health monitoring and/or continued exposure to the biological agent while performing their professional duties. Health workers may experience exhaustion and burnout, contributing to attrition of the local public health and hospital workforce. Public trust of health authorities and medical professionals may be compromised following a biological incident, potentially creating a contentious situation influencing public cooperation during future public health emergencies.

A biological incident may expose existing weaknesses in local public health and healthcare systems. Recovery presents a unique opportunity to strengthen healthcare resilience of the affected community as it rebuilds moving forward. Resilient health systems adapt to disruption and withstand challenging events, while continuing to provide quality care for patients.⁹¹ To increase local resilience, after-action planning, coordination, and capacity-building between public health, hospitals, EMS, outpatient clinics, long-term care facilities, clinical laboratories, medical suppliers, schools, childcare centers, and others must be improved. Working relationships built across sectors during the biological incident response may need to be formalized or established on a more permanent basis long term. Community decision makers should use trends observed and lessons learned during a biological incident in their area to inform strategic plans to fortify local healthcare resilience into the future.

To attain recovery outcomes, health systems must address the physical health needs of affected populations, as well as a wide range of potential psychological, emotional, and behavioral health needs associated with the incident. Additional issues may develop long after the initial response phase of the incident is complete.⁹² As recovery evolves, vulnerable populations like children and English-language learners may require continued social support to recover from incident stressors such as time spent away from school, falling behind in coursework, and lack of socialization with peers. Existing health issues such as struggles with mental health or substance use disorders in the community may be exacerbated following a biological incident and its effects. Long-term behavioral health assistance may include psychological support and crisis counseling, providing information and educational resources, conducting assessments, and referring patients for treatment of behavioral health or substance use disorders.

Emerging infectious diseases may present new and unfamiliar challenges to a population experiencing a biological incident. As new MCMs (e.g., vaccines, therapeutic medications) are developed, researched, and approved for novel pathogens, different segments of the population may be eligible to receive them at different times. Health authorities and trusted medical professionals must communicate the safety and efficacy of new treatments to the affected community in a timely, easy to comprehend, and transparent manner. Public and animal health organizations will also need to monitor long-term impacts of a biological incident on local animal populations (household pets, livestock, and wildlife), especially if the biological agent is zoonotic (i.e., a pathogen that jumped from animals to infect humans).

6.2.2 Economic Recovery

A biological incident has the potential to greatly harm local, regional, national, and international economies. Economic recovery after a biological incident is characterized by the successful return of economic and business activities within a sustainable, diversified, and resilient economy. Pre-disaster recovery planning specific to biological incident impacts can dramatically reduce the time needed to meet economic recovery challenges by thoroughly engaging economic recovery stakeholders and their networks and leveraging existing resources. After an incident, the economic recovery needs of local businesses, individuals, nonprofits, and governments tend to shift as time progresses.

Immediate and downstream economic effects may be inadvertently created when compliance with public health orders leads to modified operating procedures and business closures. Employers may be forced to temporarily close or permanently relocate due to labor shortages/workforce attrition, supply chain disruptions, lack of customers, longer-term environmental concerns, etc. These economic impacts also affect the community with a loss of income or savings. Ultimately, communities may need support for economic revitalization in the aftermath of a biological incident.

Planners must collaborate with the public sector, nonprofits, chambers of commerce, workforce development organizations, local governments, regional planning organizations, and private organizations to assist with economic revitalization increasing employment opportunities, remediating deficiencies effectively, managing supply chains more efficiently, and rebuilding public trust. Economic impacts may stem from business closures, job loss, supply chain disruptions, etc. and may also stem from public fear. In 2016, for example, the fear of contracting Zika virus disease in Florida had economic impacts on the tourism industry.

To achieve economic recovery outcomes, planners must consider the varying economic impacts biological incidents will have in their jurisdiction. Biological incidents involving a contagious agent will necessitate response measures (i.e., quarantines and movement controls that are highly effective at limiting disease spread) that may also disrupt typical business operations and create subsequent long-term recovery challenges. However, biological incidents with a discrete location – whether they are intentional, accidental, or naturally occurring – may necessitate similar response measures without leading to the same associated long-term, widespread economic recovery impacts. Planners should consider how the varying public health orders that may be implemented during response will impact recovery. Furthermore, planners can increase the adaptability of their jurisdiction’s plans by accounting for varying mitigation measures to facilitate rapid recovery.

6.2.3 Infrastructure Systems Recovery

A biological incident will impact infrastructure systems differently than other types of disasters. Long-term impacts for the operation of critical services and infrastructure during recovery may be ongoing due to long-term community NPIs, personnel illness/workforce attrition, reduced capacity, facility contamination, and/or long-term supply chain impacts.

While resource owners play the primary role in including resilience activities and identifying the greatest vulnerabilities in terms of their systems and the people and businesses they serve, achieving recovery outcomes for the whole community depends on fully operational critical infrastructure systems and the supporting workforce. Long-term shortages of critical infrastructure operators due to illness or exposure in the context of extended outbreaks or pandemics and other workforce attrition issues may prevent systems from being fully functional and may lead to disruptions in continuity of critical services, supply chain logistics, essential personnel movement, and facility safety and security. To facilitate recovery from a biological incident, planners should anticipate and identify approaches to mitigate workforce shortages and attrition due to worker illness, unavailability of childcare, need to care for someone sick within their household, etc. In addition, planners must account for prioritization of MCM dispensing and administration to essential workers in critical infrastructure sectors such as transportation, energy, and communications, among various others.

While recovery from most biological incidents will not require decontamination of a physical space, some biological agents will require immediate containment, establishment of clearance goals, and cleanup initiated during response in coordination with public health officials (as discussed in KPF 3: Control the Spread of Disease) to achieve recovery outcomes. Incidents with a discrete location may require long-term barriers or remediation activities (e.g., anthrax release in a train station). The goal of these activities is to eliminate or reduce contamination of the population, environment, and critical infrastructure to facilitate rapid recovery. The sustained health effects associated with contaminated water systems will require a coordinated public messaging focus well into the recovery phase (see KPF 2: Communicate with External Partners and the Public) with status updates on how the incident is being addressed and any protective actions in effect (e.g., when boil water orders are no longer necessary). The type of biological agent involved can also have an impact on recovery-focused activities such as hazardous waste transport, processing, and disposal. Infectious substances are regulated by the U.S. Department of Transportation’s Hazardous Materials Regulations (HMR) and generally fall into three groups: Category A (in a form causing permanent disability or life-threatening or fatal disease), Category B (not in a form generally capable of causing permanent disability or life-threatening or fatal disease), and Regulated Medical Waste.⁹⁴ As examples, Ebola-contaminated waste was classified as Category A,⁹⁵ while COVID-19 contaminated waste was classified as Category B, ⁹⁶ which resulted in differing requirements for transporting waste based on the pathogen. All HMR requirements must be met when infectious substances are transported by air, highway, rail, or water. Infectious Substance Special Permits may be required when shippers are unable to comply with HMR. Ebola waste, identified as Category A above, was unable to cross state lines without issuance of these special permits.⁹⁷ Management of large quantities of hazardous waste may prove challenging and further drain resources through recovery.

6.2.4 Additional Recovery Support Function Considerations

While Economic, Infrastructure Systems, and Health and Social Services RSFs potentially will be most affected by a biological incident, Housing, Community Planning and Capacity Building (CPCB), and Natural and Cultural Resources (NCR) RSFs must not be forgotten.

The Housing RSF and housing-related recovery outcomes help ensure adequate, resilient, and affordable housing is accessible to those whose housing situation was impacted by the biological incident. Housing recovery outcomes should be based on principles that are in line with and linked to existing long-term community recovery plans and processes. Large-scale biological incidents involving a contagious agent have the highest potential to require long-term housing support to reduce transmission, mitigate impacts, and facilitate a more rapid recovery. Collaboration with public and private organizations that have experience with temporary housing, permanent housing financing, economic development, and advocacy for underserved populations should be engaged early in the planning process.

Regarding CPCB, the achievement of recovery outcomes means a resilient recovery of SLTT communities. Engagement of communities in preparedness and recovery planning leads to a more rapid recovery with buy-in for important decisions that impact the whole community. One way to increase engagement and decrease biological incident impacts is through education. Planners may develop a community education program, including concepts such as HHS CDC’s One Health and global health security (prevent, detect, and respond to intentional, naturally occurring, or accidental incidents), to increase public understanding of biological incidents and their effects on the community.

Achieving recovery outcomes for the NCR RSF equates to restored, preserved, risk-resistant and resilient systems. Planners should focus on the community’s natural and cultural resources and historic properties that could be impacted during a biological incident to include preparedness and mitigation strategies that are inclusive, sustainable, and resilient. Certain biological incidents may require environmental remediation activities such as water system decontamination or wildlife disease mitigation. Wildlife disease control measures will require specific natural and cultural resource considerations for environmental recovery, conservation, and historic preservation.

When planning recovery actions, planners should consider how local and regional culture will impact community engagement. Planning activities should also factor in existing inequities and disproportionate impacts on vulnerable populations and traditionally underserved elements within local communities. A large-scale biological incident will have a heavy burden on those living in multi-generational or public housing, lacking access to medical or behavioral health treatment, working in positions that must report in person without the option to telework, or depending on public transportation for mobility. Planners must account for underlying factors such as poverty and language barriers throughout community recovery efforts. Vulnerable populations should be considered and supported during every stage of response and recovery activities.