This article first appeared in the St. Louis Beacon, Oct. 22, 2013: After only a week on the job, new SLU College of Public Health faculty member Alexander Garza was already the local go-to guy on the subject of chemical weapons.
The former Homeland Security official and St. Louis native landed here in August just as news broke about Syria’s chemical weapons attack. Garza’s unpacked boxes waited as he visited TV newsrooms to shed light on the assault against Syrian residents and the prospect of a similar strike in the U.S.
Two months later, as Garza settles in as SLU’s associate dean for public health practice and associate professor of epidemiology, he’s also figuring out how to assist St. Louis-area disaster planners.
“Whether it’s being involved in planning exercises or something else, the first step is getting to know people and seeing how the pieces fit together,” Garza said. “I tentatively plan to do that before the end of the semester.”
Not a disaster ‘until somebody gets sick’
While completing his undergraduate degree at the University of Missouri-Kansas City, Garza also earned his paramedic certification. Working as a paramedic in his early 20s, he gained on-the-ground emergency experience before attending medical school at Mizzou.
After medical school at Mizzou, his next stop was a residency at UM-Kansas City at Truman Medical Center, where he was chief resident and clinical instructor. Later, he completed his master’s in public health at SLU.
Eventually as assistant secretary for health affairs and chief medical officer for the Department of Homeland Security from 2009 to 2013, Garza honed his skills as a specialist in numerous areas: emergency and disaster medicine, and terrorism involving chemical, biological, radiological, nuclear and explosive weapons.
While terrorists could certainly strike in Missouri, natural disaster is perhaps a more likely scenario.
“Here in Missouri, we sit on a major fault line and we have a lot of of weather-related disasters like the tornado in Joplin so it’s not really a low-risk area. We have a lot of potential for bad things happening,” Garza said.
Regardless of their cause, all disasters are medical emergencies. "It’s not really a disaster until somebody gets sick,” is a message Garza stresses.
Often, the most pressing medical issues stem from the loss of electricity. Without refrigeration, life-sustaining medicines go bad and critical home medical equipment becomes useless. Even hospital generators can fail as they did during Hurricane Katrina, Garza pointed out.
Without power to heat and cool our homes, weather extremes can be killers by themselves. A loss of clean water supply multiplies the catastrophe. Even if someone can get to the store for water, food and medicines, the pickings can be slim.
“We live in a just-in-time society. Stores don’t usually have their warehouse in back to replenish their shelves,” Garza said. “And if there’s no way to transport things in and out of a city, you’re going to quickly run out of essentials.”
Whatever impact Garza may eventually have on our regional disaster preparation, survival often boils down to families and individuals. Waiting to be rescued isn’t a plan. Creating an emergency kit and and understanding how to take care of your own basic needs for several days is the best way to be safe.
“It’s been preached over and over again but you need to be prepared to take care of yourself for 72 hours,” Garza said.
Popular culture can help drive the point home, Garza said. A Centers for Disease Control campaign using a zombie apocalypse theme has been well-received in some areas. It includes a blog, an educational website, posters and a graphic novella.
"It plays very well with the television series 'The Walking Dead,'" Garza said. "It's getting people to think, 'Maybe I should do something.'"
Emergency training for medical personnel?
Among the biggest public-health threats facing the world today, according to Garza, are two viruses: H7N9 avian influenza, which killed 44 people in China in 2013, and Middle East Respiratory Syndrome (MERS) first reported last year and listed as the cause of death for 139 people.
Rooting for home team
When Alexander Garza answered his phone for our interview, it was with a serious “Hello.” But the somber tone wasn’t connected to the weight of his new job. It was about whether he could get World Series tickets.
“Can I call you right back?” Garza asked, two days before the Cardinals won the National League pennant.
Garza, who grew up in Maryland Heights and graduated in 1985 from St. Thomas Aquinas High School, spent his childhood cheering for the Cardinals amid shouts of "Popcorn! Peanuts!" But dinner-table conversation with his parents and five brothers centered not only on baseball but medical drama. His mother was an emergency room nurse at Des Peres Hospital.
Garza is thrilled to be back in St. Louis with his wife Melissa and three sons, 7, 10 and 12, who are now growing up with a host of cousins, uncles and a grandmother. Garza coaches their baseball teams and cheers at their swim meets.
But rooting for the Cardinals was on Garza’s mind last Wednesday. When he called backed, he was happy to report he’s all set with tickets for Sunday night’s game.
“They’re in the nosebleed section but you know, you get what you can,” Garza said. “I’m hoping it’s going to be the day they win the World Series; I want to be there for that.”
The National Institutes of Health has begun testing a vaccine for H7N9. But no potential vaccine yet exists for MERS, which is not easy to transmit but has a high mortality rate. The fatality numbers may not sound alarming at this point, and neither virus has yet ventured far from its place or origin, but each has the potential for becoming a pandemic, Garza said.
“Viruses are very adaptable and mutate very quickly,” he noted.
The value of nurses is obvious in emergencies involving pandemics, but health professionals are key in every kind of disaster. Nevertheless, emergency response training is not required in nursing education, according to the SLU School of Nursing. Exploring the addition of disaster preparedness to SLU programs is a worthwhile goal, in Garza’s opinion.
“I definitely think it’s worth a discussion with the school of medicine and nursing and school of allied health,” Garza said. “It doesn't have to be extensive, but I think at least some exposure to these skills is important.”
In 2002, a small team of SLU nursing and public-health educators trained for two weeks at Henrietta Szold Hadassah-Hebrew University School of Nursing in Jerusalem. This is a city where emergency readiness is an integral part of the culture.
Garza, who spent time in Israel studying its disaster preparedness three years ago, doesn’t know if more SLU faculty will have a chance to learn from the Israelis. But he applauds the idea, saying it’s definitely “worthwhile to see what other countries like Israel do.”
“They have a different outlook. Part of the building code is to have a safe room in every dwelling to survive an attack from rockets. They distribute gas masks to their population,” Garza said.
With Garza bringing his vast knowledge in disaster preparedness to the St. Louis area, can we expect our region to become a safer one?
“That’s a pretty heavy responsibility,” Garza said. “But I would like to think I can bring some of the experience and perspective I had at the federal level and help the city and the region be prepared.”
