The importance of recovery, the disaster phase we ignore

In 2014, a hospital in Dallas admitted a single patient with Ebola. The consequences rippled far beyond that patient’s care. Infectious waste piled up, taking nearly two weeks to haul off. Fear spread through the community, and the hospital was branded as “the Ebola hospital.” Revenue dropped by more than $20 million in just two months, and staff faced stigma.  

That episode is one that biosecurity and infectious disease expert Terri Rebmann points to in her new book chapter on how communities recover from biological disasters. Rebmann, divisional dean of the George Mason University School of Nursing, co-authored the chapter with Rachel L. Charney of DSG Global for the new book Viral Outbreaks, Bioterrorism and Preparing for Mass Casualty Infectious Disease Events. 

We spoke with Rebmann about why the recovery phrase remains underdeveloped and how the field could evolve. 

This new book focuses specifically on biological disasters. Why does that deserve its own space? 

Most of the literature in emergency management is about natural disasters like earthquakes, hurricanes, tornadoes. Biological disasters—like pandemics, outbreaks of emerging infectious diseases, and bioterrorism—are very different. The impact on health care and public health systems is unique. There was a real gap in addressing that, and this book was designed to fill it. 

For your chapter, why highlight the recovery phase? 

Recovery is the longest phase of any disaster, but it’s also the one we pay the least attention to. We rush to prepare, we rush to respond, and then we jump straight into the next event. The recovery phase often gets lost or overlooked. 

When you started looking into research on recovery efforts, what did you find? 

Honestly, very little. We searched the literature and found almost nothing that framed recovery as part of response to biological disasters. You might see reports or studies on one aspect of recovery, such as procedures and costs for environmental decontamination or studies on the impact of the event on mental health, but never a comprehensive summary of recovery efforts and costs.  

For example, after the 2001 anthrax letter bioterrorism attacks, there were multiple studies on how facilities were decontaminated and what that cost, but almost nothing was published that treated those efforts as part of the larger recovery process from this unprecedented event.  

Why do you think the recovery phase is overlooked?  

Once the active response phase is over, attention shifts. We’re either preparing for the next event or already responding to it, sometimes both at once. Meanwhile, critical work is left hanging, like restocking depleted personal protective equipment or evaluating whether our response plans were effective.  

We saw this during the 2009 H1N1 pandemic, when hospitals discovered that some of their mutual aid agreements for antivirals and protective gear weren’t honored once supplies got tight. We learned that those pre-event plans were not effective during the outbreak, but after it was over, it’s not clear whether those plans were reevaluated or revised for the next incident.  

What do you think needs to change in the way we handle recovery? 

Recovery shouldn’t be something we skip over or quickly describe and then not apply to future planning. There needs to be more planning for the recovery phase upfront—things like agreements for medical waste disposal, plans to rebuild stockpiles quickly, and strategies to address long-term psychological effects. We also need to then evaluate our recovery initiatives for effectiveness and revise as necessary.  

Right now, we tend to document the immediate response and the costs, but we don’t comprehensively capture the long-term work it takes to get back to baseline. That means the same lessons have to be relearned over and over. 

Thumbnail photo via Elsevier.