A fictional field morgue in operation during the “Crimson Contagion” exercise last year in Chicago.

A fictional field morgue in operation during the “Crimson Contagion” exercise last year in Chicago.

Chicago Department of Public Health

Despite ‘Crimson Contagion’ pandemic drills, Chicago didn’t fill public health jobs

That was a need identified by the emergency preparedness drills last year that imagined a pandemic spreading from China to Chicago.

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Mayor Lori Lightfoot hasn’t shied from ripping President Donald Trump and his administration for moving too slowly in response to the growing coronavirus pandemic, but her own administration got caught flatfooted on staffing of emergency-preparedness workers.

A series of public health exercises took place in Chicago and other cities last year to prepare for a pandemic like the one that’s crippling America today.

Nationally, Trump has been faulted for ignoring many of the recommendations that resulted from those drills.

In Chicago, Lightfoot and Gov. J.B. Pritzker have been praised for moving quickly to get people to shelter in place and fighting for resources, but City Hall wasn’t fully prepared for today’s crisis even after going through a fictional pandemic in last year’s “Crimson Contagion” exercise. The gaps in the city’s preparedness included:

• Six vacancies out of 40 emergency preparedness positions in the city’s Department of Public Health, including one for a high-level director of medical preparedness.

• The lack of a fully functional telemedicine system that allows for the diagnosis of illnesses remotely and safely finding places to treat those who are ill. Telemedicine remains a “work in progress,” one city official acknowledged.

And city officials can’t say whether all of Chicago’s public health workers have been trained on the software being used by the city during the pandemic, only that training was made “available” to them.

Still, Christopher Shields, the Chicago Department of Public Health’s assistant commissioner for emergency preparedness and response, says last year’s four-day exercise in August helped prepare the city and the state of Illinois for the current pandemic. He says officials worked on ways to:

• better communicate during a deadly crisis.

• improve the handling of shipments of medical supplies.

• set up field hospitals and morgues.

• feed hundreds of thousands of schoolchildren.

• and take steps to help ensure that millions of people stay away from each other to help slow the spread of disease.

Even before the emergency health-preparedness exercises last year, Chicago officials had years of experience to draw on, according to Shields, having learned, for example, how to handle large numbers of dead when bodies piled up in the heat wave of 1995 that killed 739 people over five days. The Cook County medical examiner’s office is arranging to lease a refrigerated space to hold up to 1,000 bodies, and a refrigerated truck already is in place.

Chicago also ramped up disaster planning after the 9/11 terrorist attacks, according to Shields.

“We’ve been doing this for years,” he says. “If we had not been doing it, we would literally be starting from scratch to build a plane in flight.”

Shields says of the Crimson Contagion drill: “So the city of Chicago, going into this exercise, we were about to have a brand new mayor, we were about to have a brand new cabinet and aldermen, we were in the process of transitioning a new health commissioner and whatnot. We kind of tunneled down more or less to focus in on areas to bring people up to speed during exercise play.”

City Hall spokesman Andrew Buchanan says the emergency preparedness job vacancies aren’t impeding the response to the pandemic. For now, others are sharing tasks to fill that roll, including a doctor hired in early March, he says.

“We are fully staffed to respond to the current COVID-19 outbreak,” Buchanan says. “The administration has deployed an entire citywide response, spanning hundreds of personnel across our own CDPH team as well as public safety, social services and housing in addition to medical and emergency response experts at the state and federal level who are also helping lead this effort.”

The Crimson Contagion exercise allowed the city to figure out the best ways to communicate in a crisis, whether that’s by teleconference, radio or face to face, Shields says.

But he says, “The whole process of bringing telemedicine into place, that is still a growth curve, I think, for everybody.”

Health officials respond to a state of emergency in the “Crimson Contagion” exercise in Chicago last August.

Health officials respond to a state of emergency in the “Crimson Contagion” exercise in Chicago last August.

Chicago Department of Public Health

The city’s preparations have been based in part on a fictional scenario that looks a lot like what’s happening now: a pandemic that begins in China and spreads worldwide. It imagined an infected 52-year-old man who flew home to Chicago from a trip to China feeling low energy and having a dry cough. He infects his teenage son, who then goes to a large public event in Chicago and triggers the spread of the illness across the United States.

Exercises have been held across the country since 2018 to test preparedness for handling a new, rapidly emerging disease. The final Crimson Contagion exercise last August showed the federal government was underfunded, underprepared and uncoordinated for a pandemic like coronavirus and that the Trump administration did little to address those problems, The New York Times has reported based on a draft report of the results.

Dr. Carolyn Lopez.

Dr. Carolyn Lopez.

Chicago Department of Public Health.

In Chicago, Dr. Carolyn Lopez, president of the Chicago Board of Health, says after the exercises, City Hall looked for better ways to obtain pandemic supplies and keep track of them.

“Very specific tracking is important,” Lopez says. “If you say you’re sending N95 masks, you’re not sending surgical masks.”

That was an issue that arose in recent days when the Trump administration sent Illinois 300,000 surgical masks instead of 1 million more protective N95 masks the governor had requested.

In the fictional Crimson Contagion scenario, nearly 50 days after the outbreak involving the tourist returning from China, 1,400 cases had been reported of a new strain of influenza virus. The projected death toll nationwide: 586,000.

In the real-life pandemic, 3,427 coronavirus cases had been confirmed in Chicago through Thursday.

A White House COVID-19 task force estimates that as many as 240,000 Americans could die.

To prepare for such a massive outbreak, the federal Centers for Disease Control and Prevention’s influenza-containment unit ran one exercise in 2018 and then a larger federal drill in January 2019. Then what Chicago officials called a “tabletop” exercise was held in April 2019, based on the scenario of the infected Chicago tourist. That was followed by the full-blown national exercise held last Aug. 13-16.

“You don’t just jump into: ‘We’ve got disease absolutely everywhere,’” Shields says. “First, what did it look like when you have a single case for something that you’re not familiar with? What does it look like when you have a small cluster, a small disease, spread?”

Chicago was the host for the August exercise, which included federal agencies and 12 states, hospitals, health departments and businesses. Dozens of operations centers across the country were set up for the drill.

“Some of the good news is that many of the things actually worked, but nothing is ever perfect,” Lopez says. “So things work, but maybe they can work better, maybe they can be enhanced.”

Officials took detailed lessons from the drills about the supply chain, as basic as needing to ensure that standard-size delivery trucks are able to get through, according to Lopez. The trucks in the exercise were too big to reach some hospitals.

Christopher Shields, the Chicago Department of Public Health’s assistant commissioner for emergency preparedness and response.

Christopher Shields, the Chicago Department of Public Health’s assistant commissioner for emergency preparedness and response.


Shields explains: “I’m now receiving X product though the supply chain but just not in a normal fashion. How do I receive that into the city, offload the material, break it down, apportion it to whatever I’m trying to achieve, repackage, distribute and deploy on a pretty linear timeline? We did that during exercise play to ensure that the drivers understood, ‘I can’t have a 53-foot tractor trailer going down Elston and try to get under the bridge.’”

Lopez says the exercises didn’t cover every possible issue — for instance, not touching on the current need to coordinate with the state’s laboratory on testing protocols.

Shields says the August exercises came as students were getting ready to go back to school; the Cubs, White Sox and Chicago Fire were playing; and the outdoor festival season was winding down. City and state officials were able to work on the massive challenges of social distancing and self-quarantining, he says.

“What does social distancing look like on-scale?” Shields says. “What is the political, social and economic impact of social distancing? What would broad quarantine look like in the city of Chicago? What would it mean if we decided to roll back school openings?”

Elena Ivanova, a spokeswoman for the city’s public health department, says, “The discussion was around when the school year needs to begin and if schools remain closed, how they can provide essential services such as school meals or if schools open, how they can implement social distancing measures? Food security for CPS students was an issue identified during the exercise, and now there is a process in place to address that need.”

Lopez says last year’s “dress rehearsal” helped prepare Chicago for what’s become the massive impact of the coronavirus, about which she says, “We’re holding our own.”

She also says: “There are people who are making the systems work, and the people are under a great deal of stress right now. I don’t know that it would have been possible to anticipate the amount of stress there is.”

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