How Philadelphia is preparing for measles and other disease outbreaks during FIFA World Cup events

On a muggy Friday days before the World Cup began, a small team of medical emergency planners inspected the cavernous, air-conditioned tent erected for patients at Lemon Hill in Fairmount Park, not far from the enormous screen where thousands can watch matches for the next 39 days.

Near a FIFA tent already full of merchandise, and branded “fan pavilions” in various stages of construction, Philadelphia’s host city medical lead, Patrick J. Brennan, paced the medical home base for dozens of doctors, nurses, and EMTs over the next several weeks.

Brennan, who is also the chief medical officer of University of Pennsylvania Health System, pointed out where the dunk tanks for heatstroke victims will go. He walked through tents with massive fans and misters and visited a smaller first-aid tent for minor medical issues.

Philadelphia is no stranger to large events, from a papal visit to the NFL draft to the annual Roots picnic. But the World Cup fan festival at Lemon Hill will be open for more than a month — and is taking place in a summer of high-profile events expected to bring more than 1.5 million visitors to the city.

Just as the international soccer clubs are packing up, visitors will arrive to mark the country’s 250th anniversary, followed closely by Major League Baseball’s All-Star Game and Home Run Derby in mid-July.

“That’s the difference — the duration of the event,” Brennan said.

Preparing for the full range of medical emergencies got underway nearly two years ago for Philadelphia’s public health leaders and largest health systems. They’ve prepared for heat-related illnesses, injuries, mass casualties, and terrorism.

Infectious disease is a leading public health concern among host cities and national health agencies.

Measles, a disease once considered eradicated through widespread vaccination and now on the rise across the country, is at the top of their list. An Inquirer analysis found that the Philadelphia region is pockmarked with vulnerable communities, where vaccination rates have fallen below the rate scientists say is necessary to prevent widespread illness.

» READ MORE: More than 200 Philly-area schools vulnerable to measles outbreak

Not far from the World Cup action, an outbreak in Lancaster, Berks, Dauphin, and Lebanon Counties has sickened 52, as public health officials struggle to contain its spread.

Now thousands of people from all over the world will turn Philadelphia into a petri dish prime for the spread of infectious diseases. Yet another concern is an Ebola outbreak in parts of Africa, including the Democratic Republic of the Congo, which has a team participating in the World Cup games in Houston.

Public health leaders say their best strategy for preventing widespread illness, especially should a case of highly infectious measles arise, is to respond as quickly and efficiently as possible.

Hospitals have added questions about measles vaccination to their routine emergency department screening, with weekend and evening contacts on call at the city lab that would test potential measles samples. Newly posted fliers in local medical buildings explain how to recognize the early signs of measles — which many doctors have never encountered.

“My main concern with measles are the pockets where people are under-vaccinated, too few people are vaccinated to really stymie an outbreak,” Brennan said. “It’s going to be hard to prevent it from coming into the country.”

» READ MORE: What are the measles vaccination rates in your district? See how your school compares.

Public health preparations for the World Cup began almost two years ago with meetings to identify health risks and develop a plan for protecting against them.

The city’s health department, public safety units, and leaders from top health systems, including Temple Health, Penn Medicine, and Jefferson Health, all had seats at the table.

They hashed out responses for potential public health emergencies ranging from bioterrorism, a mass casualty, and violence to routine heat-related health issues. Experts anticipate that the ongoing heat wave, paired with high levels of alcohol consumption, will lead many to experience heat exhaustion, dehydration and potentially heat stroke.

The prep work built on efforts for past major events, such as the papal visit or the 2016 Democratic National Convention. New this time around, Philadelphia and World Cup host cities across the country are paying much more attention to infectious disease concerns.

Until recent years, measles wasn’t “immediately on the radar,” for public health planning, said Jessica Caum, director of disease control for Philadelphia Department of Public Health.

“We’re in a different place now with measles,” she said. “More cases, increases in vaccine hesitancy, decreases in vaccination rates — all of these things are important to keep in mind.”

The planners looked at staffing levels at medical tents and hospitals, including where surge staffing could come from. They developed a plan for where to quarantine a large number of people, in the event of an outbreak of measles or other infectious disease, but declined to provide details.

“We want to be as prepared as possible,” Caum said.

» READ MORE: The World Cup arrives in Philly. Here’s everything to know, either as a hardcore fan or just curious.

All that preparation still may not provide a firewall against weeks of sustained sports chaos.

The city’s game-day strategy, should a suspected measles case crop up, is to react as quickly as possible.

Temple trained its emergency department staff to ask new screening questions about measles symptoms and vaccination status in an effort to quickly identify anyone who is at risk, said Daniel Feinberg, chief medical officer for Temple University Hospital Inc.

Anyone whose vaccination status is unclear, or says they are unvaccinated, will immediately be whisked to an isolation room if they show symptoms associated with measles, such as fever, cough, runny nose, and red eyes.

The telltale blotchy red rash doesn’t typically appear for up to four days, though hospital administrators distributed photos of it to help medical staff recognize it.

Once isolated, people with suspicious symptoms will be tested, with the sample rushed to a city lab on call for such emergencies.

Administrators lined up contact information to reach the lab in the evenings or weekends, when it is typically closed, and discussed the fastest way to get a sample to the lab — potentially to have someone with good sneakers run.

“We don’t want any time wasted,” said Carlene Muto, vice president of infection prevention and occupational health services at Temple Health.

The MMR vaccine can protect against the virus if given to someone within 72 hours of being exposed. Measles immunoglobulin, which contains concentrated antibodies, can provide temporary protection against the virus if given within a few days of exposure. But it is often reserved for infants and other high-risk patients.

The faster health providers identify a measles case, the faster they can work to trace who else may have been exposed.

The risk of exposure is high, when someone with measles attends a busy outdoor event, and the challenge of locating all the people who could have come in contact with the disease is immense.

Nine out of 10 unvaccinated people who come into contact with measles will get sick, making it among the most highly contagious diseases.

Anyone who doesn’t get treated in time and hasn’t been vaccinated will need to quarantine for 21 days.

At Jefferson, health system screening protocols are routinely updated to address the latest health threats, said Eric Sachinwalla, Jefferson’s medical director of infection prevention. Its hospitals recently added Ebola screening questions for patients who are being admitted and have traveled to at-risk countries.

Jefferson and other health systems are more likely to see “low-impact” but predictable threats: COVID-19 and other respiratory illnesses, sexually transmitted infections, and gastrointestinal diseases. These illnesses “can spread between people pretty quickly,” he said, but health systems are generally equipped to handle them.

A case of Ebola or measles, however, requires significant resources devoted to treatment and preventing further cases — so hospitals also have to carefully prepare for that possibility, he said.

“It’s balancing those two things. We plan for the high-occurrence things but also [diseases with] high potential impact,” Sachinwalla said.