We Don't Have The Beds

by DemFromCT

Since Flu Wiki is still down (server change taking time), here's a couple of bird flu articles to chew over. The first is from Bloomberg, highlighting the fragility of our modern health care system, a point repeatedly made on this blog.

Bird-Flu Pandemic, Even Mild One, Will Overwhelm U.S. Hospitals

In 1957, the University of North Carolina turned a dormitory into a hospital for dozens of students stricken by an Asian flu circling the globe. Eleven years later, Nashville medical centers filled beyond capacity when another worldwide epidemic hit.         

The famous 1918 Spanish flu that killed 50 million people isn't the only pandemic that caused a global health crisis during the past century. Two other pandemics, though much milder than the more well-known one, also strained nations' health-care systems, researchers say. The Asian flu killed at least 2 million in 1957, and about 700,000 died during the Hong Kong flu in 1968.         

If the current wave of bird flu turns into a human infection that is only as widespread and deadly as the one in 1968, the American health-care system will be severely tested, said Nancy Cox, head of the Centers for Disease Control and Prevention's influenza branch in Atlanta. ``Emergency rooms would be overflowing, doctors offices would be overflowing and hospital beds would be overflowing,'' she said March 20.         

An outbreak roughly equivalent to the Hong Kong flu might kill only about 209,000 worldwide as a result of new medicines and improved care, U.S. health officials estimate. Yet, a bird- flu pandemic similar to the one that hit almost 40 years ago is almost certain to be catastrophic, perhaps sickening one in three Americans and over-burdening the nation's 4,000 hospitals, 20 percent fewer than in 1968, health officials predict.         

U.S. hospitals are ``simply not set up to accommodate'' illness rates of up to 35 percent, levels seen in past pandemics, CDC's Cox said.  Even in the most-severe seasonal flu outbreaks, illness rates top out at 15 percent of the population, said William Schaffner, an infectious-disease specialist at Vanderbilt University School of Medicine in Nashville.

Meanwhile in the BMJ, an argument is made for ignoring the above. After all, we're just a bunch of ignorant louts that can't tell bird flu from pandemic flu.

Summary points

• The perceived threat of a hypothetical pandemic of avian flu among humans fuels fear
• Avian flu, winter flu, pandemic flu, and Spanish flu are often confused and mixed up
• Stockpiling antiviral drugs lacks an evidence base and is costly
• The energy unleashed by the fear of a pandemic should be directed at tackling real health problems
  

There's much to be argued for in the author's conclusion:

Panic in epidemics is a part of the human condition.¹⁹ The increase in health scares may reflect the absence of real attacks, making us over-react to hypothetical dangers. We should use panic, with good reason or not, to tackle the larger agenda of preventable and curable disease in the world, starting with low vaccination rates in winter flu. International health policy should stay cool and not be distracted by the latest health scare and its industry sponsored quick fix. The humanist road leading to adequate healthcare services for all citizens of the world is still long.

Yet the idea that you should not pay attention to A because I care about B is a fallacy of logic we are well familiar with political blogs. "How dare you attack Bush when you should be supporting our troops!" is but one common example. The truth is that we should be building our public health infrastructure, including a medical safety net and surge capacity (see the Bloomberg article) regardless of what happens to H5N1. And while I agree that building "adequate healthcare services for all citizens of the world" is a laudable goal, waiting until that happens before fixing the problems here in the States (again, see the Bloomberg article) is a recipe for disaster.

By the way, there may be more opinion in that BMJ issue... there are several stories on bird flu, but this one is available to non-subscribers. In any case, back to Bloomberg:
      

Emergency care in the U.S. is ``like a house of cards,'' he said, ``waiting for a big wind to collapse it.''         

Visits to U.S. hospital emergency rooms rose 26 percent to 114 million in the 10 years ending in 2003 as the population increased, Bern said. During the same period the number of emergency rooms fell 14 percent due to cost-cutting by medical centers, said David Seaberg, a director with the Physicians' College, in Feb. 8 testimony before the House Committee on Homeland Security.

Until problems like health care access and surge capacity are addressed (and this WH ain't doing it), we remain woefully unprepared for whatever comes next, when ever it is. And note that, unlike the BMJ summary points, when an educated and sophisticated population start worrying, the equation changes considerably. That's not panic and fear; it's prudent policy consideration. The fear should be that we will do nothing to address the issues. That's a fear grounded in reality.

Comments

[DemFromCT]

There was a wonderful article on panic that was sent to me by a friend:

Panic and why people usually don’t

There is a general and repeated perception that when facing severe and overwhelming adversity, people will panic. But what has happened in the past? Take the example of the London Blitz during the Second World War. Beforehand every expert, psychiatrist, planner and government official was firmly convinced that the ‘‘bomber will always get through’’, and that civilian morale would rapidly crack, with populations fleeing to the country in panic. Yet it didn’t happen, except in a few very specific circumstances, such as the Bethnal Green Tube tragedy, when a crowd surged into a crowded subway entrance. The myth of ‘‘London can take it’’ is no myth. London did take it (Jones et al., 2004).

Likewise, it seems clear from the research on 9/11 that panic was conspicuous by its absence during the evacuation of the World Trade Center. A building was on fire, about to collapse and the emergency services not yet present. Yet there was no panic, but an orderly evacuation perhaps aided by pre-existing social networks (Glass & Schoch-Spana, 2002).

It's from Journal of Mental Health,
February 2005; 14(1): 1 – 6
SIMON WESSELY

[Melanie]

Dem, have you got a link for the JMH article? I'd like to read the rest of that.

[DemFromCT]

I'll send it to you.

[orionATL]

your comments are a useful response to the

"maybe it won't be so bad after all"

and

"maybe it wont't happen at all"

comments that are starting to circulate in the press.

[DemFromCT]

orionATL, the press doesn't get it. And certain authoirs (Marc Siegel recently in the WaPo) seem to specialize in the message that it's all fear and hype. The thing is, it's really not. it's reasoned concern based on fact (the current condition of hospitals and medical care). And that's a problem the nay-sayers do not address.

[John Casper]

DemfromCT, thanks again for another great post on this.
Saw an article that flu would likely hit CA first, wrt the lower 48. This seems to make sense, IIRC from what you have written before about migratory patterns and Alaska.
OT, Leibermann was booed at a big Democratic dinner last night in CT, just wondered if you heard anything in addition to what is already out there, a lot of us are pulling for Ned Lamont.

[DemFromCT]

lieberman is unhappy with rank and file activists who are unhappy with him. he raises a lot of money for the party, so the regulars will l;ikely suppport him.

Lamont will do better than expected, but it's still uphill.

[robert gordon durst]

DoI have this right? From all I can gather googling 'round, Tamiflu has to be initiated in the first 2 days for even the smallest efficacy, and new strains are already immune to whatever little it does.

[DemFromCT]

robert gordon durst, tamiflu is not a panacea. it needs to be started within 48 hours (the sooner the better), and the optimal dose is not known. It's both expensive and in short supply. it might best be used as prophylaxis. That is why stockpiling by governments is going on, as a way to contain small outbreaks.

OTOH, there are some strains sensitive and some resistant. Since the ultimate virus strain responsible for the next pandemic is unknown, it is also unknown how useful tamiflu will be.

Finally, the concept of preparedness is far deeper than scoring some tamiflu, whether by govts or individuals. Vaccines hold out much more promise, but recent forays have been disappointing, as they seem to work at 12 times the dose of seasonal flu vaccines, and only in half the patients tested. IOW, we have no vaccine at the moment.

And now you know why we started flu wiki.

[DemFromCT]

Flu wiki, btw will be down another 24 hours or so as we resolve server issues.