Wednesday, December 20, 2006

What? Us Worry?

# 257

Selling the idea of pandemic preparedness isn’t easy. Most people don’t take the threat seriously, and even among those who do, few are genuinely preparing. Articles, such as the one I referenced yesterday by Michael Fumento, which try to dissuade people from being concerned over the H5N1 virus and preparing, only make matters worse.

For those of you who may have missed it, Mr. Fumento posted a rebuttal to my blog here.

Having a `lofty opinion’ of myself (something which all paramedics need, by the way), I have a few more words on the subject.

Born and raised in Florida, and having lived here for 40 of my 53 years, I’m used to the yearly threat of Hurricanes. Growing up, during the 1950’s and 1960’s they were very common. I was six years old when Hurricane Donna put a tree through our roof, and did some of my earliest emergency work during Hurricane Agnes in 1972. In between, we rode out a number of storms, large and small.

Then, starting in the mid 1970’s the Atlantic Ocean became relatively quiescent, and produced fewer, and less devastating storms.

Hurricanes, in Florida, became a rare event.

I watched, aghast, over the next two decades as developers began building on coastal lands that in previous years would never have been considered `buildable’ due to the hurricane threat. Houses, once solidly constructed as a barrier against these yearly storms, were cheapened in quality in order to hit price points. No one bothered to put hurricane shutters on them any more. And manufactured housing became the rage, despite their vulnerability to storm winds.

Things remained quiet, with a few notable exceptions like Hurricanes Andrew and Hugo, for the next 30 years. People forgot about the power and destructiveness of Hurricanes. Life was good, developers threw a party, and Floridians forgot the old ways.

Those of us, who remember the old days, knew that what once had been, would come again. For years we warned against complacency, urged people to prepare each hurricane season, and we were called alarmists and fear mongers. Those that pointed out the deficiencies in the levees around New Orleans were similarly dismissed.

Sound familiar?

Then all hell broke loose in 2004 and 2005. The Atlantic Ocean had awakened from its long cyclic slumber and began slinging tropical systems towards our coastline in prodigious numbers.

Many people, far too many, were caught unprepared. They’d bought into the idea that the big storms were a thing of the past, and would not come again. They placed their trust in levees that were under engineered and destined to fail. And they paid a heavy price.

Ask any resident of New Orleans, or the Mississippi Gulf Coast, if you don’t believe it.

For what it’s worth (and granted, it’s not worth much), my sense is that the odds of us seeing a pandemic event over the next year or so are roughly 50%/50%. I am not in the corner of those who believe it is inevitable. But I recognize we have a contender out there, a virus that shows signs that it could evolve into a pandemic strain, and believe it is prudent to prepare.

Just in case.

I also recognize that pandemics come in all shapes and sizes, much like hurricanes. A category 1 hurricane, while perfectly capable of being a killer, doesn’t generally take a large toll. A category 5 hurricane, admittedly a rare event, is a force of unbelievable destruction, and is capable of catastrophic devastation.

The H5N1 bird flu virus shows signs of being a Category 5 pandemic, if it should evolve into a human-to-human (H2H) strain. The early CFR (Case fatality ratio) is over 60%, or 10 times higher than the Spanish Flu. If those numbers held (by no means a certainty) during a pandemic, an Avian Flu outbreak would be devastating.

Will it come?

I can’t say. All I know is there is an area of suspicion out there, and the conditions are favorable for development. We are powerless to stop it, and our only defense is to be prepared to weather its onslaught should it come our way.

Like a Category 5 Hurricane lumbering towards landfall, a pandemic could lose some of its punch before striking, or it could veer away at the last minute. There are too many factors involved to know, in advance, how things will turn out.

But one cannot wait until the storm is lashing the coastline to begin to board up their windows, and to lay in supplies of food and water. We see this every time a storm threatens, and the store shelves are emptied, and many houses go without protection. Waiting until the signs are indisputable means waiting until it is too late.

The critics of pandemic preparedness, and those who choose to ignore the threat are no different than those who, for decades, claimed that the threat of hurricanes along the coastline were overblown. They depend on luck, and pray the next big storm doesn’t come on their watch. Some years their luck holds, some years it doesn’t.

But eventually, the law of averages catches up with them.

Critics of pandemic planning point out the costs and accuse the government of fear mongering. Frankly, I see no fear in the general public. I only see apathy.

And as far as the money is concerned, what our nation spends on public health is a pittance compared to what we spend on other, less worthy projects. In 2005, the transportation bill passed by congress and signed by the President contained over 6,000 congressional earmarks, pet projects mostly designed to aggrandize and re-elect representatives, to the tune of $24 billion tax dollars.

How much wiser would it have been to spend those dollars on improving our emergency response systems, emergency rooms, and yes, even our pandemic preparedness?

Whether a pandemic comes in 2007 is unknowable. Just as it is unknowable if a Category 5 Hurricane will strike a populated area next year. But we do know the forecast for hurricanes is heightened for the next 10 years, and all indications are that the potential for a pandemic is greater now than it has been in decades.

To ignore that potential is to ignore reality.

Telling people that it is hype, that it is fear mongering, and that there is no need for concern is simply shortsighted. If we prepare, and 2007 turns out to be a slow year for either hurricanes or pandemics, we should simply count our lucky stars.

And then prepare for 2008.


Wulfgang said...


I like your pandemic analogy to preparing for a hurricane. Very appropriate and insightful. I am sure when you wrote your diary it occurred to you that while a hurricane is pretty much a regional event confined to a fairly predictable pathway these days, because of NOAA and other weather approvements, a pandemic is totally unpredictable in nature because we have so little data to rely on. One important thing for sure though, a pandemic "cat 5" would know no international boundaries.

That's pretty scary when it comes down to it. I encourage you to hang in there and keep getting your messages out there.


Anonymous said...


I dont agree. I believe we are definitely going to have a pandemic. It is natures way. H5N1? Oh please ... please don't let it be.

I do agree we must be prepared... each and every one of us.

fumento said...

"The H5N1 bird flu virus shows signs of being a Category 5 pandemic, if it should evolve into a human-to-human (H2H) strain. The early CFR (Case fatality ratio) is over 60%, or 10 times higher than the Spanish Flu."

Stuff like this shows you're not just lame-brained but an outright liar. You claim to have read my piece. If so, then you read:

"It's true that, of bird flu cases recorded by the World Health Organization, 59 percent have died. But this is a mere artifact with an obvious explanation: Only people with the most severe cases go to the hospital and become part of the dataset.

"Research from Vietnam shows that even with inferior health care, the human death rate from H5N1 is considerably less than 1 percent, not higher than 50 percent.

"As to what the true mortality rate is, over a three-month period in 2004, Swedish and Vietnamese researchers studied 45,478 residents in a rural district in Vietnam that had H5N1 outbreaks to find out how many had contact with sick birds and how many had flu-like illnesses. They published their results in January 2006 in the Archives of Internal Medicine. They found that of 8,149 who had a flu-like illness, 650 to 750 probably caught it from birds. Yet for all of 2004, the World Health Organization data indicated only 29 Vietnamese cases with 20 deaths. Thus what might seem to be a horrific mortality rate of almost two in three, or 69 percent, appears to be actually around one in 140 or 0.71 percent. This, in the rural portion of a Communist country with a state-run medical system. That 0.71 percent is in the same range as seasonal human flu."

So you knew all this, and yet you persist with your "over 60%." The 50-50 chance thing is also a complete fabrication. Name even one ALARMIST (other than you) who is willing to stick his or her neck out this far? Robert Webster? No way! Laurie Garrett? Uh-uh! Just you, the omniscient paramedic. How would you like to put your money where that over-sized ignorant mouth is? 10-1 there will be no pandemic flu in the next 365 days. You choose the amount. I'd go beyond 365 but I've got better things to do than track bets for years on end. 2-1 would be even odds for your prediction; I'm making it 10-1.