Monday, January 01, 2007

The Definition of Insanity


# 270


A little more than a year ago I was in New Orleans, sifting through the remains of my twin brother’s belongings as we retrieved what we could from his apartment. Although it was a few short weeks after the passage of Hurricane Katrina, and the floodwaters had receded from his neighborhood; power and water were still intermittent luxuries. A curfew was still in effect and finding lodging in the city was impossible, and so our time there was short. We had to grab what we could in a few short hours.


The city looked like a war zone.


Debris filled the streets; refrigerators and freezers, bags of garbage, rolls of carpet, furniture of all types, along with the combined accumulated personal items of hundreds of thousands of residents. Damage was evident in every direction, yet it was obvious that much of it was unseen, hidden from view. The stench of mold and rotting garbage permeated the air.


We managed to collect some personal items, some important papers, some clothes, a banjo, and a box of sheet music; enough to fill the trunk and back seat of my Saturn. Not much given that he’d lived and worked out of the French Quarter for 20 years. Everything else went out to the curb. Two decades of memorabilia, memories, and possessions.


And then, before sundown after a long and heartbreaking day, we headed north out of the city, leaving it behind us, just as so many other refugees had over the previous six weeks.


My brother had been lucky. He’s a fairly well known entertainer in the cruise ship industry, and had been on a five-month contract in the South Pacific when Katrina hit. He was physically in no danger from the storm, but could only watch from half a world away as his home, and a goodly portion of his life was destroyed.


Today, the recovery in New Orleans struggles on. I have friends there, who have managed to return to that damaged city, and who are desperately trying to rebuild. The levees are restored pretty much to the condition they were in before Katrina, which is to say, inadequately for the task. No one expects them to hold if another Katrina-sized storm takes aim at the city.


And the next Hurricane Season is but 150 days away.


Of course, no one knows if another storm will threaten New Orleans in 2007. To suggest the possibility, I suppose is alarmist on my part. Critics point out that the last really bad hurricane to strike New Orleans was in 1965, Hurricane Betsy. And that the city had been spared for the next 30 years.


There had been others of course. The great New Orleans Hurricane of 1915, which is estimated to have been a Category 4 Storm, and claimed at least 275 lives. The 1947 Storm, which claimed 51 lives and caused 100 million dollars of damage in New Orleans.   Levees along the south shore of Lake Pontchartrain to protect Orleans and Jefferson parishes were built in response to that devastation.


There were close calls, too. Hurricane Camille, a monster Category 5 storm, missed the City in 1969 by only a hundred miles or so. Had it struck dead center, or slightly to the west of New Orleans, the damage it would have brought would have made Katrina seem mild in comparison.


Hurricanes Georges in 1998 and Ivan in 2004 both missed the city, but once again reminded us how vulnerable New Orleans would be should the city be hit.


In fact, the destruction of New Orleans has been called the `mostly widely anticipated disaster in American History’. It, along with a California earthquake, routinely ranked at the top of the list of gravest threats to the nation by FEMA each year.


And for decades, the residents of New Orleans had complained bitterly that their levees would not hold in the face of a major hurricane. The Army Corps of Engineers designed them to withstand a Category 3 storm back in the 1960’s, but the city, and the levees have settled since then, and their ability to protect the area has lessened with time. And obviously, the Gulf of Mexico is capable of serving up storms of greater ferocity than the category 3 design level.


Over the years, patches had been made to the levees, and monies had been appropriated. In some cases, those monies didn’t always go where there were intended. The only thing Louisiana is more famous for than the fragility of their levees is the corruption of their state and local government. The Federal Government, however,  looked the other way. Despite the glaring need for serious improvements to the levee system, no serious attempt was made to upgrade them.  It wasn't considered a `priority'.


The city, and its residents, were left largely unprotected.


One could argue that trying to save a sinking city, one built below sea level, is a fools errand, and that the money required upgrading the levees would have been ill spent. Perhaps, but it’s a moot point today. The costs of Katrina far exceed what upgrading the levees would have cost us. And that doesn’t begin to include the human suffering.


Bluntly put, the destruction of New Orleans occurred because we allowed it to happen.  It was preventable. Katrina was, at best, a Category 3 storm at landfall.  We gambled that old, under engineered levees would hold. And the residents, and the nation, lost. 


Sadly, this is an old, and familiar story. And one that takes little imagination to apply to pandemic preparedness.


Pandemics, while global events, tend to strike about as infrequently as truly horrific storms hit the city of New Orleans. Every 30 to 50 years. Of course it’s possible for the same area to be hit several times by hurricanes quick succession, as the panhandle of Florida can attest, and so statistical averages have to be taken with a large grain of salt.


Everyone, I’m sure, knows the story of the statistician who drowned crossing the river that was, on average, 3 feet deep.


But Pandemics happen infrequently enough that we tend to think they won’t happen `this year’. Politicians assume it won’t happen on `their watch’. We delude ourselves into believing we have time, and point out, much as we did in New Orleans, that the odds of a major strike happening in any given year are `slim’, and that the levees would hold if it did.


Both assumptions proved to be tragically wrong.


The rub is, preparing for a pandemic could take years: likely decades to do it right. It would require the expenditure of tens or even hundreds of billions of dollars over time. And this is a hard sell to those who believe it won’t happen `this year’. Just as it was a hard sell to convince officials after the close call with Hurricane Camille in 1969 that New Orleans needed more than Category 3 protection.


Had we bitten the bullet back then, we could have built a levee system that would have held back the waters pushed forth by Katrina. Yes, it would have been frightfully expensive. It would have required the political will to spend money on a threat that did not, as yet, loom on the horizon. But in the end, it would have saved both lives and money.


It would have been cheap insurance. We could have elected to spend $10-$15 Billion dollars back in 1970, but instead, we have suffered a $150 billion dollar loss today. We were penny wise and pound foolish then, as we continue to be about pandemic preparedness today.


Our `levee’ against a pandemic is our public health infrastructure, and today I doubt it is capable of handling even a `Category 2' pandemic.


Emergency rooms are understaffed and overcrowded. Waiting times are unacceptable, even on a normal day, and that costs lives. Hospitals, during normal flu seasons, are filled to capacity. Ambulances in many areas are stretched too thin, and response times have increased. Good medics rarely stay on the job because the pay is so low. In the aftermath of 9/11, New York City actually closed down firehouses due to budgetary constraints. And in hospitals across the country, doctors and nurses are drowning in patients and paperwork.


For the most part, vaccines and pharmaceuticals are produced in other countries. We are still using 1950’s technology to create vaccines.  Each year, we seem to have trouble just getting enough seasonal influenza vaccine.


It would take a concerted effort, over many years, and the expenditure of significant tax dollars to correct these, and many other deficits in our public health system. These are problems that cannot be corrected in a matter of months. We simply can’t wait until a pandemic has started to begin. Not if we expect any better outcome than we saw in New Orleans.


I’ve heard it said that one definition of `insanity’ is doing the same thing over and over again and expecting a different result.


The point is not whether a pandemic will occur in 2007, or in 2008. There is obviously, with the emergence of the H5N1 avian flu virus, a heightened risk right now, but it is by no means a sure thing. The point is, another pandemic will occur. This year, next year, or maybe not until 10 years from now. And when it does, the costs to the nation, and the world will be many times higher than those we experienced in New Orleans.


For us to be ready for one, we have to begin building the public health levees today. This is a long-term project. An on-going process; if we have 5 years or 10 years to prepare, and use them wisely, so much the better. We may be able to dramatically mitigate the effects of the next pandemic, and cut the costs in terms of lives lost and economic impact.


But it would be insane to waste the time we have and simply `hope'  it doesn't happen.


And should we spend this money, make a national commitment, and no pandemic arrives, what have we lost?


Worst case, we would have improved our public health infrastructure. We would be saving lives each and every day because of our improved emergency rooms, hospitals, public health departments, and emergency services. We’d be better equipped to handle non-pandemic emergencies such as earthquakes, hurricanes, floods, tornados, and even terrorist attacks.


Our quality of life would improve, as would our national security.


A terrible waste, I know.


But it’s one, I think, we could live with.


Wulfgang said...


I really like your diary comments today. You really did a good job with your avian flu pandemic comparison to a hurricane and pointing out the attendant cost savings that are inherent to advance crisis planning, as well as the need for dramatically increase health care investment now. Makes perfect sense to me.

Hurricanes, earthquakes, tsunamis, epidemics and pandemics, as well as global warming and climate change, are all classic natural warning signs that the world is truly ignoring. Why this is the case, is anybody’s guess – diversion of critical resources to the Iraq rat hole perhaps ? Ignorance, politics, a false sense of human invincibility, complacency? It’s anyone’s guess.

Right in front of our very eyes, huge calving of icebergs in both the Artic and Antarctic is occurring, and nobody gives a rats behind, it seems. In fact, just a few days ago, it was announced that an iceberg 25 sq miles across, bigger than Manhattan, broke off from the Ayles ice shelf in 2005, at Ellesnere Island, in northern Canada. Scientists have just now noticed it. The ice mass of Greenland accelerated 250% in the last two years alone, and they are losing ice at the rate of 59 miles per year. If all of Greenland’s ice melts, it would raise the ocean’s sea levels by 23 feet, let alone the further disruption it will have on ocean salinity and currents, and climates. Is the culprit global warming – most probably. All the classic warning signs are there for everyone to see, but very few people are paying attention. You might want to consider relocating now, to say, the Georgia or Tennessee mountains.

I agree with you wholeheartedly that the world is overdue for a pandemic. We are woefully unprepared. As you point out in your Katrina comparison, the whole New Orleans story could have been an entirely different ending, had the levee’s been reinforced properly well in advance.

Has the world really noticed the polar caps melting and the climate changes ? No.

Is the world really concerned about the H5N1 virus mutating into a deadly pandemic ?

Not in my opinion. Not until large numbers of people start flopping over dead. Then it will turn out like Katrina to be a very costly proposition.


FLA_MEDIC said...


Thank you for your thoughts on this. Sadly, we tend to believe that `bad things' will only happen to someone else, usually 3rd world countries, not to us. Until, of course, they do happen.

Then it's too late.