# 1918
As a former paramedic one of the subjects I've focused on in this blog is the dilemma health care workers will face during a pandemic.
I understand the angst involved, for in the fall of 1976 when the world awaited the arrival of swine flu, just about everyone I knew (my world consisting primarily of medics, nurses, firefighters, cops, and doctors) was facing the same question:
Do I work in a pandemic, and not only risk my life, but risk bringing the virus home to my family?
It isn't an easy decision. In fact, it may be the hardest decision HCWs (Health Care Workers) will ever have to make.
For the past 6 months, Allnurses.com, an online community of more than 240,000 health care professionals, has been debating this issue in a thread called Will You Work In A Pandemic?
The assumption is a severe pandemic. One worse than 1918, with a high case fatality ratio.
A key concern of most HCW's is the predicted shortage of PPE's (Personal Protective Equipment: masks, gowns, gloves) during a pandemic. Few hospitals are stockpiling anywhere near enough to see them through a pandemic wave (estimated to last 8-12 weeks).
Officials who assume that nurses and other Health Care Workers (HCW's) will blindly risk themselves, and their families, by working without protective gear should read this thread.
It is an eye-opener.
A couple of days ago, the administrator at Allnurses added a poll to the thread, and as of this writing, there have been 325 responses. The results closely mirror other polls and studies conducted over the past couple of years.
50% said they would work in a pandemic, while 28% said they would not, and 21% said they weren't sure.
(click to enlarge)
The working assumption (sorry about the pun) of most pandemic planners is that absenteeism may run as high as 40%-50% during the height of a pandemic wave. They base this on the number of workers who may be ill, or may be home caring for a loved one.
For health care workers, those numbers will likely run much higher.
Health care workers, due to their direct contract with infected patients, are far more likely to contract the virus than the average worker. The rate of attrition due to illness is therefore likely to be higher than the national average.
Convalescence from pandemic influenza, as we saw in 1918, and as we are seeing with the H5N1 virus, often takes much longer than from seasonal flu. Even if a patient survives, it can involve a grueling recovery over a period of weeks, and sometimes with lasting sequelae.
Starting with a deficit of 30% or more, and then adding the losses due to illness and home care, hospitals could see their absentee levels running 70% or more at a time when patient loads will be astronomical.
Deteriorating working conditions, employee fatigue, and a lack of medicines and supplies could further impact hospital operations.
There are also concerns about possible violence directed at health care workers by families of patients who are turned away, or are denied life-saving procedures due to their triage status.
If you think that's an exaggeration, a couple of weeks ago Lt. Joseph McClellan of the Alabama Department of Homeland Security said:
"Security will need to be provided for mass burial sites, hospitals and pharmacies as fear and chaos could take hold of the community."
And the the assistant administrator for University of South Alabama Medical Center, said in the event of the pandemic barricades will go up at the facility's entrances to keep people who don't need to be there from entering the hospital and exposing themselves to germs.
Hospitals will rapidly become become one of the most stressful, and dangerous work environments during a pandemic.
Unknown also is how many support personnel, on which hospitals rely heavily, will opt not to work. Housekeeping, food service, maintenance, and clerical workers may also elect not to risk exposure.
Without masks (good ones, not surgical masks), gloves, and gowns, health care workers in direct contact with infected patients will likely contract the virus at an accelerated rate. Many would be sickened, and some might die, for lack of proper protective gear.
It would be hard to fault anyone for not being willing to work without the proper safety equipment.
We don't expect fire-fighters to run into a burning building without their bunker gear, how can we expect a nurse or other health care worker to treat infectious patients (with a potentially fatal disease) without masks and gloves?
While the United States has reportedly stockpiled 150 million masks in the Strategic National Stockpile, and hospitals, doctor's offices, and ambulance services undoubtedly have some reserves on hand, during a pandemic these disposable supplies will be consumed at an incredible rate.
Many hospitals have been reluctant to order in large quantities of PPE's due to the uncertainty of the pandemic threat, the costs involved, and the logistics of storage. Few facilities could operate without weekly deliveries of fresh supplies.
With roughly 8 million HCW's, assuming they were all working (which they won't), you'd need 25 million masks per day, and probably 50 million pairs of gloves.
Suddenly that 150 million mask stockpile doesn't look so impressive. It might last a couple of weeks.
The private stockpiles held by hospitals would extend this timetable, but they too would quickly run out. In a matter of weeks, during a severe pandemic, our current supplies would be extinguished.
What then?
A pandemic wave is expected to last for 6 to 12 weeks, and multiple waves are anticipated during a pandemic. Even when the number of cases in a community have died down, hospitals will likely be treating some patients.
There will be little rest for the weary HCW.
If 1918 was any indication, HCW's could be dealing with 200 `pandemic days' over an 18 month period. That's going to take a lot of PPE's. And the ability to restock in between waves, when everyone in the world will be clamoring for supplies, is doubtful.
You can add to these PPE's all of the other disposables that hospitals use routinely. IV's, Infusion kits, syringes, medicines of all sorts . . . even oxygen . . . these may all be in short supply during a pandemic.
We have 2 choices.
We either pay now to protect our healthcare workers by laying in the needed supplies, or we accept that somewhere down the line in a pandemic we will pay a much steeper price.
And no, this isn't just about influenza patients. While a pandemic rages, heart attacks, strokes, c-sections, car accidents, and every other medical need we see today will continue. More than 275,000 people rely on dialysis treatments. Who will care for them during a pandemic? What about those on chemotherapy? Or receiving radiation treatments?
There are nearly 1 million people in hospital beds in the United States on any given day, and 2 million more in long-term nursing facilities. Who will care for them?
Any way you slice it, health care workers are going to be one of our most precious assets during a pandemic. Having them on the job will mean the difference between life and death for millions of people.
They deserve to be protected.
