# 3518
Over the next 60 days a staggering number of potentially `risky’ decisions are going to have to be made by a variety of public health officials, across many nations, and most will have to be made with far less time and information than they would like.
While a relatively `mild’ illness for most people, the H1N1 pandemic virus can, and does, cause severe illness and even death in some small percentage of those it infects.
Since viruses can mutate, it would be dangerous to assume that the low percentage of deaths won’t increase over this fall and winter. Maybe we get lucky . . . maybe we don’t.
It is against this backdrop that these public health decisions must be made.
Decisions that involve billions of dollars of tax payer’s money, the use of a new untested vaccine, and recommendations on social distancing that could potentially affect the economic recovery.
And the one luxury that these doctors and scientists don’t have is a lot of time.
The clock is ticking . . . the virus is spreading rapidly in the southern hemisphere . . . and is poised to ramp up here in the northern hemisphere as early as September.
There is great uncertainty regarding this virus, and there are some who believe the threat is overstated. We’ve seen some countries decide to downplay the threat, and treat this virus like a seasonal flu. Finland and South Africa are two examples.
They may end up being right, but it is a huge gamble.
Of course, mitigation efforts are not without their dangers. There are the budgetary costs of course. Billions of dollars for vaccines just here in the United States, and billions more to dispense them to the arms of 300 million Americans.
If the virus turns nasty, and the vaccine is safe, effective, and delivered in time - public health comes out looking like a hero.
But practically any other combination of events: A milder than expected virus, a less-than-effective vaccine, or one delivered too late, or worse, a vaccine that causes a substantial number of adverse side effects – and public health takes it on the chin.
There are numerous external forces at work here, most of which are beyond the control of public health officials and pandemic planners.
During a pandemic, there are so many things that can go wrong, even if they do their jobs right, that it may actually be better to be lucky than good.
At every turn, it seems, there is a `damned if you do, damned if you don’t’ decision for public health officials. School closings, fast tracking a vaccine, using an adjuvant, closing public venues to limit the spread of the virus . . .
Added to that is a distrustful, and at times, uncooperative public. A watchdog media ready to pounce on any `good’ story, and a million internet bloggers taking pot shots at their every move.
Be glad it isn’t your job.
Be glad that potentially tens of thousands of lives, the nation’s economic prosperity, and vital elements of our infrastructure don’t hinge on the decisions you are forced to make in a crisis.
And be glad that everything you say and do isn’t going to be scrutinized, analyzed, and criticized in the media over the next couple of years.
I suppose, having been in the position of having to make life-or-death split second decisions as a paramedic makes me a bit more sensitive to the plight of public health officials.
There will no doubt be ample legitimate targets for criticism during, and after this pandemic. And I’m not suggesting we turn a blind eye to egregious or malicious actions, greed, or bone-headed decisions.
But I do respect the pressure that most public health officials are working under.
That, all too often, they are working with less data and time than they really need, inadequate resources, and are subject to a variety of political, economic, and societal pressures.
And that, even with the best of intentions, their decisions may not always turn out the way we would hope.
I don’t think the public understands yet what we are about to ask of our public health sector over the coming months.
That everyone, from the underpaid and little appreciated school nurse, to the the staff of your local health department, to the doctors, nurses, and techs in your local hospitals, clinics, and nursing homes are going to be asked to go above and beyond over the next year or so.
They are not only going to be on the front lines, exposing themselves (and potentially their families) to the virus, they will be asked to work nearly impossible hours and to deal with an enormous workload.
Many will be asked to put their jobs and duty first, and their families second or third during this crisis.
Emergency operations, first responders (police, fire, EMS), and volunteers with CERT, the American Red Cross, the Medical Reserve Corps and other agencies will also be out there, doing difficult and at times dangerous work.
Even if we are lucky enough to only see a mild pandemic (and the jury is still out on that one), we need to be prepared for the idea that not everything is going to go smoothly.
Mistakes will be made, and bad outcomes are to be expected.
If we’re smart, we’ll learn from our mistakes and our shortfalls, and use that knowledge to be better prepared for the next pandemic or crisis to come our way.
My fear is, we will simply content ourselves with publicly flogging those who worked to try to mitigate this pandemic, and then go back to sleep until the next time.
