How to Make a Bad Pandemic Worse
#208



By now, both of my readers are aware how seriously I view a potential Avian Flu pandemic. Short of a global nuclear war, it is hard to imagine any event that would have a greater impact on society, or that would cause a greater loss of human life. As a doctor told me a few months ago, “if it comes, it will be the worst thing we will experience in our lifetimes”.


He should know. His father was a doctor during the Spanish Flu of 1918.


Pandemics have happened before, and we’ve always known they would happen again. On average we see one 3 times each century. Sometimes they are relatively mild, like the Hong Kong flu of 1968, and sometimes they are horrendous, like the 1918 Spanish Flu that claimed tens of millions of lives. Yet we’ve spent the last 40 years in denial, doing little or nothing to prepare.


In fact, we are probably in worse shape today to face a pandemic than we were 40 years ago. If I wanted to design a system to fail during a pandemic, I could do no better than the system we have in place today. And that simply shouldn’t have happened. We've always known another pandemic would come some day.


Our leaders have just elected to ignore it, and hoped it wouldn’t happen on their watch.


Suddenly, we are faced with the possibility that a new pandemic is on the horizon, and early indications are it could be worse than 1918. Over the past year, governments around the world have a watched, and waited, and have prayed this viral threat would go away, but few have done much to prepare. True, some steps have been taken; we’ve developed a National Influenza Response Plan (for whatever that’s worth), hospitals are holding mock disaster drills, and antivirals and vaccines are being ordered.


But the fundamentals are being ignored.


I’m not suggesting that our leaders are evil, or even stupid. But I do believe they are very shortsighted.


We’ve been told that hospitals would be overrun in a pandemic, and that most people would have to stay home and be cared for by family.

Where are the community based home nursing courses? Why haven’t public service programs showing how to care for a severely ill flu patient been crafted and run on TV stations? Where are the medicines and supplies people will need to care for these victims?

Many health care workers have confided to me that their hospital, or clinic, or doctors’ office has done nothing about obtaining the supplies they would need during a pandemic. That there are no signs that they are ordering extra masks, gowns, and gloves; essential items to protect their employees. Consequently, many of these workers have already decided to refuse to report to work in a pandemic.

These nurses, technicians, and doctors feel abandoned by their own institutions, and see no reason why they should risk their lives when the bean counters in charge of their workplace don’t care enough to stock essential supplies. I fully expect a mass exodus to occur early in a pandemic.

Michael Leavitt, Secretary of HHS, has gone around the country to every state, preaching preparation for a pandemic, and warning us that FEMA won’t be there to save us. Yet little has been done to elevate public awareness about what may be coming.

The Federal Government has a website, http://www.pandemicflu.gov/, but few people know about it, and the government seems happy not to promote it.


Every mention of a possible pandemic in the media, or by public officials, is accompanied by a disclaimer, saying it `might not happen’, which dilutes the message. And the recommendation of a 2-week supply of food on hand, when authorities admit a pandemic would last for many months, does little to convince people of the seriousness of the situation.


Consequently, pandemic preparation is the furthest thing from most peoples’ minds.


Admittedly, a Flu pandemic might not happen. At least not this year, perhaps not next year either. But one will happen again. We are overdue.


But no one wants to rock the boat. No one wants to cause a `panic’, or talk people into buying pandemic supplies instead of that new car or big screen TV this year. It might hurt the economy in the short term, and that after all, is what is really important.


There are heroes out there; Michael Leavitt of HHS, Dr. Michael Osterholm of CIDRAP, and Dr. David Nabarro at the United Nations, among others. But their voices are routinely drowned out by a complacent media and special interest groups who believe that their agenda is more worthy of public attention and federal tax dollars.


The H5N1 virus continues to mutate and spread, and for the most part, our leaders are asleep at the switch. When President Bush asked for 7 Billion dollars to help prepare for a pandemic in 2005, Congress cut that request in half, while at the same time voting for a $286 Billion dollar transportation bill that had, by some estimates, 24 Billion dollars in `pork’.


That shows you where our priorities are. Special earmarks, projects that bring employment opportunities to a politician’s district (and votes in the next election), are more important than saving lives.


It’s been nearly 40 years since the last pandemic, and except for a brief scare in 1976 over the Swine Flu, almost no heed has been paid to the next pandemic.


If we are lucky, and the pandemic doesn’t happen this winter, there is still time to rectify some of these shortcomings.


We need a massive public awareness campaign, spearheaded by the Federal government, informing the public of the threat. We need free community-based home nursing classes that will stress patient care and infection control. And we need to restore the covenant between health care workers and their employers, by stockpiling the essential protective supplies they will need, so that they will feel safe enough to report to work.


There’s more to be done, of course. Much more. But that would be a good start.


Growing up in the 1950’s and 1960’s, I remember the cold war well. The Cuban Missile Crisis, duck and cover drills in elementary schools, the civil defense films, and yes, even pamphlets the school sent home on radiation sickness, blast effects, and how to construct home fallout shelters. The government didn’t shy away from the ugly issues of the day.


Sometime in the 1980’s we lost that mentality, abandoned civil defense, and accepted that if a nuclear war were to happen, there was no point in preparing. We would all likely die, anyway. Better, they decided, to pursue a policy of mutually assured destruction, and hope that would deter any conflict.


Sadly, that same rationale has been carried over into the pandemic arena. No sense preparing, nothing we can do about it if it comes. And that simply isn’t true. There is much that can be done, if we have the political courage to do it.


We’ve escaped the horror of nuclear annihilation over the past 50 years, and hopefully always will. But a pandemic will come again. It’s just a matter of time.


It is insanity to pretend otherwise.