Tuesday, November 28, 2006

Prep Then vs. Prep Now


One of the nicest things about writing a blog is the feedback I receive. It astonishes me that anyone actually reads my ramblings, and even more so that they take the time to contact me. The other day someone stumbled upon my blog because they were researching the Swine Flu scare of 1976, and as I’ve written on that subject several times, a Google search brought up my site.

Thus, through a somewhat serendipitous route, comes this excellent question from Sharon:

I am emailing you because I googled for swine flu preps and got a link to your blog. I am wondering what kind of preps, government info/preps were made for that flu.

As a preface, I was a young paramedic 30 years ago, attached to the county health department to assist with their swine flu plan, and a member of our county’s civil defense committee.

The answer, as you will see, is easy. The reasons behind the answer, a bit more involved.

The writer makes no mention of her age, and being a gentleman, I won’t ask. But for the benefit of those under the age of about 45, allow me to summarize some of the differences between the world of 2006 and the world of 1976.

In 1976, our country’s population was roughly 220 million people, and the world’s population had just surpassed 4 billion souls. Today, those numbers stand at 300 million Americans and 6.5 billion people worldwide. Globally, that’s more than a 50% increase.

Computers in small businesses and in the home, and the revolution they would bring to the world of just-in-time inventory, were still several years away. Bill Gates was still a teenager, selling tiny Basic for Altair Computers and the most sophisticated home video game out there was Pong. Pocket calculators were finally coming down in price and replacing slide rules. We did things the old fashioned way, with pencil and paper.

Grocery stores still had stockrooms, and received deliveries once or twice week, as did most retailers. Many stores sold local produce, instead of importing it from overseas.

Hospitals were considerably lower-tech than they are today, yet they had more reserve capacity, as the bean counters had not quite yet managed to wrest control from the medical staff. We had great faith in modern medicine, miracle drugs, and hospitals; a view that was continually reinforced by TV shows like Medical Center, Emergency, and Marcus Welby M.D.

We still manufactured goods in this country. Steel, textiles, plastics, automobiles, vaccines, and medicines. Despite our dependence on foreign oil, we were far more self-sufficient as a nation than we are today.

And our civil defense system was still in operation. We still had fallout shelters, and national food reserves, maintained since the 1950’s against the threat of Soviet aggression. The cold war, and the prospect of a nuclear war, was still very real.

The Internet, of course, did not exist. Neither did any of the cable news channels. Most places in America were lucky to have the 3 major broadcast networks and an independent TV station or two. Talk radio had yet to take off in most markets. Most Americans got their news from a 30-minute (minus commercials) network newscast each evening, or from the daily newspapers.

And despite the turmoil of the 1960’s and early 1970’s, with the Vietnam War, the assassinations of two Kennedy’s and Martin Luther King, and the disgraced Presidency of Richard Nixon, most Americans still trusted their government. The deep division between political parties was not nearly as bitter as it is today.

It was, quite literally, a different world than our world of today.

When the Swine flu was detected in Fort Dix, New Jersey during the winter of 1976, it set off alarm bells among scientists. Most of the doctors practicing back then remembered the Asian Flu of 1957, and the Hong Kong Flu of 1968, and the Swine flu was thought to be of roughly the same threat level. I recall very few mentions of the 1918 Spanish Flu.

In the Fort Dix outbreak, 4 patients became ill, and one patient died. But seroprevalence studies undertaken at that army post also showed antibodies to the swine flu present in approximately 200 asymptomatic soldiers. This high rate of immunity was probably due to the fact that the Swine flu was H1N1, and that had been the prevalent strain of flu in circulation between 1918 and 1957. Even when H1N1 was replaced by the Asian and Hong Kong strains, it retained much of the genetic material from the H1N1 virus.

The Swine flu, therefore, was far less lethal than the H5N1 virus we face today, which is a novel virus in humans, although it appeared to be highly transmissible.

Scientists worried, of course, that the CFR (case fatality ratio) might go up with further mutations, and so the decision was made to vaccinate the nation. At the time, no one talked publicly about the success rate of immunization or possible side effects. We generally believed that once you got the shot, you were safe.

Given our nation’s manufacturing capacity to create a vaccine, and a fair amount of hubris, we believed we could prevent a pandemic. We were, after all, the most technologically advanced nation on earth. We had all but defeated Polio, and Tuberculosis, and had pretty much eradicated smallpox completely. We had consummate faith in vaccines. With proper planning, and a national effort, we could extinguish a pandemic before it even started.

Therefore, in 1976, there was little apparent need to prep for a pandemic. I can recall no warnings to lay in stockpiles of food, or medicines. If the government did so, I never heard it mentioned publicly. Swine flu was considered to be a killer of the elderly, and perhaps children, but with a vaccine, those problems would be minimal. Hospitals, and the EMS, it was assumed, would be busy, but the rest of society would go on more or less normally.

We learned some bitter lessons in 1976, and discovered that despite our advanced knowledge and a national commitment, that we weren’t as ready for a pandemic as we believed.

First, it took longer than expected to produce a vaccine. There were delays, and so it was October before we began the inoculation program.

Second, the task of immunizing 220 million Americans was far tougher than our officials believed. In the beginning too many people showed up for their shots, resulting in long lines and extensive delays, and many were turned away. Then we started getting news reports of possible adverse reactions to the vaccine. A handful of vaccine recipients died, although it isn’t clear to this day if the vaccine contributed to their deaths. The newspapers had a field day, with breathless reporting of the side effects, and the number of people willing to get the vaccine dropped.

President Gerald Ford, who was running for re-election that year, rolled up his sleeve on national TV and took the shot, just to prove it was safe. But the nation was unconvinced. In the end, we only managed to vaccinate 40 million Americans during the 10-week vaccination drive. By the end of November, people were more afraid of a flawed vaccine than they were the flu.

Swine flu, of course, never reappeared. No one really knows why. It reared its ugly head in one locality, and then vanished.

Today, we face a far different threat.

Bird flu has been detected in at least 55 countries, and unlike Swine flu, the H5N1 virus is a novel virus, one that humans have little or no immunity to. Thus far, it has killed roughly 60% of those people who have contracted it. Avian flu, should it go pandemic, would likely be many times deadlier than anything we expected from the Swine flu.

We now know far more about the Spanish Flu of 1918, and our national consciousness has been raised by John Barry’s book on the Great Influenza. With multiple news sources available today and the Internet, people are better informed.

We also know that vaccines are not nearly as effective as we believed in 1976, and now recognize the difficulties involved in inoculating a nation. We recognize we no longer have the manufacturing capacity in this country to produce vaccines that we had 30 years ago. The lawsuits over the Swine flu vaccine, along with the low prices our government is willing to pay for vaccine, drove most of our vaccine producers to other countries over the past 3 decades. Should we need 300 million doses of vaccine today, we will have to go to offshore manufacturers, and will have to stand in line with the rest of the world.

And of course, or technology of today has streamlined our supply chain, which has produced great savings, but at the same time has introduced a fragility to our system. Stores no longer maintain stockrooms; we have sold off our national food reserves, and have dismantled our civil defense system. We are far too dependent upon manufactured goods from other nations, including most of our medicines and vaccines.

In short, we had a far more durable system in 1976, and believed (perhaps foolishly) that we could withstand a pandemic without the need for personal or governmental prepping. We believed that the vaccine was going to save us, and had misplaced faith in our ability to create a safe and effective vaccine and quickly inoculate a nation.

While Swine flu very likely would never have produced a pandemic on the scale of the 1918 Spanish Flu, we got very lucky when it disappeared. The vaccine basket, into which we’d placed all of our eggs, turned out to have a big hole in it. Without a vaccine, Swine flu would have likely claimed hundreds of thousands of lives.

Today, the H5N1 virus could kill millions in the United States, and tens of millions around the world, and so the disruptions we might expect in food deliveries and essential services would be greatly magnified. It therefore makes sense to prepare today, when in 1976, no one thought to.

Admittedly, a long answer to a short question.

But sometimes, you have to put things into historical perspective.