The Shape Of Things To Come?

#245


Today, a surprisingly frank report on what public health officials could, and could not do to mitigate an avian flu pandemic, appeared in the British press. Titled: Bird flu could infect 26 million, it paints a less than rosy picture. While UK-centric, this article is based on research conducted at Harvard, Los Alamos and Manitoba University and was published in the Journal of The Royal Society Interface.


And it’s not what you wanted to hear.


While I may quibble a bit with their numbers, and may not agree with their conclusions, this report may well be a harbinger of a change in how our governments will tackle an outbreak of the H5N1 virus in humans.


The study maintains that countries should not concentrate on medicines like Tamiflu to combat bird flu because there are not enough of these anti-viral drugs, and it would take at least six months to develop a vaccine that would immunize the population.


Both statements are true.


Despite glib assurances to the contrary, our strategic stockpiles of antivirals are insufficient to deal with anything beyond a mild pandemic, and the promise of a vaccine within 6 months is, from all indications, nothing more than `happy talk’ to appease the masses. Limited amounts of vaccine might be available in that time frame, but enough to inoculate the populace of nations like the UK and the US are probably a year or more, after the start of a pandemic, away.


From the article (these numbers are for the UK):

The authors say their model shows that simply by isolating bird flu sufferers and reducing human contact, deaths could substantially be reduced.

While it predicts 933,514 deaths, 26 million infections and 13 million patients over the course of a pandemic, when transmission control methods, such as quarantine and isolation are entered into the equation, the number of predicted deaths slump to 660,215.

The number of people infected would drop to 18 million and the number in hospital would be 9.1 million.


Given that the United States has roughly 5 times the population of the UK, and a comparable society (no offense intended), one could justifiably assume that the numbers here would be 5 times larger. Nearly 5 million deaths, and 130 million infected.


The article references between 9.1 and 13 million patients hospitalized, but ignores the fact that there are nowhere near enough hospital beds available to accommodate them. According to the Department of Health Official Statistics, the NHS (National Health Service) reports that the UK, as of 2004, has roughly 211,000 hospital beds. Most of these are occupied.


This correlates with the United States, with 5 times the population, having roughly 1 million beds. Again, most of which are occupied at any given time.


And the problem isn’t simply the lack of beds. Beds do absolutely no good unless you have nurses, technicians, housekeeping staff, kitchen facilities, and personal protective equipment to go along with them.


How anyone expects the hospital systems of the US or the UK to absorb millions of extra patients, most of whom are highly infectious, is a bit of a mystery. Subtract the 40% of staff expected to be out sick with the flu (an optimistic number), and the ability for the health care system to cope drops even more.


At some point, even government officials are going to have to accept the math.


The article references isolation and quarantine as being viable options for reducing the impact of a pandemic. But once again, speaks only in general terms about them. Exactly what they mean by these measures, and how they would be enforced, is left to the imagination.


Isolation of infected patients is a great idea. It limits the spread of the disease. But can it realistically be done? Just exactly where do they propose to put 130 million Americans or 26 million Brits?


Obviously, it wont be in hospitals. There has been talk of commandeering public venues, such as shopping malls, high schools, and auditoriums for use as flu centers, but these must be manned and supplied, and so far I’ve seen no indication that either country is adequately prepared to take on that sort of project.


Just so we are all on the same page, this from the CDC website:

What is the difference between isolation and quarantine?

Isolation refers to the separation of persons who have a specific infectious illness from those who are healthy and the restriction of their movement to stop the spread of that illness. Quarantine refers to the separation and restriction of movement of persons who, while not yet ill, have been exposed to an infectious agent and therefore may become infectious. Both isolation and quarantine are public health strategies that have proven effective in stopping the spread of infectious diseases.


Given the numbers, the only practical solution is to isolate infected patients in their homes. A lucky few might get a hospital bed, but the vast majority will never even see a doctor. Any care they receive will be from their family. This is not an admission that most government officials are ready to announce publicly yet, but it is the bottom line.


As far as quarantine goes, it could be assumed that if there is an infected patient in the household, all family members might be quarantined as well. With the incubation period for this virus as yet unknown (but assumed to be 3-14 days), and the length of infectivity of a patient running at least 8 to 10 days, a household could be conceivably be quarantined for weeks.


Suddenly having only a two-week supply of food and water in the house, as recommended by the US government, starts to sound a bit inadequate.


But quarantine would almost certainly have to be voluntary. The government certainly won’t be in a position to place a guard at every home, and the likelihood that a voluntary quarantine will be well observed is slim. The only other option would be to try to institute neighborhood quarantines, and that too, is doomed to failure.


While I appreciate the candor that this report delivers regarding the limits of our antiviral and vaccine solutions for a pandemic, their reliance upon fanciful scenarios of having enough hospital beds for millions of flu victims, a way to isolate the infected, and a way to quarantine the exposed does little to assuage my concerns.


At some point, hopefully before a pandemic strikes, authorities need to level with the populace about what they can expect during a pandemic. And the populace needs to make preparations to deal with the rigors of a pandemic, mostly on their own.

Governments are loath to admit when they don’t have the answer.


But sometimes, there are no answers.


No good ones, anyway.