# 510
A moderately severe pandemic would require that incredibly difficult decisions be made regarding who gets treatment, and who doesn't. Despite our National Strategic Stockpiles of antivirals, the beginnings of a vaccine supply, and attempts to increase the number of ventilators, our resources are incredibly small compared to the anticipated tidal wave of patients.
Medical ethicists are pondering the problem, and in some states, they are asking the public for input. As of now, there are no firm guidelines, and there may well never be. It appears that each state may have to decide for themselves how to deal with this problem.
Today, an article appeared in the South Carolina media, addressing these concerns.
Flu pandemic would create ethical dilemmas
By CZERNE M. REID
czreid@thestate.com
To prepare for a possible flu pandemic, South Carolina is buying enough medicine for a quarter of its 4.3 million citizens.
But more than a quarter of the population could get sick in just the first wave of a pandemic.
So who should get first shot at the limited medicine supply? The sickest people? The ones most likely to recover? Doctors? Teachers? Public safety officers?
The answers to that and other ethics questions could decide who lives and who dies during a pandemic.
“The greater the risk, the more that is at stake, the more there is concern for ethical issues,” said Alexander Capron, a health policy and ethics expert who will speak Wednesday at USC Law School.
“When things are matters of life and death, questions about fairness and about avoiding undue imposition on people become much more crucial.”
Capron’s talk, titled “Ethical Challenges in Preparing for a Pandemic” is part of the school’s annual Johnson & Johnson Healthcare Lecture series.
The entire article is worth reading.
The math, which is glossed over in this article, is disheartening. There are slightly less than 1 million hospital beds in the United States, 90% of which are occupied at anytime, leaving perhaps 100,000 available.
Officials expect as many as 10 million might require hospitalization in the first pandemic wave. Obviously, millions who need hospital care won't receive it. They will have to stay home, and pray.
The supply of antivirals in the Strategic stockpile is completely inadequate, with less than enough on hand to treat 10% of the nation, and so far, there are only vague ideas about how to distribute them to people sick in their homes.
In the UK, they are promoting a `bird flu buddy' system, where everyone selects someone to fetch antivirals for them from a dispensary if they become infected. It's a good idea, even if it is only partially effective. There is some talk of home deliveries of medicines, much like ordering a pizza, but concerns are high that delivery persons would be targeted for their cargo.
During a pandemic, Tamiflu, Relenza, and even Amantadine would be more valuable than gold, and security concerns are justified.
Those who are hospitalized, according to federal guidelines, will receive the first priority for medications and treatment. The assumption here is, the sickest of the sick will be in hospitals. Of course, that assumption falls apart quickly once a pandemic hits, as hospitals will have to turn away desperately ill people.
This is, of course, a political hot potato, but it needs to be addressed.
Doctors need to know how to proceed, how to prioritize patients, and also need to know they will be protected from liability when they follow the rules.
And people need to understand that there are limited resources, and that not everyone will have access to them.
