Sunday, April 15, 2007

Home Alone

# 667

It is not a new message, but it is worth repeating. In a pandemic, you need to be prepared to care for yourself, or loved ones, in your home.

Ninety percent of Flu victims will never see the inside of a hospital.

If you think that is an exaggeration, and that health authorities will somehow magically squeeze all critically ill patients into a hospital, think again.

This graphic is from the State of Florida Pandemic plan

Admitting 640,000 patients into Florida hospitals would be a monumental task. No one really knows if that could be done. The State has roughly 3 hospital beds for every 1000 residents. That's about 50,000 beds. And most of the time, 90% are occupied.

The hope is that the impact of a pandemic can be reduced through the use of NPI's (Non Pharmaceutical Interventions) and spread across many months, thus reducing the impact on a daily or weekly basis.

Still, with only 50,000 beds, trying to get even 10% of flu victims treated in hospitals would be a major feat.

As for the other 90%? They will have to stay home, and hope someone can care for them.

Complicating matters, nearly 1.7 million Floridians live alone.

This chart is from the 2000 Florida Census. The numbers vary from state to state, with the District of Columbia having the highest percentage of Live-alone's and Utah having the lowest, but Florida is fairly representative of the nation.

(click on image for larger view)

Nationwide, 27 million Americans live alone. On the island of Manhattan, more than 350,000 people live alone. During a pandemic, these people will be particularly at risk.

Statistically speaking, if the attack rate of the virus is 35%, then nearly 10 million Americans will have no one living with them to care for them when they fall ill. In Florida alone, we'd have 600,000 singles on their own.

Of course, living with someone is no guarantee that you will have someone to care for you. Entire households could be stricken by the virus at the same time, and some people may be living with someone who would be physically incapable of rendering assistance.

As bad as all of this sounds, it only grows worse when you add in the millions of single parents living with infants and small children. Not only are they at similar risk, their children are as well.

The point of this little mental exercise is that people need to be thinking about how they will cope during a pandemic, particularly those who live alone or with small children. Pandemic influenza isn't just a `bad flu', it can render a victim incapable of caring for themselves in a matter of hours, and they could remain that way for more than a week.

While everyone needs to be preparing to care for flu victims at home in a pandemic, those who live alone, or know someone who lives alone, need to be thinking about how they will cope with this situation.

Having a pre-prepared `Flu Box' under the bed, filled with medicines and hydration supplies, is an important first step. Having a telephone next to the bed, is also an important consideration. Singles should make arrangements with neighbors or friends who can check in on them, and who can call for assistance if needed.

While details have not been announced, the government has plans to distribute its limited supply of antivirals during a pandemic. Those who live alone are at a greater risk of not receiving these vital medications simply because there will be no one to call for help, or go fetch them.

Even a moderately bad case of the flu can be deadly if a patient doesn't stay hydrated. Patients weakened by vomiting, diarrhea, and fever may be unable to care for themselves, and could die for lack of simple home care. And of course, small children in a single-parent household could be at tremendous risk, not only from the virus, but from starvation or lack of supervision.

During the 1918 Spanish Flu, many people died because their neighbors were afraid to approach an infected home. Neighbors abandoned neighbors, and friends abandoned friends, out of fear of contagion. That could happen again should a pandemic erupt.

Risking exposure to care for a friend or a neighbor is not a decision that can be taken lightly. There are genuine risks involved. Many caregivers in 1918 contracted the Spanish flu and died. It may prove difficult finding people willing to take that risk during the next pandemic.

Still, we either solve this problem, or we accept that many millions of Americans will be at tremendous risk of dying unnecessarily in the next pandemic.