(This is the first of a 3-part series on home care during a pandemic. Today, in parts 1 & 2, I'll present the challenges. Tomorrow, in part 3, I'll present a possible solution to at least some of the problems.)
# 1671
The word, whispered sotto voce in the medical community, is that if a flu pandemic comes, most people will have to be cared for in their homes . . . not in hospitals.
No one is particularly happy about this concept, but the numbers preclude any other solution. Our hospitals have very limited surge capacities in normal times.
In a pandemic, they would be overwhelmed.
Hospitals, and ad hoc flu clinics could in no way begin to care for the anticipated influx of millions of simultaneous avian flu victims. While vague references to the `sickest of the sick’ being admitted to hospitals have been made, it isn’t clear whether even that would be possible.
Much will depend on the level of morbidity and mortality of the next pandemic. If we see a mild virus, such as we saw in 1957 or 1968, then our medical systems, while overburdened, could probably cope.
A 1918 style virus, one that killed 1-in-40 American's who contracted it, would simply overwhelm the system. And a completely novel virus, such as the H5N1 bird flu virus, has the potential to be even more devastating.
Currently, the avian flu virus claims 6 out of 10 lives of those known to be infected, and that is with hospital care. The hope is this number will drop if the H5N1 virus goes pandemic, but there are no guarantees that it will.
The base assumption is that a pandemic would have an attack rate of roughly 30%. That is; 30% of the country, and of the world, would contract the virus. There are many who question that number, feeling that it is low. I tend to agree, but for the sake of uniformity, we’ll use that number.
In the United States that means that 90 million people could be stricken. In the UK, 20 million. And worldwide, 2 billion people would be hit by the virus. If the recent UK estimates which project up to a 50% attack rate are correct, the numbers afflicted would reach 150 million in the US alone.
Now, not everyone will be sickened at exactly the same time. There will be a run up to the peak number of infections, and then a tapering off. There may be several waves, as we saw in 1918. But it is probably safe to assume that at its worst; between 5% and 10% of the worlds population may be sick simultaneously.
So, let’s adjust our numbers. In the US, that means between 15 and 30 million sick at one time, in the UK, between 3 and 6 million. Worldwide, between 300 and 600 million.
In the United States we have but 1 million hospital beds, of which 90% are occupied at any given time. In the UK, just under 200,000 beds, with a similar occupancy rate.
Even if it were possible to discharge all non-flu patients (and it isn’t), there would still be between 15 and 30 patients vying for each bed.
Adding to the problem will be the loss of hospital workers due to the virus, with an expected absenteeism rate of up to 40%. Again, possibly a low estimate.
If 5% of flu victims see the inside of a hospital, it would be a miracle. In fact, that's the percentage of afflicted patients most governments are planning to see hospitalized.
Ad hoc flu clinics, set up in converted auditoriums and high schools could take up some of the slack, but are unlikely to make much of a dent. These facilities would need personnel and provisions, both of which will be in short supply.
The bottom line is, if you or a family member contracts pandemic flu, you will probably have to ride out the illness at home, under the care of your immediate family. Given the numbers, there really isn’t much choice.
How those who are homeless, or who have no family to care for them will fare, has not been adequately addressed.
In the United States, there are at least 27 million people who live alone. Millions more are single parents caring for small children, and millions more are couples where one person is the caregiver, and the other unable to reciprocate. These people are particularly at risk during a pandemic.
While we tend to concentrate on a `super-flu', one that has a high mortality rate, even a moderately severe flu can be life threatening, particularly to those who have no one to care for them.
Patients can experience days of fever, delirium, vomiting, diarrhea . . . and all of these things can contribute to a potentially fatal dehydration. Flu patients need tending. They need someone to give them fever reducing medicines, to bring them water (or better yet, ORS), and someone to monitor their condition.
Even a moderate flu can be deadly to someone left unattended.
And for millions of single parents, the thought of being incapacitated and unable to care for their infants or small children is terrifying. And of course, entire households could be affected by the flu, leaving no one well enough to be the caretaker.
All of this is covered in most State and Federal pandemic plans with the simple statement, "Most flu victims will have to be cared for at home by their families".
While this may sound callous, it is simply an acceptance that there will be no other choice. It doesn't, however, quantify the magnitude of the problem.
It simply shifts the burden to others.
While all of this may sound bleak, we aren't helpless during a pandemic. But we do need to know our enemy (the virus), and find ways to defeat it.
The Challenge then is to find ways to make it possible for people to be cared for in their homes. A failure to do that could cost hundreds of thousands of lives in a pandemic.
While the government and the Health Care system will do what they can in a pandemic, ultimately, we will have to look to ourselves for many of these solutions.
In Part II (later today) I'll explore what is required to treat a flu victim at home, including infection control, and in Part III (tomorrow) I'll propose a possible solution to at least some of the problems.
