# 2436
In a severe pandemic, such as we saw in 1918, society will be presented with a large number of very difficult problems. And while governments around the world will do what they can to help their populations cope, in the final analysis, it may come down to what people are willing to do help one another that will make the biggest difference.
When we think about a pandemic, we think first of sickness, and then probably death. In the developed world, these are things we rarely experience in our own homes anymore. We send our sick and dying, whenever possible, to hospitals. They are tended by professionals.
When people die, particularly from an illness, they often do so out of the sight of their families. We have, to a large degree, insulated ourselves against these unpleasantries.
During a severe pandemic, that probably won't be possible.
The pandemic plans of most nations envision that less than 5% of those sickened will be treated in a hospital. Some additional number might be cared for in community ad hoc flu clinics, but those plans are pretty vague, and dependent upon having the staff and supplies available to run them.
The bulk of the pandemic care burden must, by necessity, be borne at home. And that poses some very difficult problems.
Caring for someone with severe influenza, or pneumonia, is a stressful, labor intensive, and quite frankly, risky job. To do it safely and effectively requires some level of skill, supplies, and endurance.
While one might assume that it should be up to each individual family to care for their own, that ignores many of the realities of a pandemic in today's society.
- First, just here in the United States, 27 million people live alone.
- Millions more are single adults caring for small children or sometimes for elderly parents. If they fall ill during a pandemic, they would have no one to care for them or for the people they are caring for.
- With a short incubation period, and a prolonged illness, it is possible that entire families could be sickened, more-or-less simultaneously, leaving no one well enough to be the caregiver.
- Multi-generational, or extended families, under the same roof were common during the last great pandemic, but no longer. Today, elderly parents are likely to live on their own, away from family.
There are many unanswered questions about how much exposure, or viral load, a person must have before they can become infected. And while it is true that a person can shed an influenza virus before showing signs of illness, that doesn't automatically mean they have infected other members of the household.
During a pandemic, therefore, once someone shows signs of illness, they need to be isolated (as much as possible) from those who are healthy.
The problems, as you can see, are many and varied.
- How do you isolate the sick to prevent them from passing the virus to the rest of a household?
- How do people who live alone care for themselves if sickened?
- How does a healthy adult provide round-the-clock care for days on end for one or more family members?
- What happens if the caregiver falls ill?
- Who cares for the children, or elderly parents, of someone who is ill?
- How do we maximize limited resources like N95 masks, bleach or disinfectant, and most importantly willing caregivers?
While daunting, these problems are solvable.
But they require thinking beyond the four walls of your house, and requires the inclusion of your friends and neighbors (at least temporarily) into your extended `family'.
And it requires getting past the fear.
The fear of infection, the fear of your neighbors, or of involving yourself in their problems.
It is simply inefficient, impractical, and potentially dangerous for families to try to deal individually with pandemic illness. The reason we have hospitals to begin with is for these very reasons.
Obviously, if you can obtain qualified medical care for you or your loved ones, you should do so.
But assuming that hospital care is unavailable during a pandemic, the next best solution may be to set up ad hoc flu centers in your neighborhood.
Yes, I know. It sounds like a terrible solution. Complicated and messy. But from a resource allocation perspective, it may be the best one available to us in a pandemic crisis.
The math is pretty simple.
Three caregivers, from three different families all living on the same block, can care for three sick individuals round-the-clock if they never sleep, never rest, and never do anything else.
Of course, they will probably collapse in less than 48 hours.
OR . . . if you move all three sick individuals into one home, those same three caregivers can each work an 8 hour shift each day, caring for three people at once.
You may be wondering: Why would anyone willingly expose themselves to three infectious patients instead of one?
Sharing the work load would, believe it or not, cut their own risk of infection, while at the same time, reduce the risks to the rest of the neighborhood.
Fatigue breeds mistakes, and lapses in infection control measures. And fatigue also lowers the immune system, which opens the caregiver up to a better chance of getting sick.
Let's face it, being exposed 8 hours a day to three patients beats the heck out of being exposed 24 hours a day to one.
The benefits go deeper still when you consider that by moving the ill to one home you limit the exposure of family members to the illness. Fewer people exposed means fewer people to spread the virus.
Everybody wins.
You also cut down on the amount of disinfecting that must be done (one home vs three).
You even cut down on the number of masks and gloves that will be consumed by caregivers. Instead of 3 people `burning' through PPE's 24 hours a day, you just have `one'.
If a visiting doctor, or a nurse, or an EMT is available, even part time, then they only have to visit one site to see multiple patients.
And you may be able to rely on someone more dispassionate than you to care for a loved one during a medical crisis. This is a benefit that should not be underestimated, particularly in a high CFR pandemic.
For it to work, you and your neighbors will have to work in concert. You will have to accept the idea that, by working together, you all have a better chance of getting through a crisis.
And that means; everyone contributes.
Meals for patients and caregivers could be cooked offsite and delivered.
Laundry could be done by volunteers in adjacent homes. Other volunteers could help bring in needed supplies. Not everyone would have to deal directly with infected patients, but it would have to be a community effort.
Some families may need to welcome uninfected children into their homes while their parents are being cared for. During the 1918 pandemic, tens of thousands of children were orphaned due to the virus.
As patients recover, and presumably have immunity to the virus, those that are capable should step into the caregiver role.
No one should be stuck as a perpetual caregiver.
Obviously, a suitable location would be needed. And that would likely require someone giving up their home for the duration (or remaining on site to assist). It is possible that arrangements could be made to use a vacant house or apartment, or detached garage - but in any event, you will need to find a suitable place where flu patients can be sequestered and cared for.
The government isn't going to come into your neighborhood and mandate this solution. I'm not even sure they would be happy with my suggestion.
If you want it to happen in your neighborhood, you will have to make it happen.
While seemingly ambitious, this idea would work in a lot of places. It eliminates many of the difficulties of the home care option that we will be saddled with.
But, in order to work, it would require planning and cooperation between neighbors. It would also require a commitment from the entire neighborhood: a sharing of the risk, and of the work.
It is a win-win solution from practically every standpoint.
Except one - it would require neighbors to actually work together, look out for one another, and share burdens during a pandemic.
Perhaps that comes in the form of an ad hoc neighborhood flu center, or maybe it manifests itself in other ways - such as a neighborhood watch that checks on everyone each day - or a volunteer day-care arrangement for essential worker's children.
During a pandemic there would be no shortage of local needs.
To be successful, It would require - most of all - a triumph of our humanity over our fears.
An acceptance that sometimes during a crisis you have to take reasonable and measured risks for the good of your your family, your community, and your country.
That there are some things more important than just `me'.
It is an old fashioned concept. One that, admittedly, seems to have fallen out of favor. But it is one we need to revive if we are to get through a pandemic.
I've often wondered if the next pandemic won't be looked upon by future historians as some kind of global intelligence test.
To see if we were smart enough to put aside our differences, and our fears, long enough to work together in order to survive.
I'm hoping they will note that we were.
