Tuesday, May 04, 2010

Pandemics And The `Worried Well’




# 4546



Most people are highly suggestible. 


If you don’t believe that, then just let one person in a group start to yawn and see what happens with the others.   

And when the media starts talking ominously about the symptoms of a new, dreaded disease – like pandemic influenza – it isn’t unusual for people to start running through a mental check list several times a day, to see if they (or a child in their care) might be infected.


In fact, it is the most natural reaction in the world.


Nor is it necessarily a bad thing, since it is important not to expose others if you believe you might be infected.  


But if it results in unneeded panicky trips to your already overburdened Emergency Department, it can cause real problems.


Back in the 1970′s we used to see a phenomenon called the Marcus Welby Syndrome’.


For those that don’t remember, the 1970′s was a time when medical TV shows filled the airwaves. Medical Center, Emergency, and Marcus Welby, to name a few.


So strong was the power of suggestion that each week, we’d see patients come into the ER convinced they had whatever the `disease of the week’ on Marcus Welby was. 

Even when it was something rare – like Hansen’s Disease (Leprosy).


Frankly, the last place I would want to go during a pandemic outbreak is my local emergency room.  If I wasn’t infected when I got there, I’d have a pretty good shot of being exposed while I waited.


Of course, if its a true emergency, you do what you have to do


And in fact, I ended up in my local emergency room over Memorial Day weekend last year for a non-flu related medical emergency.


The problem comes when people who are either not sick, or who are only mildly ill and could easily care for themselves or their children at home, show up and clog emergency rooms.   


The so-called, `worried well’. 


And according to a presentation made at this week’s Paediatric Academic Societies (PAS) annual meeting in Vancouver, British Columbia, Canada – that’s exactly what happened in the lead up to the pandemic of 2009. 


Even before the flu had arrived in their community, worried parents were taking their kids to hospital emergency rooms in increasing numbers.


Here is the press release, followed by a link to the Abstract.



American Academy of Pediatrics

Fear of pandemic influenza clogs EDs even when disease is not present

Author of new study calls for responsible media coverage of public health emergencies

VANCOUVER, BRITISH COLUMBIA – A study of emergency department (ED) activity before and during the H1N1 influenza pandemic highlights the role public fear can play in unnecessarily straining medical facilities and will aid in ongoing preparations for public health emergencies, according to the authors.


When EDs experience surges in patient volumes and become overcrowded during a pandemic, the quality and timeliness of medical care suffers, noted William M. McDonnell, MD, JD, who will present study findings Tuesday, May 4 at the Pediatric Academic Societies (PAS) annual meeting in Vancouver, British Columbia, Canada.


To determine how public fear over H1N1 influenza and presence of the disease in the community affected use of a pediatric ED, Dr. McDonnell and his colleagues compared usage rates during three one-week periods. Fear week was a period of heightened public concern before the disease was present in the community. Flu week was a period of active pandemic disease. Control week was a period prior to the onset of concern.


Results showed that parents brought their children to the ED in increased numbers during fear week. Compared to the control week, the number of patients was up by 16.3 percent, and children ages 1-4 years comprised 54 percent of the increase.


When H1N1 later arrived in the community (flu week), the ED saw a second surge in patient volumes. The number of patients increased 22.4 percent compared to the control week, and children ages 5-18 years accounted for 91.7 percent of the increase.


"Our study shows that public fear of disease, even when actual disease is not present, can bring about the problems of emergency department overcrowding," said Dr. McDonnell, assistant professor of pediatrics in the Division of Pediatric Emergency Medicine and adjunct professor of law at S.J. Quinney College of Law, University of Utah. "As we continue developing our public health emergency planning programs, we must ensure that responsible news media coverage of public health issues provides the benefits of a free and vigorous press, without unnecessarily harming the public health."



You can read the abstract Here and you can follow news of the PAS meeting on Twitter at http://twitter.com/PedAcadSoc