crossposted to
The Next Hurrah
Since Flu Wiki is still down (server change taking time), here's a couple of bird flu articles to chew over. The first is from Bloomberg, highlighting the fragility of our modern health care system, a point repeatedly made on this blog.
Bird-Flu Pandemic, Even Mild One, Will Overwhelm U.S. Hospitals
In 1957, the University of North Carolina turned a dormitory into a hospital for dozens of students stricken by an Asian flu circling the globe. Eleven years later, Nashville medical centers filled beyond capacity when another worldwide epidemic hit.
The famous 1918 Spanish flu that killed 50 million people isn't the only pandemic that caused a global health crisis during the past century. Two other pandemics, though much milder than the more well-known one, also strained nations' health-care systems, researchers say. The Asian flu killed at least 2 million in 1957, and about 700,000 died during the Hong Kong flu in 1968.
If the current wave of bird flu turns into a human infection that is only as widespread and deadly as the one in 1968, the American health-care system will be severely tested, said Nancy Cox, head of the Centers for Disease Control and Prevention's influenza branch in Atlanta. ``Emergency rooms would be overflowing, doctors offices would be overflowing and hospital beds would be overflowing,'' she said March 20.
An outbreak roughly equivalent to the Hong Kong flu might kill only about 209,000 worldwide as a result of new medicines and improved care, U.S. health officials estimate. Yet, a bird- flu pandemic similar to the one that hit almost 40 years ago is almost certain to be catastrophic, perhaps sickening one in three Americans and over-burdening the nation's 4,000 hospitals, 20 percent fewer than in 1968, health officials predict.
U.S. hospitals are ``simply not set up to accommodate'' illness rates of up to 35 percent, levels seen in past pandemics, CDC's Cox said. Even in the most-severe seasonal flu outbreaks, illness rates top out at 15 percent of the population, said William Schaffner, an infectious-disease specialist at Vanderbilt University School of Medicine in Nashville.
Meanwhile in the BMJ, an argument is made for ignoring the above. After all, we're just a bunch of ignorant louts that can't tell bird flu from pandemic flu.
Summary points
The perceived threat of a hypothetical pandemic of avian flu among humans fuels fear
Avian flu, winter flu, pandemic flu, and Spanish flu are often confused and mixed up
Stockpiling antiviral drugs lacks an evidence base and is costly
The energy unleashed by the fear of a pandemic should be directed at tackling real health problems
There's much to be argued for in the author's conclusion:
Panic in epidemics is a part of the human condition.19 The increase in health scares may reflect the absence of real attacks, making us over-react to hypothetical dangers. We should use panic, with good reason or not, to tackle the larger agenda of preventable and curable disease in the world, starting with low vaccination rates in winter flu. International health policy should stay cool and not be distracted by the latest health scare and its industry sponsored quick fix. The humanist road leading to adequate healthcare services for all citizens of the world is still long.
Yet the idea that you should not pay attention to A because I care about B is a fallacy of logic we are well familiar with political blogs. "How dare you attack Bush when you should be supporting our troops!" is but one common example. The truth is that we should be building our public health infrastructure, including a medical safety net and surge capacity (see the Bloomberg article) regardless of what happens to H5N1. And while I agree that building "adequate healthcare services for all citizens of the world" is a laudable goal, waiting until that happens before fixing the problems here in the States (again, see the Bloomberg article) is a recipe for disaster.
By the way, there may be more opinion in that BMJ issue... there are several stories on bird flu, but this one is available to non-subscribers. In any case, back to Bloomberg:
Emergency care in the U.S. is ``like a house of cards,'' he said, ``waiting for a big wind to collapse it.''
Visits to U.S. hospital emergency rooms rose 26 percent to 114 million in the 10 years ending in 2003 as the population increased, Bern said. During the same period the number of emergency rooms fell 14 percent due to cost-cutting by medical centers, said David Seaberg, a director with the Physicians' College, in Feb. 8 testimony before the House Committee on Homeland Security.
Until problems like health care access and surge capacity are addressed (and this WH ain't doing it), we remain woefully unprepared for whatever comes next, when ever it is. And note that, unlike the BMJ summary points, when an educated and sophisticated population start worrying, the equation changes considerably. That's not panic and fear; it's prudent policy consideration. The fear should be that we will do nothing to address the issues. That's a fear grounded in reality.