Update [2008-2-10 13:32:53 by DemFromCT]:: A reader reminded me via email that Maryn McKenna wrote an excellent article in 2006 outlining the emergency departments and their ability to cope. See Anatomy of a pandemic: Emergency departments woefully unprepared for bird flu outbreak. I am neither the first nor the last to cover this area.
Problems like pandemics, surge capacity and disaster preparation do not go away by ignoring them. Hopefully, by putting some of these issues in perspective, we can better appreciate the time, dollars and energy spent on mitigating that which cannot be stopped. At the same time, we can appreciate the efforts being made by your public health people which, if invisible, are still none the less remarkable. And finally, we can appreciate how strained the current health system is... it would not take much these days to push things over the edge, despite the remarkable resilience the health system has shown.
The Washington Post had an interesting story last week about the challenges hospitals face in preparing for the next flu pandemic:
The federal government's voluminous plans for dealing with pandemic flu do not adequately account for the overwhelming strain an outbreak would place on hospitals and public health systems trying to cope with millions of seriously ill Americans, some public health experts and local health officials say.
The Bush administration's plans, which run more than 1,000 pages, contemplate the nightmare medical scenarios that many experts fear, but critics say federal officials have left too much of the responsibility and the cost of preparing to a health-care system that even in normal times is stretched to the breaking point and leaves millions of people without adequate access to care.
"The amount going into actually being prepared at a community level is not enough," said Patrick Libbey, executive director of the National Association of County and City Health Officials. "We are still talking about rearranging with little additional resources the assets of a system that are built on such a thin margin now that you have significant amounts of people without access to care, and hospitals that are periodically shutting down their ERs and the like."
These concerns aren't just reflected in news stories quoting public health officials. At a recent emergency management conference I attended, I heard the same concerns expressed by hospital representatives from all over the country. There's a reason for this... despite the great work by creative people trying to figure out how best to cope, there's just not enough of the three components that make up what's called surge capacity, the ability to flex up hospital care quickly to meet the needs of the population it serves (.pdf link). Those components can be thought of as "staff" (nurses and other health care workers and caregivers, "stuff" (from intravenous medicines to bedsheets to actual beds) and "space" (everything needs to be housed somewhere). California alone is spending hundreds of millions of dollars on this (good that they are), and given the efforts on the one hand and the concerns on the other, it's worth spending a Sunday essay reviewing what the big deal is. It's your tax dollars, and (for one disaster or another), your community (click this link).
Dr Eric Toner (from the University of Pittsburgh Medical Center's Center for Biosecurity) has been working on these issues for some years. Two of his slides illustrate the problem that an influenza pandemic would cause. In the first, the total US hospital beds availability is presented, and contrasted with what would be needed for both a
mild moderate (similar to the 1968 pandemic) and a severe (based on 1918) pandemic. SNS is the strategic national stockpile, set aside for grave emergencies and under the control of HHS and DHS.
Using FluSurge 2.0 and inputting variables from the HHS planning assumptions results in projections that indicate that hospitals would be severely stressed in the best case scenario and completely overwhelmed in the case of a severe pandemic
What Hospitals Should Do to Prepare for an Influenza Pandemic
Eric Toner and Richard Waldhorn
The ability to flex up in something this large is severely limited, which is why the emphasis has to be on home care rather than hospital care, wherever possible (something the Feds have been slow to explain and teach).
And are these scenarios plausible and actionable? Yes, according to David Nabarro (Assistant Secretary-General and UN System Senior Coordinator for Avian and Human Influenza, United Nations). Presenting the keynote at the same conference, Nabarro illustrates the concern.
This first slide by Nabarro by Nabarro shows a time line for the pandemics from the last 150 years.
The open-ended bottom shows that the next pandemic is not predictable, but expected by every international health expert who follows the topic. The second slide describes the various scenarios by which a pandemic might play out.
Note that we are currently experiencing Scenario 1, which a glance at both the weekly summaries of H5N1 bird and human cases collected at Flu Wiki and at the human H5N1 cases in Indonesia will illustrate:
So, since we are in the inter-pandemic phase now, your hospitals and communities are struggling to prepare as best they can (back to the WaPo article):
Given that that's the case, revisiting home preparedness is well worth the effort. And, to make it easier and doable, let me introduce you to a new non-profit web site (hosted by Nez Perce county, Idaho) that spells out the hows and whys (people who highlight problems ought to try and come up with practical solutions!):
In the end, understanding our health system (such as it is) a little better should help folks put in perspective why health reform at every level is such a pressing need. Whereas medical care is almost always in the news, public health is often left out (well, not here, at least). And do note that strengthening the public health infrastructure to help cope with surge (as for a pandemic) helps no matter which natural disaster comes next (hurricanes, floods, etc).
Natural disasters happen, and planning for them at the individual and family level only makes sense. Hospitals can only do so much, and depending on someone else to do 'everything', be it state or federal authorities, has been a mistake in the past. There's no reason to think that will change either in the future or anytime soon. Community efforts to improve the situation for hospitals (see CA) will work best if coupled with non-hospital community efforts to build in resilience. Planning in advance is never wasted time. Sooner or later, stuff happens.