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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.

Introduction

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.

Discussion

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.

The second slide represents the same numbers looked at in terms of projected demand, and what would be required from hospitals to cope.

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:

Scenarios 2 and 3 are what keep people awake at night. The fact that they have not happened up until now is no guarantee of what the future holds, any more than an absence of a hurricane in your area this year means there won't be one next year (and just as with hurricanes, Toner's slides illustrate that there's no such thing as a 'mild' pandemic).

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!):

Get Pandemic Ready


Conclusion

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.

Originally posted to Daily Kos on Sun Feb 10, 2008 at 05:34 AM PST.

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Comment Preferences

  •  It works! n/t (1+ / 0-)
    Recommended by:
    SaraBeth
  •  I am concerned... (4+ / 0-)
    Recommended by:
    DemFromCT, SaraBeth, Rick Winrod, jlms qkw

    ...that the extended period of warning about pandemic flu will lead to a degree of apathy and a feeling that professionals "cried wolf" over it.  I wonder if the declining investment in preparation reflects that.

  •  A harbinger for preparedness... (11+ / 0-)

    watch hospital Emergency Department's try to cope with a creeping recession (never mind a pandemic) as persons who do have insurance let it go or the decision is made for them. It will make an ugly situation uglier.

    "We can have democracy in this country, or we can have great wealth concentrated in the hands of a few, but we can't have both." - Louis D. Brandeis

    by VA6thDem on Sun Feb 10, 2008 at 05:41:27 AM PST

  •  Republican health care plan: don't get sick (7+ / 0-)

    America needs CheneyCare. If guaranteed, quality health care is good enough for the unelected Vice President, it should be good enough for the people he serves and who pay his salary. (I'm talking about the American people here, not Halliburton.)

    Check out www.cheneycare.org.

  •  Great Diary! Wake up people..... (10+ / 0-)

    we are on our own.  Bushco is trying mightily to close public teaching hospitals. We have a huge hospital, UTMB, here in Galveston, TX.  Time to wake up and smell the roses.....cause just washing our hands is not gonna do it.  Remember the FDA, USDA, CDC, etc. are all understaffed...on purpose?

    Thefatladysings has written about and brought to our attention:

    Bush Tries to Eliminate Public and Teaching Hospitals: Action Needed

    Our hair needs to be on fire big time.  We're living on the edge.

  •  web site for individual prep (13+ / 0-)

    "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

    by Greg Dworkin on Sun Feb 10, 2008 at 05:58:12 AM PST

  •  After working last night... (18+ / 0-)

    ..at an urgent care clinic, let me tell you what a "regular" flu epidemic looks like (reminder - Texas has "widespread" flu, and also harbors a strain that is not covered by this year's vaccine).
     From the time I got to the clinic, the door opened, and there were seventy-five people waiting to see one doctor, one lab worker, and two Medical Assistants and one LVN.  At least ninety percent of these folks had respiratory complaints of one kind or another, and of those 90%, probably 70% ended up with positive Quick Flu tests and walked out with a prescription for Tamiflu.
     Mind you - where I work is "urgent" care - not "emergency" care.  They do see people who have no insurance, but they must pay out of pocket.  They do not accept Medicare or Medicaid.  People who are too ill (oxygen saturation less than 92%, Forced Expiratory numbers less than 200, and the physician's judgement) are directed to the closest ER, or we call an ambulance while we give oxygen or other emergency, temporary treatment).  
     After half an hour, we had to holler for help - and got two more non-physicians, a second laboratory technician, more front desk people, and a Physician's Assistant and another physician.  In eight hours, I personally had seen eighty-two patients, my hands were close to bleeding from being washed so many times, and I'm just hoping that I don't get sick with a resistant flu virus!
     And this is a "regular" flu season.  This is an urgent care clinic that sees only a minor number of relatively non-critically ill patients, and who sees NO elderly patients.  God help us when the pandemic hits.

    In a time of universal deceit, telling the truth becomes a revolutionary act. - George Orwell

    by drchelo on Sun Feb 10, 2008 at 06:16:49 AM PST

    •  bless you and your co-workers (9+ / 0-)

      late flu season these past few years... it hasn't realy hit CT yet, but it will.

      More on tamiflu resistance (H1N1 is developing resistance, H3N2 is not) from CDC.

      Neuraminidase Inhibitor Antiviral Drugs: Small numbers of influenza viruses resistant to the neuraminidase inhibitor oseltamivir have been detected in the United States.  Of the 331 influenza A and B viruses tested for antiviral resistance so far this season, 15 (4.5%) have been found to be resistant to oseltamivir.  Currently all of the resistant viruses are H1N1 viruses, with 15 (8.1%) of all H1N1 viruses exhibiting a genetic mutation that confers oseltamivir resistance.  These resistant viruses have been found sporadically across 4 of the 9 surveillance regions.  All tested viruses retain their sensitivity to zanamavir.  Additional information on antiviral resistance can be found at:
      http://www.cdc.gov/...

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Feb 10, 2008 at 06:24:57 AM PST

      [ Parent ]

    •  as the diarist notes above, (8+ / 0-)

      we must be prepared to provide Home care.

      The last place I plan on going during an outbreak is a hospital, whether for myself or a family member.  It would be pointless, unless you were one of the very first to get there, or unless they were dispensing morphine in the parking lot for terminal cases.

      •  Amen to that! (7+ / 0-)

        ...Folks want SOMETHING done - and when they have a negative flu test, negative strep screen, no evidence of a bacterial infection, and I suggest chicken soup, lots of fluids, Mucinex and Ibuprofen, they practically beg for a "shot" or something.
         We need more grandmothers with common sense, more education about home health care!

        In a time of universal deceit, telling the truth becomes a revolutionary act. - George Orwell

        by drchelo on Sun Feb 10, 2008 at 06:40:29 AM PST

        [ Parent ]

        •  here's something (6+ / 0-)

          "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

          by Greg Dworkin on Sun Feb 10, 2008 at 06:46:17 AM PST

          [ Parent ]

        •  The funny thing is (2+ / 0-)
          Recommended by:
          maybeeso in michigan, mdgarcia

          When Kaiser goes to prescribe antibiotics to anyone in my household, I ask if it's necessary?  They always look at me like I'm the crazy one.

          And then you have the people who whine about taking them and they aren't working and going back to the doctor and I have to say, you know, it's probably a virus and that's why antibiotics won't do a damn thing for you.

          It's out of control really and frightening how many people are still uneducated about this.  And I work with engineers.

        •  Dr. Sidney Maurer (2+ / 0-)
          Recommended by:
          Rick Winrod, Ellinorianne

          was one of the founders of the Nurse Practicioner program, working with Sargeant Shriver. They were setting up neighborhood health care clinics, and like you, they were overwhelmed.

          "We thought, who could see kids? Moms. But they had to have at least three kids, so they had a good cross-section of situations to draw from," explains Dr. Maurer. "Then they went through some training, and it evolved into the Nurse Practitioners we know today."

          drchelo, it seems to me unfortunate that so many people come in for the flu when there's so little you can do for them. I wonder what can be done to give people more ability to know when it's worth coming in and when not. For example, you could even have signs/handouts in the waiting room about the flu, what you can do, what symptoms are alarming and what symptoms are not, and what you're likely to do for the patient.

          I have a useful book from Kaiser Permanente that has a whole set of symptoms and illnesses and what kinds of home care and when it needs medical attention and when it's time to call the ER. What if everyone got a book like this every year, like the phone book?

          Obviously, you still won't reach everyone. And, obviously, we still need more urgent care capacity. I consider myself relatively well informed and I still make mistakes (in both directions) about whether to see a doctor for myself or my child.

          Fry, don't be a hero! It's not covered by our health plan!

          by elfling on Sun Feb 10, 2008 at 09:53:31 AM PST

          [ Parent ]

    •  You guys don't take Medicare/Medicaid? (4+ / 0-)

      That doesn't bode well for Medicare for everyone type plans.

      Although I do think that some way of lowering the barrier to people using urgent care would be a good way to limit the load on ER's.

      •  Reimbursements from Medicare and Medicaid (1+ / 0-)
        Recommended by:
        splashy

        are below actual costs to the providers.  Steady cuts under Bushco have made it impossible for providers.  A fully funded Medicare and Medicaid (also VA) would go a long ways to provide good to excellent care for our most fragile and/or needy citizens.  The ONLY people making money in healthcare these days are big pharma and the insurance industry.

    •  Wow! Just wow! (1+ / 0-)
      Recommended by:
      Ellinorianne
  •  Imagine if we spent $70B on hospital infrastruc. (14+ / 0-)

    Instead of $700B in Iraq. I dare say we'd be in much better shape.

  •  "Right At Your Door" (3+ / 0-)

    Is an indy film that explores the premise of dirty bombs in Los Angeles.  It's a small story about a husband who finally seals his home, although his wife, who had just left for work, has not yet returned.  

    Not entirely successful as a character study, nonetheless it gives a chilling preview of a health system breakdown and government resort to martial solutions in the face of overwhelming disaster.  As "teaching material", it's probably more effective than a thousand articles.

  •  Great Piece (4+ / 0-)

    You may not think so at first, but this post ties in to my belief that the Bush Administration completely missed the point after September 11th.

    What I pictured after that was a reopening of "fallout shelters" around the country. There are public buildings all across the country with fading yellow signs from the 1950's signifying where to go in case of a nuclear attack. After September 11th, it was my belief that the rebirth of civil defense drills should have been the top priority for the country, wih renamed "emergency shelters" identified in every town in America. As an extension of that, in the case of a pandemic, these same shelters could be used for additional hospital bed space, which by your graphics above in a worst-case scenario, we would desperately need. This plan would have been fairly cheap and could have been finalized across the country within 6 months.  

    Instead, we got the Patriot Act, phony orange alerts conspicuously timed with the political problems of the current president and memos about the pressing need for everyone to buy duct tape and plastic.

    Someone should tell "President" Bush that Republicans can also die of the flu.

    "The game's easy, Harry" - Richie Ashburn

    by jpspencer on Sun Feb 10, 2008 at 06:40:27 AM PST

  •  Specifics are critical to success (7+ / 0-)

    Thank you, DemFromCT, for sharing the numbers so that everyone - government, business and individuals can make better plans.

    Too often, I lave seen federal government agencies plan for disasters without adequately researching the specifics of need and available resources, a practice that can lead to an unpleasant surprise at the worst possible time.

    I advise people to mentally walk through their typical day and consider how each of those activities would be affected by the disaster scenario. Government planners need to know how those scenarios would play out for residents in the jurisdiction, with regard to variations such as age, income level, culture, diet and health.

    Speak the truth, but ride a fast horse.

    by Deep Harm on Sun Feb 10, 2008 at 06:48:32 AM PST

    •  hey (6+ / 0-)

      remind me, who actually controls the SNS?

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Feb 10, 2008 at 06:50:58 AM PST

      [ Parent ]

      •  Well, that depends... (4+ / 0-)

        ...on the timeframe and on what you mean by "control." It can be quite complicated, as these excerpts from the CDC website indicate:

        In 1999 Congress charged the Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC) with the establishment of the National Pharmaceutical Stockpile (NPS).

        The Homeland Security Act of 2002 tasked the Department of Homeland Security (DHS) with defining the goals and performance requirements of the SNS Program, as well as managing the actual deployment of assets. Effective on 1 March 2003, the NPS became the Strategic National Stockpile (SNS) Program managed jointly by DHS and HHS. With the signing of the BioShield legislation, the SNS Program was returned to HHS for oversight and guidance.

        HHS will transfer authority for the SNS materiel to the state and local authorities once it arrives at the designated receiving and storage site.

        To receive SNS assets, the affected state’s governor’s office will directly request the deployment of the SNS assets from CDC or HHS. HHS, CDC, and other federal officials will evaluate the situation and determine a prompt course of action.

        The role played by the White House Office of Science and Technology Policy has received little attention.  The OSTP held a series of meetings in 2005 to prepare a strategy for the development and stockpiling of pharmaceuticals.  I was one of those who participated on the "radioactive countermeasures" team.

        A peformance report on SNS is available here at ExpectMore.gov.  Of course, one should take its conclusions with a grain of salt.

        Speak the truth, but ride a fast horse.

        by Deep Harm on Sun Feb 10, 2008 at 07:13:39 AM PST

        [ Parent ]

        •  but it's more HHS (via CDC) than DHS (2+ / 0-)
          Recommended by:
          maybeeso in michigan, jlms qkw

          and then local, once they get it?

          "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

          by Greg Dworkin on Sun Feb 10, 2008 at 07:16:24 AM PST

          [ Parent ]

          •  In theory (2+ / 0-)
            Recommended by:
            DemFromCT, jlms qkw

            HHS appears to control distribution.  But, in practice, the cited "other federal officials" (which I believe would be DHS and possibly the White House) would make the final decision.  Based on my years of evaluating emergency exercises, when the plan gets vague, like this, about the identity of decision makers, it usually means trouble.

            Speak the truth, but ride a fast horse.

            by Deep Harm on Sun Feb 10, 2008 at 07:25:54 AM PST

            [ Parent ]

            •  yep and partly why I am asking (2+ / 0-)
              Recommended by:
              Deep Harm, jlms qkw

              you and I have discussed before the vagueness of DHS vs HHS, which GAO has also criticized.

              Thank you.

              GAO finds gaps in federal pandemic planning

              Sep 11, 2007 (CIDRAP News) – In an analysis of the US government's pandemic influenza preparedness plan, the Government Accountability Office (GAO) yesterday called on federal agencies to clarify their leadership responsibilities and recommended interagency testing and training exercises to improve preparedness.

              "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

              by Greg Dworkin on Sun Feb 10, 2008 at 07:32:27 AM PST

              [ Parent ]

  •  hopsitals R da last place I'd be (2+ / 0-)
    Recommended by:
    Ellinorianne, jlms qkw

    seriously... who the hell would go to a hospital during a flu pandemic? you'd have to be rather foolish.

    anyways, i personally think that we need a few government controlled pharmaceutical manufacturing plants.  otherwise, we'll never be able to adequately bargain with companies to reduce the price of their meds. Especially during a flu pandemic (ala 1918), we'd have no guarantee that private companies (especially, those in other countries) would even sell us vaccines or medicines, and of course stocks would run out quickly and we'd be just another customer in line.

  •  Thank you for this (2+ / 0-)
    Recommended by:
    maybeeso in michigan, jlms qkw

    I know that there is no way that our local hospitals could handle the numbers we would see.  And we're fortunate enough to be with a half hour drive of two hospitals and 40 minutes from teaching hospitals.  I'm thinking that the health department would have to assign towns to certain hospitals because otherwise Boston would be deluged.  That doesn't bode well for those of us with mediocre local hospitals.

    I just watched the American Experience episode on PBS that was on the 1918 Influenza Epidemic.  It was well done and fairly horrifying.  It convinced me that if/when bird flu hits here our lives will have to change radically.  

    My husband and I both work in jobs where we meet face to face with people.  There is no way that he could do his job, he works in Court, from home.  While I could perhaps finagle something with a webcam I doubt I would be paid for that.  Both my husband and my son have major medical issues so I would not want them out in the world.

    Speak out for those who have no voice...Do not turn away from the great struggles before us. Do not give up on the causes that we have fought for. John Edwards

    by sobermom on Sun Feb 10, 2008 at 07:09:39 AM PST

  •  lots of chemtrails saturday in new mexico (1+ / 0-)
    Recommended by:
    Ellinorianne

    to start off 2008.

    i wonder what strain they decided on?

  •  Knowledge will help you immensely (3+ / 0-)
    Recommended by:
    DemFromCT, Ellinorianne, jlms qkw

    My wife and I are both RNs, so we will have little option to stay home if the s--t hit the fan.  Washing hands and wearing a mask all day will be the routine, as should be the norm now, if you have a cold (some doctors offices and hospitals now provide masks and ask you to wear them if you have a cold).  

    Learning about the flu, how it spreads and how to defend yourself against contamination - knowledge if you will - is your greatest survival tool.

    My greatest hope, is that gaining knowledge and training for a pandemic, is as close as we will get to the real deal.  

  •  I work at a major midwest teaching hosptial as a (4+ / 0-)

    mainframe computer programmer.  I currently maintain the inpatient nursing documentation system.  I am one of around a dozen people that have a clue about it.  The institution is in the process of changing from their in-house developed documentation system to one from an outside vendor.  Right now I am working on getting the ICU machines to 'talk' to the new documentation system.

    The hospital has, in round numbers, 260 ICU beds and around 700 'regular' beds.  This hospital is basically also the 'state' hospital.  In other words, the poorest of the poor are sent to this hospital more often than not.  The institution is in need of more beds as it is now.  This is after having moved most of the business office 'off site', lots of the 'old' medical transcripts, hard copy x-rays, etc off site, 2 * major* additions (millions of sq ft), etc.  Many of the clinics that have been moved to the 'new' areas in the last 2 years are already running out of room for exam rooms, etc for the ever growing number of patients directed there.

    When the next pandemic occurs, there will be insufficient supply of everything due to lack of will of the 'powers that be' to prepare and the current business model of 'just in time' supply.  Hospitals will have to be 'rationed' to those that are in the worst shape and those that have waited too long to get help may have to be turned away.

  •  First responders, too, are unfunded, untrained (2+ / 0-)

    EMS professionals, firefighters, police, national guard....forget it.

    Bush has totally ignored this problem to go fight his Vanity War in Iraq.

    In fact, Iraq has made it even worse that in might be, because a lot of first responders serve in the National Guard, so their manpower is down tremendously.

    •  I can speak for one small group of firefighters.. (1+ / 0-)
      Recommended by:
      DemFromCT

      I'm on the board of directors for a volunteer
      fire department, and I have seen the training material
      that we have received from the feds. I assure you that
      that our firefighters, at least, are trained for a
      flu pandemic.
      But's it's not pretty. The assumption is that in the
      worst case the medical facilities will be overwhelmed
      in 4 to 6 weeks. After that, the plan was to put
      people in improvised facilities, like gymnasiums
      and armories, and to provide trained staff that could
      keep people hydrated and provide other support.
      After those are full, there is a stage where first
      responders will not even come to your house if you
      have the flu.

      To sum up, I think first responders in general have
      received a lot of training for the flu pandemic, but
      in light of the intractable size of the problem their
      role will be more a "preventing cholera for the
      refugees in the superdome" than a "getting the
      refugees in the superdome to higher ground".

  •  Wow...Doctors and nurses come to mind (1+ / 0-)
    Recommended by:
    Ellinorianne

    How do you "manufacture" doctors and nurses for that kind of surge?

    You can't exactly build them on an assembly line and you can't put them into storage when things get better.

    Do any other countries address this issue differently?

    It does seem that home care, quarantine, and vaccine are likely to be the only feasible approaches.

    And that's just the health care side.

    Imagine a highly infectious flu breaking out in a police precinct house.  Given the normal chain of contacts, a city's services could seriously compromised.

    Ouch ouch ouch ouch.

    Free speech? Yeah, I've heard of that. Have you?

    by dinotrac on Sun Feb 10, 2008 at 07:58:19 AM PST

    •  here's the bad news (0+ / 0-)

      we're pretty much ahead of other countries.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Feb 10, 2008 at 09:11:20 AM PST

      [ Parent ]

      •  Not encouraging. (0+ / 0-)

        In the jet age, a pandemic could go international in a hurry.

        I could imagine a series of agreements by which member nations bulked up enough, not to meet a surge, but to join with other's in fighting a member nation's surge.

        IOW, perhaps the US, Canada, Mexico, whomever, could combine their excess resources to help Germany, etc.  

        But..

        That would require some sort of effective firewalling, quarantine or what have you and,

        even that doesn't work unless EVERYBODY's made preparations.

        Free speech? Yeah, I've heard of that. Have you?

        by dinotrac on Sun Feb 10, 2008 at 09:29:28 AM PST

        [ Parent ]

  •  1918 vs 1968 (1+ / 0-)
    Recommended by:
    Ellinorianne

    I have written about the difference between comparing 1918 vs 1968.  In 1918 many many homes were still without proper toilets and sanitation methods. Washing hands was not even a recommended way of avoiding the spreading of germs as were other additional factors. I think 1968 is actually the best model of comparison. I also say this because of the Swine Flu of 1918 which scared the US Government to take the responsibility to vaccinate our general public in 1976. The problem is that one possible case was reported in Ft. Dix I believe and they are not even certain, and way too many people died from the vacine so the program was halted. No one got the Swine Flu.

    I really believe that it is excellent that communities are preparing for the worse scenarios and they should. There is a great possibility that plaques, whether man made or lack of nature, could kill many people. At the same time we need to continue to be watchful ourselves. We see how fast a cold can spread in an office. Every time I go to the grocery store I make sure I wipe the handle off. I have found I seem to get my colds within a few days of grocery shopping. So I take precaution there faithfully. I am not a germ a phobia person but I am aware of sneeze guards, door knobs in bathrooms, etc and I do get my flu shot every year which seems to help me.  

    I have friends who say I need to more prepared. In the meantime, they have bought a lot of dry food, keep tons of water, and have a gun for protection for those trying to steal their rations. This is a well educated green aware couple. I think it might be a panic for them. I want to be aware and prepared but not living my everyday life being too prepared as an individual. Therefore I am glad you are bringing notice to hospitals but I think 1918 should not be in the numbers except to show how far we have advanced in sanitation knowledge.

    I'm voting for the Democrat! End of story!

    by BarnBabe on Sun Feb 10, 2008 at 08:10:41 AM PST

    •  I agree with your comment (1+ / 0-)
      Recommended by:
      BarnBabe

      but I am telling you that every hospital expert who understands 1918 vs 2008 will warn you that the lack of room in the hospital for the vast majority of patients makes the comparison more apt than you would suspect. Also, it doesn't matter what we 'know' about handwashing and modern sanitation if you don't in actuality wash your hands. Nor will there be enough gowns and gloves and personal protective equipment.
       
      Finally, in terms of the JIT economy and lack of ability to store things, we are worse off than 1918, too dependent on the internet and the grid to stay up, etc. ;-P

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Feb 10, 2008 at 09:22:04 AM PST

      [ Parent ]

      •  A harbinger of things to come (2+ / 0-)
        Recommended by:
        DemFromCT, BarnBabe


        Finally, in terms of the JIT economy and lack of ability to store things, we are worse off than 1918, too dependent on the internet and the grid to stay up, etc.

        And of course there are hugely more people today than there were in 1918, after nearly a century of completely irresponsible overpopulation.

        Which means that the challenge of supporting them all in a crisis is then enormously magnified.

        I can tell you, coming from a family in which we have extensive geneaological records, with histories both oral and written, that pretty much all of my ancestors circa 1918 lived on semi-independent homesteads and completely independent small farms, ones which were capable of subsisting on their own for many months with little or no outside input. They had stockpiles of things which they couldn't grow or make for themselves.

        Today?

        How many of the households of the extended family have a comparable degree of robustness and autonomy?

        That number would be, uh, zero, excepting my own household.

        My 1918 extended family sailed through the pandemic and all of them survived because of simple social distancing, and the means at hand to implement it.

        My 2008 extended family are not going to fare nearly so well.

        --

        •  And one further note (2+ / 0-)
          Recommended by:
          DemFromCT, BarnBabe

          The most important single asset which my 1918 forebears had was a mindset of resolute self-reliance.

          There were no government agencies or NGOs to ride to the rescue. Nor were any such actions expected.

          Now the general public mindset is 180 degrees opposite of that.

          I have a friend who was attending Cal State Northridge at the time of the 1994 quake. He relates stories of many, many people just standing around and mooing, and not doing the sorts of immediate, simple and obvious post-tremor actions which would be undertaken by any competent individual.

          My friend walked past a guy standing in front of his collapsed house, in a line of such houses. Question: hey, buddy, did you shut off your gas? Duh, no. Question: have you got a tool to do it? Uh, probably in the trunk of my car I have an old pair of channel locks, sure. Question: why the fuck aren't you doing that, then?

          The guy didn't seem to have any realization of the huge fire hazard of having broken gas mains hissing away, and of the immediate necessity to shut the goddamned things OFF. This when there were people trapped inside wreckage in the immediate vicinity.

          My buddy said that this slack-jawed bovine mindset was almost universal among the people he ran into that day. They all just stood there waiting passively.

          Because, you know, someone will come to help.

          Unless and until there is a crisis so big and systematic that no one comes.

          At which point things will really get ugly.

          Remember, Northridge 94 was a fairly modest and localized quake.

          My friend moved out of the LA metroplex as soon as he earned his CSU degree. He said that he has absolutely no intentions of hanging around to see the aftermath of The Big One when that arrives. As it is absolutely guaranteed to do at some point.

          --

          •  Well, at least I knew to do that. (1+ / 0-)
            Recommended by:
            DemFromCT

            In the 19 years I lived in California, I knew enough to turn off the gas for the hot water heater, had battery lanterns ready, Portable radio and TV's, and plenty of batteries. I also had quite a few bottles of water in storage. And, I made sure there was a plug in phone.

            Now that I am in Penna (Get to vote in April finally) and live in the country, I am still prepared for those times when the electricity goes out. And it does, as you know in the country. We still have poles that get hit, transformers that blow up, and wind that knocks down a power line. In fact, it has gone off already this year. So, with the wind storm we are getting today from that Arctic thing hitting us, I suspect that there is a chance that we will lose electricity and cable. Bye Daily Kos for the evening if we do.

            I am just concerned that some people will not be ready at all and others, such as my friends in Florida who are so prepared that they are just waiting for the day. That scares me. I just wish people would prepare without the panic.  

            I'm voting for the Democrat! End of story!

            by BarnBabe on Sun Feb 10, 2008 at 02:17:28 PM PST

            [ Parent ]

  •  Well researched, important diary (2+ / 0-)
    Recommended by:
    DemFromCT, Ellinorianne

    I'm really glad I read it!

  •  wow, scary (2+ / 0-)
    Recommended by:
    DemFromCT, Ellinorianne

    Last Tuesday evening I waited in the ER with my girlfriend for nine hours while they determined that she did not, in fact, have appendicitis.  This was one of 3 large teaching hospitals within a very small area, and an ordinary weeknight. Hospitals are already well past capacity. I can't imagine what pandemic flu would do to them.

  •  Pandemic? US hospitals aren't ready for germs! (2+ / 0-)
    Recommended by:
    elfling, Ellinorianne

    Seriously. I'm just talking about drug-resistant germs here.

    Let me tell you a story. Think back to 2005. Hear much about MRSA in 2005? No? Not surprised. It got 0% news coverage in the States.

    In England, it was front page news. Everyone thought the country was going to turn into Poxville because of MRSA. Oh, and because it was an election year, the Conservatives were saying that all the MRSA deaths were because of the universal healthcare system in place since the 1940s.

    Well, the numbers came back for that year of how many people died from MRSA. Both in America, and across the Atlantic.

    Chances of dying from MRSA in...

    England or Wales, with the press going apeshit about it, and their national statistics office saying "maybe the numbers are a bit high because of all the attention it's getting in the press": 1-in-32,000.

    the USA, where there is zero press on MRSA as a public outbreak, and no politicians are saying "hey, market-driven healthcare is KILLING US": 1-in-15,800.

    Imagine if there was a car, and it was prone to exploding and it killed a number of Europeans, and their press was going ape-shit over it. Now imagine if the same car was sold here too, and it killed twice the rate of people, and all the news showed was Paris Hilton. It's like that. But with microscopic organisms instead of exploding cars.

    For the links citing proof of the numbers, go here. Figures from the CDC, the UK Office for National Statistics, and the Census Office.

    Healthcare for profit KILLS AMERICANS.

    The nation can be made to produce a far higher standard of living for the masses of the people if only government is intelligent and energetic... (FDR, '37)

    by ShawnGBR on Sun Feb 10, 2008 at 08:44:04 AM PST

    •  MRSA isn't the only hospital-acquired bug (0+ / 0-)

      There's hospital-acquired pneumonias, C. difficile, plenty of other nasty things you can pick up in the hospital that can be very dangerous.

      High patient-to-nurse ratios are a factor, as is an attitude that infections are simply inevitable. Turns out, they're not:

      http://www.dailykos.com/...

      These projects are raising the bar for everyone. According to the Centers of Disease Control and Prevention, 2 million Americans get hospital infections each year. They do not need to. Rates in Norway and Sweden are nearly zero. Why should we accept as inevitable that patients have to die or suffer from hospital-acquired infections, wrong-site surgery, unreliable heart-attack treatment, medication errors -- and myriad other forms of error and unreliability in care -- when we can now name hospitals that have eliminated or drastically decreased each of these forms of harm?

      If these sloppy mistakes are being made now, when there is no crisis, that tells me that already our hospitals are over their true capacity. Pandemic is a big thing, but even a car bomb with 100 victims - standard issue in Baghdad, unfortunately - would stress that city's hospital system to the breaking point, even in a large metro area like Los Angeles, where you could send 10 patients to 10 hospitals.

      For-profit hospitals aren't evil per se, but they by definition will adapt to their niche to always be at a very high capacity. A for profit hospital can't afford to have doctors just standing around in the ER, or a whole wing of a building standing empty. They don't get any extra credit for saving more lives during a surge in injuries. Like much of America, they operate at the fattest margin when they use a just-in-time model. Problem is, even rich people can die because there's no room in the ER.

      An ordinary day in an urban ER will have someone with  a moderate problem - dislocated shoulder, nasty flu-like illness - sitting in the waiting room for 6 hours. We aren't prepared for any kind of event, not a natural disaster, not a terrorist attack, and not a pandemic.

      Consider this, after Hurricane Wilma, one we barely even remember in the shadow of its big sister Katrina:
      http://www.dailykos.com/...

      PLANTATION, Florida (AP) -- A week after Hurricane Wilma, more than 1 million Florida homes are still without power and many doctors' offices remain closed, leaving hospitals swamped as the only source of medical care in some communities.
      "You can't get any regular doctors on the phone. You can't get anything filled," said Tim Swett, 41. He waited five hours at one emergency room and finally left without help for a back problem he had aggravated while cleaning up his mother's yard.

      Such a little thing, something that should barely be a medical crisis at all - an extended power outage - caused an enormous surge in ER use. When we have a real disaster, we will be unable to cope unless we make a serious effort to invest in our hospitals and pay them to have more standby capacity.

      Fry, don't be a hero! It's not covered by our health plan!

      by elfling on Sun Feb 10, 2008 at 09:33:34 AM PST

      [ Parent ]

  •  Fair Warning (0+ / 0-)

    If you live near any of the Pharmaceutical sites that are making the vaccines for pandemic flu...  Move.

    http://tinyurl.com/...
    http://tinyurl.com/...
    http://tinyurl.com/...

    Having worked in the area of H5N1 as an example, I can tell you with great assurance that you are more likely to contract H5N1 from a Pharmaceutical site mis-handling rH5N1 than you are a bird.

    People will do anything for a potato.

    by il128 on Sun Feb 10, 2008 at 08:48:31 AM PST

  •  Thank you for all the information. I'm about to (0+ / 0-)

    crank up the printer and hole punch and go shopping for collapsable water containers.   We keep old detergent, bleach and white vinegar bottles.  Figure any of those are good for flushing and washing.

    Thanks again.

    911 changed very little. George Bush, his sycophants, enablers and handlers have changed way too much. --me

    by maybeeso in michigan on Sun Feb 10, 2008 at 09:13:52 AM PST

  •  Follow the technology gap (0+ / 0-)

    I agree. Our health care system is overloaded, and there really aren't enough hospital beds in case of dire emergencies. However, life-saving technology is also 10x better compared to 1968. Our epidemic control centers are also much more effective and efficient.

    I guess my point is that the chance that an epidemic would occur is greatly diminished from four decades ago, and the efficiency of care given to those patients is also greatly improved, which in a way necessitates less beds on hand.

    •  On the other hand, social engineering, (0+ / 0-)

      which is the best way to crack a security system, is not in our favor here. We laud people who go to work or school sick and sneezy, and we curse those lazy ones who stay home. One sick kid who goes to school for one or two days may save some day care costs and may bring the school those two days of revenue - but that illness will echo through 20 other kids, who may each stay out for a day, and it ripples on through.

      The first sneezy people of a pandemic are probably going to school and work, and they'll spread it far and  wide.

      Fry, don't be a hero! It's not covered by our health plan!

      by elfling on Sun Feb 10, 2008 at 09:36:57 AM PST

      [ Parent ]

    •  false sense of security (0+ / 0-)

      we are far less (not more) self sufficient than we were in 1968. and since a third of the population might become ill, with a quarter out for illnessor care responsibilities, the JIT system we have built for efficiency may not last.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Feb 10, 2008 at 09:48:18 AM PST

      [ Parent ]

  •  Why in the heck is PWC doing a study (0+ / 0-)

    for the CA plan?  That's like having an auto mechanic advise on heart surgery.  While the auto mechanic may be a specialist in their industry, they hardly have the kind of expertise of the human body that would yield a good result.
     What a waste of my CA taxes.

    My Karma just ran over your Dogma

    by FoundingFatherDAR on Sun Feb 10, 2008 at 09:56:53 AM PST

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