The Federal government’s flu plan is in it final stages of recapitulation — sorry, I mean, the final stages of preparation. The headline of the AP news story says it all: U.S. Pandemic Flu Plan: Hole up at Home. Jeez.
The federal Centers for Disease Control and Prevention is pitching the plan at medical meetings and aims to send it out for review by the end of the year. State and local governments have asked for unusually detailed and specific advice on such matters as closing schools and canceling public events, one CDC official said.
This week, CDC awarded $5.2 million in grants related to the plan, including research on whether to recommend face masks to the public. CDC also asked the Institute of Medicine, a group of scientific advisers, to meet on these measures later this month.
“We can’t afford to neglect some of the traditional approaches to contagion control because we very well may find ourselves in a situation where that’s all we’ve got for a period of time,” said CDC’s quarantine chief, Dr. Marty Cetron.
The logic here seems to be that “traditional measures” have to be used because that’s all we’ve got. Does that mean bleeding? Leeches? The trouble with some of these measures is that we have no ore idea they work than that we do about leeches. The Director of the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota says what needs to be said: are we sure this emperor isn’t naked?
“A lot of these things sound good but they lack practical application,” said Michael Osterholm, a University of Minnesota health expert involved in the planning.
Advising people in big office buildings to avoid elevators and stay 6 feet away from each other is impractical, and people can’t stay in their homes for weeks or months without needing insulin and other medications, he noted.
As for hygiene tips like sneezing into your sleeve, “we have no data that that makes any difference” in controlling a pandemic, Osterholm said.
We are flying blind. We dodged a bullet with SARS, but no one is quite sure how or why. To say it was the result of classic public health measures (which ones?) is a stretch. All the thermal scanning at airports for feverish passengers picked up not one single case. Maybe we should have everyone keep their shoes on, too, when they pass through security so they don’t catch cold. The idea that “social distancing” is going to slow a pandemic, much less stop it, is unproven and chancy. Again, Mike Osterholm says what has to be said (although few want to hear it):
However, Osterholm said there’s not enough science to recommend some measures, like “keep your distance” campaigns. Scientists know flu spreads through hand contact and big droplets when people cough or sneeze, but they don’t know how far tiny particles remain in the air, or how important that is for spreading the germ.
In fact, experts know surprisingly little about what enables a flu germ to spread.
Health officials need to give advice but should be honest about the limits of what is known “and not oversell it, which there is a tendency to do in times of crisis,” Osterholm said.
If that happens, “we will lose credibility quickly,” he said.
But some people still don’t get it.
The CDC plan will list multiple scenarios for pandemics that range in severity or attack certain age groups like children or college students, and recommend corresponding control measures.
These will include voluntary isolation of sick people, voluntary quarantine for those exposed to the germ but are not ill, and protective sequestration to separate healthy people or communities from a source of infection.
“Quarantine has gotten a very bad name and for very good reason. It has been abused in the past. It works best when we obtain and maintain the public trust,” [CDC's Dr. David] Bell said.
If those are the conditions under which quarantine works best (or at all), forget it. That they are even still thinking about quarantine shows that they have nothing left to do except their usual response of exercising police power. The virus won’t care.
So what to do? In our view, it is not a matter of stopping or slowing the progression of a pandemic. Forget it. Any scheme to do so is like the ones people come up with to stop a hurricane by detonating nuclear devices in the eye. Some Forces of Nature are more powerful than what we have to stop them. Instead, you do the same thing you do to prepare for a hurricane (unless you are the Bush administration). You get ready for managing the consequences. So far, our government (and many others) is in a State of Denial.
Managing the conseuqences means you get together with others in your community to solve the problem of how you are going to get through 8 weeks of significant morbidity, mortality and absenteeism. You ask if you have enough supplies and equipment (like respirators) for the critically ill. You arrange for overflow capacity, which you may have to pay for by making the health care system less efficient and more redundant by having excess resources. You examine those areas where “just in time inventory” is disastrous if supply lines are interrupted, e.g., fuel and energy supplies, a short list of pharmaceuticals like insulin, a few antibiotics, blood pressure medications, etc. Not everything. Just a smartly chosen list that you had the foresight to prepare for ahead of time. You figure out how to make sure food staples will be available. You make sure you have continuity of operations plans in your business or agency. You encourage people to work with their neighbors and volunteer in case they are needed because others are out sick. You prepare for people working from home because they may not be able to get to work, not because they are “holing up.”
Of course some things will be done “just because” they seem plausible, like canceling unnecessary events or schools. They might or might not do any good, but the pressure to do them will be strong. But that isn’t a plan. Mostly schools would close anyway because students and teachers will be out sick and there won’t be enough people to run them. In my university, if a professor falls ill for three weeks halfway through the term, there isn’t much that can be done about getting the course taught, especially if others are also out sick and so are students. Airline schedules will be drastically curtailed because there won’t be sufficient crews to fly them. These aren’t preventive measures. They are effects. The question is not whether to do them or not. The question is what to do when they happen.
Here’s a plan. Start beefing up the public health and social service infrastructures of our local communities with block grants for the major areas. Some money will be used inefficiently, but I can’t believe as inefficiently as the “bioterrorism” money has been used. People in health departments have been running them for a long time and know what needs to be done. Give them enough dough to let them do it. That’s why block grants make sense. Start developing programs to mobilize our communities to fight for each other in our own neighborhoods, not fight others in far away countries.
And do it like you believe in it, not because you don’t have anything else to offer. Experience in the 1918 pandemic showed that those communities who understood what they were facing and were honest with their citizens fared best. Honest with their citizens.
Honest with their citizens.