Here's what a flu pandemic might look like:
"In four weeks, we went from a ho-hum flu season to ridiculous overcrowding," said Dr. Maurice Ramirez, an emergency physician who works in several institutions in north Florida. "We have had so many people that we have them, not in beds in the hallway, but in chairs with a number taped to the wall over their heads.""We've seen a tremendous amount of flu--from an anecdotal standpoint, a much busier season than in recent years," agreed Dr. Peter A. Lipson, a private practice internist in southern Michigan who also sees patients at a walk-in clinic.
Around the country, physicians recounted local overloads, from a 30% increase in patients at a rural Virginia emergency department to a 15% hike in call volume for a central-Colorado ambulance service, all of them due either to lab-confirmed flu or to flu-like illnesses.
The soaring demand for flu-related care is backing up entire local healthcare systems. It has added hours to the time that all patients--not just those with suspected flu--wait before receiving an emergency department evaluation or before being admitted to a hospital bed. In some areas, physicians said, rates of "elopement"--patients leaving before being seen--have risen sharply; in others, it has led to increased ambulance diversions.
The doctors experiencing the influx of flu patients all said they were impressed by how sick patients have been, recounting very high fevers, frequent pneumonias, and uncommon symptoms such as stridor, a high, whistling breath sound that indicates a partially obstructed airway and is an emergency in children.
"We've admitted a lot of elderly patients to the intensive care unit," said Lipson, in Michigan. "I sent one [influenza] patient to the emergency room recently with meningitis."
The flu onslaught is not limited to healthcare institutions. Prisons around the country have experienced huge flu outbreaks, according to media reports in several states, including the California Correctional Center and High Desert State Prison, both quarantined in February, and the Albemarle-Charlottesville Regional Jail in Virginia, which last week banned visits and required staff to wear masks. On Friday, the Chuckawalla Valley State Prison in Blythe, Calif., banned movement in or out of the institution after 546 in a population of 3,147 fell ill and two died. (Maryn McKenna, CIDRAP News)
This account, of course, is not hypothetical. It's just a description of the last six weeks or so in the US, in an excellent piece by Maryn McKenna, now writing at CIDRAP. McKenna used to have the CDC beat at the Atlanta Journal Constitution and has written a highly praised account of the Epidemic Intelligence Service there, Beating Back the Devil. Now she is working on a much anticipated book on the MRSA epidemic but, thankfully for the rest of us, also keeping track of other things while at CIDRAP. And one of the things she is keeping track of is this lousy flu season.
Part of the problem is the mismatched flu vaccine has not provided as much protection as hoped, and her article has a good description of some of the causes and consequences of that unhappy circumstance. But her piece also shows how brittle the US health system is. It doesn't take much stress before it starts to break down. And by any description, propping sick people up in chairs with numbers over their heads is a system that has broken down. That's the real story here, not the vaccine mismatch. With current technologies mismatches occur periodically. The inability of the health care system to handle even a modestly bad flu season, though, that doesn't have to happen. We have let it happen by allowing our public health infrastructure to swirl down the toilet by not funding it. In some quarters that's called fiscal responsibility.
Where we come from it's called the height of folly.
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I'm concerned that the lack of a perfect fit for this year's vaccine may cause people to dismiss the usefulness of flu vaccines altogether --- especially, after a conversation with a friend of mine who has always refused to get a flu shot because she's heard that vaccinations weaken the immune system. She'll consider getting a shot when she's in the high risk group (she's 63 years old). Incidentally, she's been a research specialist in a school of public health for nearly 30 years.
Mary: Well, your friend isn't thinking too clearly about this but that's another story. Regarding the mismatch, I don't know what to say about it except to acknowledge it when it happens (which it does everyone once in a while). Any other strategy, including playing it down when that isn't warranted) is folly as far as I am concerned. Withholding info or misstating things is wrong and will wind up having even worse consequences. Just my opinion.
Revere,
Do you think we are anywhere near developing a universal vaccine (influenza) with the knowledge and technology we have today or anticipated in the near future (2-3 years)?
"...propping sick people up in chairs with numbers over their heads is a system that has broken down.." is more fit to be a description of health care in a 3rd world country rather than the US, but there, you have it.
We all know how badly broken our healthcare system is; the 'cure' doesn't require rocket science IQ's, just some common sense in our leaders. Common sense seemsto be in short demand lately hereabouts. Then again, so are staff and beds for the average joes-but not so for TPTB. They'll never have to wait for a bed, a nurse or a doctor.
Given that health care costs in the US are double anywhere else on a per capita basis and far exceeds any nations expenditures as a percentage of GDP, it is quite obvious the "funds" are not being efficiently utilized, at least not for the public good, since most finds it's way as a profit entry on a financial statement, or is spent on hiring people who deny health care and cancel insurance policies when a patient gets sick.
In a pandemic, obviously, the infrastructure will not be adequate, and you do not build infrastructure for an event that may happen every 30-50 years, so I have no issue with this.
Schools can be converted into temporary hospitals, beds should be stockpiled. Some hospitals will need to be converted to "influenza" only hospitals to isolate those in hospitals for other reasons from those being treated for influenza. The quality of care will obviously suffer in a pandemic, the average Joe will not be put on ventilators as they will be in short supply.
Those in the education system who will not be working when schools close but will still be paid, should be trained in basic patient care today, and asked to volunteer when a pandemic hits. If that does not solve any shortages, a means to draft those who are unwilling to help but have been trained should be available. Nurses and aides, and not Doctors, will be the critical staff in preventing anarchy, and so the supply has to be increased in some temporary fashion, and since the military and national Guard seems over extended, I would not look for any help from them.
The other shortage will be of caskets, as they were in 1918, which prevented many bodies from being buried promptly. So some planning needs to be done to alleviate this shortage to ensure prompt burial.
In Edmonton Alberta in the first week of March we had a TENT set up for the massive influx of pediatric emergency visits. We have grown so much and do not have the space nor the staff to deal with emergencies such as this. But the good news is we voted on March 3rd to keep the folks who created tis mess in government- with a 41% voter turnout. Gack.
I guess the thing that makes me maddest is that neither system- private or public, seems to set a high priority on the future. We will have SOMETHING nasty in my lifetime I am sure, and we will be hooped everywhere because of lack of planning and foresight.
Those in the education system who will not be working when schools close but will still be paid, should be trained in basic patient care today, and asked to volunteer when a pandemic hits.
Ya sure about that?
I have a couple of close friends who work in education. They are smart and competent and adaptive. And, by their own account, very much not the norm for their field.
All of those friends came to education by nontraditional routes, having earned degrees in fields other than "education", and having then later sweated to amass the huge number of essentially symbolic credits in pedagogy required to work as a teacher.
All of them reserve not very well concealed contempt for their professional peers who majored in education at university. As one of my friends notes, education majors have the lowest entering SAT scores of any cohort. Their later professional performance (or nonperformance) strongly bears this out.
I have had it described to me by said friends that their peers (who teach junior high school) completely loathe the teacher recertification exams which they must take. These exams essentially test the teacher's own individual capability in sixth-grade level math and English. ("What is twenty percent of one hundred?") My friends would be able to trivially take and pass such exams were they to be administered daily. Their peers sweat and struggle with remedial workbooks for months ahead of the test date.
One friend intends to leave the education workforce to be a stay at home mom starting next year. She won't send her kids to the school at which she previously taught. She'll homeschool them instead. She knows what's what.
Again, are average educators really the people you want to have as health care auxiliaries in a crisis? They might be literally worse than nothing.
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