If you travel at all, and I have to travel a fair amount, you know how brittle the air traffic system is. Last week I did an out-and-back one day affair of around 500 miles each way. Weather was good and I made it to my destination on time. The meeting went from 10 am to 1:45 pm. Then a dash to the airport for a 2:35 pm flight home. Except that higher than usual winds at my destination set in motion a cascade of air traffic delays as the number of available runways shrank and I was 3 hours late. Not terrible, but just a measure of how sensitive the system is to the slightest upset.
The health care system is just as brittle, but the 3 hour delay in terms of timely treatment would translate into lost lives, not lost hours. In the last three days news stories from three continents all came to the same conclusion. If there is a pandemic, in the immortal words of Mike Osterholm, "We're screwed."
In Seattle:
Under the worst-case scenario, a flu as severe as that which struck toward the end of World War I, an estimated 200,000 people in Snohomish County could become ill, about 2,000 people each day.
Even sending just one-tenth of that number - 200 people - to area hospitals could overwhelm the medical system, said Dr. Gary Goldbaum, health officer for the Snohomish Health District.
The public should be prepared to care for many of the sick at home, he said, with only the sickest of the sick, such as those who need mechanical ventilators to help them breathe, being treated at hospitals.
[snip]
If a flu pandemic hits, the public needs to be ready for a dramatic shift in how they get health care.
Now, if there's a concern that a symptom could signal a serious health problem, people are advised to call 911 and often are taken to the hospital to be checked out, said Goldbaum, the Snohomish Health District's health officer.
That won't be the case during a pandemic, which could sicken an estimated 200,000 people and kill as many as 4,000 people in Snohomish County alone.(Herald, Everitt, WA)
Mind you, this is a warning from one of the most prepared and forward-looking health departments in the nation. As bad as it is, they are far ahead of everyone else.
In Scotland:
The most recent guidance issued by the Scottish Executive on dealing with a major influenza outbreak states face masks, aprons and gloves should be used by health workers to prevent the spread of infection.
But GPs say they currently have few supplies of this basic equipment and the Executive has admitted that it only has a "small" stockpile of masks for NHS staff.
[snip]
"Gloves, aprons and face masks are really important in preventing the spread of infection and we are going to be needing these things if we are within three feet of a patient," she said.
"We are going to need a lot of this stuff and at the moment we certainly don't have it.
"We have aprons and gloves in general practice, but we don't have anything near the amount we would need and we definitely don't have masks."
She added: "There hasn't been any guidance from the Scottish Executive or the Department of Health as regards to them procuring this kind of equipment for general practice, so that we have it readily available in the event of a pandemic." (The Sunday Herald)
The response of the Executive?
A spokeswoman for the Scottish Executive said that guidance had been produced which sets out the level of protection recommended for staff in hospitals and primary care.
She added: "A small centrally stored stockpile of masks for NHS staff in Scotland has been purchased.
"We are also currently considering at a UK level whether we should centrally procure and stockpile face masks and other items for the health service."
Blah, blah, blah.
In Australia:
In the Land of Oz The Impacted Nurse reports from his Emergency Department -- "disaster? - sorry, but we are a little fucked up right now":
A study just published by Dr Anthony Joseph in the latest Medical Journal of Australia that predicts Australian hospitals would hopelessly fail to cope with a large-scale natural disaster or terrorist attack.
The report reveals that up to 80% of the injured would be denied immediate treatment, that 61% to 82% of critically injured patients would not have immediate access to an operating theatre, and that up to 70% of victims would not have access to an intensive care bed.
You may recall, we have discussed this once or twice before. So again, with feeling??. most of our hospitals are running at or near to 100% occupancy. Emergency departments are more often than not; overcrowded and blocked with patients that are unable to access a ward bed. We struggle to manage on a normal day and this situation is already leading to patients dying needlessly.
Unless this situation is addressed, come a large scale pandemic, natural disaster or terrorist action, our response will quickly fall apart. No ifs ands or buts. (The Impacted Nurse)
If there is a pandemic, or even a bad flu season we better radio traffic control the health care system will be coming in for a very hard landing. If it doesn't crash and burn first.
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Nurses have not been included in pandemic planning. Nor have they been involved in continuity of operations planning (who will man the ship when healthcare providers themselves die).
Thanks for writing this post.
And similar root causes in the case of undercapacity as well. Both the air system and the health system suffer from a lack of investment, and from counterproductive incentives.
A lot of money gets spent on both, mind you, but much of it on trivialities. Accelerate the rollout of ADS-B? Well, we will get around to that in due course, but there are far more urgent priorities. Why, the duty free shopping hall is a positive disgrace!
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I would think that capacity planning for any system, including a health care system, requires estimating peak loads and variability of peak loads ( standard deviation ).
You are making the argument that the health care system loading is highly variable with the possibility of hugh peaks ( pandemic, terrorist attack ). That may seem self evident, but an argument can be made that in fact health care system loading is relatively stable. It may be true that the capacity of some systems to handle routine loads is inadequate. In that case an argument can be made to increase it but that is not the same as providing large surge capacity. That capacity is very expensive and takes funding away from certain-to-be used chronic care, for example. If you consider a localized surge ( New York on 9/11, for example ) there is at least the possibility of utilizing capacity outside the immediately impacted area.
In pandemic, granted that might not be possible. If you consider the Oregon example quoted, 10% of the estimated surge would overwhelm the current system. I don't think you can make an arugment to increase respiratory acute care capacity 10 fold everywhere. As a customer (satisfied ) and funder (taxpayer ) of the Ontario (Canada) public system, I don't want or expect such resource allocation. If we had such funding available, it would make much more sense to deploy it for vaccine development and vaccine production capacity.
I am well aware of the current state of influenza vaccine technology. Having said that, it seems clear that given the funding, and time, it will/would be possible both to develope an effective vaccine and produce it in adequate volume. Note, "given funding and time". The ability to do this would presumably be useful against other agents besides H5N1. I don't see a distribution issue either, at least in Ontario. Here, the seasonal influenza vaccine is free, and readily available by a variety of channels, including your doctor, walk-in-clinic, vaccination clinics run by local health units in schools, etc. About 35% of the population partakes, apparently, and issues are few.
In a pandemic, one might assume 100% would opt to receive the vaccine, which would probably just result in longer lines and 24x7 operation of the vaccination clinics.
I've lived in both major cities ( Toronto ) and currently in rural Northwestern Ontario, and I have no doubt a vaccine could be administered quickly and efficeintly in either location. I do support a robust ( and publicly funded ) system, but I am wary of calls for massive surge capacity. You must realize that resources are not infinite and funding spent here is funding not spent on, say, knee or hip replacement surgery, or dialysis machines.