| Very often when people begin to learn about bird | | | | prevention of influenza, pneumonia and hospital |
| flu, they jump to the conclusion that because | | | | admissions, although they did reduce deaths from |
| medicine has advanced by quantum leaps since | | | | pneumonia a bit, by up to 30 percent." |
| the 1918-19 influenza pandemic (global epidemic), | | | | According to the Influenza Vaccine Supply (IVS) |
| there is nothing to worry about. They are | | | | International Task Force, "Whatever scenario, |
| certainly right about the advance of medicine, | | | | even the most optimistic, the worldwide [vaccine] |
| which has been extraordinary by any measure. | | | | production capacity will be clearly insufficient in |
| Unfortunately, when it comes to dealing with a | | | | case of pandemic." |
| bird-flu pandemic, these advances fall short in | | | | 7. Shortages of nurses and other healthcare |
| many areas. To name the most significant: | | | | personnel will be significant, because of |
| 1. Bird flu is caused by an influenza virus, for which | | | | overexposure to people with bird flu-and thus a |
| there are only four approved antiviral agents in | | | | higher illness and death rate among healthcare |
| the U.S. The virus has extensive resistance to | | | | workers, and because a high proportion will simply |
| two of these medicines already, and resistance | | | | decide not to come to work. A similar situation |
| might develop in the remaining two once they are | | | | occurred in New Orleans during Hurricane Katrina |
| used more widely in a pandemic. The two | | | | when 250 members of the police department |
| remaining medicines, Tamiflu (oseltamivir) and | | | | (one-sixth of the force) abandoned their jobs |
| Relenza (zanamivir), are in extremely short supply | | | | during the hurricane and flooding. It also happened |
| and, even with planned increases in their | | | | in Toronto during the SARS outbreak, when |
| manufacture, will remain in short supply for many | | | | some nurses and other healthcare workers |
| years to come. These medicines must be given | | | | submitted their resignations (although many were |
| within 48 hours of the onset of symptoms, which | | | | persuaded to stay). |
| can be difficult to accomplish for a variety of | | | | The shortage of nurses, which is already a big |
| reasons. Even when they are available and given | | | | problem in the United States, was highlighted |
| on time, their effectiveness is less than 100 | | | | recently by Keji Fukuda of the influenza branch of |
| percent. And because bird flu is very different | | | | the Centers for Disease Control and Prevention |
| than the usual influenza we are used to, higher | | | | (CDC). According to Fukuda, scientists are racing |
| doses given for longer periods of time may be | | | | to prevent what could be millions of deaths from |
| necessary for optimal effect. | | | | a flu pandemic, but what could trip them up is the |
| 2. While we have many wonderful antibiotic | | | | simple lack of nurses and hospital beds. He said, |
| medicines, these are not effective against bird flu, | | | | "No matter how good medical technology is, if we |
| because antibiotics treat only bacterial infections, | | | | don't have healthcare workers to care for sick |
| not viral infections. Antibiotics can be used to | | | | people and hospital beds to put them in, it's not a |
| treat bacterial infections that develop after viral | | | | good situation." |
| infections have damaged the body, allowing | | | | And it's not only the limited numbers of nurses-it's |
| bacterial infections to "take over." This can | | | | also a question of whether or not healthcare |
| happen, for example, when viral pneumonia turns | | | | workers would come to work during a bird-flu |
| into bacterial pneumonia. However, this did not | | | | pandemic. A recent article (b) reported the |
| happen in the 1918-19 Spanish flu to any extent, | | | | disturbing findings of a survey of 6,000 healthcare |
| nor in the 2003 SARS pandemic, and it doesn't | | | | works in and around New York City: |
| appear to be a significant factor in the deaths | | | | "One assumption blown away by Hurricane Katrina |
| that have occurred so far from bird flu. Hence all | | | | is that if government does nothing else, at least it |
| our sophisticated antibiotics will not be of much | | | | protects people's health and safety. |
| help with bird flu. | | | | The Mailman School of Public Health at Columbia |
| 3. The most common cause of death from the | | | | University in New York City set out to look at |
| 1918-19 influenza pandemic, the SARS pandemic, | | | | how many healthcare workers said they would |
| and from bird flu is acute respiratory distress | | | | show up for work, depending on the type of |
| syndrome (ARDS). The viruses from these | | | | emergency. There was some good news: 87 |
| diseases cause severe damage to lungs, which | | | | percent of 6,000 workers surveyed in 47 facilities |
| results in ARDS. Numerous treatments have been | | | | in and around New York said they would be able |
| tried but generally have failed. Patients with ARDS | | | | to go to work in the event of a mass casualty |
| require mechanical ventilatory support, meaning | | | | incident, and 81 percent for an environmental |
| they need to be on a mechanical respirator. | | | | disaster. |
| These are expensive machines, and the supply in | | | | Only 61 percent, however, would show up for a |
| the United States is only slightly above demand | | | | smallpox epidemic, just 48 percent during a SARS |
| during the normal flu season. Simply put, when the | | | | epidemic and 57 percent during a 'radiological |
| bird-flu pandemic strikes, there won't be enough | | | | event.' |
| of these machines, and so people who develop | | | | That's a problem, isn't it? Less than half of |
| ARDS will not have access to this potentially | | | | healthcare workers expect to work during a |
| life-saving treatment. | | | | SARS [or bird-flu] epidemic, and less than |
| 4. There won't be enough isolation rooms to place | | | | two-thirds if terrorists set off a so-called dirty |
| the large numbers of patients with bird flu in, | | | | bomb in the financial district. |
| which will result in more people becoming ill | | | | 'Although we might assume that healthcare |
| through exposure to people with bird flu. Likewise, | | | | employees have an obligation to respond to these |
| there won't be enough of some medical | | | | high-impact events, our findings indicate that |
| equipment, because of increased demand for | | | | personal obligations, as well as concerns for their |
| some items coupled with decreased | | | | own safety, play a pivotal role in workers' |
| supply-because of our reliance on a global supply | | | | willingness to report to work,' said Kristine |
| chain, foreign manufacture, and just-in-time | | | | Qureshi, a researcher in the epidemiology |
| delivery. There won't be enough personal | | | | department at Columbia." |
| protective equipment (such as disposable gloves, | | | | And so "modern medicine," no matter how |
| N95 face masks, gowns, face shields or goggles, | | | | advanced, will clearly have difficulty dealing with a |
| head caps, and shoe covers), which will increase | | | | bird-flu pandemic. In a sense, the next pandemic |
| exposure and infection. | | | | could very well be analogous to the Hurricane |
| 5. During the coming pandemic, there won't be | | | | Katrina situation, with mass confusion, lack of |
| enough beds in hospitals for all the sick people | | | | resources, visible dead bodies, acts of cowardice |
| with bird flu. Makeshift "hospitals" will have to be | | | | and acts of heroism, financial disaster, panic, and |
| established outside of existing hospitals to care | | | | every emotion possible-nothing like we are used |
| for all the ill patients. | | | | to witnessing in America; shocking. |
| 6. An effective vaccine has yet to be developed, | | | | Partly because of the limitations of both |
| and the chances that one will be developed | | | | government and healthcare capabilities, individuals |
| before a pandemic emerges are practically | | | | need to prepare for the coming bird-flu pandemic |
| nonexistent. Once a vaccine is developed, it will be | | | | themselves. There are four specific areas that |
| months into the pandemic, and many people will | | | | must be addressed, as I have written in an earlier |
| already have become ill. Because we have no | | | | article (which can be accessed on our Web site.) |
| natural immunity to this new virus, we might need | | | | (a) Rosenthal E: 2 Studies Find Flu Treatments Fall |
| two immunization shots to develop sufficient | | | | Far Short. International Herald Tribune. September |
| immunity. This makes implementing an | | | | 22, 2005. Available at: Accessed on September |
| immunization program more difficult, and | | | | 23, 2005 |
| decreases the amount of vaccine available for | | | | (b) Olmsted D: Health wrap: of disasters and |
| everyone. | | | | diseases. Monsters and Critics News, September |
| Vaccines, like antiviral medicines, are not 100 | | | | 9, 2005. Available at: Accessed on September 15, |
| percent effective in either preventing infection or | | | | 2005 |
| minimizing symptoms once infected. A startling | | | | Bradford Frank, M.D., M.P.H., M.B.A. |
| new report (a) found only limited benefit from | | | | The Frank Group |
| influenza vaccines: "In people over 65, the | | | | P.O. |
| vaccines 'are apparently ineffective' in the | | | | |