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