Bird Flu: Why Modern Medicine Won't Save Us

Very often when people begin to learn about birdprevention of influenza, pneumonia and hospital
flu, they jump to the conclusion that becauseadmissions, although they did reduce deaths from
medicine has advanced by quantum leaps sincepneumonia 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 areInternational 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 acase of pandemic."
bird-flu pandemic, these advances fall short in7. 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 whichoverexposure to people with bird flu-and thus a
there are only four approved antiviral agents inhigher illness and death rate among healthcare
the U.S. The virus has extensive resistance toworkers, and because a high proportion will simply
two of these medicines already, and resistancedecide not to come to work. A similar situation
might develop in the remaining two once they areoccurred in New Orleans during Hurricane Katrina
used more widely in a pandemic. The twowhen 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 supplyduring the hurricane and flooding. It also happened
and, even with planned increases in theirin Toronto during the SARS outbreak, when
manufacture, will remain in short supply for manysome nurses and other healthcare workers
years to come. These medicines must be givensubmitted their resignations (although many were
within 48 hours of the onset of symptoms, whichpersuaded to stay).
can be difficult to accomplish for a variety ofThe shortage of nurses, which is already a big
reasons. Even when they are available and givenproblem in the United States, was highlighted
on time, their effectiveness is less than 100recently by Keji Fukuda of the influenza branch of
percent. And because bird flu is very differentthe 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 beto 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 antibioticsimple 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 topeople and hospital beds to put them in, it's not a
treat bacterial infections that develop after viralgood situation."
infections have damaged the body, allowingAnd it's not only the limited numbers of nurses-it's
bacterial infections to "take over." This canalso a question of whether or not healthcare
happen, for example, when viral pneumonia turnsworkers would come to work during a bird-flu
into bacterial pneumonia. However, this did notpandemic. 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'tworks 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 allis that if government does nothing else, at least it
our sophisticated antibiotics will not be of muchprotects 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 theUniversity 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 distressshow up for work, depending on the type of
syndrome (ARDS). The viruses from theseemergency. There was some good news: 87
diseases cause severe damage to lungs, whichpercent of 6,000 workers surveyed in 47 facilities
results in ARDS. Numerous treatments have beenin and around New York said they would be able
tried but generally have failed. Patients with ARDSto go to work in the event of a mass casualty
require mechanical ventilatory support, meaningincident, and 81 percent for an environmental
they need to be on a mechanical respirator.disaster.
These are expensive machines, and the supply inOnly 61 percent, however, would show up for a
the United States is only slightly above demandsmallpox epidemic, just 48 percent during a SARS
during the normal flu season. Simply put, when theepidemic and 57 percent during a 'radiological
bird-flu pandemic strikes, there won't be enoughevent.'
of these machines, and so people who developThat's a problem, isn't it? Less than half of
ARDS will not have access to this potentiallyhealthcare 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 placetwo-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 medicalhigh-impact events, our findings indicate that
equipment, because of increased demand forpersonal obligations, as well as concerns for their
some items coupled with decreasedown safety, play a pivotal role in workers'
supply-because of our reliance on a global supplywillingness to report to work,' said Kristine
chain, foreign manufacture, and just-in-timeQureshi, a researcher in the epidemiology
delivery. There won't be enough personaldepartment 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 increasebird-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 beKatrina situation, with mass confusion, lack of
enough beds in hospitals for all the sick peopleresources, visible dead bodies, acts of cowardice
with bird flu. Makeshift "hospitals" will have to beand acts of heroism, financial disaster, panic, and
established outside of existing hospitals to careevery 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 developedgovernment and healthcare capabilities, individuals
before a pandemic emerges are practicallyneed to prepare for the coming bird-flu pandemic
nonexistent. Once a vaccine is developed, it will bethemselves. There are four specific areas that
months into the pandemic, and many people willmust be addressed, as I have written in an earlier
already have become ill. Because we have noarticle (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 sufficientFar Short. International Herald Tribune. September
immunity. This makes implementing an22, 2005. Available at: Accessed on September
immunization program more difficult, and23, 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 1009, 2005. Available at: Accessed on September 15,
percent effective in either preventing infection or2005
minimizing symptoms once infected. A startlingBradford Frank, M.D., M.P.H., M.B.A.
new report (a) found only limited benefit fromThe Frank Group
influenza vaccines: "In people over 65, theP.O.
vaccines 'are apparently ineffective' in the