Thoughts on flu/SARS/USA Health care

[scarletlib]

The last 2 weeks a nasty cold has been making the rounds through family and friends. Luckily my husband and I are in a position to have health insurance and sick days and so can afford to stay home and recuperate. Just talked to my sister in Tennessee last night. She has the flu and again is fortunate like us and can stay home a few days and treat the illness.

This caused me to think of the sorry state of health care in this country and the looming threat of a flu pandemic.

Remember the SARS outbreak in Canada last year? That didn't go far because the Canadians got onto it pretty fast. People who get sick with flu-like symptoms, etc. can get into see a doctor pretty quick.

Just think if SARS had started in someplace like Houston TX or any large city in this country. You have large numbers of poor, with no health insurance and no sick days. They just keep on working even while sick. If SARS had started here it might have gotten many more people infected even though it is hard to catch.

So if the new bird flu hits here it could be devastating given the current wreck of our heath care system. By the time people get so sick to make it to the emergency room where they will sit for several hours there will be no telling how many people they have infected because of continuing to work and/or not seeking help sooner because of no health insurance plan.

[barbaraann]

1. It's ok. Service Corporation International will profit from the deaths.

SCI is a Texas funeral services company. There are tens of thousands of links regarding their problems with consumers but here is one:

http://www.austinchronicle.com/issues/dispatch/2004-10-15/pols_naked10.html

[Warpy]

2. I think the rich are about to learn all over again

why investing in public health is a really good idea.

It seems those seflish jerks always think their money will protect them from the vicissitudes of life.

They always get a rude awakening. Alas, that rude awakening also generally kills a lot of us in the process.

[mike_c]

3. SARS was a dress rehersal....

Avian flu currently has an approximately 70 percent human mortality rate, and that's with hospitalization and intensive care. That's a higher mortality rate than the 1918 Spanish flu pandemic. There is no way health care can be provided on that scale if a global pandemic erupts.

At present, H5N1 avian flu has limited ability to infect humans, but it mutates rapidly (which also complicates immunization) and is increasingly sharing hosts with human virus reserviors, including humans themselves. That's where the real danger lies, because if it shares hosts with human viruses it is only a matter of time before H5N1 picks up genes that enable human viruses to rapidly infect their hosts. That's when it goes explosive, and really, it is only a matter of time before that happens. Frankly, I think the only thing that will prevent it is development of an effective vaccine-- a daunting task in itself-- and immunization on a massive scale. That's clearly not going to happen, so I think a global pandemic is very likely. The CDC and WHO are scared shitless about this one, and too few people are listening.

BTW, HHS has a draft pandemic response proposal that includes such measures as travel limitations (even within the U.S.), closure of schools and other public institutions, and prohibitions of public gatherings. Everyone seems aware that just keeping the lid on until the pandemic runs its course and the dead are buried is the only really viable response in the absence of concerted public health preparations, that as I said, appear highly unlikely.

on edit: having insurance won't be very helpful if health care services are overwhelmed.

[scarletlib]

4. you make a number of good points

my thoughts are that what could be more easily contained as far an epidemic is concerned is that the lack of upfront health care for so many will result in the disease spreading even faster than it would if a better health care structure were in place in this country.

I have no doubt that once this thing got going full tilt that the health care system will be overwhelmed.

Let's hope it doesn't come to that.

[mike_c]

5. right now the ONLY strategy that anyone has hopes for...

...is containment. That's why the WHO jumps so aggressively on each reported case of human infection-- so far they've all probably resulted from bird-to-human transmission, but when H5N1 jumps to human transmission and the outbreak starts it will be critical to contain it and to either wipe that strain out while it's still local-- a short term response at best, because the recombination will occur again-- or to hold the line until a vaccine can be developed. There's not much hope for doing the latter very effectively, even in the developed world. My gut feeling is that by this time a year or two from now there will have been a massive number of deaths, somewhere in the range of 50 million world wide, and 2-4 million in the U.S.

[depakid]

6. Containment would have to occur at the source

and unfortunately- even where public health officials are diligent with their survellience, H5N1 is proving to be tricky to identify.

According to the February 17 issue of the New Englan Journal of Medicine, Avain influenza in Vietnam and Thailand is presenting with unusual- and previously unrecognized symptoms. So it may prove difficult to know which individuals to isolate, should the disease being highly contageous. Moreover, short of damn near shutting down all travel from affected countries, it would be difficult to keep the disease from "skipping."

It's probably not going to be good enough to quaranteen at ports of entry once the disease has already gotten onto the plane or train. Of course it makes sense to clamp down there too, as was done with SARS, but at that point, the disease has exponentially more opportunities to break out into new areas....

[mike_c]

8. personally, I don't think there is any real hope for containment....

But that's the only card the WHO has at this point, so they're going with it. It won't work. Many, many people will likely die.

[Bluebear]

7. "Next year's bird flu will be SARS on steroids"

So said someone from CDC last week. I wonder if this administration has any interest in planning for it or if they are too busy liberating Syria next?

[mike_c]

9. I'd be the first to agree with you about the Bush administration's...

...misplaced priorities, but realisically there isn't much that can be done. There isn't a public health agency in the world that can make a stand against a truly virulent pandemic. Very drastic measures might have very small scale effects-- read about the two year blockade that saved American Samoa during the 1918 pandemic-- but I don't hold out much hope for global preparedness, even if the entire resources of the U.S. were thrown into the effort.

[Bluebear]

10. Southeast Asia's WHO official said governments need to ....

make emergency plans NOW, whatever those plans are.

However I fully realize what you are saying and concur. When one can board a flight from Shanghai to Chicago arrive in under a day, so can the virus in question. I guess I wouldn't mind Bushco, for instance, having some real public service announcements made (not Armstrong Williams-type payola for one of Bush's pet projects) about hygiene, hand washing, anything to at least make people aware of what we might be facing and to at least attempt to take precautions. Heck, maybe Halliburton even makes gauze masks :)

[depakid]

11. It could be much worse

though at least it's a known quantity, unlike SARS (which is what had freaked everyone out, despite it comparatively low case fatality rate).

And SARS had peculiar epidemiological characteristics. The corona virus is hardy- it can survive a long time outside the host- on things like metal railings. So a person can pick that stuff up a long after an infected person has gone.

The Bush administration isn't taking this serious enough (big surprise) although as mike c has noted, no matter what, public health servies could quickly be overwhelmed. The whole thing is a logistical nightmare.

Bush's proposed cuts include:

A 9% reduction in CDC's budget to $6.9 billion;

A 12.6% spending reduction for public health emergency centers, which distribute medications and vaccines in the event of a bioterrorist attack;

While Bush does propose an increase funding by 21% for pandemic preparation, at $120 million it's still vastly underfunded- especially considering the magnitude of the risk- and will be offset in any case by the cuts to public health emergency centers- the very infrastructure that would be vital in the event of a pandemic.

[mike_c]

12. I'd estimate that's pretty close to $2.00 for everyone who will...

...die of avian flu during the pandemic, at least if WHO predictions of potential mortality come to pass. Two bucks-- less than the cost of a cheap take-out meal at a burger joint. That's what the Bush administration figures is its share of the cost of attempting to save those lives. I won't even compare that to America's per capita funding for deliberately killing people around the world-- I'm sure the point is obvious.

[depakid]

13. I reckon that's about right

Of course the hope is that if/when the reassortment converts the virus into highly contagious human variant, the case fatality rate will drop because the resulting surface antigens will "look" more like something that peoples' immune systems are used to "seeing," and there'll be at least a a little residual immunity.

Even so, the impact of even a less virulent pandemic will have such a huge impact on the overall economy that $120 million would be chickenfeed by comparison.

It would be interesting to see some models and risk assessments on this.