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