Tuesday, July 19, 2005

Leadership on flu in Seattle, but where else?

The west coast is arguably the first place bird flu might arrive via an infected passenger, being closest to asia, although the difference in probability with any other place in the world may not be great. Even so, it seems King County, Washington (Seattle) is always a bit ahead of the curve. They get it.

Unlike most other localities they are not just putting plans on paper or restricting activities to the health department but actively involving both the medical and the business communities (story in Puget Sound Business Journal). The latter include some industry giants, such as The Boeing Company and Microsoft. The Seattle and King County health department is inquiring of these and smaller businesses what they are doing (if anything) to plan should a pandemic materialize with the thought this could be shared with other businesses.
By fall, the department hopes to have a core group of business leaders that will work with the agency on a response in the event of a major influenza epidemic.

"These things happen two or three times a century," said Dorothy Teeter, interim director of the Health Department. "If I were a business owner, I'd be very concerned about the potential impacts on my bottom line."
It is likely these companies are doing nothing, but just the inquiry might kick start some action. The health department is taking a proactive stance, since to date no business leaders have contacted them about the problem and seem unconcerned. But reasonable estimates indicate 1.2 million people (two-thirds) of the county could become infected in the first 6 weeks. The worst case would be 250,000 to 600,000 seriously ill, 5000 hospitalized and 500 to 1800 dead. The impact could be severe, with possible mandatory closing of shops, restaurants and other nonessential businesses. Even without mandatory closing, absenteeism could reach 30%.
At the same time, employers can be important sources of information for workers, and workers' families, about preparing for the flu and responding to an outbreak.

"The business community needs to play a key role, in understanding what might happen and making sure we have clear lines of communication," Teeter said.
The medical community also needs tending. While there is some awareness, the degree of ignorance among doctors is shocking. Thus the King County initiative with respect to the doctors and hospitals is also timely. Since there are only a little over 5000 hospital beds in the county, 5000 new hospitalizations would be unmanageable without extensive prior planning. Without planning, the hospitals would be in chaos.

What is unfortunate about this story is how unusual it is. Everything makes sense. By implication, the lack of comparable planning elsewhere doesn't make sense. This example of public health leadership is matched by the lack of leadership at state and national levels.

Given that leadership vacuum, individuals are trying to fill the gap. An interesting example can be found on the Flu Wiki where a physician has drafted generic letters to local businesses and City Councils to stimulate them to think about the potential consequences of a pandemic to their firms and their communities. As in King County, the discouraging thing is that it had to be done by an enterprising individual rather than local, state and national health authorities.

What's that huge sucking sound? Public health leadership vacuum.