Saturday, October 29, 2005

As I was saying . . .

Thursday Reuters reported that the US pandemic plan was being readied. Pardon me but I've heard that before. Or maybe I should say, I've been hearing it for years. Literally. They started working on the (as yet unfinished) plan in 1993. But let's say it's true. Just for fun. What's in it? Why has it taken so long? According to Department of Health and Human Services Secretary Michael Leavitt, the plan includes better disease reporting and stockpiles of vaccines and drugs.

That's it? No wonder ordinary citizens are hoarding Tamiflu. We're on our own.

Leavitt says (correctly, in my view) that at this point the role of the federal government will be limited (see also "The cavalry isn't coming"):
"If a pandemic hits our shores, it will affect almost every sector of our society, not just health care, but transportation systems, workplaces, schools, public safety and more," Leavitt said in a speech at the National Press Club.

He said the federal government was doing what it could, but he said he would detail ways for local authorities to do their share.

"One example: The federal government can deliver stockpiles of medication and supplies to a city in the United States anywhere within a matter of hours," Leavitt said.

"But it's the distribution at the state and local level that ultimately defines victory. In a moment of crisis, if we are not able to deliver pills to people over a wide area in a short time frame, lives will be lost." (Reuters)
The catch here is in (my qualifier) "at this point." We are in the (unprepared) fix we are in because the Bush, Clinton and Reagan Administrations didn't get us ready when they could have and should have. Let me correct that. Because they abandoned us.

To apportion the blame properly, we should start with Reagan, who in his eight catastrophic years in office did tremendous damage by dismantling a large part of the public service structure and its commitment to community well-being. It still takes my breath away how someone so fundamentally (but genially) awful could be considered a hero, but that's another story. The destruction of the federal and societal commitment to each other was engineered by the Reaganites (many now pulling the levers in the Bush Administration), slowed slightly (but continued) by Clinton/Lieberman and their ilk, and then driven right off the cliff by Bush wackos who are bankrupting the country with their murderous recklessness abroad and corrupt cronyism at home.

I know you have heard this here before. A lot. Here is a snippet from one of our earliest posts, "Influenza and leadership," dated November 29, 2004:
This post is ostensibly about avian influenza A (H5N1). It's really about how we are going to cope without effective public health leadership. Avian flu is a freight train coming our way. Whether or not it hits us will just be a matter of dumb luck one way or another and is probably out of our control by now. How badly we are hurt if we are hit isn't. But it isn't just a matter of an effective plan or manufacturing a vaccine, although both are part of it. As much as anything it is about a public health system that is leaderless, uninspired and dispirited.


One response is essentially nihilist. In the nuclear freeze movement of blessed memory we used to have a poster giving the steps to take to protect yourself against a nuclear attack. It ended with sitting down, putting your head between your knees and kissing your ass good-bye. That kind of response won't happen because we are hardwired to try to survive. But it would be nice to have some vision other than as a bit part in a post-apocalypse reality show.

I don't see much that our public health officials are doing to plausibly prepare for this. We go through an endless cycle of "needs assessments," contingency plans and appropriations that never find their way to the street level. Most knowledgeable people don't believe we are in much better position to cope with an emergency than we were a few years ago. We have no more surge capacity in our hospitals than before. Even a slightly worse flu season than usual overwhelms them. And there will be a serious shortage of nurses and other care givers, not to mention undertakers. It isn't as if this hasn't happened before. It has. But we aren't really in better shape. There is neither the political will, the political vision, nor the political public health leadership. We are drawing up plans on paper on how to get to the life boats when the ship hits the iceberg. Even if that works in an orderly way (and there isn't enough room for everyone), there is precious little thought what to do when we are set adrift.

So what am I saying? In an earlier post (Vioxx: What would Gandhi do?) I suggested we adopt a "constructive program" and do our own planning, constructing and implementing on a small local scale. We don't need CDC or Tommy Thompson to think about how to use hotels or motels for surge capacity (each room has a bathroom), begin to organize volunteer retired nurses and doctors (our neighbors) in case of an emergency, start talking to the mortuaries about what they will do, inquire again and again at our community hospitals about adequate supplies of respirators (including pediatric sizes since this virus seems to have a predilection for children). I know some of these things are (allegedly) being done by state health departments. But my (up close) observation is that with staffing shortages, turf battles and a stunning narrowness of vision, most of it isn't happening and the plans on paper will be out the window in the first 24 hours after a true emergency is recognized.
So here we are, almost a year later, AND I'M STILL SAYING THE SAME GODDAM THINGS.