Sunday, October 09, 2005

Pandemic Flu Awareness Week ends with a beginning

Pandemic Flu Awareness Week officially ends today. We'd like to say we planned the timing of all this, but in fact it was conceived over a month ago by the three blogger partners-in-crime who started the Flu Wiki (DemFromCT of The Next Hurrah, Melanie Mattson of Just a Bump in the Beltway and The Reveres of Effect Measure [this site, of course]). Then there was still little MSM attention to bird flu. Obviously this has all changed (late, but better late than never). The new attention has had the added effect of bringing many people to The Flu Wiki, which now averages almost 3000 visits a day.

So where are we? DemFromCT has an excellent wrap up of This Week in Bird Flu at DailyKos. Here's my overall take on it from the perspective of a practicing epidemiologist with 40 years in medicine and public health. I'll try to make it as succinct as I can (no easy task for me, as you know).
  • The threat of a serious influenza pandemic with a large global and national death toll globally is real, but of uncertain magnitude and timing.

  • Even in the worst plausible case, we're not all going to die if it happens. Not even most of us will die. Probably the majority of people (but possibly a bare majority) will be unaffected or affected little by the virus. But very many people will get quite sick and many of them will experience a protracted period of recovery lasting weeks or longer. A significant number will die in a relatively short period of time. This happens in any influenza outbreak but will be much worse if a pandemic strain emerges.

  • Because of an anticipated high rate of absenteeism (perhaps 30% or more), many things we take on faith as "just working" won't work as well or at all. For example, if there is a major snow storm and power is lost to a wide area, it may make take considerably longer to restore if the trucks haven't been maintained, the number of linemen is much reduced, the roads aren't cleared and the inventory of repair supplies is interrupted by transportation failures. The reductions in each sector can add to each other and cause a much larger effect than would be anticipated from any one separately.
Or not. As difficult as many of these issues are, they can be substantially ameliorated by advance planning.

For example, pharmacies and supermarkets typically use "just in time inventory" systems, meaning they have in stock only a quantity sufficient for short term demandThey depend on frequent deliveries to keep supplies current. If deliveries are interrupted, as they were in Katrina, many people who depend on life sustaining medicines like insulin or blood pressure medication will be in trouble. The just-in-time system is now a deeply ingrained practice and can't be reversed. But interrupted supplies are not very important for most of what pharmacies carry. Who cares if the deodorant or the viagra doesn't come in? What we need is a short list of half a dozen or a dozen high-use critical medications (insulin, blood pressure meds, some antibiotics, etc.) and an emergency source that pharmacies, hospitals and patients can access. This is a task for state and local health authorities. The National Guard can be used for transportation and logistics and community centers or other facilities used as access points. The same can be done with food staples. You won't still have your Cheezits. But you will have milk. I'm not going to spell it all out here, because you get the idea. All it takes is some forethought and planning.

Which hasn't been done, for the most part. This is a problem of community mobilization. Leadership is needed, so if your "leaders" are missing in action, step up and lead yourself. If we sit down rationally and calmly BEFORE the shit hits the fan we will be able to get through it rationally and calmly. It will still be painful, but less painful and more easily endured. Share what you know and what you learn with others. The Flu Wiki is designed for that.

Let's roll up our sleeves and get to work.