Thursday, April 06, 2006

Health care Katrina

There were three recorded pandemics in the twentieth century, in 1918, 1957 and 1968. The mildest was 1968. The worst, as all know, was 1918. 1957 was in the middle. Many of us lived through the latter two and don't remember much about them. By numbers and by memory some say they couldn't have been that bad.

That's why a recent story on Bloomberg is so interesting:
In 1957, the University of North Carolina turned a dormitory into a hospital for dozens of students stricken by an Asian flu circling the globe. Eleven years later, Nashville medical centers filled beyond capacity when another worldwide epidemic hit.


David Costello and Paul Glezen have vivid memories of the Asian flu pandemic in 1957, and Vanderbilt's [William] Schaffner easily recalls the 1968 Hong King outbreak.

A fever of 101 wasn't high enough to rate entry into the University of Notre Dame infirmary in 1957, when Costello, then a 19-year-old sophomore, got hit with the Asian flu pandemic.

Sick students lay on hallway cots at the South Bend, Indiana, college as they did in clinics and hospitals throughout that region, said the 69-year-old Costello, now a retired history teacher in Buffalo, New York.

During that same outbreak, the University of North Carolina in Chapel Hill converted a dormitory into a hospital for Asian flu-stricken students, said Paul Glezen, 75, a Baylor University epidemiologist and a public health worker in 1957.

The makeshift Chapel Hill hospital "was just for the students who lived too far away to go home,'' Glezen recalled. "It was only a fraction of the kids who were really ill.''

In 1968, Nashville hospitals that normally had beds to spare were filled to capacity, said Schaffner, who now consults to the U.S. government on flu issues. Schaffner said he caught the flu caring for patients a day after running a dangerous 103-degree fever.

"There was concern that people being admitted were acquiring flu in the hospital,'' he said in a March 10 telephone interview. "Every hospital was full and there were patients waiting in the emergency rooms.'' (Bloomberg)
Bear in mind that 1968 was a powderpuff flu pandemic. Our health care system isn't in any better shape not, then in 1968. It may be even more brittle, since the number of staffed hospital beds has been steadily shrinking even as the population has been increasing.
Emergency care in the U.S. is "like a house of cards,'' [Andrew Bern, who founded the American College of Emergency Physicians' disaster medicine section] said, "waiting for a big wind to collapse it.''

Visits to U.S. hospital emergency rooms rose 26 percent to 114 million in the 10 years ending in 2003 as the population increased, he said. During the same period the number of emergency rooms fell 14 percent due to cost-cutting by medical centers, said David Seaberg, a director with the Physicians' College, in Feb. 8 testimony before the House Committee on Homeland Security.
You can call this fear mongering about bird flu if you want. But what it says is that the US health care system and its public health infrastructure is a hollow shell. The claim we have the best medical care in the world is a falsehood, not borne out by any statistic. If we stress this system, even a little bit, we will see the curtain ripped away and what it will reveal won't be pretty.

You don't have to have a 1918 strength bug but for an influenza pandemic to be a health care Katrina. And you won't have to live in New Orleans to feel its full force.