Wednesday, April 19, 2006

Who will show up for work?

It made the wires. A small study in Maryland suggests almost half of public health workers assume they wouldn't be needed in a pandemic and would stay home. I don't take it seriously.

The study was done a year ago, before there was much talk about the meaning of a pandemic. The major determinant seems not to be a concern for personal safety but a mistaken impression that people not involved in infectious disease wouldn't be needed. This is partly a reflection of poor education in state and local health departments about the consequences of having a third or more absenteeism across all sectors of society. It also reflects the poor state of preparedness of the Maryland personnel at that point. Whether it is much better now is unknown but it would be incorrect to generalize on the basis of a non-random sample from a couple of local departments at a (now) remote time in the development of awareness of pandemic flu. The authors themselves question how representative the respondents were of public health workers. But that's not my main point.

Continuity of operations plans are now on the agenda in many departments (although not all). They usually call for role shifting as dictated by need. So if this study were to be repeated today we might see a much better response. But the problem is not limited to health departments or even the health sector. Many people provide services essential to keep things running smoothly. For example, in many small businesses only a few people are involved in getting people paid or keeping the computer system running. Sometimes only one person knows how to unjam the fax or copy machines, a small but potentially vital task.

One of the most important jobs of civic leaders is to mobilize the community to prepare for this kind of problem. There will be no shortage of willing volunteers once people understand the stakes and understand that together we will get through a pandemic much better than if we hide from each other, hunkered down in our houses, trying to avoid a virus that may be difficult or impossible to avoid. Most people won't get sick, and most people who do get sick will recover. This is not doomsday. But the disruption in society can have its own painful, sometimes lethal, effects if we don't get ready for it. And there's no reason not to get ready. What it takes to prepare has lasting benefits beyond a flu outbreak.

Will there be those who are too fearful for themselves or their families to help out? Certainly. They will need our help, too, whether they help us or not. But the overwhelming majority of people will do what they can -- if we make it possible for them and we promote the idea it is for our common good. I don't worry that health care or public health or police or fire will abandon their posts if we are prepared.

The idea we are all in this together is an ideological notion, of course. It opposes the equally ideological one that says it's every person for themselves. There are good reasons to believe we are better off as a society if we work cooperatively, but no one can guarantee for any individual person they are better off. If you hold as a moral position that a person's only concern should be to look after him or herself, then you should also be prepared to forfeit the help of others when you need it.

Your choice.