Tuesday, May 06, 2008

May 5 Flu Update

CIDRAP on ongoing flu problems in South Korea and Japan.

A veterinary is going to look at how the environment, human, and animal health are inter-related.

North Korea is inoculating poultry after outbreak in South Korea.

Here is where the pandemic rubber hits the road. A group of medical experts is looking at ventilator allocation. Remember, in a pandemic, the US would be sorely short of ventilators. Remember, also, that bird flu won't be the only thing drawing on that supply. So, what did the experts find?

To prepare, hospitals should designate a triage team with the Godlike task of deciding who will and who won't get lifesaving care, the task force wrote. Those out of luck are the people at high risk of death and a slim chance of long-term survival. But the recommendations get much more specific, and include:

  • People older than 85.
  • Those with severe trauma, which could include critical injuries from car crashes and shootings.
  • Severely burned patients older than 60.
  • Those with severe mental impairment, which could include advanced Alzheimer's disease.
  • Those with a severe chronic disease, such as advanced heart failure, lung disease or poorly controlled diabetes.

Revere blogs this topic as well, seeing a start on some progress, but in a sense, a misguided effort. And, of course, the whole thing feels like the lifeboat exercise we used to do in school when the teacher forgot to do her lesson plans.

But as some point out, the shortened list might even be a violation of federal law prohibiting discrimination by age or disability or income. If the task force report provokes discussion and argument, that's a good thing. But it doesn't provide a way to settle the issue, so it isn't necessarily progress.

Maybe instead of arguing who will go in the lifeboats if the ship sails into an iceberg we should be building safer boats with more lifeboats. Of course it's not a question of one or the other. We can do both. Unfortunately we are only doing one.

The Pacific Island Health Officer Association has discussed bird flu at a meeting.

Australia used tamiflu during seasonal flu, and now is looking at a diminished pandemic stockpile.

CIDRAP reviews best planning practices, this time with interactive kiosks in North Carolina.


At 6:04 PM, Blogger Wulfgang said...


You have a very interesting and intriguing set of articles about the soon to be released report by the group of physicians, which lists recommendations for which patients wouldn’t be treated during a pandemic. Philosophically, of course Revere is right pointing out that “we should be building safer boats with more lifeboats”, but that is not the world we are living in at the current time. It goes without saying: a severe pandemic will by its very nature, result in all people not being treated equally. When I glanced the abbreviated list (people over 85; those with sever trauma; severely burned and critical injuries; severe mental impairment; and severe chronic disease), in my view, it looked quite reasonable – in fact, it almost seems too narrow a list and quite general (probably by design). For example, it seems to fail to take into account some of following more practical considerations:

• Insured versus uninsured individuals: do uninsured individuals not get treated, or are they entitled to minimal treatment ? Do insured individuals or those with the economic means (wealthy) get preference ?

• Habitual criminals: convicted murderers, rapists, death row inmates, drug dealers and pedophiles – do they deserve any consideration at all because they made horrible life choices, are dangerous and are society misfits ?

• Premature infants: to what length should the medical treatment be extended ?

• What functional occupations or work activities get medical preference (e.g, sequences, priorities): health care and emergency workers, utility workers, lawyers and politicians (heave forbid), law enforcement, or supply chain workers ? Where do the approximate 10 million undocumented illegal aliens and migrant workers fit in, versus 290 million legal US citizens ?

• Severely handicapped individuals: is it right for any hospital or group of physicians to pass moral or medical judgment on whether these mentally or physically challenged individuals received medical care versus a healthy individual ?

I mention these few examples, because Lawrence Gostin of Georgetown University, seems to be more concerned about care rationing and ethical concerns with the “poorest and most disadvantaged citizens” (I am assuming people below the poverty level), which is only about 10 per cent of the US population. Healthy debate on the subject is indeed beneficial, but it is currently estimated that a full 90 per cent of American households are “food secure”, meaning that they have access to food at all time, to enough food for an active, healthy life for all household members. Disregarding income, the remaining 10 per cent were “food insecure” at least some time during the year, but let’s face the facts: people don’t starve in the US. During a severe pandemic, these ratios could very well reverse in order: 90 per cent of the population may become “food desperate”, and only 10 per cent remainder “food secure”. At that point during a pandemic, normal “moral and ethical concerns”, move to a rather low rung on the ladder of survival.

If we have a severe pandemic which overloads the hospitals and an entire health care system brought to its knees (which is entirely conceivable), we could face a much worse situation than ethical and legal concerns over who gets medical preference – it might very well be far more basic than that - it could become a situation whether our social and economic infrastructure and food and medical supply systems remain intact enough to maintain an acceptable standard of living, while preserving some semblance of law and order. It might be far more dire than hospital triage teams deciding “who’s allowed to die in a pandemic”, but more of a situation subjectively deciding “who’s most important that they live”, given that there are only a finite number of ventilators available.

And let’s face the facts: those hospital triage physicians who unfortunately have to decide who lives, and who dies, would most likely find themselves ultimately under the same scrutiny by others - and I’m talking about an angry father, husband, boyfriend or mother with a loaded Smith & Wesson. Not at all farfetched in my view.



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