The most ominous words ever uttered by a disaster preparedness expert were voiced during a deep background interview. This expert stated simply that given the current state of hospital preparedness and the current rate at which facilities are becoming disaster ready, there will be no meaningful level of preparedness in this decade unless someone blows up a hospital. This may seem a bit extreme, but declassified documents show that Al Qaeda seeks to steal an ambulance and blow it up at a major American trauma center.
Unfortunately, this scenario is based on the lesser of the threats currently facing healthcare. History over the last three centuries has taught us that novel avian pandemic flu occurs every 91 years (plus or minus 3.5 years for antigenic drift). Given that the last major pandemic was the 1917/1918 Spanish flu this means that we can expect a pandemic flu outbreak between 2006 and 2013.
New Headlines – Not New News
Nursing homes, correctional institutions as well as the disabled and children have not been considered in local, regional or state pandemic planning. In fact they are barely mentioned even in federal planning. In June of 2006 the Institute of Medicine published reports on the state of preparedness but pointed out that even emergency services had been left out of much planning.
It is imperative that healthcare professionals of all stripes become expert not only in pandemic planning but in the “All Hazards” approach to disaster and catastrophic event planning. Whether it is a pandemic, a hurricane, an earthquake, a forest fire, or a terrorist event that threatens the community, bitter experience has taught us that concentrations of individuals living in institutional settings whether in prisons, military barracks or university dormitories become the “cave canaries” of society.
In 1918 Spanish flu outbreaks, which actually began in Kansas, were first seen in epidemic form in U.S. military barracks. The outbreaks of measles in the 1980s were first seen in university dormitories across the United States. And the largest concentrations of the recurrence of tuberculosis, as we all know, is seen in correctional institutions.
The 2003 SARS outbreak also provided us a small scale example of the effects for a pandemic on healthcare. Following the outbreak of SARS in Canada, healthcare workers in 4 Toronto area hospitals began to fall ill. Soon nurses and doctors were looking through protective equipment at colleagues and friends. The disease had changed the normal “us and them” relationship to “us and me.” These professionals watched their friends die. The result of SARS on the healthcare professionals who worked in these 4 Toronto hospitals was that 50% left healthcare entirely.
It is a Mathematical Certainty
The true impact of this disease lies in the numbers. In 1918 100 percent of the entire world was exposed to what would later be called the Spanish Flu. This new strain of avian flu had never been encountered before by a human population, and as a result, there was no immunity to this particular strain. Of that world population, one third would ultimately fall ill, in fact, 50 to 80 percent of the youngest, healthiest, and strongest would fall ill when future generations would divide out the victims.
When these ominous numbers were scrutinized further, a far more dire picture evolved. Research into the 1918 pandemic, as well as pandemics before and since 1918, have shown that the majority of illness and death occurred not in the very old or the very young, not in the sick and infirm, but in those who are in the “prime of life”; those age 18 to 40.
There is a Bigger Problem.
Because of the way that novel avian viruses (pandemics) attack the lungs and cause “immune system storms”, the ultimate irony of a pandemic is that the younger and stronger you are the more likely you are to die. In 1918 fully two-thirds of all those who became ill were in the age range of 18 to 40. More distressing is the fact that 98 percent of all of those who died were age 18 to 40 years. In fact, those over age 55 had no greater rate of illness or death during the pandemic of 1918 than they did in any other flu season in the years immediately before or after that great pandemic. Similarly, those less than 18 years of age suffered no increase in death rate.
The implications for America’s hospitals and healthcare institutions are inescapable. Fully two-thirds of the active workforce will fall ill during the 16 to 18 months of the disease throughout the pandemic. Up to 50 percent of the workforce may not report to duty. The reasons are well demonstrated in the history of pandemics. Twenty-five percent of the young workforce (the 18 to 40 years) will die in that 18 months. Who will replace them?
The ultimate impact of the pandemic on healthcare:
- During the pandemic outbreak, up to 50% healthcare workforce absenteeism
- During the pandemic outbreak, up to 25% healthcare professionals death rate
- Following the pandemic outbreak, 75% of healthcare professionals still alive
- Following the pandemic outbreak, 50% of remaining healthcare workforce quits
- Over the course of the pandemic outbreak, the healthcare workforce shrinks 62.5%
Lest healthcare embrace the lessons for preparedness this is the fate of us all.