0
Should the town have a flu strategy?
22 November 2005
Every day I read headline news about avian flu. New cases, new deaths, more birds found with the same or similar strain in another country. Bird flu replaces Iraq, the Gomery inquiry and the looming election as the top story most days.
There are wildly varying predictions about the timing of the next pandemic, its spread, its mortality. The only thing everyone agrees is that something infectious is coming and, based on historical data, a pandemic is due very soon.
Are we prepared? Can our current emergency plans, can our hospitals and medical services accomodate the effects of a pandemic? Can our police, fire and town services operate under stressful conditions where up to a third of their staff may be ill and unable to work? Are we prepared to deal with the vast numbers of sick, even dying, in our community?
No, we're not. No one is. The World Health Organization (WHO) says so:
Look at a simple scenario. The WHO estimates that 25-35 percent of any population will be infected by a flu. With a larger-than-average proportion of seniors here, that ratio may be even higher. And seniors are the most at risk from the illness and most likely to suffer symptoms that require hospitalization.
Figure a town population of 21,000, with a third of them sick. That's 7,000 people sick, in quarantine, incapacitated or in hospital. If 10 percent require hospitalization, that means 700 beds are required. Our hospital has about 80 beds and is generally full year round. Even if only 1 percent require hospital care, that's 70 more beds than we have available. The emergency room can handle about 30-40 people at any one time. Where do these people go? Stay at home?
If they stay at home, who will look after them? Who will check on them, make sure they have food, medication, take care of their pets or other needs?
Our nursing homes and seniors' residences will be full of sick and dying people, none of them able to escape the infection because they have nowhere else to go. But the staff that cares for them - nurses, support workers, janitorial staff, cooks - will have their own ranks reduced by the flu. Worse, places of confinement like this will help concentrate and spread the disease.
The mortality rate of avian flu H5N1 is currently 50-70 percent. The survivors have only stayed alive thanks to intense medical care in hospitals, on respirators, taking drugs and receiving 24-hour monitoring. This makes H5N1 very scary. It's not up there with Ebola for mortality (90%), but it's still staggeringly lethal, and by far the most lethal flu bug ever discovered.
However, that may not always be true if the virus mutates: it could be less lethal - and it could be worse. No one knows. The most virulent strains even have fatal hemorrhagic symptoms - victims bleed internally, compounding the treatment. Like Ebola. All we know for sure is that no one has any natural immunity, no one is safe.
It will spread like the flu did in 1918, ravaging some communities, while leaving others relatively unscathed. But this time it will spread faster. If a pandemic hits, the disease will take perhaps as few as 60 days to spread around the world. There are headstones in Collingwood cemeteries marking the graves of those who died in that pandemic. Even without modern transportation to aid its spread, it reached us here easily.
And we're a mere two hours away from the world's most multi-cultural city: Toronto. SARS broke out first in Toronto. Avian flu may make itself known there first, too.
There have been two other pandemics since 1918, both considerably gentler. The 1957 pandemic killed 2 million people and the most recent one, in 1968, killed 1 million people. Last week, WHO said it considers the most likely scenario to be a death toll of between 2 million and 7.4 million people, or about 1 percent of those infected.
But it could be much higher. In late 2004, Shigeru Omi, regional director of WHO’s Western Pacific Regional Office, warned, the "The maximum range is more ... maybe 20 to 50 million people." In September, 2005, Dr. David Nabarro - WHO's UN coordinator for avian and human influenza - warned the death toll could be 150 million.
The 1918 pandemic killed 20-40 million worldwide, and had a mortality rate of 2.5 percent. If the next pandemic has a similar mortality rate, that means 175 out of those infected 7,000 will die here. If it's only 1 percent, then 70 will die. That's still 70 people in this community dead.
Ontario has about 12 million people. About four million will be infected, and 40,000 will likely die (at 1 percent) and maybe as much as 100,000 (at 2.5 percent). Can our funeral homes, crematoriums, and cemeteries handle this load? Do we have enough people to even bury our dead?
Imagine if every municipal department - including police, fire and ambulance - had one third of its employees on sick leave. Imagine if every business, every restaurant, every bank, every medical office has a third of its employees off. And that every business and store has a third of their customers sick, unable to shop.
Would you go to restaurants, the gym, the library, movies, bars, theatre, art gallery or other places of public gathering while the flu was killing people? Local businesses, especially the hospitality sector, will be hard hit.
We need a comprehensive emergency plan to deal with influenza, a plan that's separate from other emergency plans, and looks at issues such as infection control, emergency staffing and maybe even community lockdown and curfews. We need to be prepared. And thanks to a receptive staff who agreed, we are going to start some tabletop planning exercises next month.
I also believe we should have a policy to encourage staff to get their flu shot. While the current vaccines will probably not protect against H5N1, they will at least help counter the threat of collateral influenzas which could use the pandemic opportunistically to invade. And they will keep vaccinated people from infecting others with a different strain.
The town could set up an in-house clinic for town staff and their families to make it easy and convenient to gett he shots. We should also have a mandatory refresher course for everyone on how to avoid catching the flu, and about washing your hands frequently (with water and basic soap - not antibiotic soaps which are ineffective against viruses).
Anyone who refuses to have a shot should be told they cannot come to work when 1) they are sick, and 2) there is an outbreak of flu in the building they work in. You can make the choice not to get a flu shop, but no shot, no pay for missed days.
This should also extend to all town operations and functions, including council, committees and boards. Anyone who does not have a record of a flu shot will be told to not attend meetings when there is an outbreak of flu in that building or department.
Here are the numbers showing the vaccine's efficacy, from the Mayo Health Clinic in the United States:
This will be difficult. At least two members of council recently boasted that they never got vaccinations and - tens of thousands of pages of medical research, data and study to the contrary - they did not see any need for them. We have to overcome deeply-seated fears and primitive superstitions about vaccinations - we may need a strong, focused educational campaign to bring these people into the 21st century. If only some of us do it, it won't be very effective - those who refuse will continue to endanger the health and wellbeing of the rest of the community.
There are wildly varying predictions about the timing of the next pandemic, its spread, its mortality. The only thing everyone agrees is that something infectious is coming and, based on historical data, a pandemic is due very soon.
Are we prepared? Can our current emergency plans, can our hospitals and medical services accomodate the effects of a pandemic? Can our police, fire and town services operate under stressful conditions where up to a third of their staff may be ill and unable to work? Are we prepared to deal with the vast numbers of sick, even dying, in our community?
No, we're not. No one is. The World Health Organization (WHO) says so:
Quote
Is the world adequately prepared?
No. Despite an advance warning that has lasted almost two years, the world is ill-prepared to defend itself during a pandemic. WHO has urged all countries to develop preparedness plans, but only around 40 have done so. WHO has further urged countries with adequate resources to stockpile antiviral drugs nationally for use at the start of a pandemic. Around 30 countries are purchasing large quantities of these drugs, but the manufacturer has no capacity to fill these orders immediately. On present trends, most developing countries will have no access to vaccines and antiviral drugs throughout the duration of a pandemic.
From the WHO FAQ sheet on Avian Influenza
No. Despite an advance warning that has lasted almost two years, the world is ill-prepared to defend itself during a pandemic. WHO has urged all countries to develop preparedness plans, but only around 40 have done so. WHO has further urged countries with adequate resources to stockpile antiviral drugs nationally for use at the start of a pandemic. Around 30 countries are purchasing large quantities of these drugs, but the manufacturer has no capacity to fill these orders immediately. On present trends, most developing countries will have no access to vaccines and antiviral drugs throughout the duration of a pandemic.
From the WHO FAQ sheet on Avian Influenza
Look at a simple scenario. The WHO estimates that 25-35 percent of any population will be infected by a flu. With a larger-than-average proportion of seniors here, that ratio may be even higher. And seniors are the most at risk from the illness and most likely to suffer symptoms that require hospitalization.
Figure a town population of 21,000, with a third of them sick. That's 7,000 people sick, in quarantine, incapacitated or in hospital. If 10 percent require hospitalization, that means 700 beds are required. Our hospital has about 80 beds and is generally full year round. Even if only 1 percent require hospital care, that's 70 more beds than we have available. The emergency room can handle about 30-40 people at any one time. Where do these people go? Stay at home?
If they stay at home, who will look after them? Who will check on them, make sure they have food, medication, take care of their pets or other needs?
Our nursing homes and seniors' residences will be full of sick and dying people, none of them able to escape the infection because they have nowhere else to go. But the staff that cares for them - nurses, support workers, janitorial staff, cooks - will have their own ranks reduced by the flu. Worse, places of confinement like this will help concentrate and spread the disease.
The mortality rate of avian flu H5N1 is currently 50-70 percent. The survivors have only stayed alive thanks to intense medical care in hospitals, on respirators, taking drugs and receiving 24-hour monitoring. This makes H5N1 very scary. It's not up there with Ebola for mortality (90%), but it's still staggeringly lethal, and by far the most lethal flu bug ever discovered.
However, that may not always be true if the virus mutates: it could be less lethal - and it could be worse. No one knows. The most virulent strains even have fatal hemorrhagic symptoms - victims bleed internally, compounding the treatment. Like Ebola. All we know for sure is that no one has any natural immunity, no one is safe.
It will spread like the flu did in 1918, ravaging some communities, while leaving others relatively unscathed. But this time it will spread faster. If a pandemic hits, the disease will take perhaps as few as 60 days to spread around the world. There are headstones in Collingwood cemeteries marking the graves of those who died in that pandemic. Even without modern transportation to aid its spread, it reached us here easily.
And we're a mere two hours away from the world's most multi-cultural city: Toronto. SARS broke out first in Toronto. Avian flu may make itself known there first, too.
There have been two other pandemics since 1918, both considerably gentler. The 1957 pandemic killed 2 million people and the most recent one, in 1968, killed 1 million people. Last week, WHO said it considers the most likely scenario to be a death toll of between 2 million and 7.4 million people, or about 1 percent of those infected.
But it could be much higher. In late 2004, Shigeru Omi, regional director of WHO’s Western Pacific Regional Office, warned, the "The maximum range is more ... maybe 20 to 50 million people." In September, 2005, Dr. David Nabarro - WHO's UN coordinator for avian and human influenza - warned the death toll could be 150 million.
The 1918 pandemic killed 20-40 million worldwide, and had a mortality rate of 2.5 percent. If the next pandemic has a similar mortality rate, that means 175 out of those infected 7,000 will die here. If it's only 1 percent, then 70 will die. That's still 70 people in this community dead.
Ontario has about 12 million people. About four million will be infected, and 40,000 will likely die (at 1 percent) and maybe as much as 100,000 (at 2.5 percent). Can our funeral homes, crematoriums, and cemeteries handle this load? Do we have enough people to even bury our dead?
Imagine if every municipal department - including police, fire and ambulance - had one third of its employees on sick leave. Imagine if every business, every restaurant, every bank, every medical office has a third of its employees off. And that every business and store has a third of their customers sick, unable to shop.
Would you go to restaurants, the gym, the library, movies, bars, theatre, art gallery or other places of public gathering while the flu was killing people? Local businesses, especially the hospitality sector, will be hard hit.
We need a comprehensive emergency plan to deal with influenza, a plan that's separate from other emergency plans, and looks at issues such as infection control, emergency staffing and maybe even community lockdown and curfews. We need to be prepared. And thanks to a receptive staff who agreed, we are going to start some tabletop planning exercises next month.
I also believe we should have a policy to encourage staff to get their flu shot. While the current vaccines will probably not protect against H5N1, they will at least help counter the threat of collateral influenzas which could use the pandemic opportunistically to invade. And they will keep vaccinated people from infecting others with a different strain.
The town could set up an in-house clinic for town staff and their families to make it easy and convenient to gett he shots. We should also have a mandatory refresher course for everyone on how to avoid catching the flu, and about washing your hands frequently (with water and basic soap - not antibiotic soaps which are ineffective against viruses).
Anyone who refuses to have a shot should be told they cannot come to work when 1) they are sick, and 2) there is an outbreak of flu in the building they work in. You can make the choice not to get a flu shop, but no shot, no pay for missed days.
This should also extend to all town operations and functions, including council, committees and boards. Anyone who does not have a record of a flu shot will be told to not attend meetings when there is an outbreak of flu in that building or department.
Here are the numbers showing the vaccine's efficacy, from the Mayo Health Clinic in the United States:
- 70 to 90 per cent prevention rate in healthy recipients
- 30 to 50 per cent prevention in elderly recipients
- 50 to 70 per cent reduction in total hospitalizations
- 50 to 85 per cent reduction in deaths
This will be difficult. At least two members of council recently boasted that they never got vaccinations and - tens of thousands of pages of medical research, data and study to the contrary - they did not see any need for them. We have to overcome deeply-seated fears and primitive superstitions about vaccinations - we may need a strong, focused educational campaign to bring these people into the 21st century. If only some of us do it, it won't be very effective - those who refuse will continue to endanger the health and wellbeing of the rest of the community.
