Bird Flu: Why Modern Medicine Will not Save Us
Very often when people begin to learn about bird flu, they jump to the conclusion that because medicine has advanced by quantum leaps since the 1918-19 influenza pandemic (global epidemic), there is nothing to worry about. They are certainly right about the advance of medicine, which has been extraordinary by any measure. Unfortunately, when it comes to dealing with a bird-flu pandemic, these advances fall short in many areas. To name the most significant:
1. Bird flu is caused by an influenza virus, for which there are only four approved antiviral agents in the US The virus has extensive resistance to two of these medicines already, and resistance might develop in the remaining two once they are used more widely in a pandemic. The two remaining medicines, Tamiflu (oseltamivir) and Relenza (zanamivir), are in extremely short supply and, even with planned increases in their manufacture, will remain in short supply for many years to come. These medicines must be given within 48 hours of the onset of symptoms, which can be difficult to accomplish for a variety of reasons. Even when they are available and given on time, their effectiveness is less than 100 percent. And because bird flu is very different than the usual influenza we are used to, higher doses given for longer periods of time may be necessary for optimal effect.
2. While we have many wonderful antibiotic medicines, these are not effective against bird flu, because antibiotics treat only bacterial infections, not viral infections. Antibiotics can be used to treat bacterial infections that develop after viral infections have damaged the body, allowing bacterial infections to "take over." This can happen, for example, when viral pneumonia turns into bacterial pneumonia. However, this did not happen in the 1918-19 Spanish flu to any extent, nor in the 2003 SARS pandemic, and it does not appear to be a significant factor in the deaths that have occurred so far from bird flu. Hence all our sophisticated antibiotics will not be of much help with bird flu.
3. The most common cause of death from the 1918-19 influenza pandemic, the SARS pandemic, and from bird flu is acute respiratory distress syndrome (ARDS). The viruses from these diseases cause severe damage to lungs, which results in ARDS. Numerous treatments have been tried but generally have failed. Patients with ARDS require mechanical ventilatory support, meaning they need to be on a mechanical respirator. These are expensive machines, and the supply in the United States is only slightly above demand during the normal flu season. Simply put, when the bird-flu pandemic strikes, there will not be enough of these machines, and so people who develop ARDS will not have access to this potentially life-saving treatment.
4. There will not be enough isolation rooms to place the large numbers of patients with bird flu in, which will result in more people becoming ill through exposure to people with bird flu. Likewise, there will not be enough of some medical equipment, because of increased demand for some items coupled with decreased supply-because of our reliance on a global supply chain, foreign manufacture, and just-in-time delivery. There will not be enough personal protective equipment (such as disposable gloves, N95 face masks, gowns, face shields or goggles, head caps, and shoe covers), which will increase exposure and infection.
5. During the coming pandemic, there will not be enough beds in hospitals for all the sick people with bird flu. Makeshift "hospitals" will have to be established outside of existing hospitals to care for all the ill patients.
6. An effective vaccine has yet to be developed, and the chances that one will be developed before a pandemic emerges are practically nonexistent. Once a vaccine is developed, it will be months into the pandemic, and many people will already have become ill. Because we have no natural immunity to this new virus, we might need two immunization shots to develop sufficient immunity. This makes implementing an immunization program more difficult, and decreases the amount of vaccine available for everyone.
Vaccines, like antiviral medicines, are not 100 percent effective in either preventing infection or minimizing symptoms once infected. A startling new report (a) found only limited benefit from influenza vaccines: "In people over 65, the vaccines 'are apparently ineffective' in the prevention of influenza, pneumonia and hospital admissions, although they did reduce deaths from pneumonia a bit, by up to 30 percent. "
According to the Influenza Vaccine Supply (IVS) International Task Force, "Whatever scenario, even the most optimistic, the worldwide [vaccine] production capacity will be clearly insufficient in case of pandemic."
7. Shortages of nurses and other healthcare personnel will be significant, because of overexposure to people with bird flu-and thus a higher illness and death rate among healthcare workers, and because a high proportion will simply decide not to come to work. A similar situation occurred in New Orleans during Hurricane Katrina when 250 members of the police department (one-sixth of the force) abandoned their jobs during the hurricane and flooding. It also happened in Toronto during the SARS outbreak, when some nurses and other healthcare workers submitted their resignations (although many were persuaded to stay).
The shortage of nurses, which is already a big problem in the United States, was highlighted recently by Keji Fukuda of the influenza branch of the Centers for Disease Control and Prevention (CDC). According to Fukuda, scientists are racing to prevent what could be millions of deaths from a flu pandemic, but what could trip them up is the simple lack of nurses and hospital beds. He said, "No matter how good medical technology is, if we do not have healthcare workers to care for sick people and hospital beds to put them in, it's not a good situation."
And it's not only the limited numbers of nurses-it's also a question of whether or not healthcare workers would come to work during a bird-flu pandemic. A recent article (b) reported the disturbing findings of a survey of 6,000 healthcare works in and around New York City:
"One assumption blown away by Hurricane Katrina is that if government does nothing else, at least it protects people's health and safety.
The Mailman School of Public Health at Columbia University in New York City set out to look at how many healthcare workers said they would show up for work, depending on the type of emergency. There was some good news: 87 percent of 6,000 workers surveyed in 47 facilities in and around New York said they would be able to go to work in the event of a mass casualty incident, and 81 percent for an environmental disaster.
Only 61 percent, however, would show up for a smallpox epidemic, just 48 percent during a SARS epidemic and 57 percent during a 'radiological event.'
That's a problem, is not it? Less than half of healthcare workers expect to work during a SARS [or bird-flu] epidemic, and less than two-thirds if terrorists set off a so-called dirty bomb in the financial district.
'Although we might assume that healthcare employees have an obligation to respond to these high-impact events, our findings indicate that personal obligations, as well as concerns for their own safety, play a pivotal role in workers' willingness to report to work,' said Kristine Qureshi, a researcher in the epidemiology department at Columbia. "
And so "modern medicine," no matter how advanced, will clearly have difficulty dealing with a bird-flu pandemic. In a sense, the next pandemic could very well be analogous to the Hurricane Katrina situation, with mass confusion, lack of resources, visible dead bodies, acts of cowardice and acts of heroism, financial disaster, panic, and every emotion possible-nothing like we are used to witnessing in America; shocking.
Partly because of the limitations of both government and healthcare capabilities, individuals need to prepare for the coming bird-flu pandemic themselves. There are four specific areas that must be addressed, as I have written in an earlier article (which can be accessed on our Web site.)
(A) Rosenthal E: 2 Studies Find Flu Treatments Fall Far Short. International Herald Tribune. 22 september, 2005. Available at: Http://www.nytimes.com/2005/09/22/health/22flu.html?th&emc=th . Accessed on September 23, 2005
(B) Olmsted D: Health wrap: of disasters and diseases. Critics News and Monsters, September 9, 2005. Available at: Http://news.monstersandcritics.com/health/article_1047166.php/Health_Wrap_Of_disasters_and_diseases . Accessed on September 15, 2005
Bradford Frank, MD, MPH, MBA
The Frank Group
PO Box 138
Lakewood, NY 14750