Using Our Time Wisely

Flock of Geese SmallThough bird flu has been discussed in the media for over a decade now, few citizens have actually considered what a pandemic would mean in respect to their daily lives.  PandemicFlu.gov recently posted a fantastic article that discusses how a pandemic would impact every American family and business, along with steps everyone can take to mitigate the impacts.  Avalution has reposted the article in its entirety.  A link to the original article can be found at the bottom of the posting.

Just last week, Margaret Chan, the Director-General of the World Health Organization, called bird flu the greatest global health threat of the 21st century.

A pretty strong statement by any measure.

You’d think that newspaper editors would have screamed “Stop the Presses”, and “Set aside 20 column inches above the fold on the front page!” . . . but they didn’t. If it appeared in your local paper at all, it was probably tucked away somewhere deep inside, nestled inconspicuously between refrigerator ads and a recipe for rhubarb pie.

Bird flu, you see, is the Rodney Dangerfield of global threats. It doesn’t get any respect.

The idea that we could be facing a pandemic is such an alien thought to most Americans, and that includesnewspaper editors, that they relegate it to the same threat level as an asteroid strike, or a tsunami hitting the Atlantic coastline.

Possible, maybe . . . but unlikely.

And so most Americans, when asked about avian influenza, think, “Oh that, I remember last year there was some talk about it. I guess it fizzled.”

But the H5N1 virus hasn’t gone away. Far from it. It continues to mutate, spread, and infect new hosts. And as it does so, it increases its chances it will adapt to human beings. How long that will take is unknown, but scientists who are watching it are no less concerned today, than they were a year ago.

For the first time in history, we have the ability to observe a virus as it evolves and moves towards a pandemic strain. We can watch as it picks up genetic changes that make it more adaptable to non-avian hosts, or resistant to medications, and we can track its progress as it spreads around the globe. But since we’ve never watched this progression before, we really don’t know how long it takes.

Unlike our grandparent’s generation, we have an opportunity to prepare.

So while there is uncertainty, the signs are ominous that we may be moving in the direction of a pandemic.

In light of these developments, for more than a year the Federal government has been urging Americans to prepare for a pandemic. The HHS has a website, www.pandemicflu.gov , with checklists and advice for families and businesses on how to do so.

To date, very few of our citizens have taken heed.

In some ways, this reaction is perfectly understandable. We are inundated with media reports of new threats to our health, our security, and our pocketbook every day. If it isn’t terrorism, or a looming oil crisis, it’s contaminated pet food, or the dangers of high cholesterol.

After awhile, we either become fatalistic over such threats, or our eyes simply glaze over from the continual assault. As far as most people are concerned, bird flu needs to take a number and get in line. There were other global threats here before it.

The media has, to date, been very inconsistent in its coverage of avian influenza; vacillating between breathless hyperbole and dead silence, and that has hurt awareness. The public honestly doesn’t know what to think. In their defense, it is a difficult subject to cover. It is a complex story, filled with nuance and scientific jargon, and one that often moves at a glacier pace.

Until the idea that a pandemic may be looming becomes part of the public’s daily consciousness, the idea that we should be preparing is unlikely to gain traction.

Obviously, for pandemic planners, this presents a real problem. They need people to understand the gravity of the situation, and take action; but that won’t happen until they actually believe the threat is genuine.

Federal, State, and local planners know they cannot prepare for a nation of 300 million people. The logistics are impossible. Unlike the aftermath of a hurricane, or flood, or earthquake, where the damage is localized and help can be summoned from surrounding areas, a pandemic will strike the entire nation at roughly the same time, and the effects could last for months.

As Michael Leavitt, Secretary of the HHS has said many times, “Any community that fails to prepare with the expectation that the federal or state government will rescue them will be tragically mistaken.”

The clarion call to prepare couldn’t be clearer. And yet, it goes largely ignored.

I will spare the reader apocalyptic visions of a world engulfed in a pandemic. Until we actually see a pandemic erupt, we won’t know how bad it will be, and so estimates of the number of deaths, or the total impact on our economy are mere guesses. Any number I might choose could legitimately be challenged as being either too optimistic or too severe.

Suffice to say, it will likely be very, very bad. Billions of people worldwide could be stricken, and many millions of those would likely die. Economies would suffer, and some might even collapse. And the psychological trauma of all of this will be incalculable.

But even without knowing the exact scenario, there are certain things we can be pretty sure will happen during a moderate or severe pandemic. Things we must prepare for today, if we are to be able to handle them when they come.

We are likely to see major disruptions due to absenteeism, travel restrictions, and fractures in our supply chains. Goods and services we take for granted may be in short supply, or temporarily unavailable. Communities may be isolated, and largely on their own.

Since the prospects of having a vaccine or adequate supplies of antiviral medications are slim, we will need to use NPI’s, or Non-Pharmaceutical Interventions to slow the spread of the virus.

This means schools and day care centers will be closed, perhaps for months. Some businesses may be forced to close due to high absenteeism, lack of raw materials, or because they would contribute to the spread of the virus. Public venues and meetings may be prohibited, and people will be instructed on the merits of `social distancing’ and preventative hygiene.

Basically that means frequent hand washing, avoiding crowds, covering our mouths when we cough or sneeze, and staying home when we are sick or suspect that we’ve been exposed to the virus.

I know, in a world where we’ve come to expect that we can take a pill or a shot to prevent illness, that this sort of response seems inadequate. But these measures can make a difference in how many are sickened at any given time. And quite frankly, they may be all we have.

One of the hallmarks of the CDC’s plan to slow the spread of the virus is the use of voluntary home quarantines of those exposed to the virus. If a family member is infected, then everyone in the household will be asked to stay home until the incubation period has passed and they know themselves not to be infected.

This means that entire families may be unable to leave their homes for several weeks. Without food, water, and medicine already stockpiled, these people will either face deprivation, or must leave their homes and risk spreading the virus in order to get supplies.

When people are prepared, they are not just securing their own safety; they are helping to protect their community.

And there are no guarantees that the grocery store shelves will remain stocked during a pandemic. With an anticipated absenteeism rate of 40% in the workplace, deliveries may fall behind, factories may be unable to produce goods at the normal rate, and raw materials may be held up in a faltering supply line. Shortages of some goods are not only possible; they are likely.

People who rely on prescription drugs may find that obtaining heart medicines, insulin, or other needed medicines may be difficult or impossible during a pandemic, and they need to be acquiring extras to see them through.

When you look at the ripple effect a pandemic would have on our economy and our ability to provide essential goods and services, the need for individual preparation quickly becomes obvious.

Added to this we must also anticipate that, if we become ill, most of us will have to be treated by family members in our homes. With fewer than 1 million hospital beds, most of which are occupied at any given time, there is simply no way to provide hospital services to millions of concurrent flu victims. When you add in the attrition rate of health care workers to the virus, the prospects of receiving hospital care grow even worse.

Households therefore need to be equipped and informed on how to take care of their own medical needs during a pandemic.

No one in the government likes this reality, but they’ve run the numbers, and they know what is possible, and what isn’t.

We pride ourselves on being a modernized society, with superior medical care, and a broad safety net for those who are unable to care for themselves. We rally as a nation to rush aid to areas stricken by disaster, both here and abroad. It’s what we do, and who we are. To be unable to do these things is almost unthinkable. But during a pandemic, the numbers simply don’t work, and our government’s options are limited.

When we think about a pandemic, we think of it mainly as a public health problem. And while that is undoubtedly a large component, it is also a logistics problem. How do we move goods and maintain services during a prolonged crisis where nearly half the nation, or for that matter, half the world, is unable to work?

The answer is, we can’t. Not at normal levels, anyway. System failures are inevitable, as are shortages of essential goods. We simply must be prepared to deal with that eventuality.

The HHS has advised all families to be prepared with enough food, water, and medicine to last at least two weeks. The operative words here are `at least’. In a severe pandemic, two weeks probably won’t be enough, but it is a start.

Everyone needs to find their own comfort level with how much they need to prepare, and frankly, since we can’t know how bad the next pandemic will be, no one can know what is adequate. For me, 2 to 3 months seems a reasonable minimum; but some will regard that as insufficient while others might consider it an over reaction. Here, every individual family will have to decide what is doable, and what is reasonable, given their location, circumstances, and personal assessment of the threat.

And it must be stressed that preparing today, while supplies are abundant and the supply chain is intact, is not hoarding. In fact, it may be the most ethical thing you can do for your community.

By being prepared in advance, you remove your family’s needs from the last minute rush that will inevitably occur when a pandemic begins. By being reasonably self-sufficient, you will be one less household looking for assistance from overtaxed relief efforts. If you have more than you need, you can elect to help out neighbors and friends. And if you aren’t obsessed with finding your next meal, you might even have time to help out in your community during a crisis.

Preparing is as ethical as it is essential.

Ninety years ago, when the last great pandemic struck, it was common for families to have a month or two worth of food set back. It was a way of life. People raised gardens, canned food, and generally bought in bulk. They bought sacks of flour, corn meal, sugar, and salt. Convenience foods didn’t really exist. They didn’t rely on home pizza deliveries, fast food restaurants, or stopping by the market three times a week.

In many ways, our great-grandparents were far more prepared than we are today.

By being prepared for a pandemic, we are also prepared for other disasters. The food in your pantry will be just as valuable during the next hurricane, or flood, or other natural disaster. And buying in bulk now, while prices are relatively low, is economical, too.

Most scientists admit `it isn’t if, but when’ the next pandemic strikes. Another pandemic is a virtual certainty. The only real question is the timing, and the severity.

Our government agencies, and governments around the world, are spending billions of dollars to prepare for a pandemic. To them, this is not some obscure academic exercise, or a drill. They take this threat seriously. I’ve no doubt, if they thought they could afford to ignore it for a few more years, they would.

But the evidence grows stronger with each passing day that we are growing nearer to seeing another pandemic. According to the WHO, we are closer to a pandemic today than we have been since 1968, the last pandemic year.

While not conclusive, the evidence is convincing.

Pandemics occur, on average, every 30 to 40 years, and it’s been 39 years since the last one. Over the past 300 years, we’ve seen 10 pandemics, and there is no reason to believe this historical pattern has changed.

We currently have a particularly lethal influenza virus, H5N1, circulating in the wild that has already proven its ability to jump from birds to humans and other mammals, and we’ve seen indications of limited human-to-human transmission. It only lacks one thing to spark a pandemic: a mutational change that increases its ability to spread.

That change could happen today, tomorrow, or next month. Or perhaps it will take another year or two. Admittedly, it may never happen with this virus. We simply don’t know.

But we do know, that once it happens, our time to prepare will have ended. With modern airline travel, the virus could spread around the globe in a matter of weeks. Anything we haven’t done by then will likely not get done.

David Nabarro of the United Nations said last year, when discussing the threat of a pandemic, that we are operating on `God given time’.

We need to use it wisely.

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