Preparing to Survive the H5N1 Avian Flu Pandemic

Areas of concern during an Influenza Pandemic

An area of major concern in a pandemic is the almost immediate reduction in the work force.  Estimates range from 25% to 40% in all professions.  People will stay away from their jobs because they or a family member have flu symptoms, fear of contracting the virus and contaminating their families, a reduction in or failure of public transportation, fear of social unrest due to reduction of law enforcement personnel or to provide childcare because schools have closed.  Needless to say, economic and social disruption will be great.  In a recent survey in New York City (Quereshi et al., 2005), 52% of health care workers indicated that they would be unwilling to work during a SARS outbreak. Similar numbers might be expected to be unwilling to work during an influenza pandemic.  The major concern was personal safety and the safety of family members.

Medical and Health Services

Hospitals:

Hospitals will be hard hit during a pandemic— not only from the volume of patients, but from staffing shortages, shortages of equipment, supplies and food, and from loss of revenue from various sources.  In the United States there are 105,000 mechanical ventilators, 75,000 to 80,000 of which are in use at any given time for everyday medical care. During a routine influenza season, the number of ventilators needed rises to 100,000. In an influenza pandemic, the United States may need as many as several hundred thousand additional ventilators.  Nonessential medical services and surgery may be cancelled.  Medical testing for non-influenza conditions may cease.  If these services were canceled where will the cancer testing, biopsies and chemotherapies and radiation occur?  What about heart surgery, maternity wards, prenatal care, and infant ICUs?  What about visitations and hospices for terminally ill patients? 

There is no surge capacity in most hospitals so other facilities, from gymnasiums to warehouses to hotels to sports stadiums, would have to be quickly refitted and provided with staffing—but, there would be no excess health-care workers from other regions to come to the rescue—no available hospital beds.  Based on county projections, as many as 57,000 additional hospital beds may be needed in King County.  It has been suggested that recovered victims, who have immunity, might be enlisted to help the sick or do other essential work. The medical questions are endless and the answers are few.

Long Term Care Facilities:

Long Term Care Facilities may be especially hard hit due to staffing shortages.  Doctors would be in short supply.  The condition of non ambulatory residents could become unstable very quickly without the caregivers who care for them and administer their medications throughout the day.  These facilities will also be at high risk for looting because of the medications kept on premises, resident’s valuables, the easily accessible food supply and the lack of security.  Another problem would be the potential for employees and relatives of residents to introduce the virus while working or visiting loved ones.  Strict quarantine protocols would have to be enacted to prevent contamination of the premises and its residents.

Mortality Considerations:

Cold storage plants or refrigerated trucks will have to be used as temporary morgues until proper burials or cremation can be provided. Historically, the number of deaths during a pandemic has varied greatly. Death rates are largely determined by four factors: the number of people who become infected, the virulence of the virus, the underlying characteristics and vulnerability of affected populations, and the effectiveness of treatment and preventive measures. Accurate predictions of mortality cannot be made before the pandemic virus emerges and begins to spread.  Estimates range from 2 million to 350 million deaths world wide, but any estimate is purely speculative.

 Quarantine and Controls

Governments will not hesitate to impose quarantines, including requiring people who may have had exposure to the virus to stay within their homes, denying entry rights to planes, buses, trucks and ships from other areas or countries where the disease is spreading, forcibly isolating people showing suspicious symptoms, closing schools, shutting down public transportation, banning concerts, parades & sporting events, and making businesses liable for enforcing emergency restrictions on their staffs. The public will accept these restrictions as long as the initial panic lasts, but when the strains on the health care system and the economy become too painful, and new infections don’t seem to be appearing, people will begin to resist, possibly violently, the government control over their lives.

Economic

WHO flatly predicts that stock markets would close once a pandemic was confirmed.  Soaring death rates would puncture the housing bubble and create vast housing oversupply. Apartment owners would slash rates to try to replace deceased tenants.  Restaurants, theaters, sports venues, vacation & recreation businesses, air lines and any businesses that depend on serving the public in either large or small groups would probably close or be severely affected.  Many business would have to close simply because employees will stay home.  The number of bankruptcies would be very high.   Based on 1918 experience, the effect would be most severe in the major cities, where infection and death rates would be higher than in smaller centers.

Water, Power & Gas

These three utilities all require a minimum number of staff to keep them operational.  If the technical staff are reduced below that minimum they will fail and the utility will not be available to homes and businesses.  If the water supply is interrupted we will dependent on water we have stored for emergencies, the collection of rain water or bottled water distributed by emergency personnel. (like the victims of hurricane Katrina)  If water service is interrupted, even briefly, the pressure in the pipes may drop allowing contaminated ground water to enter the pipes through small leaks.  Tap water will then need to be purified for drinking (boiling or chemical additives) until pressure is restored and the contamination flushed out.  If the heat source in a home is interrupted in winter (the power grid on the west coast is extremely fragile) pipes may freeze and the water supply may be lost.  The ability to cook and keep food refrigerated or frozen may be lost.  Loss of lighting may make homes and establishments more vulnerable to looting and other crimes.  The loss of water or power could be especially devastating to hospitals or long term care facilities.

Food Supply and Distribution

Shortages would emerge everywhere.  At the first sign of a pandemic, there would be a run on indispensable items such as food water and medications.  Supermarket shelves would be emptied in days if not hours.  With complex distribution systems hampered by staffing shortages and possible quarantines it may be days or weeks before shelves are restocked to even a minimum level.

Communications Services

Local TV and Radio broadcasts will probably cease if there is a regional power failure in your area as will cable TV.  Satellite TV may remain active but you will need an alternative source of power to operate your system to view it if your power is be out.   Landline telephone systems have an excellent record of remaining operational even during power failures.  However, in the event of a widespread prolonged blackout, they will not be able to continue to function for long.   Cell phone towers have a small backup power capability but won’t last.  If the grid fails, all phone service will eventually fail as well. 

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