Showing posts with label mortality. Show all posts
Showing posts with label mortality. Show all posts

Saturday, May 2, 2009

Morbidity vs. Mortality

A Wall Street Journal article by Ron Winslow and Avery Johnson opines that a deadlier strain of flu virus would overwhelm the US healthcare system.

Sadly, it won't even take a deadlier strain to accomplish this.  Even if every single person who gets the virus recovers, a pandemic will cause a surge in the number of people sick enough to require hospitalization.  And that alone will wreak havoc on our healthcare infrastructure.  

We have, essentially, zero excess capacity in our healthcare system tpday.  I was involved in a full-scale emergency response exercise a few years ago and the local ambulance company did not expect to have any ambulances to spare for use in the exercise.  (They did eventually manage to find exactly one, but the real response to such a disaster would have called for many more.)

When I was helping the same health department with their pandemic response plan, we polled the local nursing homes to see what they had in terms of excess beds and respirators.  The answer was, "none to speak of."  --And hospitals are the same way.  

Severe economic pressures force these organizations to grow leaner and leaner all the time, to trim excess capacity wherever they find it.  And we haven't developed any worthwhile incentives to reverse that trend.

So people don't have to die in large numbers in order to overwhelm our healthcare system; they just have to get sick enough to require care.  Indeed, the sad truth is that those who die during a pandemic may use up fewer "bed days" than those who get sick, but pull through. 

Most hospitals right now couldn't deal with the results of a bus crash by themselves.  In order to meet the needs of an influx of patients like that, hospitals rely on their ability to transfer (or divert) patients to other nearby hospitals.  During a pandemic, however, this won't be an option, because those nearby hospitals will be equally overwhelmed.

Like many others who are looking at this problem for the first time, the authors of this article are putting an undue emphasis on mortality (death) versus morbidity (sickness) when it comes to the effects on the healthcare system.  In many ways, mortality is the most important thing about a pandemic.  It's certainly what worries me the most on a personal level.  But when it comes to the healthcare arena, it takes a back seat to morbidity.  

Because the thing that's going to transform the healthcare infrastructure from a moderately well-oiled machine into just a greasy pile of slag isn't the number of people who die, but the wholly unmanageable number of people who get sick.

Wednesday, April 29, 2009

Edging closer to Phase 6, an Official Pandemic

The BBC just reported that there has been a confirmed case of human-to-human transmission in Spain. 

Here is the definition of Phase 6:

Phase 6, the pandemic phase, is characterized by community level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in Phase 5. Designation of this phase will indicate that a global pandemic is under way.

"Community level outbreaks" are "sustained disease outbreaks in a community," and that criteria hasn't been met by this case; we'd need to see more than one generation of human-to-human transmission before we could call it a sustained disease outbreak in this community, but hope is swiftly waning that this outbreak will fail to become a pandemic --especially since we haven't been able to contain it in the Northern Hemisphere, where the flu season is coming to an end.


Today also saw the first confirmed death from the H1N1 strain in the US, a toddler from Texas.  My heart goes out to the parents and to the families of all of those who have died in Mexico, already.  I hope that not too many more of us will have to face what they've been through.

Sunday, April 26, 2009

Swine Flu Map

Update: The map has been re-designed to be easier to read and continues to be updated frequently.  The link for the map has changed, and the link listed below is the latest version.

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This site maps confirmed and suspected cases related to the swine flu outbreak and gives information on mortality, along with reports of suspected cases that turned out not to be swine flu:

tinyurl.com/swinemap09

It's a useful tool for visualizing the outbreak and because it links to the news reports that back up the data it's mapping, you can assess the reliability of the information yourself.  So far it's being updated very frequently, despite (or perhaps because of) the fact that we're in the middle of the weekend, so keep an eye on this site for the latest.