America Has Limited H1N1 Flu Resources (Except For Their Own Children)

September 23, 2009
Experts Warn: America Has Limited H1N1 Flu Resources (Except For Their Own Children)
By Peter Laird, MD

Since the H1N1 flu broke out in late spring, while many prepared and warned about the dangers of this fast moving pandemic, others chose instead to mock those preparations, calling them an over reaction. The alleged but yet unproven knowledge that the majority of patients have a limited and mild H1N1 course does not mitigate the fact that this flu affects a different population than the seasonal flu. Pregnant women, children and young adults are at the top of the list of those who have died. Paradoxically, the elderly have fared better from a presumed latent antibody protection from prior flu outbreaks before 1957.

A recent article goes so far as to call these “exaggerated fears” the greatest threat above and beyond the actual expected impact that the H1N1 virus will have.

Could Swine Flu Panic Be Worse Than Outbreak Itself?

With infections typically causing only mild illness, experts point to exaggerated fears as the real threat

"We have limited resources in the U.S. -- if this [swine flu] captures our negative imagination, it's going to hurt our health-care system," said Dr. Marc Siegel, associate professor of medicine at New York University School of Medicine in New York City. "Our emergency rooms will be flooded with worried people, doctors' phones will be hanging off the hook, everyone will be afraid of every sniffle and wanting to get tested for the flu."

Overwhelming hospital capacity is a very real issue as I have discussed earlier, but not because concerned parents will seek medical care for their sick children, but instead because America has diminished its ability to deal with unexpected health demands and surges through a systematic destruction of our hospital infrastructure over the last three decades.

Hospital Capacity: The Silent H1N1 Waterloo

America’s health infrastructure is smaller and in many ways less effective than it was in the 1970’s at its peak capacity. In my town of Antelope Valley California, in the early 1990’s there were four active, full service hospitals and 200,000 residents. Now in 2009, we have only two active hospitals and over 400,000 residents.

Resource rationing is the survival mode of all American ER’s today with many facing severe physician staffing shortages. Patients who would have been admitted routinely even ten years ago are returned to their primary care physician for continuation of out patient care. However, with a severe primary care shortage, many patients languish in limbo between urgent care centers and overflowing emergency rooms.

Yet, when the experts themselves encounter H1N1 face to face, there are no limits to resource expenditures. Monotreme's blog ventured into this discussion by pointing out the alleged hypocrisy that Dr. Siegel noted above poses when he not only prescribed Tamiflu for his son but then went so far as to recommend prophylactic treatment for all of the campers. In doing so, Camp Modine spent $45,000 fighting this virus to protect his son and his fellow campers:

Summer Camp ’09: A Swim, a Cough, a Quarantine

Camp Modin brought the outbreak to a dead halt by offering prophylactic Tamiflu to all of the campers and counselors, a move it took on the advice of one of the parents, Dr. Marc Siegel.

“Tamiflu is used prophylactically in nursing homes quite successfully,” said Dr. Siegel, an associate professor of medicine at N.Y.U. Langone Medical Center. “And I think when there’s a big outbreak in summer camp, where kids live very close together in their bunks, it makes sense to follow the same protocol.”

“We’ve taken 6,000 temperatures this summer,” said Howard Salzberg, the camp director. “We’ve bought all the Clorox wipes in every Wal-Mart we could drive to. We’ve spent about $45,000 on this, $30,000 on Tamiflu alone, and probably another $15,000 on the masks, the gloves, the games for the kids in isolation.”

The CDC continues to advocate against the prophylactic use of Tamiflu except for certain high risk patients where even there they advise watchful waiting. However, the take home message from Dr. Siegals correct intervention at his son's summer camp is that this approach worked:

Almost 300 campers and 100 staff members went on prophylactic Tamiflu for 10 days, Mr. Salzberg said, and the H1N1 virus stopped spreading.

When the H1N1 virus has finally run its full course during the next two years, the differences in case fatality rates between the developed nations will likely fall into the categories of those that used a Tamiflu blanket, and those that depended on herd immunity and let happen, what happens. Understanding the effectiveness of Tamiflu especially in close group environments such as our children's schools, with no vaccine readily available for weeks, refusing to use prophylactic Tamiflu will result in the unexpected deaths of many healthy children and young adults, nothing to speak of those with CKD and other chronic medical illnesses.

Instead of speaking out about "negative imagination" that could result in panic, in my opinion, Dr. Siegel would do better to instead speak out against the CDC mindset of withholding widespread use of Tamiflu and instead advocate for delivering large quantities of Tamiflu at the first sign of a local and regional outbreak. After all, if his recommendations expended a large amount of Camp Modine's limited resources, don't your children deserve the same expenditure as they head back to school and face outbreaks of H1N1? My question to Dr. Siegel is how shall history remember him?

http://www.billpeckham.com/from_the_sharp_end_of_the/2009/09/experts-warn-america-has-limited-h1n1-flu-resources-except-for-their-own-children.html