A tsunami of sick people has swamped hospitals in many parts of the country in recent weeks as a severe flu season has taken hold. In Rhode Island, hospitals diverted ambulances for a period because they were overcome with patients. In San Diego, a hospital erected a tent outside its emergency room to manage an influx of people with flu symptoms.

Wait times at scores of hospitals have gotten longer.

But if something as foreseeable as a flu season — albeit one that is pretty severe — is stretching health care to its limits, what does that tell us about the ability of hospitals to handle the next flu pandemic?

advertisement

That question worries experts in the field of emergency preparedness, who warn that funding cuts for programs that help hospitals and public health departments plan for outbreaks and other large-scale events have eroded the very infrastructure society will need to help it weather these types of crises.

“There’s nothing really that can impact on a national level — or for that matter on an international level — more quickly than influenza,” warned Michael Osterholm, director of the Center for Infectious Diseases Research and Policy at the University of Minnesota.

A dozen years ago or so, government officials placed pandemic influenza preparedness efforts on the front burner because of fears that a dangerous bird flu strain — spreading quickly across Asia at the time — might trigger a catastrophic pandemic.

Those worries were focused on H5N1, a poultry flu virus that infects few people but kills more than half of those confirmed to have been infected.

Then in 2009, the first flu pandemic in four decades did hit. But instead of bird flu, it was a swine flu virus called H1N1. There were not mass casualties. In fact, the global death toll was estimated at just over 200,000 — fewer people than the World Health Organization says die from seasonal influenza most years.

Pandemic influenza lost its big, bad bogeyman status. And in the years since, budgets for preparedness work have suffered.

“It’s true to some degree that we’re even more vulnerable now than we were at the time when H1N1 hit,” said Dr. Jeffrey Duchin, head of infectious diseases for the Seattle & King County public health department.

“We did learn a lot during the H1N1 outbreak about how to do things better,” Duchin noted. “But we haven’t invested in turning those learnings into action and better preparedness. … After H1N1, it’s pretty much fallen off the radar.”

Hospital and public health preparedness programs have sustained cuts in the order of about 30 percent in recent years, said Dr. Oscar Alleyne, a senior adviser with the National Association of County and City Health Officials, adding: “The level of funding is a concern to us.”

In the aftermath of the 9/11 attacks, Congress freed up money to help hospitals plan for and respond to mass casualty events, said Dr. Tom Inglesby, director of the Center for Health Security at Johns Hopkins University.

That has helped institutions respond to contained events — incidents like the Boston Marathon bombing or last year’s Las Vegas shooting, Inglesby noted. “But when you start scaling up beyond that and you introduce the variable of contagious disease, hospitals are pretty brittle,” he warned.

A modeling program called FluSurge developed by the Centers for Disease Control and Prevention to help hospitals plan generates some pretty sobering scenarios, he noted. In a bad pandemic, hospitals might have four times more people in need of a ventilator than they have ventilators, and far too few intensive care beds for the seriously ill.

“So there would be a big mismatch between demand for care, lifesaving care, and the ability to provide it,” Inglesby said. “We would have a huge problem in this country.”

The problem with influenza relates to the way it attacks, sickening large numbers of people in a relatively short period of time.

A hospital can plan for how much cancer care it will need to deliver based on the size of the nearby population and estimates of rates of various cancers. Affected people will seek care over the course of any given year.

But with flu, most of the severe illness happens in the space of a few weeks in any one location. The pressure that puts on a health system is exacerbated by the fact that some of the people needed to care for the sick fall ill themselves.

Getting help from elsewhere — as a community will often do in the case of a major medical disaster — isn’t really an option during flu epidemics, because other places are either dealing with their own or steeling themselves for a wave that’s about to hit. In the first week of this month, the entire continental United States was reporting widespread flu activity.

Osterholm noted that in the time since the 2009 pandemic, health care systems have been operating on ever-tighter margins, leaving them pressed to respond even to what are ordinary system stressors.

“Even before flu season struck here, our hospitals were struggling to cope,” Duchin agreed. “We have hospitals that have large numbers of patients living in the hallways routinely. … Flu season comes and it all gets worse.”

“These should be wake-up calls to us,” Osterholm said of severe flu seasons like this one.

But the inability to predict the intervals between flu pandemics makes it easy for officials to shift preparedness efforts into the “should do” instead of the “must do” column.

There were nearly 40 years between the 1918 and 1957 pandemics; then the 1968 pandemic hit 11 years later. And then there was a 41-year interval before 2009. There is virtually no way to tell when the next will occur.

If anyone knew for sure that the next pandemic was coming soon, then society would begin planning aggressively, Inglesby said. “But since we have uncertainty about the timing and severity of the next pandemic, we’re kind of in this relatively modest national effort to prepare hospitals, which is doing what it can with the resources available.”

Leave a Comment

Please enter your name.
Please enter a comment.

  • But I want to save everyone. With the help of my blood, create a medicine against the flu. Production technology. Infecting me with the flu, when I am exiting, extracting white blood from the blood, the leukocytes are copied

  • The pandemic is close. You could deal with the flu with my help. But these prejudices have done their job. I am Russian. You could, with the power of my blood, create the most potent cure for influenza in the world. Immunity at me is stronger in 2 times. I am Muslim. 1) In summer, I washed my ablutions 2 times a day in ice, artesian water, and now 3 times a day in icy water from a tap. I live 2-storeyed single-domain domain 2) I drink 3 to 5 liters of water a day due to illness. 3) Nutrition and healthy drinking. 4) I do not work therefore calm. On the advice of a local immunologist made 2 immunograms (a blood test). There, all indicators are exceeded. The deputy head of the health department of the city of Almetyevsk confirmed that I have very strong immunity and the local immunologist also confirmed. It remains to receive a confirmation from the 33 polyclinics. The head of the speedcenter saw my analyzes surprised and with the joy of Dalva permission to re-analysis. But I’m in a hurry. Disabled 2groups since childhood for 2 rare internal incurable diseases, 1) diabetes insipidus for this disease for 36 years I take medication adiuretin. For this disease I can drink 20 liters a day. nNo taking medicine I drink from 3 to 5 liters of water per day 2 olivopontocebrial degeneration with otrophy created. For this disease I’m in a hurry. Because of the shakiness of penetration and double vision in the eyes I can get under the car. Due to the uncontrolled allocation of saliva constantly pressurized. I want to create the most powerful medicine for influenza in the world.

    Please inform me upon receipt.

    • Yes, your message was received. We have now activated the Remote Access Dehomogenizer to extract your blood. In three days, we should have all of it. You will have the satisfaction of knowing that your death will save countless others. Thank you for your sacrifice!

    • @ Mark Thorson—3 whole days?! “But I’ve had this cough for over 3 weeks, no fever, drove myself to the hospital and my knee hurts! I’m SURE it’s the flu!!” (Sorry–I work in an emergency room). Anyway, thanks, I needed that! : )

  • Just as we prepare every year for Hurricane Season, and someone else may prepare for winter storms, why not also prepare for Cold and Flu Season before you need it?

    Include extra boxes of tissue, nasal saline spray, cough syrup, vitamin C, Grannie’s “cure all” cod liver oil, herbals that we use (ginger, turmeric, hot peppers, elderberry etc.), quarts of chicken broth or home canned, Gatorade or other rehydration mixes, vaporub, ginger ale, and cough lozenges.

    If you are caring for someone else that is ill (elderly or child), use face masks to avoid exposing/exposure, and enforce diligent hand washing with soap.

    Whether it starts as congestion, sinus drainage, cough, or full blown “ache all over” that you are dealing with, just knowing you don’t have to make a trip to the store for the basics is a relief. Plus, you can avoid exposing/exposure from whatever else is going around.

    Who doesn’t want a good hot pot of Gram’s chicken soup? We like it spiced up with added garlic, hot pepper flakes always helps, as does hot ginger and rosemary tea (lots of antiviral and antibacterial) plus they taste good.

  • I’ve been talking about this for over 2 decades. And not a single person in this industry takes it seriously. I don’t expect anything to change…

  • The Rhode Island story is from 11 days ago and if you read the article, diverting ambulances is commonplace. As a Rhode Islander many are unaware that it and much of Connecticut are mini versions of California. We are a test kitchen for how the neo-socialist-marxist-communist society is gonna work. Hint: it ain’t pretty. Providence which 100 years ago as a gleaming industrious city almost exclusively white is now a 3rd world cesspit with a white minority and a non-english speaking plurality mostly living off of government subsidies paid for with taxes of the workers from the suburbs and towns. The inner city 3rd world people treat the ER as their concierge medical service all paid for by us. Suspect your 15 year old daughter might be pregnant? Call the ambulance and take them to the ER demanding a pregnancy test – happens daily. I neighbor is an emergency room physician and my sister just retired after 40 years as a pharmacist at the Miriam Hospital in Providence. The end is nigh.

  • The 2009 Swine Flu was not a pandemic. Really, neither was the 1957 or 1968 flu. All of them only killed a fraction of a % more than the average seasonal flu which is typically has around a 0.2% mortality rate.

    The 1916-18 Spanish Flu came in three waves and was the last really serious pandemic. It killed about 2% of those that caught it: about 600,000 in the USA and at ~30M world-wide. Some say as many as 200M.

    However, H5N1 is still out there killing more than 50% of those that catch it (60% the last time I checked). WHEN, not IF, it finally mutates to be person to person contagious like the current flu strain, that will be the mother of all PANDEMICS.

    BTW, Tamilflu, is an anti-viral compound from the Star Anise plant. It is very effective if you take it for 1-2 weeks BEFORE being exposed to keep you from catching the flu but nearly worthless after you’ve aleady caught the flu. Real black licorice and black elderberry probably work just as well. (They have an anti-viral compounds in them.) The most important preventative is probably make sure you get a PPV vacination for pneumonia as that’s what usually kills you when you get the flu. Get the PPV23 not the (cheaper?) PPV13 as it covers more strains.

    BTW2, this year’s flu shot is very ineffective as they guessed wrong on the strains a year ago when they made it.

  • everyon at my office that took the flu shot in Nov/Dec are now out with the flu..those that didn’t take it are here at work strong and healthy.

    it sure looks to me that there was something very bad in that last flu shot..NEVER, EVER take a vaccine, EVER

    • I and several family members took our flu shots and we are just fine. You are being alarmist with zero facts to back up your story.

    • While your anecdotal story may be true, the flu vaccine has absolutely nothing to do with your colleagues getting sick. Pure luck–or more likely, better hand hygiene.

  • This article seems to indicate most of the advances toward flu shots and treatment came during the GW Bush years and that the budget was cut during the Obama years. Oddly, I remember the Left and it’s media relentlessly bashing Bush on this issue (as well as many other issues) for “not being prepared”, “cutting the budget”, etc. but then they praised Obama in his handling of the flu pandemics-the exact opposite! It’s sad that the American people must wait over a decade for the Left’s so-called “mainstream” media to finally be honest in their reporting of issues, whether by design or by accident. Then they wonder why they’re not trusted and seen to be partisan, when they have lied to destroy every Republican President since Lincoln, yet lied to assist every Democrat President during the same period…it is beyond coincidence.

    • My dad is currently in the ED diagnosed with influenza A. I called the local fire dept for a welfare check last night after I spoke to him (I live several states away) and he seemed confused and sounded congested. I was thinking hypoxic and/or dehydrated since he is 89 and lives in an area hard hit by the flu. The ED confirmed as much when after treating him they had given him IV fluids, and upon walking him around before deciding whether to admit or release he could not maintain an O2 saturation above 86.
      Perhaps given that we can’t plan on a pandemic and given the costs/mandates of Obamacare, Medicare, Medicaid, etc perhaps making it uneconomic or infeasible for hospitals to be unable to properly respond to large(r) numbers of acutely ill patients, perhaps we need to develop a “shelter in place” involving simple things to address and improve the patient’s outcome before any hospitalisation? Why not push for a home humdified O2 concentrators and simple electrolyte replacement salts to be reconstituted with tap or bottled water while at home? Perhaps there are simple things to be done that could both save $ and lives rather than wait for a patient to present who has spiraled down to a emergent health situation.
      Perhaps it is time someone present a well thought out shelter in place plan similar to the ones you hear about for weather emergencies of having a two week supply of food and water in place BEFORE the event?
      Yes it may not be definitive hospital level care, but what do most acute infectious diseases always first start do to the patient? Dehydrate and/or O2 desaturate the patient. Start there. At home.

    • The “o2 desaturation” you’re talking about is generally from pneumonia. As far as I know there’s not a lot that can be done at home short of antibiotics and oxygen.
      Pneumonia is a major killer worldwide due to poor living conditions…and lack of antibiotics.
      I otherwise agree with your premise. However, a “shelter in place” plan needs to be assembled on a home by home basis. No government entity is going to come out and encourage the public to stockpile a few weeks worth of food, water, electrolyte rich beverages and, oh, IV equipment and saline bags of you can get ahold of them. People in my area raid the grocery store (the one that’s within walking distance) when 2″ of snow is forecast. What do you think will happen when that news is announced? Panda-freaking-monium.
      We, as an advanced, civilised society are woefully unprepared for any sort of major event.

Sign up for our Daily Recap newsletter

A roundup of STAT’s top stories of the day in science and medicine

Privacy Policy