Sept. 3, 2009 -- There are the facts and there is the truth. Facts are often debated, because facts depend on how you calculate them. Truth is often ignored because it is often unpopular and usually unpleasant.
Press coverage about the coming unique H1N1 influenza surge has focused thus far on the facts -- how many people will get sick and how many will die, how many vaccine inoculations will be available and how many shots will be needed to protect someone from this virus.
Thus far, most coverage, and the government announcements on which the coverage is based, have ignored two unpleasant truths -- first, that it is unlikely the health care delivery system will be able to respond to a significant flu wave and second, that the economy is likely to be severely affected by a widespread and long-lasting flu surge.
Thus far, government planning to meet these two challenges has been spotty at best. The truth is, gaps in the health care delivery system need to be filled and planning to address the economic impact of a flu surge needs to begin soon.
Challenge to the Health Care Delivery System
The facts are, over the next month the U.S. health care system will be challenged by a relatively benign influenza surge that will test the federal government's ability to efficiently deliver drugs and vaccines where they are needed. Every level of government and the private sector will need to operate and cooperate to meet the flu challenge and minimize its impact on people's health.
Large numbers of people, over an extended period of time, are expected to become sick during the expected H1N1 flu surge. Sadly, it is possible that many will die. Within the last week, two government agencies were bickering over the facts of the expected death toll. Early last week, the President's Science Advisory Council issued a report estimating between 30,000 and 90,000 deaths. Later in the week, the Centers for Disease Control (CDC) said the 90,000 number was overstated.
The truth is, estimating the death toll grabs headlines, but it is not as important as planning to minimize the suffering from disease.
We have seen no specific plans for identifying where outbreaks are occurring, how severe they may be, how to determine how much of the critical supplies should be sent to those areas and how they will get into the hands of medical personnel in hospitals and doctors' offices. The truth is, without such plans, needed supplies will be shipped where they are not needed, while places where they are needed will go without.
Too Late to Prepare?
The only way we can affect the suffering from this disease is to assure that the stockpiles of anti-viral drugs (Tamiflu and Relenza) are released by governments in a timely manner and delivered to patients within 48 hours of the onset of symptoms, when they can do some good.
The most effective way to prevent the spread of the disease is vaccination, and only limited vaccine supplies will be available starting mid-October, which may be too late to stem the tide. As of today, we have seen no plans for identifying where the vaccine is most needed and getting whatever vaccine is available to people who are at risk in a timely manner.
The facts are, this strain of flu is milder than most, and by every advance indication, the death rate will be relatively low. The facts are, large numbers of people will need emergency medical attention and our hospital emergency rooms are already understaffed and over-committed.
A 2008 report by the American College of Emergency Physicians said, "many emergency departments in the United States are critically overcrowded and unable to respond to day-to-day emergencies, let alone disasters and acts of terrorism." In 2003 and 2004, between 40 percent and 50 percent of U.S. emergency departments experienced overcrowding according to the CDC.
The truth is, flu cases will be an additional burden to the normal emergency department loads. During a flu surge, normal emergencies will not cease. People will still have heart attacks, be involved in auto accidents, fall off ladders, deliver babies, be stabbed or shot.
Imagine yourself becoming sick in the middle of the night with a high fever, cough, headache and difficulty breathing. Your spouse takes you to the local hospital emergency room where you encounter 20 or 30 other people sitting on benches hacking and coughing. The expected wait to see a doctor is two to three hours or more and you feel terrible. Will you wait or will you tough it out and go home?
If you decide to wait to see a doctor, there isn't much that can be done to help you. If no Tamiflu or Relenza is available, there may be nothing that can be done to relieve your symptoms because these drugs must be started within 48 hours of the onset of symptoms to be effective.
If you are sick enough to be admitted to the hospital, but not deathly ill, there may not be a bed or even a cot available for you. If you are lucky enough for a bed to be available, you are likely to be warehoused in a hallway or other makeshift treatment area.
Challenge to the U.S. Economic System
The truth is, the coming flu surge also will test the economic recovery now in its early stages. The economy will decline as a consequence of a flu surge. If not managed properly, the decline could become disastrous. Under the best of circumstances, the economic consequences of a flu surge are likely to linger far longer than the disease itself.
We have yet to see any specific estimate of the economic impact of this coming flu surge or any plans for recovering from that impact once the flu passes over us. When the flu strikes, people will stay home. They will miss work, stop going to restaurants and concerts or attending movies and sporting events. They probably won't go to the mall or look for cars and homes. The impact on the merchandizing and production sectors of our economy will be significant.
Taking Action to Minimize Impact of a Flu Surge
The President's Science Advisory Council report called for a single person within the White House to coordinate all efforts across agencies in response to a flu pandemic. We believe that is an excellent idea that should be implemented immediately. There will be no time or ability to establish procedures, or even to create a telephone list of who to call once the flu strikes.
The facts are, H1N1 flu has lingered in the United States at camps and other gathering places over the summer and schools that have reopened early have experienced outbreaks of flu. The truth is, planning for distribution of needed resources to meet a flu emergency should begin immediately, and planning for the economic impact of a long flu surge must be initiated quickly if it is to have any significant impact.
The truth is, preparing to tackle the healthcare challenges of an impending flu surge is not a job for a committee, nor can it be begun during the emergency. A single point of coordination for flu response should be appointed within the federal government to establish a means for distributing critical supplies where they are needed.
Minimizing the Impact
The truth is, people need to be made aware that the flu will have an impact on the U.S. economy and an economic recovery plan to minimize the financial impact of a flu surge needs to be prepared now. Without such candor and advanced planning, the impact could be exacerbated.
The truth is, we don't know what is going on behind the scenes. If steps have already been taken, or if plans to undertake them have already been made, the American people need to be told the truth about the potential healthcare system vulnerabilities and how they will affect those who become sick. Similarly, we need to be told about the potential economic impact on all of us, and how we can take steps to minimize the economic impact.
Steve Brozak is president of WBB Securities, an independent broker-dealer and investment bank specializing in biotechnology, medical devices and pharmaceutical research. Dr. Larry Jindra is director of research for WBB Securities.