Daily Archives: April 28, 2009

Don’t Mess With the Pig- The Swine Flu is no Joking Matter

I am not an alarmist by any means.  I am a realist and a historian.  If we know anything from human history there have been great plagues as well as epidemics and pandemics of various types.  Our world is rich in life and beauty but it is also full of really really nasty diseases that on occasion get loose and act really really bad.   Influenza, which normally kills about 30-40,000 people annually in the United States is one of those ugly nasty diseases.    Even mild cases can make you want to die and this is the easy stuff.  I’m not smart enough to make a prediction that the Swine Flu will be the next big pandemic, but it has potential and that potential needs to be addressed to ensure the safety of everyone, even lawyers.

The Avian and Swine variations of the flu are like normal flu on steroids.  They kill if they are not contained quickly.  The last scare we had with the Swine flu was back in the 1970s.  I remember getting the vaccine for it.  Hopefully those anti-bodies as well as all the ones from every other flu bug that I have been vaccinated for or exposed to will keep me safe with good preventive measures. That bug was contained and it did not become an epidemic.  Because it didn’t the pharmaceutical companies that produced the vaccine were beaten down.  A small minority of people had side effects from the vaccine.  The pharmaceutical companies, for all their faults, got hosed on this.  They had their asses sued off and were not protected.  Maybe we should pray, like Henry IV that if this Flu becomes a pandemic that it kills all the lawyers first.  People, especially we Americans then developed the attitude that this is not a threat.  This attitude could cost us big if we are slow to react.

The fact is there will be another epidemic or pandemic.  The really big one was the Great Influenza or the “Spanish Flu of 1918-1919.  This was nasty a virulent strain of Influenza A subtype H1N1, the same subtype as the current Swine Flu. It killed people by the millions worldwide, most of whom were the young and able bodied.  Thousands of US Soldiers in France and Stateside Camps got sick and died with the first outbreak in the US coming at Ft Riley Kansas.  Back then there was no mechanical ventilation nor antibiotics. So if you were blue from lack of oxygen you were put in the “you’re going to die line.”  Back then the mortality was about 2.5-5% with anywhere from current estimates 50-100 million deaths world wide.  In the United States it is estimated that 28% of the population was effected with between 500,000 and 675,000 fatalities.    More than half the fatalities were in 20-40 age group.These were the “Flu virgins.”  Regular Flu kills the elderly and young children, this Flu was different, it ate up the young and otherwise healthy people with no immunity.

With supportive care in the United States and other first world countries that will be significantly lower but still catastrophic.  Estimates range to 2 million dead in the United States alone.  Because we are a much more fluid society in the event of a real pandemic the government will have to take draconian measures.  These will have to ensure that public safety limiting movement, deciding who gets vaccines first and who gets treated the most acutely with the coresponding reality that in a pandemic there will be people for whom the best you can do is palliative care. This will offend sensitivities of religious people, good hearted “secular” humanitarians as well as various political factions.  Civil Libertarians will be outraged.  Media goons and talk show hosts will rant against the government.  Conspiracy theorists will come out in droves.  Unfortunately if this outbreak becomes a epidemic or even a pandemic drastic actions may be required until the emergency passes.   Marital Law may be an option.  I’m not a big fan but if this gets really ugly it may have to happen.

I am an ICU chaplain.  Really bad Pneumonia’s are a pain in the ass to treat for Intensivists and quite often exacerbate or cause cause problems in other organ systems.  This flu and the Avian flu produce pneumonia’s in spades both viral and bacterial. In the Spanish Influenza it was the bacterial pneumonia’s that killed the most people.  Through in ARDS, pulmonary edema and hemorrhages in the lungs.   If you have ever been in an intensive care unit and seen a young person on a vent battling a pneumonia and barely hanging on to life then grab your seat.  Lot’s of young people will die.  Likewise there will not be enough ICU beds and ventilators to go around should this reach the pandemic stage.  Resources will be short and physicians and government officials will have only bad and worse choices.  Those in the front lines of the battle, young physicians, nurses and technicians will be among the casualties.

I am not privy to any plans of the Department of Homeland Security, Department of Defense or CDC.   However, I am graduate of the USMC Command and Staff College.  I am sure that both departments have been preparing for such case since the Avian flu started showing up in the 1990s, as well as the threat of terrorists using biological weapons post 9-11.  Unfortunately there are some who would see what these agencies are doing to plan for a worst case scenario as some diabolical plot, a conspiracy theory to make the government more powerful.  If fact there are some of the Keepers Of Odd Knowledge that are alleging a government plot to engineer such a virus.   I have seen this from both left and right wing bloggers and I’m sure that their message will get out and cause people to act stupidly and jeopardize public health.  In other words, they will damn everyone else, and do what I want even if it means that they spread a virus that will kill those around them.  Sorry this is selfish, irresponsible and just plain idiotic.  Prudence is the watchword.

On my way to the ball park I heard a radio talk show host talking about the “Napolitano Flu.”  He was taking a shot at the Secretary of Homeland Security.  Unfortunately for the millions of listeners this man and others like him will not take the threat seriously.  I’m not going to say that there will be a pandemic with this outbreak.  However, a pandemic is bound to happen and when, not if,  it happens the blood of these people’s listeners will be on their hands.  Ignorance and idiocy in encouraging stupidity is not a virtue even if you have valid criticisms of the way the government is handling the situation.

Anyway, those are my thoughts on this.  I hope it goes away.  I don’t want any of this to happen.  Anyone with half a brain doesn’t want it to happen. However it will someday and maybe even with this strain.  God I hope not.

Peace, Steve+

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