Are We Ready?
A large-scale disaster like a pandemic flu or terrorist attack could overwhelm the nation's healthcare providers
Some threats are scary because of their sheer scope, straining resources for an extended period. A severe flu pandemic would demand thousands of beds, not to mention the 740,000-plus ventilators estimated by the Bush administration's preliminary flu strategy. (Currently, there are only about 105,000.) In a just-in-time global economy, goods aren't stacked in warehouses but arrive only when needed. With a pandemic, that delivery system would grind to a halt if enough people were sick and unable to manufacture or transport goods, says Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. Hospitals could run out of oxygen, spare parts, medical devices, masks, food, and medications--pretty much everything that can't be produced locally.
Even the thought of an outbreak could tax the system. "Much likelier than a bird flu epidemic is a concern about a bird flu epidemic," says Kent Sepkowitz, director of infection control and an infectious disease specialist at Memorial Sloan-Kettering Cancer Center in New York. In 2001, 15 anthrax cases prompted thousands of people, worried that they had been contaminated, to flood emergency rooms in the New York City area. A more likely scenario for a bird flu outbreak, says Sepkowitz: "a case or two of avian flu in humans and a crush of snifflers and people who have flulike symptoms."
Hospitals are trying to identify infections early on, when they can be more readily contained. Some promising technologies include syndromic surveillance, which would allow healthcare providers to identify patterns that could signal bioterrorism or an outbreak--such as an unusually high number of patients reporting flulike symptoms. In Texas, nine hospitals in the Memorial Hermann Hospital system now pool symptom data from their nearly 340,000 emergency room visits annually, says Bradley. The technology has potential, says Richard Platt, chair of ambulatory care and prevention at Harvard Medical School, who is testing such a system. It's expensive, though, and needs further study to determine how--or whether--it will actually help.
As with the Texas hospitals, institutions need to coordinate both before and during disasters--something they haven't always done. "There are 67 acute-care hospitals in New York City; each one, though it may have a network, operates independently," says Isaac Weisfuse, deputy commissioner of disease control in the New York City Department of Health and Mental Hygiene. His department is working to improve ties between those entities with, say, more frequent forums. The New York State Department of Health, meanwhile, set up a program after 9/11 that allows hospitals to share capacity information to see where beds are available in case of an emergency.
Rebuild it. The city of Seattle, experts say, is on the right track. A coalition of 200 people, including CEOs of medical centers, physicians from private group practices, pharmacists, and nurses, is rethinking emergency care there. "We wanted it to be like Apollo 13: Dump all the pieces on the table and rebuild it," says Dorothy Teeter, interim director and health officer in Seattle and King County's health department. The team's task: deciding who would do what if a disaster occurred--not hospital by hospital, but on a regional basis.
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