The Real Worst-Case Scenario for Swine Flu 2.0
Thomas P.M. Barnett
Sept 3, 2009
Could a new wave of the H1N1 virus become as crippling to Obama as Katrina was to Bush? An in-depth assessment of the risks to moms and politicians across the country.
The more and more I talk to people around Washington these days — fellow security guys, policy consultants, health-care experts, parents — the more I realize that
the next wave of the H1N1 virus ("swine flu," if you must) is going to be a bigger deal than even the mask-wearing paranoiacs at the county fair will let on. And the more I pour over the new H1N1 report released to the White House from President Obama's seriously legitimate science-and-technology advisory council,
its worst-case scenario seems even more frightening than the one from Stanley McChrystal that landed on his desk yesterday.
The Obama geek panel's "plausible scenario" suggests an early flu season peaking in the middle of October that could kill 300 percent more people than our usual flu season does. That's
ninety thousand people in the next couple months — more than ten times as many Americans as we'll lose in Iraq and Afghanistan in the next couple administrations. Even the council's low-end prediction of thirty thousand would arguably double the usual death count because this won't be your aging grandma succumbing to swine flu; the report rather darkly — and repeatedly — emphasizes fatalities among kids, for whom "the consequences of infection in this epidemic are already known to be far more severe."
Children shouldn't have to die this way.
So the good news? The advisors said they were "deeply impressed" with the administration's decisions to date, describing them as "probably the best effort ever mounted against a pandemic." That's good for my four kids and me, but it's also good for Obama: pro-pig approval ratings, data shows, should help drum up Democratic votes for the mid-terms — or at least help Rahm ram through health-care reform ("never allow a crisis go to waste," Emanuel likes to say).
But even if one vaccination can now perform a two-dose job against H1N1, the new report highlights the virus' second wave arriving too early for widespread vaccination. That means one in every two Americans could plausibly contract this novel flu strain, and that means the political finger-pointing could get nasty. And all this from a "moderate" pandemic.
Inside the Numbers:
Is H1N1 the Second Coming of Katrina?
Okay, more good news: H1N1 has a stunningly low death rate, and most young people recover within a few days without requiring medical treatment beyond what a caring mom would instinctively muster. On the other hand, swine flu has a stunningly wide reach, and these kinds of vast infection numbers — even if only a small fraction of cases lead to hospitalization — will swamp the capacity of our nation's health-care infrastructure rather easily.
Sure, the president's science advisors say this fall's flu wave won't be a rerun of the super-deadly 1918 flu (another H1N1 strain, by the way), but it sure as hell won't be a Chicken Little drill like the swine flu of 1976, when a government-distributed vaccine resulted in more panic than prevention. For the no-drama Obama crowd, that sort of swag (scientific wild-ass guess) can't be comforting. Hurricane
Katrina killed fewer than two thousand Americans, but it saddled the second Bush administration with a popular perception of sheer incompetence that it never shook off. And with the health-care debate bringing out the big-picture "desperation" vultures in full force, the political stakes for Democrats couldn't be higher.
Just how difficult could things get for moms and Obama alike? Let's drill down on the report's worst-case scenario numbers: Up to half of Americans (or 150 million people) could become infected, with as many as 80 percent of those (120 million) exhibiting symptoms. As many as three-quarters of those with clear symptoms (ninety million) are expected to seek medical attention, and of those, 2 percent (1.8 million) will need hospital care. Of those hospitalized, only about 1-in-5 will require intensive care, and the large majority of those will survive — hence the much Drudged-about estimated ceiling of ninety thousand. The lower ranges of this scenario (not to be confused with any best-case "floor") cut all of those estimates in half, with the death toll cut by two-thirds — or a double-plus-bad flu season (thirty thousand H1N1 cases conceivably on top of the usual, elder-concentrated loss).
Left to its own devices (or unmitigated, in doc-speak), the peak incidence date of October 15 should see no more than 1-in-50 Americans (six million) come down with the flu, but, because of the clustering effect by age, any enterprise that employs or involves concentrated numbers of young adults (read: school) could be temporarily decimated. That, in turn, could trigger some extraordinary measures aimed at "social distancing," like canceling major sporting events, or conducting them sans fans, as Mexico has already done. Then there's the familiar tactic of closing schools, which the World Health Organization is telling countries to consider. But in an education-heavy economy like ours, each week of classes canceled across the country would shave half a percentage point off our GDP, according to the medical journal The Lancet.
No matter how you slice it, swine flu is going to cost America plenty.
Consider what the worst case calls for: six million people infected six-and-a-half weeks from now essentially means we need 450,000 hospital beds — pronto! According to the report, that's asking for seven out of every ten hospital beds that are readily accessible in America today — and asking for it at a time when occupancy rates typically hover at much higher percentages (a standard goal being 85 percent). Conceivably, almost half a million Americans would suddenly be chasing less than one hundred thousand free beds. That means triaging the "worried well" (typically, a vast additional diagnostic burden) from the truly needy, and then reducing that truly needy number down to the available beds. Under normal conditions (or, I guess, in anti-Obamacare propaganda), that's called rationing, with the losers encouraged to accept home-based care (not a bad idea in terms of social distancing, but a burden on families). Of course, in an emergency, you can free up some beds by suspending voluntary admissions, but what about intensive-care beds? The worst-case load prediction is 25 percent higher (seventy-five thousand) than the current U.S. total (sixty thousand), and most intensive-care units are virtually filled up. All the time. And, the report notes, "the number of ICU beds available for pediatric patients is especially limited."
Don't even get me started on how tightly we staff our hospitals today, or the scary fact that barely one-third of U.S. medical workers typically get a flu shot every year. Little wonder that Dr. Harold Varmus, medical superstar and co-chair of the president's council, warned that H1N1's second wave will "stress every aspect of our health system."
The Fallout: As Goes the Flu, So Goes Obamacare?
How all this affects Obama's push for health-care reform is anyone's guess right now — and, I guarantee you, every pundit's favorite after Labor Day. The president's speech to a joint session of Congress should provide more of a sense of how he'll spin the swine into the legislative mix, but his instinct — if only to get them to wash their hands and cover their sneezes — is clearly to strike the fear of God into his constituency, at least in the short term (The height of this global pandemic is less than seven weeks away!).
In political terms, emphasizing worst-case projections sets up the White House to claim a convincing victory after the fact, while simultaneously noting all the system's vulnerabilities — hence the compelling need for reform. Far from being his Katrina, H1N1 could prove to be Obama's congressional vote-grab — if he plays his cards right (and keeps his germaphobe vice-president — not to mention the out-in-the-tumbleweeds former one — away from microphones). Beginning on page 45 of the report (the PDF of which is all worth reading), there's a long section on the challenges of data collection and management during this crisis, with not-so-subtle calls to avoid waiting for new policies amidst the rise of a pandemic. If that doesn't sound like a winning argument for electronic medical records, I don't know what does.
For now, unfortunately, we just can't be certain how bad a hand we're being dealt here. With SARS and avian flu, the higher death rates were often fueled by "cytokine storms" triggered by the virus within previously hardy individuals. These potentially fatal immune-system overreactions (when signaling chemicals [cytokines] are over-stimulated) usually occur in young adults, meaning their bodies fight back so hard that vital organs (typically the lungs) are damaged catastrophically. Thankfully, there's no solid evidence we'll see this year's version of H1N1 triggering large numbers of such cases, but it's one of the many reasons why this report came with the authors' caveat that "features of 2009-H1N1's next wave cannot be accurately predicted."
What we can predict this fall is an issue — finally, a real issue, of importance to public good and public policy — that goes beyond the partisan (and wing-nut) chatter to really test our mettle. And while your kid will try to fight back in his middle-school classroom with that hardened immune system, the president will have a lot more than germs to battle.
http://www.esquire.com/the-side/war-...u-death-090309
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