Ramifications : Part I

The consensus among many scientists is that a pandemic is overdue, and that the H5N1 virus is poised in pretty good position to become our next global pathogenic threat. Many say a pandemic is inevitable, but caution that we don’t know when it will happen. Our government seems to be on track to be `ready’ by this fall. `Ready’ being a relative term, and in no way meaning they can cope with a pandemic.

At this point, you either believe there is a strong probability of a pandemic occurring in the next 12 to 18 months, or you don’t. I personally believe it is more likely than not.

Over the next few weeks I intend to talk about the ramifications of a pandemic. What we can expect, and hopefully, things we can do to cope. If BF news breaks, I will interrupt this series, and bring it to you. But for now, H5N1 is simmering quietly in remote regions of the world, and is out of the news.

Once one has gotten their head around the concept of a pandemic actually happening, the next step is to think of how it will affect us. Some problems, such as food shortages, economic issues, and the inability of hospitals to handle the influx of patients have already been discussed here, and will likely be repeated. But there are other issues, many of which few people have thought of, and so I will use this forum to bring them to your attention.

For those of us that are baby boomers, many of us have elderly parents, and many of them are in nursing homes or extended care facilities. During a pandemic, these facilities will be highly vulnerable, and their patients at extreme risk. One need look no further than the debacle of Hurricane Katrina last year, to see what can happen when a nursing home is unable to cope with an emergency.

Nursing homes are typically breeding grounds for influenza, and seasonal flu takes a heavy toll every year. Visitors come and go, and bring germs with them. The patients are fragile, with compromised immune systems, and are cloistered in close quarters. Seasonal Flu Vaccines are apparently less effective on the elderly. The result is that each year, thousands of nursing home residents die of seasonal flu.

Pandemic flu will strike these facilities hard.

Under normal circumstances, nursing homes are generally understaffed and those that work there are underpaid and overworked. Good nursing homes do exist, but they are sadly, in the minority. I can only hope that some of the hellholes I witnessed during my paramedic career have either been closed or upgraded.

But the truth is, these facilities work under extreme budgetary constraints. Most long-term residents rely on Medicaid to pay for their care. And Medicaid hardly provides for 4 star accommodations.

Imagine what happens during a pandemic. Many of the staff will be out with the flu, or taking care of family members stricken by the virus. The government expects absenteeism rates to run around 40%. Already understaffed and overworked, this will make the standard of care in a nursing home, already marginal, plummet.

Worse, the assumption is that healthy employees will brave the pandemic, and report for work. Nurses, nurses’ aids, volunteers, maintenance personnel, and kitchen help. Little or no thought has been given to the idea that many will elect to stay home rather than expose themselves to the virus, and likely bring it home to their families.

It’s a lot to ask of a minimum wage worker to show up and risk death or illness during the height of a pandemic. And I doubt many will. A 40% absenteeism rate is extremely optimistic. From my talks with other health care professionals, I’m expecting 70% to 80% not to show up. And those that do may be soon inundated by the job, and, seeing the writing on the wall, decide to bail.

We have, at last count, roughly 2 million, mostly elderly, people in nursing homes in this country. Tens of thousands more are in `unlicensed’ facilities, which are more common than one might think. Most are there because they not only cannot care for themselves, but also because their medical conditions are so bad, their families cannot care for them either.

When Mom breaks a hip, or Dad has a stroke, or Granny develops Alzheimer’s, the burden of caring for them at home becomes almost an impossibility for some families. As bad as they can be, a nursing home can be their only recourse. We can decry the `pop drop’ mentality of this country, and yearn for the days when we kept the elderly at home and cared for them, but for many families this is impractical.

But come a pandemic, there is a strong likelihood that our parents and grandparents could be abandoned or neglected in these facilities. Basics such as food, water, and hygiene may become impossible to supply. Advanced care, such as meds, oxygen, or IV’s will evaporate in a matter of days or weeks. Deliveries of these items will dry up in a matter of days or weeks.

If you have someone you care about in a nursing home, now is the time to find out how prepared they are to handle a pandemic. You may even wish to think about ways of bringing them home. It won’t be easy, but it may prove to be your only choice. At some point, nursing homes may even begin calling relatives and asking them to pick up their loved ones, as they can no longer provide care.

It’s an ugly situation, and there are no simple solutions. For many of the medically fragile in our world, a pandemic will eliminate their safety net, and few will survive.

The virus, if it comes, will kill many people. But you don’t have to catch the virus to be killed by the pandemic. You simply have to be dependant upon a system that barely works now, and will likely fail miserably when the pandemic arrives.

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