#215
Rarely mentioned, but certainly in play, are conflicting ideas as to how to manage an H5N1 Avian Flu pandemic. The curious notion that we can do that aside, there seems to be two camps in this debate. Those who want strict controls like quarantines and travel restrictions put in place, and those who believe those methods are counterproductive and doomed to fail.
At first blush, most people would instinctively assume, if you do all that you can to limit the number of people exposed, that you save the maximum number of lives.
Simple, right?
Perhaps not. By slowing down a pandemic, you run the risk of lengthening it, which could possibly confer even greater misery and loss of life upon the public.
Allow me to explain.
There are three ways for a pandemic to end. First, the virus mutates into a less infectious, or deadly strain. Second, an effective vaccine is created, manufactured, and distributed. And third, the population, through exposure, gains herd immunity.
A mutation that rendered the virus less potent would be a great thing, but it is uncertain if that would happen, and how long that might take. Months? Years? Never? It’s anyone’s guess.
Obtaining a vaccine will take at least six months once the H5N1 virus mutates to a pandemic strain, and more likely 1 to 2 years. Some experts say 3 years is a more reasonable estimate.
And so that leaves us with herd immunity. Simply put, when we are exposed to the virus, we either 1) have a natural immunity and do not get sick 2) acquire immunity from the exposure and remain asymptomatic 3) we become ill, and if we survive, we have at least some immunity to the virus, or variants of it, in the future.
When a sufficient percentage of the population acquires immunity, the pandemic slows, sputters, and dies out.
So this unseemly debate, generally held out of the earshot of the public, is whether it is better to try to slow a pandemic down, or is it better to allow the pandemic to rapidly run its course?
Many feel the virus will likely infect all those that are susceptible to it, regardless of what we do. The only factor we may have control over is: over what time frame?
So we must ask: In the long run, which policy would save the most lives? And which policy would do the least amount of damage to our infrastructure, economy, and society?
And here we run into dueling scenarios, with far too little real data to know who is right. Everyone, regardless of their position on this matter, has to make assumptions about what would transpire, and there is no way to know with certainty how valid those assumptions are.
Those in favor of slowing the virus, point out that the `pain level’ of society would be lessened if spread out over time. There would be fewer deaths each day, fewer people in need of scarce medical resources, and it would leave open the possibility that a vaccine might be developed down the road, or the virus could mutate to a less lethal strain with time.
Opponents to slowing the virus point out the futility in attempting to do so. The draconian measures it would take, including quarantines, border closures, travel restrictions, and the closures of schools, public venues, and most non-essential businesses would be oppressive in a free society and nearly impossible to impose. And by prolonging a pandemic, the impact on society, and the economy would be greater.
And both sides have valid points.
Something as simple as closing the public schools, perhaps for months, would seem to most people to be the prudent thing to do. After all, schools are notorious breeding grounds for illness, and kids invariably not only spread them among themselves, but also bring it home with them. If schoolmates were falling sick and dying, would parents really send their kids to school?
But the opposite camp would point out that closing schools would place a tremendous burden on working parents, many of whom might be forced to leave essential jobs to watch their kids at home. They also point out that kids might not stay home if the schools were closed, and would congregate elsewhere, spreading the virus anyway.
And the questions only get tougher.
If a large city has an outbreak, do we cordon off the area, close the roads, and use force if necessary to keep people from leaving? Is that even remotely practical? Most scientists would say it wouldn’t work. Yet I suspect, at least in some places, it will be tried.
Should the government tell everyone to `hunker down’ at home for months, or should they encourage people to go to work or to volunteer to help if they can? It is not a simple question. How many people can actually prepare to at stay home for months? And on the opposite side, how many people will willingly report to their jobs and risk exposure?
Should authorities use our limited Tamiflu supply as a prophylactic measure to try to slow the spread in a community, or save it for those actually infected? There won’t be enough to do both.
Do we close all public gatherings, including churches? Do we outlaw funerals for the duration? Do we mandate the use of masks in public? Close down public transportation? Impose travel restrictions between cities and states?
Just how far do we go? And would any of these measures make an appreciable difference?
So far, while there have been hints of stronger actions under consideration, the US government has been largely silent on most of these issues. I suspect that most officials believe that there is little we can do to limit the spread of a pandemic, and are hoping that the upside will be shorter crisis. The internal debate undoubtedly continues, and so we get mixed messages.
The Federal recommendation of only 2-weeks of food and supplies in the home would suggest they aren’t expecting citizens to hunker down for months. The advice to `wash your hands’ and `cover your coughs’ suggests they aren’t going to advocate masks, which are in short supply, for the general public. And in recent months, we’re hearing more school districts contemplating staying open during a pandemic.
I expect that there will be attempts to keep people working during a pandemic, particularly those doing essential jobs: doctors, nurses, cops, EMT’s, hospital employees, utility workers, truckers, community volunteers, mortuary workers, and anyone in the food production industry. The death toll would go up tremendously if these sectors were shut down, and the government knows that.
All of this debate, however, may prove to be moot. Managing a pandemic may be simply beyond us.
It may be the equivalent of standing on the shores of the Pacific and ordering a Tsunami to turn back.
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