# 2637
No matter how many times it's been said, I seriously doubt that most people in the UK and the United States `get it'.
That during a pandemic, 95% or more of those stricken will have to be cared for at home.
It is a matter of simple mathematics.
Here in the United States, there are roughly 1 million hospital beds, and 90%+ of those are occupied at any given time by heart attacks, strokes, trauma victims and other assorted medical cases.
In the UK, there are roughly 200,000 beds, and 90%+ of those are occupied.
While some beds could be freed up by discharging non-critical patients and delaying elective procedures, the shortfall in the face of millions of flu victims would still be enormous.
And of course, staff reductions due to a pandemic are expected to be heavy as well. It isn't enough to have an empty bed. You have to have nurses, techs, and nursing aides available to provide care.
The UK pandemic plan for General Practitioners, released yesterday, emphasizes that during a pandemic, the public should not rush to their GP if they have the flu.
GP's will not stock or dispense antivirals during a pandemic. Access to antivirals will come from calling a National Pandemic Flu Line service.
From the UK Plan:
GP's are urged to post the following notice in their surgery (clinic), advising anyone with `flu symptoms' to go home and call the hot line.
The concern here is not only that GP's would be overwhelmed by flu cases, but that non-infected patients would be exposed to those carrying the virus in the waiting room.
Of course, it remains to be seen whether people will accept this advice, or whether they will still show up at their doctors expecting treatment for themselves, or a loved one.
The UK plan envisions that `up to 4%' of those affected may need hospitalization, but admits there may not be hospital beds for them.
For every 100 patients with flu symptoms up to four of them may require hospital admission, if there are beds available. Up to a quarter of these patients are expected to require critical care.
The average length of stay in hospital is likely to be up to six days (ten for patients in intensive care). Modelling suggests that up to 2.5% of all flu victims may die.
At first blush it may appear that some of these assumptions are at odds with each other.
After all, the statement that 4% of those infected may require hospitalization, and of those that 1/4th may require critical care implies that only 1% would have grave complications.
Yet a death rate of up to 2.5% is envisioned. How does that work?
Here I can only assume that being seriously ill isn't enough to get you admitted to a hospital. You have to be in serious condition and considered salvageable, as well.
Unstated, but implied, is that a certain percentage of those who will die from a pandemic will do so at home.
The following chart comes from a sister document to yesterday's release, Pandemic influenza: surge capacity and prioritisation in health services - provisional UK guidance.
Based on this chart, it is envisioned that during a pandemic, only 28% of those infected would get to see a doctor, and only 4% would gain admission to a hospital.
These numbers are based more on what can be done, than on the expected severity of a pandemic. If far more people become severely ill, or if the CFR is higher than 2.5%, there is no magic wand to wave to increase health care capacities.
Before anyone screams, "This isn't fair!", I think we can all agree there is nothing fair about a pandemic.
These are realities. There are only so many doctors, so many hospital beds, and so many staff. Like it or not, people are going to have to accept that.
The situation here in the United States is unlikely to be any better, and could be far worse.
All of this, of course, highlights the need for families to be equipped and prepared (mentally and physically) to care for loved ones who get sick during a pandemic.
Now, before a pandemic becomes a reality, is a good time for everyone to develop a family pandemic plan.
One of the things you can do is to download, print out, and read Doctor Grattan Woodson's excellent guide on the home treatment of influenza.
Every home should have a `flu kit', with over-the-counter medicines, masks, gloves, alcohol hand gel, and disinfectants, and everyone who lives alone should have a `flu buddy', to go fetch medicines or help care for them if they get sick.
The good news is, even in a severe pandemic, most people will survive. During the Spanish Flu of 1918, as horrific as it was, here in the United States fewer than 1 person in 100 died.
By being educated and prepared, we can help lower the mortality rate of any pandemic, even for those cared for at home.
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