Tuesday, July 28, 2009

Imagination and H1N1 preparedness

Got an e-mail today from a Bloomberg reporter asking about my thoughts on the state of US preparedness for H1N1. Specifically he was interested in the ICU capacity as it applies to dealing with the more severe respiratory failure that has been reported in association with this infection. You might wonder why he called me of all people. Well, this is because I published a bunch of papers recently (that have been dutifully ignored by policy makers) that quantify the expected stress to the healthcare system in the US posed by the sky-rocketing increase in the population of patients requiring ventilators to assist them with breathing. How naïve I was to think that our numbers might be used for planning purposes, so that we could be better prepared for this growth!

A year since we first started to come out with the numbers, there are still no reliable estimates, or even attempts to derive them, as far as I can tell, of the US ICU surge capacity. And this information is more critical now than ever, as we are faced with the potential for untold numbers of H1N1-related hospitalizations accompanied by severe respiratory failure. It is shocking to me that we are leaving these infrastructure issues to chance.

But wait, why am I so shocked? This is just another byproduct of our fragmented healthcare "system". There is no one either to take or to designate responsibility for planning. While our professional organizations are doing the best they can, their approach is usually siloed and somewhat distracted: in case you have not heard, we are also tackling the most rampant pandemic of antibiotic resistant infections, which affects ICUs disproportionately.

So, who will take charge of this hot potato? The CDC? Homeland Security? FEMA (chuckle-chuckle)? Press your representatives to tackle this thorny issue, because if you are worried about planned rationing now, wait until you see what unplanned bedlam looks like. Condi Rice said that the US intelligence community just did not have the imagination necessary to anticipate the 9/11 terrorist attack. Let us not have to resurrect this tired excuse this flu season.


  1. I strongly agree. It has been obvious for several years in the UK that the ICUs are run at such a high capacity that there is no slack in the system for eventualities such as flu pandemics and that the numbers are even worse for our PICUs.

    We are already seeing problems with ICU availability in the UK and we are probably only in the early stages of this pandemic.

    It should be easier for us because of the NHS but the fragmentation across Primary Care Trusts and other Health Authorities plus the lack of appropriate liaison with relevant authorities.

  2. Thanks, Evidence! Yes, the issue of ICU capacity is enormous! I hope that we can learn from some of the lessons of the Southern hemisphere as their flu season progresses.

  3. I discovered your paper on ICU utilisation when I was trying to find stats about the number of ICU beds in the US compared to other countries for my blog post on H1N1, ICU utilisation, and EMTALA: http://theoctopustrap.blogspot.com/2009/07/reform-rationing-swine-flu-and-futile.html

    As for getting an ICU bed; two weeks ago I had to beg and transfer patients 30 miles across town (Australia's largest city); more recently it's been tight but not impossible.

  4. DHS, thanks for your comment! I think that we need to learn from the Aussie experience, and I do not believe that we will be prepared without a serious coordinated effort.

    As for comparative bed numbers, you might check out the work of my colleague Hannah Wunsch -- she has done some of that research.