Epidemiologist: ‘We’ve Left Ourselves Unprepared’ For Pandemic

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There are more reports of cases involving the H1N1 swine flu in Massachusetts.

State officials say an Amherst College student has a suspected case, while the “probable case” of a student has led Boston authorities to close the Harvard Dental School and clinic for Friday.

To consider concerns going forward, WBUR spoke to David Ozonoff, an epidemiologist and professor of environmental health at Boston University’s School of Public Health.

Do you agree with the World Health Organization’s assertion that a pandemic flu is imminent?

PROF. DAVID OZONOFF: Yes, I do. And in fact I think WHO has done the right thing. Some of us think they might have done it a day or two earlier.

What do you mean by that?

OZONOFF: Essentially, what WHO is doing is they are putting their member countries on notice that there’s an imminent serious public health problem — a possible pandemic. And they have very good reasons for saying that, and it’s important to have advance notice and warning for it so that you can prepare.

Just how dangerous might this be? How nervous should people be?

OZONOFF: Well I don’t think people need to be nervous, but I think they need to be cognizant of what’s at stake here. What we have is a novel virus that is a virus to which the human population has not been exposed. That means there’s no natural immunity to it.

So let’s assume that the virus continues clinically to be relatively mild, very close to what we usually experience every year with seasonal influenza.

That part’s not very scary. What is of concern is the fact that it can spread much more quickly, to many more people, than the normal seasonal virus.

Are we prepared to deliver medical care should an actual pandemic develop? In Massachusetts, the state has 50,000 courses of anti-viral medication available, and an additional 200,000 courses from the federal supply. Is that enough? 

OZONOFF: Well, first of all, the problem with treating influenza is not getting anti-virals to everybody. The anti-viral that we’re talking about, Tamiflu, makes some difference if it’s given early enough, but it doesn’t make a lot of difference.

It may shorten by a day or so the length of the illness and maybe make some of the symptoms a little bit milder, but people will still be sick.

And, that’s only effective on the margins. We are not at all prepared to handle the kind of surge in demand that would come from many cases in a relatively short period of time.

And essentially we’d have gurneys lined up in the hallway, waiting rooms stuffed with people sitting there for six, seven, eight hours instead of the current two or three hours. So it would really be a problem.

We’re not talking apocalypse here, but if it happens to many, many people in a short period of time, that’s a completely different matter.

You’ve said that even if we do gain control of this virus now or in the coming weeks, and the threat lessens over the summertime because temperatures warm up and viruses don’t generally like warm temperatures, it’s possible for it to reappear in the early fall. 

OZONOFF: Not only possible, but this has happened in one pandemic already. In 1918, there was a relatively mild first wave, just about this time at the end of the flu season, in spring of 1918. It then disappeared and people forgot about it, and it reappeared again in August at the Commonwealth Pier in Boston. And when it poked it’s head above water in August, it was already a monster.

We probably have succeeded in worrying people. How serious a threat are we facing in the coming weeks? Is there a storm coming? 

OZONOFF: I think the threat that we’re facing is sort of a known, familiar and practical kind of thing. Which is that any virus that can make a lot of people even a little bit sick puts a real strain on our resources. That’s our fault, that’s not the virus’ fault.

It’s our fault that we have disinvested in the kind of community infrastruture that we need to take care of each other. So I think we need to be very concerned by the fact that we’ve left ourselves unprepared.

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