The Resilient Economy - Part 6 - Medical Care
One of the most difficult challenges for creating a resilient economy involves health care. The general theme throughout this series of blogs has been self-sufficiency. However, when it comes to medical care, there are many treatments that require specialised medical care which a patient cannot provide for themselves. Still, there are some steps which can be taken which will make medical care more resilient.
Diet and exercise. We've heard those two words so often that there is a temptation to tune them out. However, the simple fact is that many chronic illnesses can be avoided or delayed through diet and exercise. For example, type II diabetes is almost always caused by excess weight gain. This can require a variety of medications to treat. Medications that may be difficult or impossible to obtain during a pandemic. Most of these cases of type II diabetes could be avoided through exercise and a healthy diet. Any major disruption of society is likely to require hard, physical labor, so getting into good shape should be considered an essential "prep". In Part 3 of this series, I argued in favor of home gardens. One of the benefits of this approach is that people are more likely to eat healthy if they grow their own food. I know this has been the case for me.
Protective sequestration. The best way to avoid getting infected from a flu virus is to stay home. The public should be encouraged to prepare to remain in their homes for at least 12 weeks. They should be given blunt information about the current kill rate of H5N1 (over 60%) and the possibility that it could go pandemic at any time without a reduction in virulence. They should also be told that mandatory movement restrictions may be imposed to stamp out outbreaks.
Free vaccinations. There has been a lot of discussion about how much health care should be provided at taxpayer expense. This is a broader topic than can be treated here. However, free vaccinations should be one public health measure that everyone supports. First, since not all vaccinations are effective (only about 70% for flu), vaccination programs work best on a population basis. The more people vaccinated, the less likely someone is to get infected, even if their vaccination failed. Second, vaccinations are cost effective. The diseases that result if most people are not vaccinated can be very expensive to treat. Since the people who are not vaccinated are often poor, their treatment will fall to the taxpayer. Vaccinations could be offered at schools. Parents could be given a form that would allow them to opt out of any vaccine that they did not want their child to receive. During a flu pandemic, it is especially important that as many people as possible be vaccinated for "regular" flu. This is because the rapid flu tests do not distinguish between "regular" flu and H5N1. Patients identified as having flu will likely be treated differently than those without it.
Stockpiling medications. For some people, medications are necessary to continue living. Since many medications are made overseas and may not be available during a pandemic or other catastrophe, it makes good sense to stockpile at least 6 months of any critical medication. Any laws or insurance policies that interfere with this strategy this should be repealed. In addition, the US government should create stockpiles of antibiotics and other essential medications. Unused medication that will expire could be provided to hospitals for patients unable to pay for treatment. Tamiflu, relenza and other antivirals should also be stockpiled in case of an influenza pandemic. Individuals who wish to stockpile their own antivirals should be allowed to do so.
Self-sufficient Hospitals. During a catastrophic event, keeping hospitals functioning will be a major challenge. Because there may be disruptions in essential services, hospitals should be given financial incentives to install renewable energy sources (solar panels, wind turbines, etc.) to ensure power is available. They should also stockpile simple-to-prepare food that could be rotated into the cafeteria.
Pandemic triage. For a flu pandemic, it will be essential to keep infected patients out of the regular hospital. To accomplish this, there would need to be a separate triage area where the infection status of patients is established. In this triage area, all patients would be housed in individual rooms, perhaps in a hotel, and would be required to wear surgical masks to prevent infection of other patients and health care workers. The latter would wear Powered Air Purifying Respirators in the triage area. After a quarantine period, non-infected patients would be admitted to the "regular" hospital. Ideally, health care workers would remain in the hospital for the duration of a pandemic to avoid bringing in the virus. This should be done entirely on a volunteer basis. Flu patients should be given whatever treatments are available. Antivirals are currently the most effective treatment, if given shortly after infection. Hopefully the number of flu patients will be kept to a minimum by protective sequestration of the public during outbreaks.
Providing normal medical care will be impossible during a pandemic or other catastrophe. A significant number of people are certain to die as a result. However, I believe these numbers can be decreased if the steps suggested here are taken.
Saturday, March 21, 2009
