 This week I had the opportunity to attend a global conference on
disaster management, one 'track' of which was focused on health
emergencies. There is certainly no unanimity about what we should be
doing to prepare for and cope with a future pandemic (a pandemic is an infectious
disease outbreak that is both virulent -- i.e. deadly -- and highly
transmissable human to human), but over the course of the conference a
consensus became apparent. I think this consensus reflects a growing
sense of maturity and awareness of the lessons of history and our
limited ability to anticipate or predict events in complex
environments.
Here are what I think were the twelve most important areas of expert consensus about the next pandemic:
- Most people cannot be expected to plan ahead or prepare for it:
It is not in our nature to plan for eventualities until and unless we
are convinced they are virtually certain and imminent. We can send out
all the information we want on emergency preparedness and emergency
kits. Most people will ignore it until it is too late.
- Public expectations of what
government will do to prevent, mitigate and manage a pandemic are
substantial, growing and largely unrealistic. This is
another instance of the phenomenon of learned helplessness, and it's
exacerbated by governments that are prone to overpromise things to
assuage gullible voters. After Katrina, we should know better.
- Isolation of communities won't work:
We are all too interdependent today to be able to cut our community off
from the rest of the world for any length of time until a pandemic is
over.
- Closing borders and air routes won't work:
Pandemics spread very quickly and easily and use multiple alternate
routes to 'work around' blockages. Short of an immediate, very early,
complete shut-down of all long-distance transportation (which is
impossible -- no one has the capacity to engineer this), a true
pandemic will become global.
- Except for expert professional users, masks won't work:
The use of masks and other protective equipment requires a complicated
series of steps to be rigorously followed. Even health professionals,
who are trained in these procedures, often miss a step and get
infected.
- It is the duration and recurrence of a pandemic that will wreak the most havoc, not its virulence or transmissability:
Pandemics can easily last 18 months or more, and can recur in 'waves'
after life has almost returned to normal. We can all manage
extraordinary procedures for a short time. Few of us can cope when
these situations become chronic.
- The economic consequences of a pandemic will be much more severe than the health consequences:
A pandemic will likely drastically curtail both business operations and
consumer spending on non-essentials. It could precipitate a recession
or even a 1930s-style depression. It is harsh to try to compare
economic costs with human ones, but, as with 9/11, costs and losses in
the trillions, by most people's standards, dwarf deaths in the
thousands.
- The codependence of telecom and electrical systems poses a huge vulnerability in a pandemic:
Information flows, and the continued functioning of health facilities,
are critical to mitigating tragedy during a pandemic. Maintaining our
telecom systems now depends on maintaining electricity -- most phones
are now digital and powered by the grid. Blackouts caused by storms,
sabotage or simple equipment failure will take much longer to recover
from because of personnel shortages, and repairs require a functioning
telecom system to report and coordinate information.
- The tools that will work in a
pandemic are those that are (a) simple to use and maintain, (b)
intuitive to understand, and (c) available at the point of use:
So, for example, satellite phones will be needed when regular cell
phones are disabled, but most people don't know where to get them, or
how to use them, or that they only work out-of-doors. Emergency
generators are hard to learn to use and require frequent proper
maintenance. Antivirals need to be administered according to a strict,
complicated regimen. Every complication, every extra step, reduces the
effectiveness and value of tools that could otherwise save lives. And
surveys indicate most people will be looking at simple sources -- TV
and newspapers, not the Internet -- for pandemic information.
- Resilience, practice and improvisation skills are more critical than good planning in a pandemic:
Redundant systems, people who have been through emergency situations or
rehearsals, excellent, evidence-based decision-making skills, trained
facilitators who can make effective ad hoc use of volunteers who
have natural immunity, and people with the competence to adapt to
quickly changing circumstances, have been shown to help in
emergencies far more than having a detailed plan. Plans can't predict
what will happen in complex situations, so they're only useful when
scenarios play out 'according to plan', which they seldom do.
- Science and technology will not reduce the certainty of a pandemic:
Viruses and bacteria evolve faster than science can invent ways to
defeat them, and as we get better at creating antimicrobials we
actually accelerate the evolution of immune microbes. We can never
catch up. There will be a pandemic, and it will be soon.
- Antivirals and vaccines will be of limited use: Antivirals
are complicated to use, have a short shelf life, have side-effects, and
may not be effective against novel disease strains anyway. Vaccines
take months to develop, by which time most of the damage may already
have been done. Due to a phenomenon called cykotine storm, those with
strong immune systems may be the most vulnerable to pandemic disease (this happened during the Spanish Flu in 1918, and happens in H5N1 poultry flu). What will most
determine who lives, who gets sick and who dies is the natural immunity
of each individual to the particular virus, and its virulence. And if
it turns out you have natural immunity, you will be needed (see point 10).
Are you ready for this? What do you think most people will do --
panic and overload the phone lines and help lines, or stay calm and
rise to the occasion? Category: Science and Health
|
MADE IN CANADA
trust your
instincts 
