Outside editorial: Swine flu's lessons for public health

Posted: Friday, June 12, 2009

It doesn't take a severe pandemic - or even much of a disease outbreak - to overwhelm America's public health system.

That's an important lesson highlighted in a pair of new reports about this year's swine flu outbreak. New cases are still being reported, but in the northern hemisphere at least, flu season is over. Still, the flu scare and the response to it document vulnerabilities in the U.S. public health system.

Experts say the world is overdue for another major influenza pandemic. Swine flu provided a reality check on the effectiveness of years of planning in our current system.

The good news is that it performed better than it would have just a few years ago. There were national and state stockpiles of antiviral drugs, for example, and better systems for collecting case information and communicating with the public.

The bad news is that, even with stepped-up planning, preventable problems still surfaced.

When the virus first surfaced, many clinics and doctors' offices lacked masks and other protective equipment to prevent health professionals from becoming infected. From a business perspective, that's understandable. Pandemics don't happen every day; buying and storing that equipment is expensive.

But failure to stock it could have important public health consequences that would be magnified during an even more virulent pandemic.

Doctors and nurses who aren't protected would be reluctant to treat suspected flu cases. That would increase the strain on hospital emergency rooms, which probably would be overwhelmed.

Many public health agencies and laboratories proved unable to cope with swine flu. In some cases, it took more than a week to get test results back - far too long to contain a larger outbreak.

Since 2006, no federal money has been available to help state and local health agencies with the costs of pandemic preparation. Specialized workers were laid off or reassigned. That has to change. Preparing for a crisis is not something you can do after the crisis occurs.

The new reports were prepared by the Government Accountability Office and a nonpartisan group called the Trust for America's Health. Some of the vulnerabilities they describe will be difficult to resolve because they involve the way Americans pay for health care.

For example, thousands of uninsured or under-insured people who should have seen a doctor did not because of concerns about the cost. Anti-viral drugs only work when given during the first 24 to 48 hours after symptoms appear.

Another vulnerability: company sick-leave policies and a lack of child care for working families.

The Trust for America's Health report cited numerous media reports about people with flu symptoms who went to work anyway because they couldn't afford to miss time or they worried they would lose their jobs.

The group also reported on parents who sent sick kids to school because they couldn't afford to stay home with them.

During a pandemic, people who don't get care when they should or send their sick children to school spread disease. They may pay a price for that behavior, but so will the rest of us.

Measured by the standards of other infectious disease outbreaks, swine flu has had relatively little effect on the United States. Most experts believe worse pandemics await us in the future.

We can choose to invest in public health, reform the medical system and cover the uninsured. Or we can wait and hope it's not already too late.

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