Virulent outbreak of not ‘if, but when’ warnings.

By Lawrence Solomon

First published by the Financial Post on May 14, 2005

The great pandemic—the one that harkens back to the Great Spanish Flu Pandemic of 1918-19 when 25 million to 50 million died worldwide—has begun. Like many pandemics, it begins slowly, its origins isolated and obscure. Then it explodes, replicating its deadly strain and claiming victims in the millions. Simply put, if it isn’t stopped quickly, it takes on a life of its own.

“The next influenza pandemic: Not ‘if’ but ‘when'” was the title of a Centers for Disease Control and Prevention (CDC) satellite broadcast a mere five years ago this month, warning of a vaccine shortage and disruption of social and community services. “The question is not ‘if,’ but ‘when’ we are going to have another pandemic in the foreseeable future,” Professor Albert Osterhaus, director of the Dutch Influenza Center said the following year, in co-chairing a EU health conference in Brussels. “It’s not ‘if’ but ‘when'” said the U.K.’s Pat Troop of the Health Protection Agency in one of many outbreaks of the warning spreading around the globe. “Not ‘if,’ but ‘when,'” said Professor Barry Schoub, the director of South Africa’s National Institute for Communicable Diseases, in an outbreak on the Dark Continent. “Not ‘it’ but ‘when,'” repeated authorities in Thailand, in Hong Kong, in Vietnam. “Not ‘if’ but ‘when,'” said Germany, France and Italy. “Not ‘if’ but ‘when,'” came news from a World Health Organization conference last year.

“This is a question of not ‘if’ but ‘when’ this will happen,” said Dr. Karen Grimsrud, last month, in demonstrating that an especially virulent form of the pandemic had spread to Canada. Grimsrud, deputy provincial health officer for Alberta and Wellness and a member of the Alberta Influenza Pandemic Working Group, is at the forefront of a desperate battle fought by provincial and national authorities who recognize that flu pandemic “could, at worst, see our society grind to a halt.” The scale of the virulence can be seen in the issues that the gathering of health care workers and planners grappled with in Edmonton. Asked Martin Meltzer, a senior health economist with the U.S. Centers for Disease Control Office of Surveillance: Who would keep our streets safe if our police officers were sick or dying? Who would extinguish a house fire if our firefighters were ill? Indeed, who would care for the sick themselves if our caregivers were incapacitated?

Meltzer’s mathematical models—he’s talking here of a moderate scenario that sees only 35% of the American population infected—estimate up to 300,000 deaths and one million hospitalizations with an economic impact of up to $70-billion. “You need to ask yourselves how many people are likely to get ill?,” Meltzer told the meeting. “How many people will need or want to see a doctor? How many people will need to go to a hospital? How many people are likely to die?” Also, “What is your morgue capacity?” “Can you get a refrigerator truck? Who do you call to get one? How many trucks can they give you? These are tough questions.”

How tough? We’ll need to throw granny overboard, he says, because the government can’t protect us all. Protecting our seniors in a mere flu epidemic is one thing: protecting them in a pandemic is another. “I’m going to want to allocate my scarce resource (the life-saving vaccine) according to economic principles,” Meltzer said. “And you’ll notice that in this scenario grandma and grandpa go right to the bottom of the list…. It’s a difficult thing to put in front of politicians and policy-makers.”

Dr. Theresa Tam, the chief of viral respiratory diseases with Health Canada’s Centre for Infectious Disease Prevention and Control, puts out scenarios every bit as grim as Meltzer’s—Canada could expect up to five million outpatient visits, nearly 140,000 hospitalizations, some 58,000 deaths, and an economic impact of up to $24-billion, she reported, citing a high-toll scenario. We are seeing here a mutation of the pandemic: Meltzer’s model has struck Dr. Tam; it has become the basis of Canadian projections, and the Canadian plan. “How to deal with all the extra corpses is in the plan as well,” Dr. Tam said, in affirming that “Your health care workers are your front line, and that is the rationale in caring for health care workers and paramedics first.”

Alberta predicts 600,000 outpatient hospital visits, 13,000 hospitalizations, and up to 26,000 deaths. “And that’s a mid-range pandemic, not worst-case scenario,” said Grimsrud.

The worst-case? No one really knows but the latest site to be hit, Toronto just this week, shows the pandemic of pandemic warnings in full force. Or possibly this is a new mutant, whose DNA government scientists have yet to unravel.

According to Dr. Barbara Yaffe, the associate medical officer of health at Toronto Public Health, 914,000 Torontonians could be hit, up to 12,000 of them requiring hospitalization and 5,000 requiring morgue space. “This is not of ‘if’, it’s a question of ‘when’,” Dr. Yaffe announced.

Lawrence Solomon is a columnist, author, and executive director of the Toronto-based Consumer Policy Institute. @LSolomonTweets LawrenceSolomon@nextcity.com