Monday, July 20, 2009

Getting it Right the Second Time

The New York Times is reporting today about efforts in New York City to better manage another outbreak of H1N1 "swine" flu. Not surprisingly, ER's were pretty flooded by the "worried well" in April and May, so they are trying to beef up their triage system outside of the hospitals. They are also instituting new communications plans.

This is all welcome news to me and my readers. I have posted twice about the need for better communication and attention to the panic side of the pandemic (see Flu Preparedness: Body AND Mind and The 2009 Flu Pandemic). It looks like New York is thinking in the right directions, and that's all good.

What is surprising, however, is the numbers being cited. Conventional wisdom, based on biological terror attacks such as the Aum Shinrikyo sarin gas attack in the Tokyo Subway System, holds that anywhere from 80-95% (with 80% being the most commonly cited number) of people seeking medical attention in a public health emergency are either the "worried well" or at best do not need to be hospitalized. However, based on the Times' numbers, on the worst days of the outbreak in May, 40-50 people were hospitalized while an average of more than 1,400 people were seen in the Emergency Room for "flu like symptoms." That means that the "worried well" and the not very sick accounted for about 96.5% of those going to the ER.

For those of us who have prepped for disaster with the so-called "80-20 rule" (80% of people will be worried well, while 20% will be actually ill), this is a sobering statistic. What it means is that we have vastly underprepared for people's level of panic about this disease, and the triage plans that even the most prepared jurisdictions have might not be enough.

Unless, of course, we get better at communicating and more directive about who should do what. Telling people that the symptoms include "fever," for example, is not going to be enough. Public Health authorities are going to need to say,
If you do not have a fever higher than X [and I leave it to them to determine what X is] you do not have the flu. Do not come to the triage center.
Note how I phrased this. It will not be enough to say not to come to the triage center. They need to say why. Doing so will increase credibility and make people listen more. It won't be perfect, but it might tamp things down to that 80-20 ratio. Because if it's going to be 96-4 and we have a major outbreak, our health system is in deep trouble.


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Naomi Zikmund-Fisher
is a clinical social worker, former school Principal and a Crisis Consultant for schools and community organizations. You can learn more about her at
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