LibertySteward
Grassroots Paradigm Emerges From New Mexico Medical Symposium for Disaster Medicine and BioTerrorism
posted Oct 30, 2005
HUGE REFUGEE PROBLEM IN COLOMBIA AND ECUADOR. GENOCIDAL CONFLICT SPILLS OVER THE BORDER
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The model for pandemic response is shifting in New Mexico.
The University of New Mexico Health Sciences Center School of Medicine held a symposium on Oct 29th at the Albuquerque Hilton Hotel in conjunction with the New Mexico Flu Consortium, the Public Health Department and the Office of Continuing Medical Education for health care professionals.
In attendance were Mack Sewell, State Epidemiologist, David Shay from the CDC, and Michael Richards Director of UNM Center for Disaster Medicine who guided the Opening Plenary.
Breakout sessions followed guided by Deborah C Hall, MD who covered ETHICAL CONSIDERATIONS.
Maggie Gallaher MD, Gary Overturf, MD and Chad Smelser MD discussed VACCINE PRIORITIZATION.
INFECTION CONTROL was led by Bernadette Albanese, MD, Cynthia Johnson, BS, and Marilyn Garin, RN.
The noon hour was punctuated with some Pandemonium chicken, Institutional Beef and assorted hotel food, but the real encouraging and reassuring highpoint was the lunchtime lecturer Margot White JD who delivered a strong appeal for attention to civil and human rights and care for the poor, homeless, disabled and indigenous populations least able to address their own needs and care. She noted the food conglomerates culpability in contributing to the problem by housing pigs and chickens in huge agro complexes in Southeast Asia, which is how these mutational steps first began. She emphasized that New Mexico would do well to assure its immigrant undocumented population that they have a civil right to equal treatment and would not be unfairly treated or deported if they sought help from the health care system.
The afternoon breakout sessions dealt with RISK COMMUNICATION led by Karen Armitage, M.D., DOH.
ANTIVIRAL PRIORITIZATION was facilitated by Gary Overturf M.D., UNM and David Shay M.D. CDC.
SURVEILLANCE was directed by John Baumbach MD, MPH, MS, DOH and Mack Sewell DrPH, MS Division Director DOH.
And last but not least, PSYCHOSOCIAL CONSEQUENCES by Anne Pascarelli Barraza - Special Populations at DOH and Jack Pischner Med, LPCC, DOH.
The medical community it seems is learning to recognize it’s limits when faced with a global pandemic scenario from bio-warfare or a virus such as a fast moving influenza that people have no immunity to. The original model dictated an over-arching Federal response, whereas the new formula indicates a rebirth of interest in neighborhood empowerment over front line response to disaster or disease. At least it was evident that many in the audience felt this way whether or not they will be allowed by the federal directives and steering committees to enact such a system remains to be seen. It is difficult for them to stand up and say what they really want as many of the directors of the symposium, who themselves seem imbedded with the Federal perspective, are also their peer reviewers when it comes to maintaining their license to practice.
When there is a shortage of a vaccine and prioritization of treatment is paramount many will have to turn to prevention, self regulated regimes of hygiene maintenance and community based support systems for everything from food, medicine, livestock and pets, to triage, maintaining local clinics, pharmacy and clerical staff. While the entire medical establishment is overloaded with chaotic activity and huge patient loads the people in their locale are going to have to do everything they can for themselves. Strengthening the quality of response to the poor and homeless populations will be important and getting everyone the care they need will need will require places where they can go for treatment.
There was a refreshing respect for civil rights that was contagious especially evident in the breakout sessions apart from formal facilitators, because the focus shifted to getting input from frontline health care workers who will find themselves in the midst of this chaotic event trapped between Federal imperatives and angry and desperate patients. There was a noticeable twitter of laughter from the audience when they heard that important government officials considered themselves high on the vaccine priority list for those that would get the limited vaccine first It seemed to underscore the gulf between federal government imperatives and private opinions on their differences. With only a few million doses on hand and 90 million necessary at a minimum the window of time and opportunity to develop and distribute a vaccine is closing.
Viruses become resistant to certain medicines and often vaccines become ineffective against new mutations of the virus. There will be a lag time between when a mutational strain is identified and when a vaccine tailored to tackle it is rolled out for distribution and even then enough medication will simply not be available to inoculate everyone. Furthermore citizens and governments are already hoarding Tamilflu even though the virus has already been demonstrated to have developed a resistance to it and even though no one knows if it will even be effective against a human to human transmittable virus. All this for a virus that still has to accomplish 5 out of 10 recombinant mutational sequences to become fully transmittable as a human to human threat.
What all this means is that the system is going to be plainly overtaxed. There will be a large population of worried well citizens who will think they are sick, or presenting symptoms they imagine are worse than they are. This in turn means that the Department of Health will have to evolve guidelines on how to recognize symptoms, when to actually seek medical help and where to go within the new intake model. Isolating the sick from the well will be a priority. Educating the common citizen at the local level to these new procedures in the model will be the overriding priority hopefully before the event is upon us.
Quarantine was deemed best if voluntary in the opinions of many in attendance who thought it should be arrived at through citizen participation and trust in a reasonable explained response model yet to be fully developed and disseminated. However Quarantine and Isolation can be forced as provided for in the new body of Outbreak Law and police powers can be used to enforce it. It should be clarified on Tuesday, when President Bush issues his new plan to the media whether this will involve violations of Posse Comitatus and use of the military to enforce imperatives on the domestic citizenry. Quarantine will constitute an unrealistic and untenable constraint on many indigent people with few recourses such as the ability to stockpile food and medical supplies in the home prior to the event. Indigenous health care workers were specifically concerned about their largely rural poor populations. There was also concern for the pet and livestock populations owners may have to maintain and others may have to provide for if the owners get sick or die. According to the main symposium directors mortality statistics are modeled on a 30 percent fatality rate, i.e. 3 out of 10 people could die from this level of pandemic.
Some aspect of intake dynamics were discussed as hospitals will utilize new triage procedures and outpatient treatment facilities and locations to isolate the real sick from the worried well or those suffering other types of ailments. Local communities will have satellite outpatient units with limited technology and equipment that will assess who is really sick and needs to be transported to where. Alternate forms of transportation other than ambulances will be necessary due to the shortage under such circumstances of those kinds of vehicles. Volunteers will be needed at all levels when critical personnel get sick and can’t fill their posts. There will be those who are unwilling to expose their family and choose to stay home from work. Some health care workers may elect to refuse the vaccine and subsequently will not be able to work as a front line health care worker who could inadvertently spread the disease to their own patients. Mortuaries will be overloaded and local means may become and issue for communities.
In this impossible situation there is a strong probability local people will blame authorities for insufficient response or after the pandemic in court. Responding to a medical pandemic is a nearly impossible event anyway without having to shoulder the immense blame for everything in hindsight. And health care workers will be plainly stressed by everyone else’s stress. Many felt that a top down approach to disaster management just doesn’t reassure people and can’t be in harmony with local needs and realities. Katrina was mentioned as part of the learning curve that pointed out weaknesses in the system. People in their neighborhoods need to be involved at all levels of response so the system cannot break down.
The Department of Health will be assessing the input of the professional community from the symposium and upgrading their overall plan within the next couple of months.
