Who's the most important in a flu pandemic?

Posted at 3:32 PM on January 29, 2009 by Bob Collins (8 Comments)
Filed under: Health

Around 10 a.m. on Friday, you can go online and see the draft framework the Minnesota Department of Public Health is going to use to determine who gets "critical health care resources" in the event of a flu pandemic. It's more a matter of when, not if, a pandemic hits us, the Minnesota Department of Health says.

When it does, up to 30,000 Minnesotans may die.

Who should get first crack at life-saving vaccines, drugs, or equipment such as antiviral masks? That's what the guidelines will reveal. For example, health care workers would seem to be first in line for vaccine, but there won't be enough vaccine, so which health care workers should get it first?

One of the things the federal government has advised states is to be prepared for strong suspicions and distrust. Guidelines also said "social worth" should be considered.

In ordinary circumstances, the distribution criterion, 'to each according to his or her social worth,' is not morally acceptable. However, in planning for a pandemic where the primary objective is to preserve the function of society, it is necessary to identify certain individuals and groups of persons as 'key' to the preservation of society and to accord to them a high priority for the distribution of certain goods such as vaccines and antiviral drugs. Identification of key individuals for this purpose must be recognized for what it is: it is a social worth criterion and its use is justified in these limited circumstances. Care must be taken to avoid extension of the evaluation of social worth to other attributes that are not morally relevant.

Here's the Web site that will be active at 10 a.m. You'll be able to comment on the draft framework.

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Comments (8)

This is just a start of rationing health care. As baby boomers age you will begin to see more discussions about who gets treated and who does not as they age. Today we keep most people alive even if their quality of life is poor.

With a large senior population we will not be able to keep everyone alive. These guidlines will tell us who was important to those who set the guidlines.

Posted by bigalmn | January 29, 2009 4:18 PM

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I'll be the contrarian. If we're only talking about losing 30,000 Minnesotans, I don't know that a strict evaluation of who 'deserves' the vaccine is very relevant. If we're only talking about the health care professionals who will be caring for the ill, prioritize based on age and energy levels. Innoculate the health care workers who have the energy & ability to work long hours during a crisis. They're also most likely to offer maximum 'return on investment' over their future careers. For the rest of us, 30,000 of 5 million is a huge hit, to be sure, but statistically about a 3 in 500 chance of expiration. I like those odds.

Posted by bsimon | January 29, 2009 4:55 PM

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True, but the 30,000 is only the people who die. It's not the total number of people who will get the flu.

So I guess the question is one of selecting who are the people who shouldn't GET the flu at all?

Posted by Bob Collins | January 29, 2009 5:00 PM

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Yeah, I'm curious how 30,000 dead translates into overall mortality rate for a disease like the flu. Certainly a chunk of the population will never contract the disease in the first place. If half of the population contracted the disease and we had 30,000 deaths, the mortality rate would be about 1.2%. I don't think we really need to start panicking about the "preservation of society" until we're talking at least a 10-15% mortality rate.

They seem to be talking about "preservation of business as usual." It's true that there's a point in preventing people from simply getting extremely sick for long periods, though.

Anyway, I'd mostly worry about people who either travel a lot or interact with lots of people -- cops, restaurant workers, retailers, even people who man the front desk at the post office or other government agencies.

Posted by mulad | January 29, 2009 5:32 PM

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//cops, restaurant workers, retailers, even people who man the front desk at the post office or other government agencies.

Bloggers. Of course.

Posted by Bob Collins | January 29, 2009 6:13 PM

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Ahhh, don't worry. First of all, this vaccine their talking about, any vaccine they have on hand may not provide that much protection in the first place so whether you get it or not may not may not make of a difference. I wouldn't take that 30,000 figure too seriously either, that's a guess of a speculation based on a guess. No one really knows. First responders and health care workers, certain government workers who are needed to keep the infrastructure going, are first on the list.

But really, the most important thing if or when this happens (and it may not happen in our lifetime) is going to be the basic nuts and bolts, early detection, and isolation. You know we already have had outbreaks of asian bird flu in Canada and elsewhere, and it's been contained. I'm not saying we shouldn't have a plan or take this seriously, but there's been a lot of money riding a lot of hype for the last few years.

Posted by Paul | January 29, 2009 8:18 PM

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>> that's a guess of a speculation based on a guess

all models are wrong; some are useful.

risk assessment is based upon best guesses. Often these are useful. Don't take scientific "guesses" to be the same as "totally ignorant wild guess in the dark". see:
http://www.cdc.gov/ncidod/eid/vol12no01/05-1013.htm - Journal of Emerging Infectious Diseases, covering the "art" or risk assessment.

The problem is extrapolating from deaths to society functioning, which cannot be found from 1918 data. In 1918, more of the country was still living in a rural environment. Almost uniformly, families were single-earning Dad-has-the-job. Neither of which is true today.

your kid gets the flu - who stays home to take care of her, since day care won't take her? My family discovered this last year.

> My younger son got the flu; yes, Influenza, not just 'sick'. I stayed home with him. What happened? I got the flu. At this point, I would have been pretty incapable of taking care of anyone else in the family getting sick.

What's the family's choice, if both parents work full time?

I'm a grad student. Our choice was that I stay home: me missing classes was preferable than my income-earning husband missing work. I missed 10 days of classes, wrecking complete havoc with my studies. It was a fine line whether I could finish my courses, which would have meant staying in school for an extra year, which would have been a stupendous financial burden on us.

We all know how many people go to work, despite being sick. This will be particularly noticeable the lower the pay is, since they can least afford to miss work. It's not just one person missing work, it's the waves expanding past that.

We ought not see this as some hypothetical public health menace.

Posted by Elizabeth T | January 30, 2009 3:46 PM

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I am 66 years old and retired.

When a pandemic is actually deteremined to be in progress, I believe there should a recruitment of older retirees to work as treatment care-takers first. Should we become infected, we should not be treated until/unless children and their parents are first treated.

I'm not sure what we could do or how we could help, that would be the health providers' job to coordinate us.

I'm sure this sounds weird but considering world population and who's necessary for subsequent societies, this is what I believe.

Posted by PD Lefebvre | February 2, 2009 4:44 PM

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