by Mario Rizzo
Recently the Obama Administration declared the H1N1 pandemic a “state of emergency.” While there is a largely technical meaning to this, some people have understandably gotten nervous. All this adds to the extraordinary public concern about a flu that, so far, as proven milder than the seasonal flu – albeit with a different profile of people getting ill.
The problem is and is going to be the stress on emergency room facilities with people who are alarmed but not really in need of ER services. There will be a cost to the swine flu precautionary activities. By increasing the waiting time and confusion in ERs some people with life-threatening problems will die who otherwise would not have.
While I am not aware of any systematic analyses of this problem, the following data is cause for concern.
“For someone in a life-threatening situation, the recommended wait time before receiving medical attention in an ER is less than one minute; in 2006, 1 in 1.35 (74%) of those patients waited longer, sometimes far longer. The average wait was 28 minutes. At the next level of urgency, patients needing emergent care, the recommended time is 1 to 14 minutes, and 1 in 1.98(51%) waited longer. The average wait for these patients was 37 minutes, up from 23 minutes just three years before.
The consequences of this slowdown can be deadly. A 2009 study showed that patients arriving at the ER with chest pain are significantly more likely to suffer cardiac arrests and heart attacks when the emergency room is crowded. And the prospect of flu victims flocking to already stretched ERs this flu season has many physicians and public health officials across the country concerned. ‘Our emergency healthcare system suffers from severe crowding on a daily basis,’ says Dr. Kristi Koenig, director of public health preparedness for UC Irvine Healthcare. Handling an additional onslaught of flu victims would be ‘very challenging.’”
Compare this with the very small swine-flu mortality rate in the US of 0.75%. (This is the best estimate I have been able to find.) It is true that this is the overall rate and one might expect that those cases which go to the ER would be worse than the average. However, the greater the public panic the more the ER rate will approach the average rate. And, just as important, not all the ER cases will be swine flu – some will be simple colds.
The data we really want is a comparison between the mortality rate of those in the ER with swine flu (or imagined swine flu) and the increase in mortality (from say cardiac problems) due to greater waiting time induced by the ER overload. As far as I know (inform me if I am wrong!), we do not have this data.
Nevertheless, there is a significant likelihood, it seems to me, that the swine flu panic induced by the government will cost more lives on balance than are saved. It will be very informative to come up with some answers once the data is in.
(Of course, I understand the difference between ex ante and ex post and that there was (is?) a risk that the H1N1 pandemic could have been more lethal. Yet what was the evidence that this was likely? More importantly, who is looking at the bigger picture given the obvious constraints on medical services? To what extent is the government more worried about the costs easily seen rather than those that are unseen?)