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Flu stresses hospitals, shows we're not ready for emergencies

by Maggie Fox /  / Updated 
St. Charles Bend emergency department staff tend to patients in a converted waiting area at the hospital in Bend, Oregon, on Jan. 9. The waiting area has been used to treat and triage patients to handle the increasing number of patients, most of them suffering from the flu.
St. Charles Bend emergency department staff tend to patients in a converted waiting area at the hospital in Bend, Oregon, on Jan. 9. The waiting area has been used to treat and triage patients to handle the increasing number of patients, most of them suffering from the flu.Joe Kline / The Bulletin via AP

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Alabama has a flu emergency. Schools have closed in San Antonio and Cleveland and Oklahoma.

Think hospitals are under a strain now, from a slightly bad flu season? Wait until a really bad one hits.

Experts agree the U.S. is not ready for a bad epidemic, or even for some other disaster that would affect hospital supplies. And funding cuts mean even a little strain has a bigger impact than in years past.

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This year’s flu season is moderately severe, but not anywhere close to being one for the record books. So far, it’s not as bad as the 2014-2015 flu season, the Centers for Disease Control and Prevention says.

Yet a few hospitals have been forced to set up triage tents in parking lots; ambulances are being diverted from busy emergency rooms to quieter centers and emergency department staff across the country are working double shifts.

“Some states even had states of emergency called,” the CDC’s Dr. Daniel Jernigan told reporters last week.

Mike Osterholm says it’s a sign of decades of neglect.

Related: The biothreat is real and we're not ready

"Each year, the healthcare system gets a thinner and thinner veneer of preparedness,” said Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

“It takes less and less impact for a healthcare system to go from routine to crisis.”

It’s not all just influenza, of course. Winter is the peak season for many different viruses, from respiratory syncytial virus (RSV) to norovirus or “stomach flu”. Add in the regular outbreaks of foodborne disease, bacterial pneumonia and strep throat and that’s a formula for busy ERs everywhere.

It’s predictable, year in and year out.

“Flu seasons every year are bad,” Jernigan said.

Yet, every year, school systems and hospitals get caught short. There are spot shortages of drugs that fight flu such as Tamiflu and for the past three years, there’s been a shortage of certain preparations of saline solution — a hospital staple.

This year, the saline shortage has been made even worse by Hurricane Maria’s devastation in Puerto Rico, the U.S. territory where 40 percent of the saline supply is made.

Related: Swine flu hit the Americas hard

“We’re deeply concerned by this situation,” Food and Drug Administration Commissioner Dr. Scott Gottlieb said Tuesday.

“This is a serious situation and right now we are at the limits of our conserve and adaptation strategy,” said Dr. Paul Biddinger, director of the Center for Disaster Medicine and vice chairman for emergency preparedness at Massachusetts General Hospital in Boston.

The hospital is considering putting off non-urgent surgery until things get better.

“From a policy standpoint, we need to look back on this event and see what we can do to strengthen our national supply lines for IV fluids," Biddinger said.

“It takes less and less impact for a healthcare system to go from routine to crisis.”

“It takes less and less impact for a healthcare system to go from routine to crisis.”

It’s also an I-told-you-so moment for Osterholm, who pointed out for years how vulnerable Puerto Rico is to hurricanes and how it might be good policy to encourage companies to spread their manufacturing out over a broader area of the country.

Many reports have pointed out these weaknesses in the U.S. emergency infrastructure, yet year after year budgets are slashed, public health workers are laid off, and recommendations for increased preparedness funding are ignored by Congress.

Congress has steadily cut public health budgets for more than 15 years.

And now it’s starting to show, Osterholm said.

“If what is happening today had happened 15 to 20 years ago, it would not be much of a blip in terms of interruption, but today it is,” he said.

Osterholm is among a batch of experts who have been warning for nearly two decades about the threat of new pandemics, biological attacks and other emergencies.

The Blue Ribbon Study Panel on Biodefense, a bipartisan group with a range of expertise, has issued several reports saying the U.S. is extremely vulnerable to a biological attack — either from people or from nature.

Infectious disease experts have been urging the U.S. government to do more to keep the country prepared for outbreaks of diseases such as a new strain of flu, Ebola and severe acute respiratory syndrome, or SARS.

Defense experts point out that other countries have prepared biological weapons such as smallpox and anthrax.

Influenza specialists say repeatedly that the chance of a new flu pandemic is 100 percent. Flu mutates constantly, and a major new strain emerges about every 20 years. The last one was H1N1 "swine" flu in 2009, which was fairly mild, but worse epidemics are probable.

Related: New GOP bill would cut preparedness fund

No country can be ready without having stockpiles of drugs, vaccines and equipment, plans for deploying them and someone with the authority to make fast decisions.

Yet the Health and Human Services Department has taken down flu.gov, which reflected a Cabinet-level organization dedicated to helping Americans prepare for flu. The URL now redirects to the CDC’s flu webpage.

Congress struggles to even pass a budget and the federal government is again at risk of a forced shutdown later this week.

There’s no planned increase in funding for agencies to prepare for an infectious disease emergency, despite many recommendations from experts in fields from medicine to security to politics.

Last year's budget provides just $57 million for influenza pandemic planning.

“I think it is in part a sense that until it’s a downright crisis, everybody assumes everything is OK,” Osterholm said.

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