My "day job" is in the accounting department of a vacation rental company, wholly owned by a publicly traded holding company, as such accounting standards tend to be rigorous so I have some concept of "corporate accounting"—to say nothing of some level of interest.
Today's news item of interest (my thanks to: DeepImpact2005 @ FluWiki) hit two areas of interest: Influenza Pandemic and Bean Counting.
By Michael Smith , North American Correspondent, MedPage Today
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine.
BALTIMORE, Dec. 4 -- A flu pandemic like the one in 1918 could cost U.S. hospitals $3.9 billion, but a human-to-human outbreak of the H5N1 avian influenza strain could dwarf that estimate.
This opening line is of major importance, at least in my estimation. I ask that you indulge me as I give a little background on why the above sentence is noteworthy and paradigm challenging.
Planning assumptions for a severe pandemic rarely account for anything worse than 1918. In fact, today is day two of a web dialogue on the US vaccine prioritization preliminary guidance, and the "PanFlu aware" who are participating are continually running up against the facilitators inability (or refusal) to step outside of the possibility that the next PanFlu could be worse, or even significantly worse, than the 1918 pandemic.
This steadfastness is in the face of WHO findings, multiple scientific papers, notable experts, and just plain common sense given available facts.
The sentence also makes the distinction of a human transmissible avian influenza. That distinction is not well understood, even after all the coverage of H5N1 and pandemic influenza. Influenza A comes in two varieties: human and avian. People only get avian influenza rarely because of (partly or mainly) its "binding affinity", the cells it will bind to and enter for viral replication. Although scientists do not yet know the entire puzzle of what makes an avian influenza adapted to humans, the binding affinity is a big piece of the "why".
However, it is an avian influenza virus adapted to human infection and transmission that is the most deadly to humans of the influenza viruses. The genetic makeup is still entirely of avian origin but the virus undergoes changes at the nucleotide or the amino acid level that give it human infection, replication, and transmission capabilities. As I noted above, we still don't know exactly what those changes are or even on which gene or genes they have to occur to confer this ability, but the puzzle is slowly being unraveled. Hopefully, we will find out in time as it is that bit of knowledge that gives us the greatest potential of having meaningful advanced warning.
The article continues:
The lost revenue to hospitals from a 1918-style pandemic would come from deferred elective cases and uncompensated care for flu victims, found Eric Toner, M.D., and colleagues at the Center for Biosecurity of the University of Pittsburgh, in Baltimore.
The average community hospital would lose $353,985 by deferring cases over an eight-week pandemic period, Dr. Toner and colleagues reported in the quarterly Journal of Health Care Finance.
At the same time, the effects of the pandemic would mean uncompensated costs of $430,607 per hospital to treat the influx of flu patients, the researchers said.
Across all U.S. hospitals, that adds up to $3.9 billion -- a sum that could create severe financial strains in the health care system, the researchers said.
"Some hospitals may not have sufficient cash on hand to cover these losses," they said.
For a macro-level analysis I recommend HealthyAmericans White Paper: Pandemic Flu and the Potential for Economic Recession: a state-by-state analysis (pdf here). In it you will find their assessment that an increase in healthcare spending will go a long way in offsetting down turns in the other major sectors of a state's economy. I remember my reaction when the paper hit the internet—unbelief is a bit of an understatement.
Government planning assumptions also suggest that if a pandemic were on the 1918 scale, hospitals would find it difficult to treat all the patients who required care.
For example, Dr. Toner and colleagues said, the average community hospital has 20 ventilators available and -- by deferring cases -- could have 81 free beds.
But at the height of a 1918-style pandemic, 42 patients would need ventilators and 290 would need beds, they said.
All this is based on extrapolations of planning assumptions from the Department of Health and Human Services, which were predicated on the 24% mortality rate from infections in the 1918 flu.
If the pathogen involved is a humanized version of the H5N1 avian flu strain, "the severity and duration of a pandemic could be greater than [the government] assumes," the researchers said.
The health and human services department is assuming inpatient mortality would be about 24% in a 1918-type pandemic, they said, but when the H5N1 virus has infected humans it has killed more than half of its victims.
As of Dec. 4, the World Health Organization says there have been 336 confirmed cases of H5N1 influenza in humans, of which 207 have been fatal.
"A 1918-like pandemic is far from the worst case possible," Dr. Toner said in an accompanying audio interview on the journal's website. (Click here to go to the website to hear the entire audio)
"A pandemic with [the H5N1] virus could certainly be worse than that, worse than 1918," he said.
Again, it is important to note the distinction Dr. Toner is making. A human adapted H5N1 avian influenza is a "different beast" than the 1918 pandemic strain, which, via genetic reconstruction, was determined to have been wholly avian on a genetic level as well. We don't understand why H5N1 has such a frightful mortality rate, but just because we don't understand it doesn't make it not so.
Among other things, the numbers of sick would swamp available capacity. At the height of such a pandemic, an estimated 60 million people could be sick, 30 million could need intensive care, and six million could need ventilators.
Currently, Dr. Toner said, there are 105,000 ventilators in the entire U.S. and about 87,000 intensive care beds. "The numbers are truly frightening and far exceed our ability to care for those numbers of patients," he said.
Even though this article addresses the financial burdens a pandemic will place upon most hospitals the supporting underpinnings are some of the best I have seen outside of dense scientific papers. Admitting it's crass and insensitive to lean on financial concerns to support PanFlu concerns in general when I refer to what will be human lives and miseries, it's as the saying goes—money talks.
The question is—is anyone listening?