11 September 2011


I just got back from watching "Contagion", Stephen Sondheim's hyper-realistic and emotionless portrayal of a fictional pandemic. I wasn't wild enough about the film to recommend it, but it brings up many points that merit further discussion. One of these is the film's portrayal of badly-overcrowded hospitals.

A pandemic's overwhelming demand on the medical system is a very real concern. Doctors are rather busy people even during periods of ordinary demand on the medical system. Medical residents work close to 80 hours a week, and hospitals try to keep their patient load as close to full-capacity as possible (they aren't so different from businesses, after all). Pandemics can quickly use up medical supplies, sparking shortages of body bags, ventilators, and antivirals. They tax medical systems designed to be running as close to capacity as possible.

Worse still, front-line medical workers are some of the likeliest to catch pandemic disease, because of their exposure to ill patients. Some medical workers will not want to come into work, for fear of catching the disease or spreading it to their families.

How to respond to these sudden demands? During the 1918 influenza pandemic, student nurses, medical students, retired medical personnel, and the barely-trained or untrained endeavored to fill the gaps in the medical system. We potentially could expand the scope of care to allow podiatrists, veterinarians, and nurses to treat patients without supervision during crises.

A more systemic fix is to incorporate more redundancy into the medical system and expand its capacity. Residents would work fewer hours, hospitals would have extra beds and operating rooms, equipment would be stockpiled. Although this would require extra cost, the trade-off is that it might pay off tremendously when we need it most.