The U.S. Medical Care System and the Swine Flu

May 4, 2009

Only days after U.S. officials announced that a potentially dangerous strain of the flu was infecting people in this country, hospitals all over the country were overwhelmed by people seeking diagnosis and treatment. In Galveston, Texas, for example, the local hospital almost immediately ran out of flu testing kits. At Loma Linda University Medical Center outside Los Angeles, emergency room workers had to set up a tent in the parking lot to handle the new patients. In Chicago, ER visits at the city’s biggest children’s hospital doubled, forcing administrators to open new space to accommodate the growing crowds of children and their parents.

Some high-priced hospital administrators even had the nerve to complain that many of the people seeking treatment didn’t have the flu. “It’s a major drain on resources,” one hospital vice president told the New York Times.

This evades the basic problem: if there were a bad swine flu epidemic, these hospitals couldn’t have handled it. Hospitals have been downsizing relentlessly in their drive to maximize profits and so-called surpluses. They cut the number of emergency departments and hospital beds by nearly 10% between 1996 and 2006, even as demand for emergency services skyrocketed, with even worse cuts since the economic crisis hit. Emergency rooms regularly turn away patients on so-called “normal” weekends. So imagine what would happen during a potentially deadly flu epidemic.

Hospitals have also not invested in the necessary equipment and staff to deal with a flu epidemic. For example, they did not stockpile enough extra ventilators, for those with lungs that fill up with fluids, since each ventilator costs $30,000. Nor do hospitals have the extra trained staff to care for the patients and monitor them.

Neither have hospitals built units with special ventilation systems to prevent germs from circulating to the rest of the hospital. This means that hospitals will spread the disease–especially endangering the staff.

The first line of defense against a flu epidemic is a public health system able to manage the testing and treatment of infected residents and mount vigorous public education campaigns. But corporations have opposed most public health services, seeing them as competition that cuts into their profits. Thus, public health systems hardly exist in big parts of the country. And those that do have had their funding cut repeatedly, along with the rest of state and local public services.

The economic crisis has made things worse. In 2008, local health budgets were slashed by 300 million dollars, and 7,000 health care workers were laid off. “The entire system is lining up to decrease resources at the time we need them most,” said Dr. Paul E. Jarris, executive director of the Association of State and Territorial Health Officials.

To reassure the public, the Obama administration advertised that it had stockpiled millions of doses of anti-viral drugs, like Tamiflu, to treat people who come down with the flu. The problem is that in order for these drugs to be effective, they have to be administered in the early stages of the disease. But with more than 50 million people in this country without any medical coverage, and tens of millions more with inadequate coverage, they most likely won’t go to the doctor until it is too late.

Neither does the U.S. have an adequate system to produce vaccines to prevent people from getting the flu. The pharmaceutical industry has not invested in new technologies that use faster, more reliable methods of producing vaccines. Instead, they still produce vaccines from hens’ eggs, a technology that goes back more than half a century. At the earliest, a new vaccine for the swine flu could not begin to reach the public for another six months–that is, way too late for a lot of people if the disease becomes serious.

Currently officials claim that the strain of swine flu does not pose as big a medical risk as first feared. But even if that is true, on average 36,000 people die in the U.S. from the flu every year. So even a small uptick in flu deaths could very well mean tens of thousands more people will die–simply because in every way, medical care for profit gets in the way of what medical science could really do.