Se­vere flu ex­poses se­ri­ous flaws

The Standard Journal - - LOCAL & NATIONAL - By Morten Wen­delbo Texas A&M Uni­ver­sity

Flu sea­son in the U.S. typ­i­cally peaks in Fe­bru­ary, but this year’s out­break is al­ready one of the worst on record. As of Jan. 6, 20 chil­dren have died from the flu, and over­all mor­tal­ity caused by the flu is al­ready dou­ble that of last year’s.

One rea­son the flu is so se­vere this sea­son is that the dom­i­nant strain is H3N2, which has an im­pres­sive abil­ity to mu­tate and is par­tic­u­larly ag­gres­sive against Amer­i­cans over 50.

Mak­ing the threat worse is the fact that most of the IV saline bags used in com­mon med­i­cal treat­ments and pro­ce­dures — in­clud­ing se­vere cases of the flu — are made in Puerto Rico, which is still reel­ing from Hur­ri­cane Maria. Hos­pi­tals in some ar­eas around the coun­try that are op­er­at­ing at or above ca­pac­ity be­cause of the flu are quickly run­ning low on saline, re­sort­ing to time-con­sum­ing and po­ten­tially dan­ger­ous treat­ments of pa­tients.

The IV saline short­age is un­likely to cause a life-threat­en­ing break­down of med­i­cal treat­ments. But the short­age does ex­pose a dan­ger­ous flaw in the med­i­cal sup­ply chains that ev­ery­one re­lies on to counter dis­ease out­breaks or bioter­ror­ism. Many dif­fer­ent types of im­por­tant med­i­cal equip­ment and medicines ei­ther come from abroad or rely on a sin­gle pro­ducer.

Glob­al­iza­tion has changed the way we pro­duce, transport and store al­most any­thing, in­clud­ing medicines and med­i­cal sup­plies. Now that it’s in­ex­pen­sive to transport goods, many can be eas­ily pro­duced abroad at sub­stan­tially lower costs. In nearly all cases, that ben­e­fits pro­duc­ers and con­sumers alike.

For the med­i­cal in­dus­try, ap­prox­i­mately 80 per­cent of all pharmaceuticals used by Amer­i­cans are pro­duced over­seas. The ma­jor­ity of this pro­duc­tion takes place in China and India.

Forty-three per­cent of saline in the U.S. comes from Puerto Rico. The U.S. was al­ready run­ning be­low op­ti­mal lev­els of saline when Hur­ri­cane Maria hit. Rapid trans­porta­tion of goods also al­lows most in­dus­tries to rely on “just in time” de­liv­er­ies. That means goods ar­rive only shortly be­fore they are needed, rather than ar­riv­ing in large ship­ments.

In most si­t­u­a­tions, and for most goods, that causes few is­sues. How­ever, when there’s an in­suf­fi­cient stock­pile, de­liv­ery de­lays can be life-threat­en­ing. Many of our hos­pi­tals re­ceive ship­ments of crit­i­cal pharmaceuticals three times a day.

As re­searchers study­ing how coun­tries can pre­pare for dis­ease and dis­as­ters, it’s clear to us that the IV saline short­age is just the tip of a gi­gan­tic ice­berg.

There are two ways the “just in time” sys­tem can be dis­rupted: an un­ex­pected surge in de­mand or a de­lay in de­liv­ery. In this case, both oc­curred si­mul­ta­ne­ously. The U.S. is deal­ing with an un­usu­ally po­tent strain of the flu, while Hur­ri­cane Maria brought pro­duc­tion in Puerto Rico to a grind­ing halt. If only one of the two had oc­curred, it’s un­likely the U.S. would have ex­pe­ri­enced a short­age.

Now, hos­pi­tals over­run with flu pa­tients have to turn to al­ter­na­tives to IV saline. One is an IV push pro­ce­dure, in which med­i­ca­tions are man­u­ally “pushed” into the IV line. This can be deadly if not done cor­rectly.

In the case of IV saline, the si­mul­ta­ne­ous oc­cur­rence of both de­mand and de­lay was ac­ci­den­tal. Un­for­tu­nately, it’s not only pos­si­ble that such confluence will oc­cur in the fu­ture — it’s likely. In the case of pan­demics or bi­o­log­i­cal war­fare, there will likely be both a surge in de­mand for im­por­tant goods and a si­mul­ta­ne­ous dis­rup­tion of pro­duc­tion and de­liv­ery.

If a pan­demic dis­ease se­verely af­fected China or India, where large shares of medicines come from, pro­duc­tion could be knocked out or slowed. That would leave the rest of the world vul­ner­a­ble to the dis­ease’s spread, be­cause there would be no sup­ply of cru­cial medicines to com­bat it. The 1918 in­fluenza pan­demic caused dis­rup­tions that pre­vented coal from be­ing de­liv­ered to the north­east­ern U.S. That left some with­out heat in the height of win­ter, caus­ing peo­ple to freeze to death and com­pound­ing the deadly pan­demic.

To­day, such a break­down could leave hos­pi­tals and other cru­cial in­fra­struc­ture with­out elec­tric­ity. If the spread of the dis­ease is in­ten­tional, as in cases of bioter­ror­ism or bio-war­fare, ad­ver­saries could tar­get global sup­plies of cru­cial treat­ments.

Jen­nifer Bur­rough via AP

Shawn Bur­rough, 48, needs a res­pi­ra­tor to help with his breath­ing as a re­sult of con­tract­ing the H3N2 flu strain.

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