Disease Tipping Points

I look to Malcolm Gladwell for advice in all things. Except hair care. And the central tenet of his The Tipping Point is that almost inconsequential things can create huge outcomes.

This is a key idea that hasn't been fully translated yet to the study of pandemic flu--which is ironic, since much of Gladwell's work is based on epidemiology. Scientists and talking heads keep discussing vaccines and treatments--which are very important concepts, to be sure. But there's very little discussion of the actual healthcare situation that will occur in a pandemic.

Let's look at three key factors: sanitation in healthcare, antibiotic resistance and biomedical waste after the jump.

Now, the first thing to realize is that modern hospitals have very little surge capacity. Affected areas will need to call in partner and federal resources--like DMAT teams--to help out. A best practice treatment environment would likely involve different treatment areas for different levels of illness. Hopefully, nobody will be dumb enough to try and separate families and this will work fine.

However, it brings up certain key issues that haven't been looked at. First, the sanitation of these areas is critical. Disease like MRSA and this new typhus strain are starting to pop-up in hospitals. At the same time, sanitation workers are starting to grumble about crappy (get it?) equipment and staff shortages. These treatment areas will likely be intense locales, capable of quickly spreading disease to treatment workers. Keeping them spotless will be one way to keep any pandemic from tipping into a catastrophe.

Antibiotic resistance. Remember that? It's the health crisis that was getting all the play before Avian Flu came along and stole its germ-y thunder. It's getting worse. Slowly, in fits and starts, but it is growing. Unless it's monitored and reversed now--with steps like decreased preventive antibiotics in livestock--it could create additional chaos within any pandemic. Also, of course, the phenomenon raises the spectre of antiviral resistance--which should be planned for as part of any pandemic response.

Biomedical waste. This is the stuff with blood on it that gets carted away from hospitals and, usually, incinerate. In a pandemic, of course, it will be the infectious stuff with blood on it. Biomedical waste is usually serviced by private contractors who are probably not of a particularly public service mind. In a pandemic, these contractors will have to expand their work considerably while dealing with a risk of infection. I'm not convinced they're ready to do that. And, if they don't, these treatment areas may spawn piles of infectious waste.

Any of these issues, though small, could be large enough to tip an epidemic into a pandemic or tip a pandemic into a true catastrophe. I'm no epidemiologist, but it seems like, you know, planning for them would be a good idea.

Comments

[Moncler Dunjacka]

That was my thought,too.

[notso smart]

Interesting but I would suggest misses the point. Nosocomial transmission has been and will continue to be a tipping point for communicable diseases http://www.cdc.gov/ncidod/EID/vol10no5/03-0791.htm . Rare is the case in which hospital cleanliness or medical waste actually transmits disease.