America's RNs call for much broader response to swine flu



After years of shredding our public health infrastructure and ill-advised minimal preparations for the next great global pandemic, the spreading swine flu threat is at last making clear the very real calamity that could be just around the corner. If not today, surely from the next epidemic.

The Obama administration's call on Congress Tuesday to allocate $1.5 billion for combating the virus is a start, but only a start. The RNs of the National Nurses Organizing Committee and California Nurses Association (NNOC/CNA) believe that far more is needed in federal action, in regulatory crackdown on insurance practices that potentially inhibit those who are infected from seeking help, and in global coordination.

From SARS to avian flu to the swine influenza, the only question has not been if, but when.

Three years ago, during the advent of an avian flu outbreak, in an article by Conn Hallinan and Carl Bloice in the national magazine of the National Nurses Organizing Committee, we warned that the 'firewalls for stopping the next great pandemic are getting thinner.'

If the swine flu or the next pandemic has only the fatality of the 1918-1919 global influenza pandemic -- 2.7 percent -- it would have a catastrophic effect. That pandemic killed 675,000 Americans and anywhere from 50 to 100 million people at a time when the world's population was less than a third what it is today, and when populations were far more isolated.

Obviously, there have been medical advances in the past 90 years. But on many other levels, conditions remain as precarious as ever.

In the U.S., public health services are often first on the chopping block when budgets are tight -- such as the now evidently foolhardy decision of politicians to slash $870 million from the President's economic stimulus bill that was allotted to fight pandemics.

And many politicians compete to see who can transfer more resources from the public setting into the pockets of private healthcare corporations -- often while harvesting hefty campaign contributions from those same companies.

The result is a virtual decimation of many community clinics, especially in rural and medically underserved communities, and a starving of badly needed funds for public hospitals and services.

Over the past eight years especially, we've also seen a rash of hospital and emergency room closures, reductions in available hospital beds, and the type of equipment needed to fight pandemics. For example, in 2005, we noted, there were only 105,000 mechanical ventilators, between 75,000 and 80,000 of which are in constant use. Ventilators are particularly important if a pandemic takes on the characteristics of the 1918-1919 flu in which a major killer was acute respiratory distress syndrome.

Hospital and bed closures are all too often driven by the insatiable lust of healthcare industry corporations for greater profit that can be secured by relocating in wealthier communities or re-allocating resources to more profitable services, such as boutique clinics and surgery centers. Such is curse of our absurd reliance on the privatization of healthcare.

An immediate shift in priorities and thinking is needed, if not for swine flu, for the coming plague. Here's the first call to action by the national nurses movement (link is a .pdf):

• Recruit and mobilize teams of scientists to create the appropriate effective vaccine for the virus. • Cease and desist any reductions in public health programs at federal, state and local levels. Lift any freezes on public health funding currently in place. • Implement a moratorium on any closures of emergency rooms, layoffs of direct healthcare personnel, and reductions of hospital beds. • Allocate funding for recruitment and retention of school nurses, public health nurses. • Expand the network of community clinics, especially in medically underserved areas. • Add thousands of additional ventilators/respirators, which are critically needed in the event of epidemics. • Assure the availability of protective equipment for all healthcare personnel. • Require all insurance companies to suspend or waive all out-of-pocket expenses, including co-pays, deductibles, or co-insurance that discourage individuals from seeking preventive care for early signs of infection.

On the international level, it's apparent that the World Health Organization is overwhelmed. A global infrastructure similar to what is being discussed for the economic crisis should be formed and sanctioned, at least by the G20. International cooperation and most importantly, transparency of data from all sources, health care facilities, governments, and individuals, is essential to identify the virus and track its patterns. The global health community must have the authority to require systematic, uniformly collected information to be reported on influenza cases in order to start formulating an effective vaccine.

Within the U.S., we should learn the lessons of the 1918-1919 flu pandemic, one of which was the enormous mitigating effect on mortality of adequate nursing care. We need to rededicate our nation to expanding the supply of nurses and safe patient care in our hospitals and clinics, which is a central component of the healthcare safety net that is especially vital at times of public health crises.

Finally, in order to promote containment and convention, we must eliminate the greed-driven barriers to care based on ability to pay.

Recent reports have emphasized the growing number of Americans who are skipping routine medical screenings, exams, and general preventive care due to the skyrocketing co-pays, deductibles, and other use charges imposed by insurance companies.

Price gouging by the healthcare industry has already put tens of millions of families in healthcare jeopardy, especially in an economic crisis. At a time when untold numbers are already exposed to a dangerous virus, we need to be removing any barriers to medical care that would exacerbate the spread of contagion. We can not afford to wait.