Who is "essential" during a pandemic?

The Johns Hopkins Berman Institute of Bioethics published new research on who should be considered "essential" in the event of a pandemic flu outbreak. Of course, medical workers and firefighters are on the list but so are a surprisingly diverse group of other folks who often go unrecognized in keeping us alive and happy. From a press release:
After examining several accepted public health rationing strategies that give priority to all healthcare workers and those most susceptible to illness, the authors propose a new strategy that gives priority to a more diverse group. “Alongside healthcare workers and first responders, priority should be given to the people who provide the public with basic essentials for good health and well-being, ranging from grocery store employees and communications personnel to truck drivers and utility workers,” says (Nancy Kass, Sc.D, Deputy Director of Public Health for the institute.)
Rethinking Who Should Be Considered 'Essential' During a Pandemic Flu Outbreak

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  1. This raises the even broader question of “How little could we get by on?”

    By now we were supposed to be enjoying 12-hour work weeks. Instead, we are wasting our time producing a huge pile of mostly-unused data.

    Wouldn’t we be better off if society trimmed down to the essentials and we all worked less?

    I’m for it.

  2. Hmm, social triage.
    It’d be great, yes, to be able to say who lives and who dies. I think a great question would be “How can we make sure the survivors, whomever they are, will have the greatest advantage?”

  3. The main problem with these types of exercises is that the ones who make the actual decisions tend to view themselves as being the essential ones. Politicians and bureaucrats always seem to be included somehow.

  4. When I was living in Pennsylvania about 10 years back, during one of the “storms of the century,” the word went out that all nonessential personnel should go home.

    It really makes you take a long, hard look at yourself…

  5. The word “Pandemic” has been used so much in the last several years its true meaning has lost its effectiveness. How many times in the last several years have we been warned of an imminent pandemic? I know it’s been at least 3-4 times.

    From Wikipedia: “A pandemic is an epidemic of infectious disease that spreads through human populations across a large region; for instance a continent, or even worldwide.”

    I think a good comparison to decide how well a city or community would be prepared for an actual pandemic, is how well it has shown to be prepared for a natural disaster. If hurricane Katrina had instead been a pandemic, how well prepared were the local, state, and government emergency management agencies?

    From EMS Responder.com Pandemic Readiness: How Prepared are Facilities Really? http://tinyurl.com/yrfqzs

    An excerpt: “In fact, PWCHRI (Pricewaterhouse-Coopers Health Research Institute) found that “facility and staff resources are limited, public health and private medical sector plans are inadequately coordinated, communications and tracking systems are incompatible and funding is not sufficient to support development of a sustainable infrastructure for an effective response.” PWCHRI followed its assessment by indicating that Congress has appropriated nearly $8 billion for disaster preparedness since 2002, but a lack of accountability prevents an accurate assessment of the healthcare industry’s preparedness or progress.”

  6. How could they forget the telephone sanitizers, the hairdressers and the middle management?

    Ha! I was thinking of that same Douglas Adams reference. If I recall correctly the society that made that call was eventually wiped out by a disease contracted through a dirty telephone.

  7. Count me in the pessimistic column, but a true pandemic (airborne, highly infectious, multiple vectors) in the modern era would be spread so quickly (air travel, highly mobile populations) and so widely that by the time the powers that be got around to implementing “The Plan” there’d be more holes in the chain than links.

    Add in panic, social breakdown and poorly prepared state/local/federal governments and the notion of having some kind of call-up list of essentials gets more and more of a paper dream by the second.

    The optimism? We catch and contain outbreaks, isolate them, treat them on that level before they spill out. Control at that level is easier to maintain than trying to keep the whole of society in check while the working are burning.


  8. by the time the powers that be got around to implementing “The Plan” there’d be more holes in the chain than links?

    MgFarrelly, right on!

    So from my perspective, if want to believe there will be a pandemic then you should probably change your lifestyle if you want to survive it. Don’t count on the government to get the first one right… Do we really get a couple shots at this?

  9. Somehow I think web developers are way down on that list! Maybe I should consider a career change. ;-)

  10. Why are people so upset about these sorts of things…when it comes to keeping most people alive, I’m all for it.

    I’m college educated with a few degrees, one in health care (though no one is going to want to tell me their problems when they are focusing on survival!), I do volunteer work, and I consider myself an all-around good guy.

    Guess what? My physical problems mean that I’m most likely going to be left behind. Sucks? Sure…but if I were making the decisions, statistics like me would be on the too-bad list. I don’t think I’d fault anyone for giving my meds that probably won’t work anyways to someone that could help…then again, I have thought about politics! Maybe I have my way out as others mention!

  11. The question is, if there are limited doses of a rush-production flu vaccine, who gets them?

    The Berkman Institute’s list sounds sensible. What we need to do is keep basic services running: food, water, electricity, sanitation. We can’t care for every citizen who falls ill, but we can help give people the means to care for themselves and their loved ones.

    Lay in a stash of water, canned fruit, canned soup, and other stuff you can eat when you’re sick that doesn’t need cooking or refrigeration. You’ll also want extra aspirin and/or ibuprofen and other palliative remedies. If you have room, a bunch of extra toilet paper and paper towels wouldn’t be a bad idea.

  12. Severe Panflu Response Strategies suggests that we press-gang able bodied flu survivors into a Survivor Corps which can function right through a flu effectively regardless of vaccine supplies. There is also a Severe Pandemic Flu Strategies video.

    In terms of coping with this kind of stuff, like “when things fall apart” there are some really interesting new ideas about fallback communes that are worth looking at – think about having our own out-of-town flu quarantine villages. Interesting notion.

  13. Health care professionals, emergency personnel, FEMA and it’s local equivalent (in TN, its TEMA), the National Guard, and law enforcement.

    “Alongside healthcare workers and first responders, priority should be given to the people who provide the public with basic essentials for good health and well-being, ranging from grocery store employees and communications personnel to truck drivers and utility workers,”

    If the pandemic is bad enough that providing the bare essentials to the populace becomes a problem, the group I listed should be able to take care of providing those essentials until the epidemic has been contained and controlled. I mentioned law enforcement specifically because if obtaining those bare essentials becomes a problem, rioting and looting would likely become a problem.

  14. But what about celebrities? Especially those who are famous for being famous?

    And how about the children of the wealthy?

    Where are your priorities?

  15. Hey! I can speak to this!
    I recently got my Masters in Public Health, including fascinating/terrifying classes in running responses to natural and man-made disaster and CERT (Civilian Emergency Response Team) certification.

    About four years ago, Scientific American ran a great article about a smallpox pandemic model run on the super computer at Livermore labs. (sorry, I can’t find a link- can anyone find it for us?).

    The comforting thing is that the model predicted that many people will “self quarantine” (i.e. stay home of their own accord) and that will lesson the impact considerably.

    The amazing thing is how many people you don’t see are important- the truck drivers who deliver medicine and food to the hospitals, the civic workers who keep the roads clear and the water/lights/power running and the garbage picked up.

    What is truly scary for many large, expensive areas, is how fast they will be left to fend for themselves because all the people who really RUN things can’t afford to live within walking distance to work. All of Beverly Hills and West Los Angeles is one good earthquake or traffic-halting quarantine away from total shut-down.

    Things you can do:

    Have emergency supplies that can last you about three weeks. Water and disease-stopping cleanliness are your first priorities.

    Take a first-aid and CERT class

    Always keep your gas tank at least 1/2 full

    Take a phlebotomy class and learn to administer shots, then register with the local health authority to be a first-responder for administering the vaccines in case of an outbreak. They are critically short of people to do this, and this way you and your first-degree family get first crack at the vaccine!
    You will also be doing a service by freeing up nurses/doctors with more extensive medical skills to tend the truly ill instead of being a needle-jockey.

  16. Tom Hale –

    They don’t mind you linking, they just don’t want sites posting their pdfs offsite, because they update them with new info.

  17. If a true pandemic comes, I foresee some difficulty in convincing heavily armed persons that they are not essential.

  18. #23: Hence the point by Tom in #16 that the National Guard and law enforcement need to be included in the “essential” list.

    I can certainly imagine crazy survivalist groups making runs on vaccine depos.

  19. #24 – It takes quite a bit of air to kill someone. I’ve seen a few feet of air given intravenously.

  20. I’m on that list of “essential” employees, but my pay isn’t commensurate with that supposed essentiality. I can’t afford $30 just to download the paper.

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