Guaranteed Healthcare

Lost in the increasingly dysfunctional healthcare reform debate over phony death books and how much protection money must be paid to the drug and insurance industries to soften their opposition, a major public health tsunami is about to slam the U.S.

It's name is H1N1. OK, not exactly an unreported story, but perhaps under reported. Even with a President's task force report Monday that concluded:

Nearly 2 million Americans could be hospitalized during this winter's novel H1N1 influenza pandemic, with as many as 300,000 clogging intensive care units in heavily affected regions.

Overall, 20% to 40% of the population could develop symptoms of the strain commonly known as swine flu, and 30,000 to 90,000 could die, according to the report. During a normal flu season, the virus kills about 35,000 Americans.

So how prepared are we to respond to this pandemic?

After we began receiving reports of nurses being infected in hospitals that were failing to meet proper safety standards, the California Nurses Association/National Nurses Organizing Committee decided to conduct a survey to assess hospital readiness to respond to this pandemic.
The findings, from 190 hospitals in nine states? In a word: worrisome:

• At more than one-fourth of the hospitals, nurses cite inadequate isolation of swine flu patients, increasing the risk of infection to others.
• At 18 percent of the hospitals, RNs report that nurses have become infected; one Sacramento, Calif. RN has already died.
• More than one in five, 22 percent of the facilities, do not have enough of the appropriate N-95 respirator masks.
• At up to 40 percent of the hospitals,  nurses  are expected to re-use masks, in violation of Centers for Disease Control Guidelines which say all healthcare personnel who enter rooms of patients in isolation for H1N1 should wear a fit-tested disposable N95 mask, and that the masks should not be reused.  
• Nurses at 26 percent of hospitals report that infected patients are not being properly isolated, in appropriately ventilated rooms, raising the possibility of the infection spreading to others in the facility. At nearly a third of the facilities, proper infection controls are not being followed.
• Nurses at fewer than half of facilities (49 percent) report that they have been adequately trained on H1N1 issues, including identification of infected patients, and procedures for caring for these patients.

• Nurses at only 35 percent of facilities report that they are guaranteed adequate sick leave if they become ill while caring for a patient, penalizing them for appropriately staying home while infectious.
Perhaps it should be obvious, but worth re-stating. If hospitals become incubators for spread of the virus, the pandemic will be far worse. And if nurses and other front line healthcare workers are infected, forced to work when sick, or incapacitated, it will drastically erode the ability of our nation to fight H1N1.

No one as yet thinks we'll have a repetition of the 1918-1919 flu pandemic that killed 675,000 Americans, though it's worth recalling that the first wave of that flu strain was relatively mild as well, and lulled a lot of people into complacency. In the wreckage and despair afterwards, several writers and researchers concluded that one of the greatest lessons was that a stronger nursing infrastructure would have saved many lives.

And, of course, before there was swine flu, there was avian flu and SARS. Some researchers talk about the repeated emergence of super bugs, and there's at least one refrain that links them all together.
That would be the disintegration of our public health safety net, which nearly disintegrated in the Bush years with cut after cut to public health funding. Another reflection of that problem is the widespread hostility to public health, whether it be public hospitals, public clinics, public healthcare workers, that is a byproduct of mean spirited politicians and the steady drumbeat of attacks on "government-run" healthcare.

All of which brings us back to the national healthcare debate.
An article (sub. req'd.) in the National Journal from August 8 expressed surprised that proponents of reform had not done a better job of linking the swine flu pandemic to the overall need for reform.

If more people are covered, more people would receive primary care rather than waiting until they end up in an emergency room, the Journal noted, adding "fewer people would be likely to delay treatment. The result... is authorities could better monitor the flu and hospitals would face less of a strain at a time when they would need all they resources they could muster."

The best way to mitigate the looming disaster would be comprehensive reform that expands and shores up the public safety net and makes sure that people aren't walking around spreading infection because they can't afford to go to the doctor or hospital. It will be no surprise to anyone that nurses think the best way to achieve this is through expanding Medicare, our uniquely American healthcare safety net, to cover everyone.

In the interim, we should at least be doing more to push hospitals to comply with safety standards, and make sure the federal guidelines that exist now are not weakened.

We often end these diaries asking for calls to legislators or malicious insurance companies to fight for guaranteed healthcare for all.  But, fighting for individual patients, think globally, act locally, is equally vital.  Especially if you have a high-risk patient in your family or circle of friends, call your local hospital, and ask them if they have adequately prepared for the H1N1 pandemic, and are taking this threat seriously by implementing appropriate patient safety precautions.

Read more about our findings and recommendations at www.calnurses.org