|Type of paper:||Research paper|
|Categories:||History Medicine Population Public health|
Over a century ago, in 1918, the world experienced the highest tidal wave of death in human history. A new respiratory virus, known as Spanish Flu, invaded the human population infecting over 500 million and killing between 50 to 100 million persons. If the figure were adjusted for population, it would translate to 220 to 440 million people today. In the United States, the flu caused 657,000 deaths triggering the average life expectancy in the country to drop by around 12 percent (Vance 4). The main reason why the flu killed so many people was that it spread so fast and it had a short incubation period. For instance, outbreaks of flu-like illnesses were first documented in March 1918. More than 100 American soldiers at Camp Funston in Kansas became infected with the flu. In less than a week, the number of infected people in the area had more than quintupled (Escuyer et al. 132).
Faced with a new virus that was proving to be catastrophic and not enough medical resources, the United States government proposed and implemented nonpharmaceutical interventions such as restrictions on public gatherings, school closings, isolation, and quarantine. Despite not knowing the cause of the flu and the science of vaccination being in its infancy, many healthcare researchers enthusiastically proposed the use of quarantine to curb its spread. However, in the early to mid-1930s, new public health policies such as advances in virology and the use of vaccines were prioritized over traditional approaches. The 1918 Spanish Flu Pandemic birthed American public health protocols that combated infectious diseases.
Lack of Proper Diagnostic During the Spanish Flu
As mentioned earlier, many medical practitioners of the time advocated for the use of quarantine to prevent the spread of the virus. Because the country lacked a central monitoring system, there were no specific guidelines for diagnosing the infection. As a result, the constituents of the vaccines differed from one city to another based on the diagnosis. Even so, all the vaccines attacked different types of bacteria isolated from those infected with the virus (Friis and Thomas 52). This approach resulted in the enduring idea that the Spanish Flu was a bacterial disease. It was believed that a bacteria known as Bacillus influenza, first discovered by a German bacteriologist in the 1890s, was the cause of the virus. In the 1920s, Spanish Flu vaccines were widely being used in the country despite the lack of supporting evidence of their benefits. Various health administrators including the New York City Health Commissioner, advocated for standardized diagnostic procedures to help in the creation of a standard vaccine. The commissioner also proposed the systematic assessment of the effectiveness of the vaccines that were already being used (Greenberger 1465).
Improvements to Diagnostics Since the Pandemic
After recognizing the influenza flu in 1931, the American public health system had to implement a new means of diagnosing and studying the virus. In the years between the 1940s to the late 1980s, the primary means of diagnosing the flu involved culture in cells and eggs using influenza-specific direct fluorescent antibodies. Currently, there is a variety of laboratory tests that can be used to confirm infection. The first tests were announced in the 1990s, including rapid immunoassays and rapid molecular assays. While immunoassays could provide results within 15 to 20 minutes, they had low to moderate sensitivity to the virus (Jester 32). Rapid molecular assays had higher sensitivity hence more accurate in testing the virus. Since then, commercial, academic, and public health laboratories can now execute moderate to complex examinations using virus culture and other molecular assays. By making use of information from such clinical sources, in addition to the high-complexity polymerase chain reaction testing done at over 60 public health research centers across the United States, the country can detect both seasonal and novel pandemic viruses more accurately and timely.
The Center for Disease Control and Prevention (CDC), a division of public health research centers, regularly performs post-modern genetic coding on all samples it receives. The state health departments, with the help of the CDC, monitor infectious disease characteristics by using the virologic data from the genetic sequencing process at the state level. In particular, the CDC can detect disease activity, its geographic spread, and the effectiveness of antiviral medication or vaccines for it. The organization is also tasked with the responsibility of developing candidate vaccine viruses. Nowadays, the treatment of such infections does not necessarily require confirmatory diagnostic because antiviral medication is most effective when initiated as soon as the onset of the disease is noted (Escuyer et al. 132).
Hospital Preparedness Initiatives After the Pandemic
The U.S. government was not prepared for the impact of the flu, notably its health care sector. In some instances, government officials went as far as stifling communication regarding the pandemic to prevent ruining the country's reputation by failing to eliminate the virus. Because there was no disease surveillance and medical countermeasures, the country relied heavily on nonpharmaceutical interventions (NPIs), which encompass various measures such as washing hands, staying at home, avoiding crowded areas among others (Jester 1469). Multiple initiatives, other than NPIs, have since been put in place to ensure the preparedness of the country in the event of such a virus. For instance, in 2018, the US government's Department of Health and Human Services (HHS), in collaboration with the WHO, implemented coordination and communication for pandemic preparedness around the country. The Strategic National Stockpile is an arm of the CDC responsible for managing and distributing medical countermeasures such as ventilators, antiviral medications, and personal protective equipment. The Stockpile was initially established with the sole objective of supporting the procurement of medical countermeasures for responding to terrorism in the country. It soon evolved to change its role from managing countermeasures in case of terrorism to preparedness for pandemics and other natural disasters. The Stockpile ensures that medical materials are available in times of public health emergencies when local supplies are overstrained or depleted (Friis and Thomas 52).
In addition to supplies of medical equipment and antiviral medicine, pandemic preparedness initiatives also include advances in access to health care. Flu on Call is an example of initiatives meant to increase health care accessibility during public health emergencies. The action created a national network of nurse triage telephone lines. With such infrastructure in place, the nurses can guide patients to get the right care. As a result, the program increases access to antiviral drugs by those infected. The public health administrators, together with the CDC, are investigating the use of such triage lines to providing adequate information, access to prescriptions, and clinical advice. Such a move would require manning the triage lines with trained professionals. If proven effective, the triage lines would control outpatient medical resources by reducing the upwelling demand on emergency supplies while relieving the health care system (Greenberger 1465).
Finally, the Department of Health and Human Services has a specific section whose sole responsibility is to come up with the preparedness of hospitals in times of need. The subdivision, known as the Office of the Assistant Secretary for Preparedness and Response, creates and evaluates such programs to ensure the readiness of the health care system to deliver necessary care in situations that exceed the system's day-to-day capacity (Rosner 38). The objective of the program is to guarantee patient outcomes are not compromised because of the emergency nature of pandemics. As such, the program enables rapid patient recovery by minimizing the need for federal and state resources in times of need. Notably, this initiative demands a high level of cooperation and coalitions among the various players in the health care system. The collaborations make it possible to have an organized framework for a pandemic response while at the same time coordinating regional health care to create defined geographic locations to offer critical services.
Lack of Proper Health Care Infrastructure
During the Spanish Flu of 1918, medical services were quickly overwhelmed. With no specific medical countermeasures, most patients depended on supportive care. Unfortunately, even supportive care was also limited because the supply of doctors, nurses, support staff, beds, medications, and equipment was insufficient to meet the demand. The lack of protective equipment resulted in many health care workers being infected in the process of treating other patients. With a declining number of medical professionals, student nurses and physicians were assigned full duties of doctors after expediting medical school graduations and board examinations. On the other hand, health care infrastructure, including hospitals, were overflowing with patients. As a result, parish halls, gymnasiums, and schools were transformed into hospitals to house patients temporarily (Escuyer et al. 132).
Improvement to Health Care Infrastructure
Since the pandemic of 1918, the public health sector has experienced significant advances to reduce the strain of medical resources in times of emergencies. The improvements that have occurred over the past decade have addressed both the issue of availability of medical professionals such as physicians, nurses, and support staff, as well as medical supplies. For example, hospitals have intensive care units that can provide exceptional monitoring of patients. Additionally, these ICUs can also offer specialized life-saving care to patients with severe complications from infectious pandemics (Greenberger 1466). Other infrastructures that have been put in place include mechanical ventilators meant to support patients with respiratory difficulties. The use of public institutions such as churches and schools, as seen in the pandemic of 1918 have been replaced with specialized wards for monitoring purposes.
During the Spanish Flu, healthcare workers such as physicians and nurses accounted for a significant number of total deaths from the pandemic. The workers were infected with the virus when treating the patients. As a result, the number of patients rapidly increased while doctors and nurses were dying, making it difficult to contain the spread and treat the infected patients. As such, researchers saw the need to protect healthcare workers during such public health emergencies (Kamradt-Scott 90). The US government, through the CDC and various state health departments, stocks personal protective equipment to reduce exposure of workers to respiratory viruses. Some of the protective devices availed by the government include powered air-purifying and N95 filtering facepiece respirators in addition to ordinary gloves, gowns, face shields, and goggles. Medical personnel can also protect themselves from viral transmissions from patients by placing modern surgical masks on them (Greenberger 1466).
Introduction of Vaccines and Antiviral Medications
During the Spanish Flu, it took over ten years to have vaccines with the first clinical trials being conducted in the 1930s despite the view that vaccines were the first line of defense against the pandemic. Significant changes have occurred impacting the development and distribution of vaccines in times of outbreaks.
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