Oh dear. The bird flu experts tell us not to worry, these people sit in a lab, they
don’t tend the sick, and as a clinician, an intensivist who will be at the coal
face when it all happens, I’m a little more circumspect.

We are told that medicine is a whole lot better than in 1919 and this is
undoubtedly true, in 1919 you stayed at home, the doctor came to you and then if
his ministrations proved ineffective the undertaker came to take your corpse away. Only the poor and
the indigent went to hospital. We are told that when the next pandemic occurs
(and one will occur, if not with H5N1, then with another strain) that with the
combined miracles of improved medical care, modern pharmaceuticals and the
discipline of intensive care medicine will result in the carnage being much
less. I’m afraid being at the coal face of intensive care medicine I can’t share
their optimism.

Let’s look at this from a logistical point of view, and use Melbourne as a case
study. Victoria has around 350 to 400 intensive care beds, most of these are in
Melbourne (but then so is most of the population) and most (but not all) are in
the public system. Now, in the event of a pandemic, emergency departments will be
flooded with all and sundry, all clamouring for anti viral medication,
antibiotics for the accompanying bacterial infections and climbing over one
another to get their loved ones into the few intensive care beds that exist.

Intensive care is known in the business as Expensive Scare. It costs
the price of a small used car to keep one patient in one bed for one 24
hour period. Three nurses are required to provide the one-on-one
nursing care that is required over the day’s three shifts (in desperate
times brought on by a pandemic, 12-hour shifts will probably become
necessary). The patient will be supported by an extensive array of
technology, of which there is a finite supply. Let us assume for the
exercise that we see the same 50% infection rate as we saw in 1919 with
a 1% fatality rate (supposedly less than in 1919).

In Melbourne that means two million people with the flu and, of those two million, 20,000 Melburnians will be
casualties of the pandemic. Over a six month period that’s 100 a day. Which
means on average each day of a six month pandemic 100 people will die. Makes the
road toll look rather insignificant. Each of those 100 will be desperately sick
and will require an ICU bed if they are to have any hope of survival.

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