Occupational Psychiatry--Independent Psychiatric Evaluations--Workers' Compensation

Organizational Consultation--Second Injury Fund Evaluations

C. Donald Williams MD CGP

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Occupational Psychiatry--Independent Psychiatric Evaluations--Workers' Compensation

 
bulletI wrote the following paragraphs 4 years ago, when H5N1 was feared as a source of pandemic. We know now, April 30, 2009 that H1N1 is on the verge of becoming a world wide pandemic, with a current WHO classification of Level 5, which means sustained human to human spread in two countries. It may be only a matter of a very few days before it reaches level 6. What follows in discussing H5N1 is true for today's situation. Mitigation--which entails basic practices of "cover your cough, stay home if you are sick, and social distancing--i.e. avoid crowds" is excellent advice. Communities that followed these practices had much lower sickness and death rates in 1918. Also, be sure to have at least 2 weeks food supply on hand, and preferably cash for essentials, in case of some infrastructure failure, which at this point does not appear likely.
bullet"The H5N1 Avian Flu virus is likely to achieve human to human transmission. If it does not, the H7 or H9 strains may; a Pandemic will occur at some point in our lives or our children's lives. The Spanish Influenza Pandemic of 1918-19, which resulted in the death of 650,000 Americans--is our best guide to what we will face. We are only beginning to be prepared as a nation and as communities for this foreseeable calamity. It is apparent that there will be no "outside help" when it strikes--because there will be no "outside" to help. Pandemic Preparedness for Yakima County is intended to serve as an incentive for community mobilization. It may be applicable to other similar communities. The Yakima Daily Republic newspaper accounts on microfilm for September 19, 1918 to February 5, 1919 provide an "emotionally anchoring" and intellectually meaningful guide--with historical roots-- to what mid-sized communities (100,000-500,000) might expect in the event of a pandemic. 

The 1918-1919 Yakima Daily Republic microfilm excerpts dramatize the political dimensions of a Pandemic. Business and social needs were in a state of tension beginning in late November 1918. The "social distancing" measures which had been in place were lifted prematurely, contributing to a second wave of Spanish Influenza. Health officials and politicians responded to a number of conflicting constituencies in 1918-1919, and will do so again. Our challenge is to hold an open discussion to promote the most reasonable and scientifically sound course of action and public policy decisions.

Prepare your business for an influenza pandemic. This Business Influenza Pandemic Planning checklist (.pdf) was developed by the Center for Disease Control (CDC) and the Department of Health and Human Services.

Power Point Slideshow  (5.3 MB) of Spanish Influenza in the Yakima Valley, 1918-1919, prepared with the assistance of Barbara Andrews, Yakima Health District. (Broadband needed) revised May 27, 2006.

Australia has prepared well for a pandemic flu event. The speech by Tony Abbot,  former Australia Health Minister is clear and balanced.  I also recommend Jeff Duchin M.D.'s (Chief, Communicable Disease Control King County, Epidemiology & Immunization Section) PowerPoint presentations to community and businesses (which is linked with permission).

"Pandemic influenza: Studying the lessons of history." Stephen S. Morse. Proceedings of the National Academy of Sciences. (104)18:7313-7314. This article makes the point that if a city introduces "social distancing" measures and maintains them as long as possible the death rate can be reduced by as much as half. The fatality rate in St. Louis in the 1918 Spanish influenza pandemic as measured by excess deaths was much less than that of other cities. Our Yakima experience in 1918--(see slide show above)--dramatized the effect of prematurely relaxing restrictions in our own community. http://www.pnas.org/cgi/content/full/104/18/7582 (Hatchett RJ et al. Public health interventions and epidemic intensity during the 1918 influenza pandemic, PNAS, (104)18: 7582-7587) and  http://www.pnas.org/cgi/content/full/104/18/7588 (Bootsma MCJ and Ferguson NM. The effect of public health measures on the 1918 influenza pandemic in U.S. cities, PNAS, (104)18:7588-7593) present the research data to support Morse's assertions. These are open access articles and the links are to full text.


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Last modified: 08/17/2011