tetano
Editor, Senior Moderator
In the beginning, nothing was visible. Somewhere in the world, an otherwise harmless enzootic gastroenteric virus of wild waterfowl (ducks and geese) apparently “host switched” into human beings and began causing respiratory infections. The virus caused a low rate of human mortality from pneumonia. It went undetected as it spread gradually around the globe, killing at a rate (about 1 to 2%) that was invisible beneath the high background mortality rates of the era. But when the pandemic eventually began to grow exponentially, it caused unmistakable statistical upticks in metropolitan mortality (between July and October 1918) and then exploded
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Fourth, the possibility that more than 2 million people could suddenly need intensive care with ventilatory support is a frightening reminder of the challenges of an influenza pandemic. Obviously, ICU capacity to address such a surge does not exist: although the contents of the U.S. Strategic National Stockpile are classified, it seems highly unlikely that enough ventilators, antibiotics, antivirals, and other supplies necessary to prevent mass deaths from a 1918-like pandemic would be available. The burden of preventing infection and transmission to others, and of medically managing care for millions of people with severe illnesses, would thus be placed squarely on public health and medical practitioners.
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We hope that the 1918 pandemic’s lessons will help us plan for future high-fatality pandemics. There is an enormous body of literature on the 1918 pandemic’s clinical, pathologic, bacteriologic, surgical, radiologic, and epidemiologic features. The physicians and scientists who contributed to that literature hoped to guide future physicians. Sooner or later, millions of lives will depend on our learning from them and acting on their lessons.
https://www.nejm.org/doi/full/10.1056/NEJMp1814447
...
Fourth, the possibility that more than 2 million people could suddenly need intensive care with ventilatory support is a frightening reminder of the challenges of an influenza pandemic. Obviously, ICU capacity to address such a surge does not exist: although the contents of the U.S. Strategic National Stockpile are classified, it seems highly unlikely that enough ventilators, antibiotics, antivirals, and other supplies necessary to prevent mass deaths from a 1918-like pandemic would be available. The burden of preventing infection and transmission to others, and of medically managing care for millions of people with severe illnesses, would thus be placed squarely on public health and medical practitioners.
...
We hope that the 1918 pandemic’s lessons will help us plan for future high-fatality pandemics. There is an enormous body of literature on the 1918 pandemic’s clinical, pathologic, bacteriologic, surgical, radiologic, and epidemiologic features. The physicians and scientists who contributed to that literature hoped to guide future physicians. Sooner or later, millions of lives will depend on our learning from them and acting on their lessons.
https://www.nejm.org/doi/full/10.1056/NEJMp1814447