Note: I did do a conference call. It’s not all Jenga and mac and cheese.
IN SHORT: CDC is the hub for all infectious disease activity in the United States. Every positive flu test goes to those great women and gents, and they generate the data to color the maps that inform the public and help health departments and hospitals and pharmaceutical companies shift around the resources needed to care for sick people in hard-hit areas. THAT SERVICE HAS BEEN SUSPENDED.
Not to mention god forbid a batch of spinach has salmonella smeared on it or the drinking water in some former steel town is poison. CDC epidemiologists are the people that turn random cases into public health guidance.
Reliable governance is priceless, for individual and population health and the well being of business and commerce. I’m voting for consistency.
If I wrote the book on public health I would insist on a subtitle. Here’s how it would read:
Public Health: IT’S NOT ABOUT YOU
I’m punting to the expertise of Aaron Carroll and his timely Upshot article this week. I myself, a yearly getter of the flu shot, have the flu. AND I WOULD GET THAT FLU SHOT AGAIN. Because, of course, it is not about me. And sure the flu I have is possibly less virulent than it could have been and I haven’t needed to tap the resources of any health care facility so my only cost has been reduced personal productivity (I’ve met writing deadlines but my apartment is disgusting and hair is dry shampoo). But even assuming that my flu shot did nothing to make my personal experience of flu season better, I’d still get one.
First, a statistical concept used to evaluate the efficacy of an intervention or treatment: N.N.T. or number needed to treat. Surgery is the easiest example to cite to explain it. In an appendectomy, N.N.T. is always 1. One surgery, 1 removed appendix. Unless something really weird is going on.
If everyone that got the flu shot was guaranteed to not contract the flu, then flu shot N.N.T. would be 1. One shot equals one protected patient. But the flu shot was never planned as a N.N.T.=1 type of disease prevention. The flu is too wily, too quick to mutate. Flu shots are here to reduce the disease burden in our overall population. Less infections mean less contagion, lower overall cases mean demand on public health resources is manageable, people that do get sick have better access to the care they need, and ultimately less morbidity and mortality (illness and death) result.
According to Dr. Carroll’s article, this year the flu shot’s N.N.T. is 77. For every 77 people that get the flu shot, 1 will avoid what would have been an flu infection. Considering the cost of the flu vaccine (literally zero dollars if you have any sort of insurance which legally ethically and morally you should but that is another conversation) is five minutes at CVS plus mild soreness for a day…I like to imagine my group of 77 responsible flu shot getting citizens saved a baby this flu season. Maybe that 2 week old baby I saw at the thrift store last month and wanted to scream “FOR ALL THAT IS GOOD AND HOLY GET THAT CHILD OUT OF THIS HUMAN VIRUS SOUP.”
So there’s the lesson for the day. But read The Upshot, Dr. Carroll tells it in true doctor-professor speak, and continues to explain the important role of cost/benefit in the vaccine:
Let’s say that this year’s flu vaccine is even worse than we think. Maybe the absolute risk reduction will be as low as 1 percentage point, making the N.N.T. 100. That’s still not that bad. Even at an N.N.T. of 100, for every 100 people who get a flu shot, one fewer will get the flu. That’s a pretty low N.N.T. compared with many other treatments that health experts recommend every day.
I’ve been writing full-time for three months now. Being off the hospital floor has done wonders for my aching back, my parenting, my complexion…and I won’t lie I’m not sorry about missing a horrendous flu season. But I miss patient care. Taking care of strangers was a privilege. And the antidote for the morning news. Bigoted, hateful things lose power after a half dozen conversations with the typical rainbow cast of normal humans at your local public hospital.
I miss it today. Here’s a post I found in languishing in my drafts folder. An attempt to capture what I loved about patient care.
My reasons for being a nurse are selfish. I love stories. Taking care of humans for a living was my passport into every socioeconomic, ethnic, racial, psychological, pharmacological kind of humanity. The wildest thing is that everyone thinks their story is the normal one.
A patient might present with humor. Maybe stoicism. Open tenderness for their spouse. They give me stories that show how brave, how smart, how kind, how resilient they are. Or they may present with impaired coping: venom between parents and children. Complete submission to despair. The desire to mete out as much pain as they have been given.
The way people handle crisis of health: physical pain, just plain bad news, never ceases to amaze. An appetite for what people have to say for themselves is what makes me love being a nurse. And hate it.
Sometimes the stories are whispered. Yelled. Told in profane or racist or sexually suggestive language. Sometimes the story is just a kiss between people who have long since celebrated their 30th anniversary. Divorced spouses who sit him beside her as she’s dying. An elderly woman whose power of attorney is a neighbor that takes three days to locate and another to drop by and sign a DNR. A grandpa whose eighteen grandchildren from six different states come stream in. His hypertension abates when they stand around sharing details of their days. Another patient who becomes hypertensive when her mother is in the room.
People sing hymns. People fight with the priest. A retired four-star general occupies the room next to a man living in government housing. Everyone engulfed by their own narrative, healing or getting sicker, thinking they are the normal one. Feeling like this is the first time anything so scary or tragic or miraculous has ever come to pass.
It’s little me, the nurse, that gets to know all these stories. I still pass like a specter through them, over the borders of these private worlds, from room to room.
So that might not happen, but at the very least a continuing resolution for CHIP, children’s health insurance that covers nearly 9 million kids, is achievable.
As for the rest; it is important to have goals. I’ve got faith.