Monday, May 05, 2008

The Hard Call

End of the world scenarios have always been popular in fiction. On film from George Pal's When Worlds Collide and War of the Worlds to Night of the Comet to Armageddon to all the remakes of I Am Legend, the film vault is fairly full. The book side is also pretty full. From H.G. Wells comes such as War of the Worlds and the Time Machine, Dean Ing's Pulling Through, Crichton's Andromeda Strain, David Brin's The Postman, and John Ringo's new novel The Last Centurion; all talk in various ways about the end of the world.

The United States government has spent a fair bit of time and money pondering end of the world scenarios and how to survive them. This used to fall under Civil Defense and it concerned shelters and food supplies in case of disasters like nuclear attack. Remember 'Duck, roll, and cover?' I don't but have seen those films. While the various government entities at all levels also looked at how to protect the infrastructure from any kind of attack. Now all of this is rolled into two organizations: Department of Homeland Security and the Federal Emergency Management Agency.

One of the greatest threats to modern Western civilization though is not nuclear weapons or terrorists, but something far smaller. As prosaic Earth germs devastated the Martians in War of the Worlds, more lethal such bugs can wipe out the human race if given the right circumstances. In Rainbow Six, its a genetically modified version of Ebola that almost does it. The Andromeda Strain was of alien origin. Brin's hero is in one of the last militia levees trying to protect grain silos after such bio-weapons as the Super Mumps have run their course. Ringo's new novel is about a new version of Bird Flu that has jumped to humans in mainland China that races around the world bringing civilization to its knees. All this is of course fiction.

Reality can be far more horrific. The Black Death that knocked Europe to its knees was pretty grim with some villages becoming ghost towns with nothing alive and bodies left to rot where they died. This was the setting for Masque of the Red Death. Or in a fit of gallows humour, Monty Python has someone calling out 'Bring out your dead.' The Spanish Influenza of 1918-1919 swept the world killing some 20 to 40 million people, far more deaths than was experienced by all combatants in World War I. And estimated 675,000 Americans died of the Spanish Influenza out of an estimated population of 104,550,000 people or almost 0.65% of the US died. If this flu struck the current US population of over 302,200,000 then over 1,964,000 would die if that 0.65% mortality rate held true. But that historical mortality rate might not hold true since the modern world is far more mobile than it was in 1918. In 1918 the fastest transit system was still the ship, in 2008 it is the airplane and we can span the globe in mere hours versus days in 1918. As SARS proved how fast such can spread with air travel.

So where is all this heading you ask? Well the US government in conjunction with doctors and others have decided to take a frank look at how to respond to a modern pandemic. More specifically on who to try and save, this is what the military calls triage and dates to Napoleonic times. You separate your casualties into three broad categories: those who will die no matter what you do so you set them aside to die, those who are in grave danger but can be saved if operated on quickly, and finally those who are wounded but not severely and can wait for treatment. Now apply this to a modern flu pandemic wracking the whole country or even the world and look at who can best serve saving civilization if the resources are applied to saving them. This is what this study set out to do.

Naturally the lawyers are already tossing sand into the gears of this study and its recommendations even before its officially published. To quote Gostin, public health law Georgetown, "The recommendations would probably violate federal laws against age discrimination and disability discrimination." Gostin and others like him would handcuff all the doctors and nurses to force them to employ what could be scarce resources upon people with incurable cancer or mental illness while possibly letting otherwise healthy people die. All in the name of legally imposed fairness amidst a pandemic. The world would end not with a bang, but with a whimper.

To quote Dr. Asha Devereaux who lead the task force, compiling the list "was emotionally difficult for everyone." And as she later adds: "You never know," Devereaux said. "SARS took a lot of folks by surprise. We didn't even know it existed."

This is why I call this post The Hard Call.

Update: Thanks DiabloVision for catching my math goof: 0.65%.

1 comment:

outrider said...

Let the lawyers rant. I suspect in a cataclysmic event of the nature being discussed, the results of any court cases will be superfluous and promptly tossed out the window.