National Nurses United

public health for 12 years in Illinois and Iowa. In a pandemic situation, Osterhold predicts that "health care workers would become ill and die at rates similar to, or even higher than, those in the general public." Prioritizing Public Health One recent influx of money for public health comes from the De- partment of Homeland Security to prepare for bioterrorism. Brun- ner estimates his county receives about $1 million from Homeland Security, which he is happy to get because, he says, "it helps the Health Department deal with all communicable diseases." But others worry that Homeland Security's concerns end up diluting the mission of public health. "Bioterrorism distracts public health from its true mission," says Dr. Victor Sidel, distinguished university professor at Mon- tifiore Hospital in New York, and past president of the APHA. Sidel calls the spending on biological warfare "wasted funds" and says the real problem is that "public health has been starved, and is being starved." Brunner also wishes for the same kind of focus and funding on "what is really killing our people, which are chronic diseases, like cancer, HIV, diabetes, cardiovascular problems, not to men- tion violence." And he worries that the bioterrorism focus may "divert attention and intellectual resources from public health issues that are more important." Sometimes the problems seem almost overwhelming. Glob- al Solution's Francis told Revolution that "there is not the in- hospital or in-public health capacity to deal with a flu pandemic," and Brunner agrees that the inability of U.S. medicine to respond in the way it should is "built in." Besides the insufficiency of beds in U.S. hospitals, according to Osterholm, there are only 105,000 mechanical ventilators, between 75,000 and 80,000 of which are in constant use. Ven- tilators are particularly important if a pandemic takes on the characteristics of the 1918-19 flu, in which a major killer was acute respiratory distress syndrome (ARDS). Lewis says: "The bottom line is that we are about as ready as they were in 1918 when millions died here in the U. S. But they had an excuse. There wasn't much of a public health infrastruc- ture and no vaccine. We have no excuse for not fully utilizing the resources that are available to us today." "We are in a major crisis and we need something on the order of a Manhattan Project," Levy argues, adding, "the greatest threats out there to us are not military, they are disease." For Sidel, the solution is long-term: "What we need is a decent medical care system, a universal system that unites public health and medical care." He points to H.R. 3000, legislation reintro- duced by U.S. Rep. Barbara Lee (D-Calif.) that would establish a United States Health Service (USHS) and provide health cover- age for all Americans. Sidel sees the bill, which was first intro- duced by Lee's prede cessor, Rep. Ron Dellums, as a step toward creating a system that "will prepare us for what will surely come." In the meantime, Brunner successfully lobbied to keep his Vietnamese translators and the county board of supervisors "re- stored most the cuts in health care." So Contra Costa has dodged yet another bullet—for now. Carl Bloice is a freelance writer based in San Francisco. Conn Hallinan is a foreign policy analyst for Foreign Policy in Focus and a Lecturer in Journalism at UC Santa Cruz. This article was reprinted from Revolution magazine. An emergency hospital for influenza patients 1918–1919 O n Sept. 6, 1917, the Army hospital at Camp Devens, 35 miles north-west of Boston, had 84 patients from the 45,000 soldiers packed into the training facility. The hospital, staffed by 25 doctors and 200 nurses, was, from all accounts, excellent. The facility could handle up to 1,200 sick soldiers. On Sept. 7, a soldier from D Company, 42nd Infantry Division, was admitted for what appeared to be meningitis. It wasn't. The soldier was the first in Camp Devens to con- tract the pandemic flu of 1918-19. Within two days, 1,543 soldiers were down with it, many of them developing a par- ticularly aggressive and lethal pneumonia. By Sept. 26, the medical staff was so overwhelmed they stopped taking patients. In his book The Great Influenza, author John Barry described the horror of a hospital with inadequate "surge capacity" to handle the flood of sick and dying soldiers: "All the beds have long been filled. Every corridor, every spare room, every porch was filled, crammed with cots occu- pied by the sick and the dying. There was nothing antiseptic about the sight. And there were no nurses…70 of the 200 nurses were already sick in bed themselves, and with more falling ill each hour. Many of them would never recover. Philadelphia General Hospital, which was treating flu- stricken sailors from the local Navy yard, had 126 nurses. Despite gowns and masks, 54 of them were hospitalized, and 10 of them died. Among the dead was Emma Snyder, who had cared for the first flood of sailors who had poured through the doors on Sept. 11. On Sept. 19, she was stacked with the other bodies in the hospital morgue. She was 23." COURTESY OF THE NATIONAL MUSEUM OF HEALTH AND MEDICINE, ARMED FORCES INSTITUTE OF PATHOLOGY, WASHINGTON, D.C. C A L I F O R N I A N U R S E N O V E M B E R 2 0 0 5 17 Past as Prologue?

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