Anyway, starting shortly after 9/11 and the anthrax letters over the following month, the United States began really thinking about how it would handle a widespread epidemic of infectious disease. Actually the thinking began during the Clinton Administration, but it took 9/11 and the anthrax letters to spur serious action and planning. A few years after 9/11, SARS, followed by avian influenza in Asia and and swine flu in Mexico further propelled interest in planning for severe epidemics.
As the Departments of Homeland Security, Health and Human Services, and Defense, and state and local governments think about preparedness, some things need to be taken into account.
For instance, what do Americans do now if they feel ill? People who have jobs that provide sick leave will likely stay home until they feel better. If they have health coverage, they may go to their doctors or primary care centers--often relatively soon in the course of their illness. On the other hand, people who don't have jobs with sick leave or medical benefits will likely stay at work until they either get better or until they are so ill that they have to seek care, likely at a hospital emergency room; at which point they may be highly infectious, and will have been highly infectious for a while.
Remember, we are talking about the status quo, what people do now, under "normal" circumstances.
So, think about what the national and state and local governments want people to do in case of an avian or swine flu epidemic (or zombie apocalypse, if that works for you). They would like them to stay at home as much as possible. They would like them to contact their physicians and primary care clinics for advice and not congregate in hospital ERs--which would likely serve as an accelerant for disease transmission. In other words, the governments would like Americans (and may plan to compel them) to behave in a manner that they have not been conditioned by their health system to behave.
Our governments spent billions of dollars planning and preparing for attacks with biological agents in the weeks and months following 9/11. We spent billions more planning and preparing for severe flu epidemics. But we have paid little or no attention to the health care systems that Americans will use in the event; or how Americans of all stripes will interact with those health systems. Americans who have little or no health coverage, or whose employers do not provide sick days -- or will fire them if they stay home sick, or with sick children -- are not incentivized to do what the authorities would like them to do should we ever face a serious communicable disease epidemic.
A key virtue of the current health care reform--call it Obamacare or Romneycare--is that workers will have options to staying at work, sick, until they can't stand it and go to an ER where they can mingle with infected and uninfected persons in great numbers and close quarters.
Yet critics of health care reform complain of the cost, or of government intrusion, not realizing the cost that a modern day Spanish flu would wreak on our economy, or the extent of government intrusion that would be needed to keep millions of Americans away from work and emergency room care and at home in quasi-quarantine.
Mostly, I find the rhetoric of "job-killing health care reform" ironic, if not a bit obscene. Let us have a good outbreak of avian or swine flu, and it won't be jobs that are killed. It will be the people who worked at them.
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