Web Letters: Managing Flu

Philip Alcabe's commentary on the swine flu scare raises important issues that have not been given proper attention. Unfortunately, in a desire to emphasize needed changes to influenza management, he makes the mistake of dismissing traditional approaches and downplaying the very real threat that at some point, we will be visited by a pandemic equal to the Spanish Influenza of 1918.

As a front-line critical care practitioner and researcher on acute respiratory distress syndrome or ARDS (the primary cause of influenza mortality), I would suggest that we need to maintain and strengthen our current approach to influenza management, as well as augment the efforts as outlined by Alcabe. ARDS is a huge problem and even under optimal management circumstances it carries a mortality rate between 25-60 percent.

Frankly, we do not have the surge capacity to deal with a lethal pandemic of ARDS. This includes limited hospital beds and supplies of mechanical ventilators, as well as simple needs such as oxygen delivery devices, pharmaceuticals and intravenous fluid solutions. Furthermore, the combination of clinician work overload, along with the rapid attrition when front-line clinicians themselves become ill, could easily render our advanced technology virtually impotent. Unfortunately, media sensationalism distracts from the debate. To be sure, SARS and Avian flu are real and serious health threats that could easily re-emerge. Dismissiveness of standard practices for influenza abatement does nothing to help our situation.

Richard Kallet, MS RRT FCCM
San Francisco General Hospital

San Francisco, CA