Progress for tomorrow: Preparing for the next disaster
HEALY: Now, from a public health point of view, suppose there is an outbreak on the campus. Can you send other students home? They're getting on airplanes and they're going all over the country.
BENJAMIN: Well, you know, public health authorities are going to make some decisions about whether people can leave or not. I mean, they'll do, obviously, a disease investigation.
One of the challenges we will have on a campus that large, at least early on, is trying to do some contact tracing, although that's going to go away pretty quickly. I'm not even sure contact tracing is actually going to happen in a pandemic situation, or even early on. There may not be very much of it. But it may turn out that the public health authorities have to shut down the campus but decide who can leave and who cannot leave, and they may have to put people either in isolation who are sick and who are quarantined in some kind of situation - and as Art said, someone is going to have to figure out how to take care of them.
HEALY: All right, now – okay, our young – our 22-year-old or 21-year-old is on a campus. They've had an episode of pandemic flu - you know, small cluster, one dormitory. Do you put all the other students and faculty and everyone on Tamiflu?
INGLESBY: If this is the first case in the country –
HEALY: No, no, no, we don't know yet.
INGLESBY: We don't know yet.
HEALY: You have to make a decision.
INGLESBY: So this is the suspected first case in the country?
HEALY: Yes. We called the CDC or we called Dr. Kellerman and he said, well, you know, the CDC is worried there may be one or two other outbreaks; we're not sure.
INGLESBY: On the books I think the policy right now is to use Tamiflu and antivirals for people who are sick, but I think if you actually had that singular circumstance where you thought you had the first one or two people identified, I think the policy would be to surround them with as much Tamiflu and try and prevent the spread.
I don't think most public health experts think that's the likely way for it to happen. I think we will discover it in our midst, more likely, but I think – if it was your scenario I think it's possible we would try and stamp it out. That's certainly one of the plans for Southeast Asia – we find some localized areas of person-to-person spread and millions of Tamiflu doses will be flown into the area.
HEALY: Dr. Kellerman, in the emergency room?
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KELLERMAN: If you have it, or if you can get it, and if it's effective, none of which any university or system knows today. I mean, we're all struggling with do you rely, as you said, on the government to send a push-pack? Maybe you don't. Do you try to order it on your own – thank you very much, will ship in two years when we get around to your order. Two years from now is it actually going to be effective or is this virus going to be resistant to it? It's a very, very tough bet. As Walt Orenstein, a former head of the National Immunization Program at CDC said, there is only one right answer to this epidemic: Do nothing and have nothing happen. That's not acceptable to most planners. So we're going to make our best guess and do the best we can and hope it's good enough.
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