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  • Keith T. Bishop

Coronavirus - A Shocking Depiction of "What if."

For a chilling account of the 1918-1919 Spanish Flu and how a similar pandemic today risks the stability of America's dysfunctional healthcare system, read these excerpts from my novel The Republican Bond – Returning Negative Yields (January 2016).

Because when yields to society turn negative, creative destruction is sure to follow.

  • Imagine the ACA is repealed and not replaced.

  • Imagine another devastating recession leave millions unemployed and tens of millions uninsured.

  • Imagine the Coronavirus COVID-19 or another future virus becomes the twenty-first century's version of 1918-1919 pandemic flu. It lasts for two full years.

What if?

In Shock How Fast it Happened

Manhattan; Monday, December 10, 2018; 7:14 P.M. EST

In shock how fast it happened, Vanderpool stood bed-side holding her cold limp hand. Coming down with flu Sunday evening, Elaine alerted her father early Monday morning describing her condition. Told she was a Vanderpool, not a Shannon and to tough it out, Elaine waited past sundown to call 911. Short of breath with dangerously low blood pressure, paramedics rushed her to the hospital. Minutes after being admitted to intensive care she started experiencing seizures. Coding, unable to stabilize her, hospital staff frantically performed CPR for forty-five minutes. She took her last breath before her father arrived and was pronounced dead December 10, 2018; 7:14 p.m.; barely twenty-four hours after contracting influenza. In her mid-thirties, healthy and from a prominent family, she would be the first resident of New York City to die of flu that season.

Already reeling from a tanking economy, social unrest, and hostilities across the globe, the United States and the rest of the world were about to experience another shock to the system. It took only days before influenza, a hybrid strain of human, avian, and swine flu touched every corner of the globe. 42 Health officials warned the coming epidemic would be more deadly than the one exactly one hundred years earlier. The great flu pandemic of 1918-1919 took the lives of an estimated thirty to fifty million people worldwide. 43 In those two years, a fifth of the world’s population was infected. This flu was most deadly for people ages twenty to forty, an unusual pattern of morbidity for influenza, which typically kills the elderly and young. It infected 28% of all Americans (Tice) and an estimated 675,000 Americans died, ten times the fatalities of the world war (WWI). Of those U.S. soldiers who died in Europe, half of them fell to the influenza virus and not to the enemy (Deseret News). An estimated 43,000 servicemen mobilized for WWI died of influenza (Crosby). 44

Cited as the most devastating epidemic in recorded world history, more people died in a single year than in four years of the Bubonic Plague from 1347 to 1351. Known as “Spanish Flu” or “La Grippe,” the influenza of 1918-1919 was a global disaster. The flu affected so many that the average life span in the US was depressed by ten years. The influenza virus had a profound virulence, with a mortality rate of 2.5%; previous influenza epidemics were fatal to fewer than 0.1%. The death rate for fifteen to thirty-four-year-olds from influenza and pneumonia was twenty times higher in 1918 than in previous years (Taubenberger). People were struck with the illness on the street and died rapid deaths. One anecdote was told of women playing bridge together late into the night. Three of the women died from influenza that night (Hoagg). Others told stories of people on their way to work suddenly developing flu and dying within hours (Henig). One physician writes that patients with seemingly ordinary influenza would rapidly “develop the most viscous type of pneumonia that has ever been seen;” when cyanosis appeared in the patients, “It is simply a struggle for air until they suffocate,” (Grist, 1979). Another physician recalls that the influenza patients “Died struggling to clear their airways of a blood-tinged froth that sometimes gushed from their nose and mouth,” (Starr, 1976). The physicians were helpless against this powerful agent of influenza. In 1918, children would skip rope to the rhyme (Crawford):

I had a little bird,

Its name was Enza.

I opened the window,

And in-flu-enza. 45

By year end, just three weeks after Elaine’s death, realizing their worst fears were materializing, the Centers for Disease Control desperately sounded alarms. Concerned about the negative effects on the economy, U.S. government officials downplayed the threats, calling the warnings premature and without warrant. Anxious about a deepening recession and remembering that prior concerns such as Severe Acute Respiratory Syndrome (SARS), Swine Flu, Bird Flu, and Ebola had all passed with little effect, the public paid scant attention to health professionals. With 90 million people now uninsured due to political infighting, the perfect storm was forming; soon The Republican Bond’s yields would record fresh lows.

No Magic Bullet

Atlanta, GA; Friday, March 8, 2019; 4:00 P.M. EST

In the executive meeting room, two dozen members of the hospital hierarchy waited patiently for the Governor to join the conference call. Beyond a few whispers, the room was silent until the Governor spoke.

“You have fifteen minutes, be concise,” the head of Georgia opened the conversation.

“Thank you, Governor. This is Stephen Adams, Dean of the Hospital. Mayor, are you still on the line?” Adams wanted to verify.

“Yes, I’m here,” the Mayor responded.

“Good. Governor, Mayor, as forewarned weeks ago, we have reached a tipping point in our ability to serve the community,” the Dean claimed.

“What exactly is the problem?” the Governor snapped.

“The flu pandemic has become a full-blown crisis paralyzing the entire hospital. For three months now, we have faced waves of patients. But it’s not just the number of sick who remain hospitalized for prolonged periods of time; it is the aggressiveness of the virus. In the past few weeks we’ve gone from an incomprehensible death rate of two to three per day to five deaths yesterday,” the Dean informed him.

“Why aren’t you prepared for this, after the millions of dollars in training provided by the state for such events?” the Governor demanded to know.

Interjecting, the Mayor asked, “From my briefings, I thought every hospital in the state had specific policies and procedures in place to handle anything from a terrorist attack to an earthquake.”

“Mayor, this is true. We model our plans after the Western Galilee Hospital in Israel, considered the finest in the world for disaster response. In the case of mass causality incidents such as terrorism or a devastating earthquake, we are prepared to mobilize and care for hundreds and hundreds of wounded. Under those circumstances, we have plenty of hard data to aptly predict what a hospital’s needs are—how many gurneys, beds, ventilators, and pints of blood. We even have a good idea how many people will die, how many will need immediate life-saving care, and the number of wounded that can wait for treatment dependent upon the event. But a human tragedy involving a virus, especially one this lethal, we are utterly ill prepared for. If the appropriate measures are not taken immediately, and not at just this hospital but institutions across the nation, the entire healthcare system will collapse,” the Dean warned.

“Please, Dean Adams,” the Governor pleaded.

“Governor, people around the world are suffering, but none more than here in the United States. I assure you there is not one hospital or emergency care unit in the world capable of handling this pandemic the way we are trying to,” Adams claimed.

“Then what is the solution?” the Governor barked.

“We have to urge people with the flu to remain at home and not seek treatment at their local hospitals,” the Dean told him.

“Are you serious? I can’t tell the public that a hospital is no place for a sick person,” the Governor angrily responded.

“Governor, this is Dr. Benjamin Goldman, the Physician Director of Mass Casualty Preparedness for our Emergency Department. You must understand this is not Ebola. The strain of influenza sweeping the world is a hybrid virus of bird, swine, and human flu. A simple cough or sneeze can spread microorganisms as far as six feet, with germs living on surfaces for up to eight hours. 56 It is extremely contagious; our infection level is approaching thirty percent, the highest in the western world. The mortality rate is above three percent, arguably higher than the pandemic of 1918 – 1919. Do you realize many of the people dying are healthy young adults between the ages of twenty and forty? When they die, they often succumb within twenty-four hours of showing signs of the virus. That’s if they’re lucky. Otherwise, they slowly suffocate over a period of three to four excruciating days as the most vicious form of pneumonia I’ve ever witnessed fills the patient’s lungs with fluids, regardless of treatment.”

“What are the treatment options?” asked the Mayor.

“That’s the problem, there are none; we have no magic bullet—no one does. Besides lots of rest, fluids, and prayer, there is nothing anyone can do. The reality is, most of the people dying will perish regardless of whether they come to the hospital or not. And for the vast majority who survive, they remain extremely sick for days, sometimes weeks, occupying beds needed for more urgent care. To minimize the growing epidemic, we must encourage the public who suffer from flu symptoms to remain at home, not go out in public, and most significantly, refrain from coming to hospitals and infecting others, especially the staff. On a typical day, most hospitals already run at or near full capacity. Unlike a one-off event like terrorism that has a finite life, this is a sustained tragedy; and over the past three months it has exhausted all our resources. And it continues growing by the day, destabilizing the entire healthcare system. Critical staffs like maintenance, food services, and housekeeping are failing to show up for work. Morale is suffering, and the entire organization is reaching a breaking point,” Dr. Goldman informed him.

“I don’t consider hourly workers making nine dollars an hour critical staff. Hire new ones,” insisted the Governor.

“Governor, you don’t—” Dean Adams started, but the Governor cut him off.

“I will not in good conscience tell the insured people of Georgia they will not be cared for in our hospitals. They are already suffering enough with the economic and social crises plaguing the nation,” declaimed the Governor.

“But Governor, unless they are suffering from pneumonia, it is in no one’s best interest to seek medical attention, it only magnifies the health risks,” argued Dr. Goldman.

“Excuse me, doctor. Telling the insured they can’t seek treatment is inhumane,” insisted the Governor.

“Being insured has nothing to do with it, Governor,” countered the Dean.

“Dean Adams, it has everything to do with it. They pay their premiums and deserve care. It is the tens of millions of irresponsible citizens who lack insurance that are overloading the system,” declared the Governor.

“Whose fault is it Governor, that nearly one hundred million people have no access to affordable healthcare? How we deliver basic healthcare for everyone is why we are in this predicament. Insured or uninsured, the people’s expectations are irrational; just look at the rest of the world, virtually every other nation is managing the pandemic significantly better than we are,” snapped Dr. Goldman.

“This is no time to express your discredited political opinion, Dr. Goldman,” the Governor snapped back.

After a few seconds of silence, Dean Adams tried once again to urge the elected officials. “Governor, Mayor, please a statement must be made. Insured or not, the public has been trained just to show up to the emergency room whenever a perceived need occurs. Only this time it’s a tsunami of people who have fallen ill over the last few months. Someone in a leadership position must make a bold statement in the best interests of the general public. We are days, maybe hours away from an inability to provide services to anyone: maternity, heart attacks, cancer, accidents,” a passionate Dean Adams argued.

“Gentlemen, I have all the faith in the world in your abilities to manage the problem. Like most things, this too shall pass. If you have any additional needs, please contact the Lieutenant Governor,” the Governor said as he ended the conference call.

His Worst Fears Realized

Atlanta, Georgia; Tuesday, March 12, 2019; 10:15 A.M. EDT

When he entered the waiting room, Dr. Goldman glanced at the Emergency Room TV monitor blaring to no one. Abandoned thirty-six hours earlier, the scene was staggering. Everywhere he looked filthy, crusted, rumpled hospital blankets were heaped on chairs and corners of couches. Fouled paper towels and saturated tissues, thick with snot, littered the tables and floor. The handle of a fallen mop jutted from a bucket teeming with human excrement and acted as a crude barrier to the main entrance. Sidestepping a spray of vomit, he approached two gurneys abutting a fish tank. The stretchers were piled high with moist, stained pillows and balled-up soiled hospital gowns, obscuring the tank’s windows. He brushed the linens out of the way and peered into the tank. Fish floating on top turned his stomach. Though he was used to seeing ghastly trauma conditions, it was the repulsive smells he could no longer endure; decaying fish, sweat, puke, diarrhea, and urine permeated the air. His worst fears had been realized; beyond the ICU ward, his hospital was a wasteland.

They had battled critical staff shortages for nine weeks. When word spread that ER Nurse Allison Sanders, a mother of three, died early Saturday evening within twenty-four hours of contracting influenza, and another hospital employee from housekeeping was in ICU with pneumonia and encroaching cyanosis, it was the hospital’s last gasp. Within hours, few able bodies in maintenance, housekeeping, food services, or admissions were present; by Sunday morning there were none.

In a heartbeat, the Atlanta facility’s implosion went viral. Healthcare centers in Boston, New York, Charlotte, Tampa Bay, Cincinnati, Chicago, Kansas City, Minneapolis, Fargo, Denver, Little Rock, Dallas, El Paso, Tucson, Los Angeles, Sacramento, Portland, and Seattle faced similar fates. By day’s end, regardless of size, no city or healthcare organization was spared. Nearly 2,000 of the country’s approximately 5,700 registered infirmaries 57 ceased servicing their communities.

Instantly millions found themselves, insured or not, unable to seek medical treatment as healthcare capacity was sliced 40% overnight. The elite however, flush with cash, assets, and connections maintained their healthcare services. It would be only days before bond holders declared a credit event, demanding immediate positive returns on The Republican Bond—or else.

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