at a deficit. See John G. Bartlett and Luciano Borio, “The Current Status of Planning for Pandemic Influenza and Implications for Health Care Planning in the United States,” Clinical Infectious Diseases 46 (Mar. 15, 2008): 919-25.
114 Hospitals have been closing: Neil A. Halpern, Stephen M. Pastores, and Robert J. Greenstein, “Critical Care Medicine in the United States 1985-2000: An Analysis of Bed Numbers, Use, and Costs,” Critical Care Medicine 32, no. 6 (June 2004): 1254-59. Between 1993 and 2003, the United States saw a net loss of 703 hospitals, or 11 percent, and a decline in inpatient beds of 198,000 or 17 percent. See American Hospital Association figures cited in Institute of Medicine, Hospital-Based Emergency Care: At the Breaking Point (Washington: National Academies Press, 2007), 38. Sixty percent of U.S. hospitals reported in 2001 that they were operating at or over capacity. See the Lewin Group, Emergency Department Overload: A Growing Crisis, the results of the AHA Survey of Emergency Department (ED) and Hospital Capacity.
114 vacant ICU beds were rare: Lewis Rubinson et al., “Augmentation of Hospital Critical Care Capacity After Bioterrorist Attacks or Epidemics: Recommendations of the Working Group on Emergency Mass Critical Care,” Critical Care Medicine 33, no. 10 (2005): 2392-2403. In a severe pandemic, the demand for these ICU beds could outstrip capacity by nearly five times. See Eric Toner et al., “Hospital Preparedness for Pandemic Influenza,” Biosecurity and Bioterrorism 4, no. 2 (2006): 207 -14. Even in a moderately severe outbreak, half the states would run out of hospital beds within two weeks. See Trust for America’s Health, Ready or Not? Protecting the Public’s Health from Diseases, Disasters and Bioterrorism, Dec. 2006.
114 a severe nursing shortage: See Elizabeth Daugherty, Richard Branson, and Lewis Rubinson, “Mass Casualty Respiratory Failure,” Current Opinion in Critical Care 13, no. 1 (Feb. 2007): 51-56; Derek C. Angus et al., “Current and Projected Workforce Requirements for Care of the Critically Ill and Patients with Pulmonary Disease,” Journal of the American Medical Association 284, no. 21 (Dec. 6, 2000): 2762-70; Mark A. Kelley et al., “The Critical Care Crisis in the United States: A Report from the Profession,” Chest 125 (2004): 1514-17; Gary W. Ewart et al., “The Critical Care Medicine Crisis: A Call for Federal Action,” white paper from the Critical Care Professional Societies, Chest 125 (2004): 1518-21; and J. K. Stechmiller, “The Nursing Shortage in Acute and Critical Settings,” AACN Clinical Issues 13, no. 4 (Nov. 2002): 577-84. The nationwide shortage of nurses has been estimated at between 100,000 and 291,000. All but ten states had a shortage of registered nurses in 2006. See John G. Bartlett and Luciano Borio, “The Current Status of Planning for Pandemic Influenza and Implications for Health Care Planning in the United States,” Clinical Infectious Diseases 46 (Mar. 15, 2008): 919-25; and Trust for America’s Health, Ready or Not? Protecting the Public’s Health from Diseases, Disasters and Bioterrorism, Dec. 2006.
114 Emergency rooms are being shuttered: Eric W. Nawar, Richard W. Niska, and Jianmin Xu, “National Hospital Ambulatory Medical Care Survey: 2005 Emergency Department Summary,” advance data from Vital and Health Statistics, no. 386, June 29, 2007. For a comprehensive overview of the crisis facing U.S. emergency departments, see Institute of Medicine, Hospital-Based Emergency Care: At the Breaking Point (Washington: National Academies Press, 2007). According to figures from the American Hospital Association cited in the IOM report, the number of hospitals with emergency departments declined by 425 over the decade ending in 2003.
114 departments were routinely overcrowded: “State of Emergency Medicine: Emergency Physician Survey,” American College of Emergency Physicians, October 2003. Sixty-two percent of U.S. hospitals surveyed in 2001 said their emergency departments were operating at or over capacity. For large hospitals and those offering the most advanced trauma care, the percentage increased to about 90 percent. See the Lewin Group, Emergency Department Overload: A Growing Crisis, results of the AHA Survey of Emergency Department (ED) and Hospital Capacity, Apr. 2002. As the IOM writes, “In many cities, hospitals and trauma centers have problems dealing with a multiple-car highway crash, much less the volume of patients likely to result from a large-scale disaster.” Institute of Medicine, Hospital-Based Emergency Care, 265.
114 once every single minute: Catharine W. Burt, Linda F. McCaig, and Roberto H. Valverde, “Analysis of Ambulance Transports and Diversions Among U.S. Emergency Departments,” Annals of Emergency Medicine 47, no. 4 (2006): 317-26. See also Sally Phillips, “Current Status of Surge Research,” Academic Emergency Medicine 13 (2006): 1103-8.
114 hospital executives were too preoccupied: “Emergency Preparedness: States are Planning for Medical Surge, but Could Benefit from Shared Guidance for Allocating Scarce Medical Resources,” U.S. Government Accountability Office, June 2008.
114 decreased 18 percent: Ibid.
114 producers of medical oxygen: Michael D. Christian et al., “Definitive Care for the Critically Ill During a Disaster: Current Capabilities and Limitations,” Chest 133, no. 5 (May 2008): 8S-17S.
114 tremendous shortage of ventilators: Ibid.; and Isaac Weisfuse, “Summary Background on Hospital Pandemic Preparedness in NYC,” in Beth Maldin-Morgenthau et al., “Roundtable Discussion: Corporate Pandemic Preparedness,” Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science 5, no. 2 (2007): 171.
115 about 740,000 people would require ventilation: “States are Planning for Medical Surge,” U.S. Government Accountability Office, June 2008.
115 between 53,000 and 105,000: Michael T. Osterholm, “Preparing for the Next Pandemic,” NEJM 352, no. 18 (May 5, 2005): 1839-42; and Elizabeth Daugherty, Richard Branson, and Lewis Rubinson, “Mass Casualty Respiratory Failure,” Current Opinion in Critical Care 13, no. 1 (Feb. 2007): 51-56. A study by New York State found that even in a moderate pandemic, there would be a state-wide shortfall of 1,256 ventilators. In a severe pandemic, the total demand for ventilators in peak weeks would run to 17,844, almost three times the existing capacity. See NYS Working Group on Ventilator Allocation in an Influenza Pandemic, NYS DOH/NYS Task Force on Life and the Law, “Allocation of Ventilators in an Influenza Pandemic: Planning Document,” Mar. 15, 2007.
115 the Spanish flu’s victims: David M. Morens, Jeffrey K. Taubenberger, and Anthony S. Fauci, “Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness,” Journal of Infectious Diseases 198, no. 7 (Oct. 1, 2008): 962-70; Jonathan A. McCullers, “Planning for an Influenza Pandemic: Thinking Beyond the Virus,” Journal of Infectious Diseases 198, no. 7 (Oct. 1, 2008): 945-47; and John F. Brundage and G. Dennis Shanks, “Deaths from Bacterial Pneumonia During 1918-1919 Influenza Pandemic,” Emerging Infectious Diseases 14, no. 8 (Aug. 2008): 1193-99.
115 80 percent of all prescription drugs: Michael T. Osterholm, “Unprepared for a Pandemic,” Foreign Affairs, Mar.-Apr. 2007.
115 “interconnectedness of the global economy”: Ibid.
116 would run short on everything: Michael T. Osterholm, “Preparing for the Next Pandemic,” Foreign Affairs, July-Aug. 2005.
116 an unpublicized conference call: Personal notes of conference call, Jan. 15, 2004.
116 an article for Science: Richard J. Webby and Robert G. Webster, “Are We Ready for Pandemic Influenza?” Science 302, no. 5650 (Nov. 28, 2003): 1519-22. Webster also raised concerns in 2003 in Robert G. Webster and Elizabeth Jane Walker, “Influenza,” American Scientist 91, no. 2 (Mar.-Apr. 2003): 122.
116 “Klaus was very excited”: Interview with Dick Thompson.
117 “Hitoshi suddenly came alive again”: Interview with Peter Cordingley.
118 The cases continued to come: WHO: “Preliminary Clinical and Epidemiological Description of Influenza A (H5N1) in Vietnam,” Feb. 12, 2004; Tran Tinh Hien et al., “Avian Influenza A (H5N1) in 10 Patients in Vietnam,” NEJM 350, no. 12 (Mar. 18, 2004): 1179-88; and Pham Ngoc Dinh et al., “Risk Factors for Human Infection with Avian Influenza A H5N1, Vietnam 2004,” Emerging
