The cure for a good night's sleep

The "Great Influenza" pandemic of 1918 set a standard for medical teamwork between physicians, nurses, and medical ancillary personnel who assisted in the care of the influenza patients, both because of the enormous patient volumes and the need to replace medical staff as they die off in the pandemic.

If your problem is that you fall asleep immediately upon placing your head on the pillow, followed by 8 hours of uninterrupted slumber, let me suggest some summertime reading for you. The Great Influenza: The Story of the Deadliest Pandemic in Human History, by John M. Barry, is the New York Times best-selling description of the birth of science-based medical education and practice in the United States and the challenging flu pandemic shortly thereafter.

The pandemic

In 1918, a new strain of influenza virus created havoc in overcrowded U.S. military camps and troop transports, blunted a German offensive in Europe that might have changed the war, wiped out entire villages in Alaska and Africa, and killed 50 million to 100 million people worldwide. Premodern physicians blamed clouds of bad air (miasma) and recommended treatment with bloodletting, while the medical scientists struggled to determine whether the causative agent was a bacterium (most incorrectly concluded that it was the bacterium known today as Haemophilus influenzae) or a "filterable virus" and searched for a vaccine or antiserum.

The United States was on a wartime footing, and the government chose to suppress information about the pandemic, fearing that it might hurt morale or undermine the war effort. Experts in the nascent field of public health urged steps to limit transmission of the disease, but they were mostly ignored by politicians and military officials. One expert was quoted as saying that the magnitude of the disease threatened the very existence of civilization.

Good news, bad news

The good news is that the pandemic eventually burned itself out, aided in some cases by public health measures. Also, medical research related to the pandemic eventually demonstrated the viral etiology and also demonstrated for the first time that genetic information is passed between microorganisms by DNA and not by proteins (conflicting with conventional wisdom that considered DNA too simple a molecule).

The bad news is that modern molecular genetic techniques on preserved tissue samples have established that the pathogen was not too dissimilar from our contemporary H5N1 "bird flu," and the author convincingly makes the case that we are not much better prepared today (if at all) to withstand such a mutated virus. We currently have a nursing shortage in the United States, the number of hospital beds per capita has decreased (in response to societal demands that we increase efficiency of health care), and most inner-city emergency rooms already are overwhelmed with 6- to 8-hour waits, so no surge capacity is available to respond to a pandemic.

It probably will not be possible to make vaccine rapidly enough. The United States currently only manufactures half the vaccines we need for our citizenry, and it is logical that no other country will export vaccines to us until it has first met the demands of its own population. The World Health Organization, United Nations, and pretty much everybody else says it is not a matter of whether a new pandemic will occur but simply a question of when.

What will happen to ophthalmology practices in the event of a severe pandemic? I expect that most of us will have empty waiting rooms, with only patients who truly have emergent problems willing to seek medical care. Elective surgeries (blepharoplasties, LASIK, cataract extractions, and yes, even Botox injections) will be put on indefinite hold, probably for 6 months at least.

As in 1918, all physicians, nurses, and medical ancillary personnel will be enlisted to assist in the care of the influenza patients, both because of the enormous patient volumes and the need to replace medical staff as they die off in the pandemic.

Enjoy your summer!

Peter J. McDonnell, MD is director of The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, and chief medical editor of Ophthalmology Times. He can be reached at 727 Maumenee Building, 600 N. Wolfe St., Baltimore, MD 21287-9278 Phone: 443/287-1511 Fax: 443/287-1514 E-mail: pmcdonn1@jhmi.edu