Seriously, Reopen the Government or a Pandemic Could Kill Us All

Like the military, the CDC protects us from outside threats. So why is it so severely furloughed?

What would happen if a H1N1 (swine flu) pandemic occured during the shutdown?
National Journal
Brian Resnick
Oct. 15, 2013, 7:31 a.m.

When Re­pub­lic­ans were talk­ing about re­open­ing the gov­ern­ment piece by piece, cer­tain very vis­ible or emo­tion­ally charged pro­grams rose to the top. Es­pe­cially emo­tion­al was a dis­cus­sion about re­open­ing the na­tion­al parks and me­mori­als. Many con­ser­vat­ives, who came out in full force this last week­end, said that the met­al bar­ri­cades dis­honored the dead. Sim­il­arly, the week be­fore, there were cries to re­fund the Na­tion­al In­sti­tutes of Health to en­sure that young can­cer pa­tients were put on ex­per­i­ment­al treat­ments.

What was left out of the dis­cus­sions was the Cen­ters for Dis­ease Con­trol and Pre­ven­tion.

“To me, the CDC and in­fec­tious-dis­ease mon­it­or­ing is to the mil­it­ary what a hos­tile en­emy threat is,” Gregory Po­land, an in­fec­tious-dis­ease ex­pert at the Mayo Clin­ic. “We don’t fur­lough our mil­it­ary and say, ‘Well, we won’t just have any na­tion­al se­cur­ity un­til the Con­gress gets its act to­geth­er.’ But why aren’t we will­ing to save something that could cost just as many lives?”

When it comes to data, we already have a na­tion­al­ized health care sys­tem. The CDC provides dis­ease-track­ing ser­vices that no oth­er agency or private en­tity does. The CDC is the agency that makes the judge­ment call about what flu vac­cines to dis­trib­ute across the na­tion. Without the CDC, we have no real-time track­ing of dis­ease out­breaks. It mon­it­ors high-se­cur­ity labs that do tests on deadly patho­gens like an­thrax. It col­lab­or­ates across in­ter­na­tion­al bor­ders to stop out­breaks.

“That’s what CDC does, and we have no oth­er agency to do it,” Po­land says.

So while the clos­ing of the WWII me­mori­al of­fends, the clos­ing of the CDC could kill.

Po­land fur­ther ex­plains the con­sequences, in this lightly ed­ited in­ter­view.

How is the coun­try’s pro­tec­tion against dis­ease out­breaks di­min­ished dur­ing the shut­down?

The is­sue isn’t really only for flu, but for a vari­ety of in­fec­tious dis­eases, we don’t have real-time sur­veil­lance. Hence, we lose a situ­ation­al aware­ness, or in­tel­li­gence about what’s hap­pen­ing. Re­mem­ber, CDC has [fur­loughed] 9,000 work­ers; they’ve got about 4,000 left. Ima­gine try­ing to do your job with two-thirds less re­sources.

They are re­spons­ible for put­ting to­geth­er the in­form­a­tion they get from in­di­vidu­al states in­to a co­hes­ive pic­ture. We don’t have that abil­ity. They are re­spons­ible for mon­it­or­ing what’s hap­pen­ing in­ter­na­tion­ally and what could be im­por­ted in­to the U.S. We don’t have that cap­ab­il­ity. We can’t fol­low flu out­breaks, we can’t se­quence vir­uses.

[The shut­down] really does put us at risk. In terms of in­flu­enza, it puts us at risk from sev­er­al points of view. No. 1, we don’t know what’s hap­pen­ing na­tion­ally. All we can do is de­pend on what in­di­vidu­al states re­port. Many of the state-level pub­lic health de­part­ments are un­der­fun­ded and un­der­staffed. We don’t have the abil­ity to se­quence vir­uses and real­ize — whoops — sud­denly a nov­el vir­us, like a new pan­dem­ic vir­us has popped up. We would have delayed-re­cog­ni­tion of that. We might not have the abil­ity to de­term­ine wheth­er any of the vir­uses cir­cu­lat­ing are res­ist­ant to any of the an­ti­vir­als we have. That in­form­a­tion is im­port­ant to get out to phys­i­cians, so they can treat — let’s say you have a young child or a preg­nant wo­man on a vent­il­at­or due to com­plic­a­tions of in­flu­enza.

Are there no private agen­cies do­ing sim­il­ar re­search as the CDC?

Let me try to give you an ana­logy. In terms of any, in­stead of in­fec­tious dis­ease let’s say a crime threat. You prob­ably have a pretty good idea about what’s hap­pen­ing in your neigh­bor­hood. You have no idea of what’s hap­pen­ing a hun­dred miles away in the next-biggest city. And you don’t have any idea what’s hap­pen­ing in the state next to you.

The only way you would have that pic­ture of what’s hap­pen­ing, what the threat is, is be­cause some en­tity re­spons­ible for piecing to­geth­er all of those pieces would be do­ing their job. That’s what CDC does, and we have no oth­er agency to do it. We only have state pub­lic health labs. And they are simply not staffed and don’t, es­pe­cially the small ones, have the ex­pert­ise to do this. They don’t have any real way to share in­form­a­tion across states. CDC is that co­ordin­at­ing body.

To me, the CDC and in­fec­tious-dis­ease mon­it­or­ing is to the mil­it­ary what a hos­tile en­emy threat is. We don’t fur­lough our mil­it­ary and say, “Well, we won’t just have any na­tion­al se­cur­ity un­til the Con­gress gets its act to­geth­er.’ But why aren’t we will­ing to save something that could cost just as many lives? Why are we will­ing to do that for in­fec­tious dis­ease threats?

How does the shut­down im­pact your op­er­a­tions at the Mayo Clin­ic?

It prob­ably has the same im­pact for us as it does any med­ic­al cen­ter, and that is, we’re not go­ing to be get­ting na­tion­al in­tel­li­gence about what’s go­ing on. We’ll know what’s go­ing on in our area. But we serve a na­tion­al and in­ter­na­tion­al pop­u­la­tion and we won’t have up to the minute data.

We’re talk­ing in dra­mat­ic terms. Is any of this over­stated?

Let me take you back to Feb­ru­ary 2009. Out of nowhere, a few un­usu­al res­pir­at­ory ill­nesses in a rur­al part of Mex­ico, and then a few of those cases in Texas, and then a bunch of those cases in the North­east states. With­in a couple of weeks, CDC in­vest­ig­ates, se­quences the vir­uses and pushes the but­ton. “Na­tion: We’ve got a nov­el pan­dem­ic vir­us.” What would hap­pen if that happened now? There would be delayed re­cog­ni­tion, thou­sands more would get ill, would die. we would be fly­ing blind. It would be delayed de­vel­op­ment of a vac­cine to cov­er it, we wouldn’t know what an­ti­vir­als to use.

The oth­er thing could hap­pen too. The sea­son just kind of ped­als along — no new vir­uses no sur­prises, no new vir­uses or in­fec­tious dis­ease threats any­where in the world. And the shut­down re­solves and we’re a little be­hind on next year’s vac­cines. We’re some­where in that spec­trum.

How is the country's protection against disease outbreaks diminished during the shutdown?

The is­sue isn’t really only for flu, but for a vari­ety of in­fec­tious dis­eases, we don’t have real-time sur­veil­lance. Hence, we lose a situ­ation­al aware­ness, or in­tel­li­gence about what’s hap­pen­ing. Re­mem­ber, CDC has [fur­loughed] 9,000 work­ers; they’ve got about 4,000 left. Ima­gine try­ing to do your job with two-thirds less re­sources.

They are re­spons­ible for put­ting to­geth­er the in­form­a­tion they get from in­di­vidu­al states in­to a co­hes­ive pic­ture. We don’t have that abil­ity. They are re­spons­ible for mon­it­or­ing what’s hap­pen­ing in­ter­na­tion­ally and what could be im­por­ted in­to the U.S. We don’t have that cap­ab­il­ity. We can’t fol­low flu out­breaks, we can’t se­quence vir­uses.

[The shut­down] really does put us at risk. In terms of in­flu­enza, it puts us at risk from sev­er­al points of view. No. 1, we don’t know what’s hap­pen­ing na­tion­ally. All we can do is de­pend on what in­di­vidu­al states re­port. Many of the state-level pub­lic health de­part­ments are un­der­fun­ded and un­der­staffed. We don’t have the abil­ity to se­quence vir­uses and real­ize — whoops — sud­denly a nov­el vir­us, like a new pan­dem­ic vir­us has popped up. We would have delayed-re­cog­ni­tion of that. We might not have the abil­ity to de­term­ine wheth­er any of the vir­uses cir­cu­lat­ing are res­ist­ant to any of the an­ti­vir­als we have. That in­form­a­tion is im­port­ant to get out to phys­i­cians, so they can treat — let’s say you have a young child or a preg­nant wo­man on a vent­il­at­or due to com­plic­a­tions of in­flu­enza.

Are there no private agencies doing similar research as the CDC?

Let me try to give you an ana­logy. In terms of any, in­stead of in­fec­tious dis­ease let’s say a crime threat. You prob­ably have a pretty good idea about what’s hap­pen­ing in your neigh­bor­hood. You have no idea of what’s hap­pen­ing a hun­dred miles away in the next-biggest city. And you don’t have any idea what’s hap­pen­ing in the state next to you.

The only way you would have that pic­ture of what’s hap­pen­ing, what the threat is, is be­cause some en­tity re­spons­ible for piecing to­geth­er all of those pieces would be do­ing their job. That’s what CDC does, and we have no oth­er agency to do it. We only have state pub­lic health labs. And they are simply not staffed and don’t, es­pe­cially the small ones, have the ex­pert­ise to do this. They don’t have any real way to share in­form­a­tion across states. CDC is that co­ordin­at­ing body.

To me, the CDC and in­fec­tious-dis­ease mon­it­or­ing is to the mil­it­ary what a hos­tile en­emy threat is. We don’t fur­lough our mil­it­ary and say, “Well, we won’t just have any na­tion­al se­cur­ity un­til the Con­gress gets its act to­geth­er.’ But why aren’t we will­ing to save something that could cost just as many lives? Why are we will­ing to do that for in­fec­tious dis­ease threats?

How does the shutdown impact your operations at the Mayo Clinic?

It prob­ably has the same im­pact for us as it does any med­ic­al cen­ter, and that is, we’re not go­ing to be get­ting na­tion­al in­tel­li­gence about what’s go­ing on. We’ll know what’s go­ing on in our area. But we serve a na­tion­al and in­ter­na­tion­al pop­u­la­tion and we won’t have up to the minute data.

We're talking in dramatic terms. Is any of this overstated?

Let me take you back to Feb­ru­ary 2009. Out of nowhere, a few un­usu­al res­pir­at­ory ill­nesses in a rur­al part of Mex­ico, and then a few of those cases in Texas, and then a bunch of those cases in the North­east states. With­in a couple of weeks, CDC in­vest­ig­ates, se­quences the vir­uses and pushes the but­ton. “Na­tion: We’ve got a nov­el pan­dem­ic vir­us.” What would hap­pen if that happened now? There would be delayed re­cog­ni­tion, thou­sands more would get ill, would die. we would be fly­ing blind. It would be delayed de­vel­op­ment of a vac­cine to cov­er it, we wouldn’t know what an­ti­vir­als to use.

The oth­er thing could hap­pen too. The sea­son just kind of ped­als along — no new vir­uses no sur­prises, no new vir­uses or in­fec­tious dis­ease threats any­where in the world. And the shut­down re­solves and we’re a little be­hind on next year’s vac­cines. We’re some­where in that spec­trum.

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