Sick or Swim

UPDATE: Click here for breaking news about swine flu on Slog.

I s it time to panic? As The Stranger went to press,
only 67 U.S. cases of swine flu had been confirmed; however, that
number was escalating rapidly. Meanwhile, in Mexico, swine flu had
sickened an estimated 1,600 people and killed an estimated 152. And on
Monday, April 27, the World Health Organization raised its pandemic
alert level to 4, signaling “a significant increase in risk of a
pandemic.”

To deal with staggering budget shortfalls, city, state, and county
governments are cutting back on everything, including funding for
health care. At the same time, thousands upon thousands of newly
unemployed people are finding themselves without health insurance. It’s
a perfect storm waiting to happen.

On April 27, county health officials briefed the King County Council
on the county’s preparations for a pandemic. Afterward, council chair
Dow Constantine said he was “reassured to know that we have a plan and
that the plan’s being executed.” (The plan involves stockpiling
Tamiflu, developing a public education campaign, creating a
communications network, and adding hospital beds.) However, he added,
“Clearly, even the best public health department is not going to be
able to stop a virus from spreading in a world that’s as mobile as
ours.” He added: “The problem here is that a lot of communicable
disease and epidemiology funding is subject to getting cut.”

Health care isn’t just getting cut—it’s being decimated. Last
year, the county adopted
a budget that slashed $11.3 million from
public health. Along with another $8.2 million in “lifeboat” funding
that was secured only through June, that’s more than $20 million in
reductions to the county’s public-health safety net. Most of those cuts
affect things like family planning, child health care, and TB
prevention—you know, trivial stuff—but the programs being
cut also include public health clinics, communicable-disease testing,
and immunizations.

James Apa, spokesman for the King County health department, says the
“good news” is that “there was some foresight in funding for emergency
response in situations just like this.” The bad news? “It takes
resources to sustain the level of preparedness we have now.” In other
words, if the pandemic hits now, we may—may—be
ready. If it hits in a couple of years—when, according to the
adopted county budget, the risk to public health “as a result of the
lack of financing [will be] significant and unacceptable”—those
without health care may be on their own.

“The cuts mean that, in the future, we will no longer be able to
plan as comprehensively as we did this time,” says county council
member Julia Patterson, who chairs the King County Board of Health.
“This is a perfect example of why we need to adequately fund our public
health-care system.” This year, the state legislature declined to give
the county additional tools to pay for public health.

With Washington’s unemployment rate nearing 10 percent, thousands
are out of work and without health care. Under the budget adopted by
state legislators this week, some 35,000 low-income people will lose
their state-
funded health insurance, leaving nearly a million
state residents with no health care by 2010. The budget also includes
less money for nursing homes, fewer state-paid hours for home
health-care workers, and fewer workers at hospitals and clinics.

“You have all these people losing their health coverage, and they
have to make the tough decision between paying their mortgage and going
to the doctor,” says Rebecca Kavoussi, assistant vice president of
government affairs for the Community Health Network of Washington,
which works with more than 130 clinics around the state.

And the “safety net” Washington has in place is beginning to
disintegrate. Without health care, free and low-cost clinics will be
flooded with new patients who are unable to pay, upsetting an
already-delicate balance between paying patients and the uninsured.

The City of Seattle, for its part, has been preparing for a
catastrophic event for years. But the city’s last big emergency
response—to several weeks of snowfall—was an abysmal
failure that still has city officials scrambling to cover their
asses.

“So far, we’re keeping it low-key, because we don’t know what
kind of risk we’re going to have here,” says city council president
Richard Conlin, who heads up the council’s emergency-preparedness
committee. According to Conlin, the city has an emergency hospital that
can be set up at Seattle Center in about four hours. However, that
facility only has space for about 300 beds. That, plus the 500 beds the
county has said it can provide, makes 800 additional beds.

King County has between 3,500 and 4,000 hospital beds; on any given
day, 90 percent of them are full. If more than a few of the 540,000
county residents officials estimate could be sickened in a pandemic
need to go to the hospital, they’ll quickly find they don’t have
anywhere to go. “If we’re facing a serious pandemic, we have protocols
for how to deal with it, but it’s going to be really difficult,” Conlin
says.

As for what residents can do to deal with the possibility of a
pandemic, health officials recommend stocking up on water and
nonperishable food (a two-week supply is good), staying home if you’re
sick, washing hands frequently, and letting public health officials
know about suspected outbreaks.

Barb Graff, director of the city’s Office of Emergency Management,
says she hopes people will stay home if they’re sick. But she
acknowledges, “There are a lot of people who feel if they stay home,
they could lose their jobs. An economic backdrop like we’re
experiencing makes any cascading thing more difficult.”

This story has been updated since its original publication.