What does it look like when a health care system breaks down?

I found this description by Mike Davis on loc 1073 of The Monster Enters helpful for understanding the particular pressures which a pandemic places on the healthcare system. In spite of the tendency to reduce this to a matter of beds within the system, as can be seen in the current conspiracy theory that the NHS crisis in London is fabricated because the raw total of bed occupancy is slightly down on last year, the challenge of a pandemic is much more multifaceted encompassing factors like the capacity to isolate patients, availability of protective equipment and communication between different healthcare actors. I can imagine how this process would break down in a non-linear way, with tipping points where a system stops functioning rather than a gradual and predictable reduction in capacity.

In Hong Kong the hospital system almost broke down because of the lack of infection control in emergency rooms and the shortage of isolation units (single, negative-pressure rooms). In any event, JAMA reported, “neither jurisdiction had enough infection control practitioners and infectious disease specialists.” The distressing spread of SARS among medical personnel, however, was not due to the virus’s super-infectivity, but, rather, to surprisingly widespread failure of hospital staff to adhere to proper protective clothing and standard hygiene (such as simple hand-washing). In both cities, lines of authority were blurred or contradictory, and general practitioners were often left totally in the dark about diagnostic and therapeutic procedures. In the end, the nineteenth century, not the twenty-first, defeated SARS: “containment of SARS relied heavily on application of public health and clinical infection-control measures rooted in nineteenth-century science.”12

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