I’ve watched a few episodes of “Doomsday Preppers,” and I’m always struck by the myriad ridiculous ways these people think the world will end. For years I’ve had my own apocalyptic concern, and the folks on my side (unfortunately) are supported by science, PhDs and fancy letters after their names, rather than assault weapons, bug-out bags and suffixes like “Jr.” But, ridiculous or not, there isn’t much you can do about world-ending events — other than pandemics.
If you look at all the factors that put a population at heightened risk for the spread of flu, illness and infectious diseases, Aspen scores pretty highly in migratory categories.
Just over 220,000 people flew out of Sardy Field in 2012. The sanitation district estimated from water usage that the number of people in Aspen on a single day in 2011 peaked at over 15,000 on Dec. 30. SkiCo recorded just over 1.3 million skier visits for the 2011-12 season. These numbers will rise, with enplanements at Sardy Field expected to grow 9 percent by 2017. That’s a lot of people, and a lot of them are foreign.
Certain factors amplify the spread of illness. Cruise ships are a commonly used example. Aspen is in no way a cruise ship, but it is a place where people from all over the world come and mingle for extended periods of time, and as such, a pretty good amplifier for illness. It’s an inherent risk in any place with high volumes of tourists.
And that’s just the tourists. I’ve asked a lot of people their plans for the off-season and the answers so far span 17 countries, including Mexico, Sri Lanka, Ireland, Costa Rica, Serbia, The Netherlands, The Bahamas, Italy, Spain, Germany and Nicaragua.
A sneeze at the airport in Sri Lanka can be in Aspen in under 24 hours. It’s real. It happens. The city and county recognize it. The Pitkin County Emergency Operations Plan contains “Emergency Support Function No. 8 — Public Health and Medical Services Annex,” dealing specifically with public health emergencies.
If you know nothing about the spread of infectious diseases and the threat of pandemics, you might want to keep it that way: It’s one topic where ignorance really is bliss. The World Health Organization website states: “When it happens, the first influenza pandemic of the 21st century could have potentially catastrophic consequences for human life, health, and the world economy.” (Note the use of “When.”)
Influenza is ever changing. The big concern is that it will morph into a strain against which the immune system has little defense. There are numerous examples of this through history. The Spanish Flu pandemic of 1918 infected an estimated one-third of the world’s population and killed over 40 million people in 18 months. Spanish Flu is similar to the current Influenza A virus subtype H1N1, or swine flu. Bird flu, or H5N1, doesn’t easily infect humans but kills about 60 percent of those it does, versus the Spanish Flu, which killed about 10 to 20 percent of infected people, but spread with ease. A virologist’s — and everyone else’s — worst nightmare is a strain of flu with the severity of bird flu that spreads easily, such as via airborne droplets from a cough or sneeze, like the common cold.
This only sounds like fear mongering until it happens.
There is presently much debate about the hospital expansion. Most of the criticism touches on whether it is too big, and many local letter-to-the-editor writers have stressed that it will be a big expense, yielding little to no increase in the range of hospital services.
A recent letter to the editor by AVH emergency physician Dr. Greg Balko addressed many of these issues (“Hospital expansion from the inside,” Aspen Daily News, April 13). What really caught my attention was his description of the negative-pressure isolation room, and the lack of a decontamination area. So I took a brief tour of the emergency department and spoke to Dr. Balko about AVH’s ability to deal with infectious disease and epidemics.
Presently, AVH doesn’t “have much of anything” to deal with an epidemic, Balko said. It’s easy to believe when you see what ER staff refer to as the “hallway of curtains,” a situation offering little protection from the spread of viruses.
Decontamination generally involves stripping infected people, washing them and dressing them in a protective suit. The person then is placed back in the ER in isolation, with a separate ventilation system, observed and treated.
But at AVH, staff would have to set up a temporary decontamination area outside, near the ER, said Balko. It’s a time consuming process involving portable tents and showers, and can be complicated by weather factors.
The contaminated water from the shower would not be treated, as there is no infrastructure to deal with it, and would run off down the road (and likely into the rivers). The process would not be climate controlled, possibly complicating a person’s medical condition.
AVH’s current isolation room is to the side of the entrance, through a separate door and out of sight. It’s not the worst scenario for a single sick person, but with multiple and continuous cases, it inevitably would fail. A facility like AVH might end up hosing down folks in the parking lot. Then the patients would be placed back into the ER. But with only one isolation room, the infected would be placed back into contact with staff and other patients — protected by only face masks. And this is how a few cases of new flu could create a town infected.
Balko said one of his big concerns regarding the current facility is “a pandemic turning up on our doorstep.” He said that while he has every confidence in AVH staff, it’s the facility that worries him. The expansion would add another three negative-pressure isolation rooms, along with private patient rooms. These aren’t luxuries pandering to privacy concerns, but a necessary safety measure (which, as luck would have it, also addresses privacy issues).
I don’t think it matters in what order the work is done.
Much of the work in phases one and two addressed broader needs, such as heating, ventilation and mechanical systems, which benefit the entire facility, according to Ginny Dyche, AVH director of community relations. From the labs to admissions, it is all critical work, she said.
So in terms of wants versus needs, it’s clear phases three and four contain many indisputable needs. The hospital has asked for a continuance of tonight’s planned public hearing to address issues raised by the public. But, when it happens, I would ask those at the hearing to take into account the insufficiencies of the current ER, and urge council to move the project forward.
Contact Christian at firstname.lastname@example.org.