Pandemic Disruption of Essential Services and Supplies
By Grattan Woodson, MD, FACP
The 1918 Spanish Flu Pandemic appears to be the most relevant historical model for gauging how a severe bird fu pandemic might affect our society. John Barryâ€™s 2004 book, The Great Influenza, is an excellent source for information about this event. A major difference between then and now is that we are at much greater risk today because the worldâ€™s population is 3 times greater, and is much more concentrated in urban areas. Whatâ€™s more, most Americans like many in the developed world are entirely dependent on outside sources for just about everything we consume including food, water, and electrical power. Even folks who live in rural America buy most of their food in grocery stores and depend upon an intact electrical power grid to operate their well pump for water. This makes us more vulnerable to effects of a breakdown in our commercial and civil infrastructure than we were in 1918 when we were more self-reliant.
Many commentators and some public officials are tragically confused regarding this very point. They say our technologically advanced civilization we will be less vulnerable to a severe influenza pandemic than in the past. This mistaken opinion is founded on the notion that our economic and social structure is not subject to collapse, when in truth it is a virtual â€œhouse of cardsâ€. In fact the more â€œadvancedâ€ our civilization has become the more vulnerable it is, because of its higher complexity. Simpler less complex social structures are at much lower risk of disruption. While commentators in the media will inform us that we have â€œnothing to fearâ€ because of the prowess of our healthcare system and our mighty technocratic society compared to the relative primitives of 1918, donâ€™t believe a word of it. Every time I hear them say, â€œdonâ€™t panic, there is nothing to worry aboutâ€ I get more concerned and prepare all the harder. 1
The unintended consequence of increasing interdependence
The provision of these essential goods and services to cities requires the highly coordinated efforts of a large number of people, many of whom are specialists in their field of endeavor and cannot be replaced easily. During a major pandemic, economically critical activities are likely to be interrupted by widespread illness and death among the working population or their family members as occurred in 1918.
The interdependent nature of modern society increases the risk that a systematic failure could occur. This can happen if one or two fundamental economic resources failed resulting in a domino effect precipitating the collapse of other key but dependent commercial and industrial segments of the economy. In other words, a failure of one critical system leads to the failure of another and so on until the entire system collapses. Taken together, these factors could result in the temporary disruption in the delivery of basic supplies and services we all now take for granted. The resulting chaos might be accompanied by a period of civil unrest especially within large urban centers.2,3
When viewed from this prospective, our modern advanced society and economic structure would seem to be at greater risk from an influenza pandemic than its more primitive ancestor 100 or more years ago. The increased vulnerability is almost certainly far more detrimental than the benefits derived by advances we have made over this same time.
Help from outside is unlikely
Once the pandemic begins there will be no help from any outside source. This is one of the primary warnings to local governments by the US Department of Homeland Security in a report on pandemic planning and preparedness released in May 2006.4 The reason for this is that modern modes of human transportation will bring the pandemic viral strain to every region of the developed and undeveloped world at about the same time.
Unlike hurricane or earthquake relief efforts, there will be no unaffected states or countries available to send help. In a major pandemic the medical systems of every country will be rapidly stretched to the breaking point, unable to treat even a fraction of their own citizens seriously ill with the virus. There will be no antivirals or vaccines available to most people. Even cold medications, regular antibiotics, and routine medical supplies like syringes and gloves could become scarce. It is true that patients becoming ill at the very beginning of the first pandemic wave will probably get a hospital bed and medical attention. However, in the event we are confronted with a severe pandemic, it wonâ€™t be long before all available medical resources are exhausted and the doors to the hospital closed to all new patients. See Official Pandemic Plans.
Ironically, some of the features of our modern world economy that provide us with our high standard of living are the same ones that place us at such high risk for collapse during pandemic influenza. Part of our vulnerability stems from the intensely interdependent nature of our economyâ€™s infrastructure and the pervasive use of â€œjust in timeâ€ inventory methods. Other reasons include the highly specialized nature and productivity of todayâ€™s work force. If a significant number of workers in the advanced economies are unable to work due to illness or death, this will be severely disruptive to the economic and industrial life of every affected nation.
Expert observers of the pandemic, including virologists, epidemiologists, and economists who have approached the issue from entirely different perspectives, share the opinion that an influenza pandemic could have these fairly dire medical, economic and social effects on developed and undeveloped nations alike.5, 6, 7
Our vulnerable commercial and civil infrastructure
The US electric power grid
A severe influenza pandemic could lead to a catastrophic and prolonged failure of the electrical power grid in the US. How is this possible? Most power production in the US is coal fired, and these units depend upon regular delivery of coal by rail. Power industry guidelines call for generating plants to keep a 25-day coal stockpile onsite to ensure uninterrupted power production in the event of a coal supply disruption. These coal stockpile guidelines are voluntary. An informal request for information on the adequacy of coal stores at several large electrical power generating plants serving the Southeast US revealed that in December 2005, these stores had been depleted to about a 3-day supply. Nuclear and hydroelectric electrical generating facilities are not dependent on frequent supplies of fuel, and could remain online as long as there were a sufficient number of plant personnel available to operate the plants safely.
The delivery of coal by rail would seen to be one of the weakest links in the health of the US electric power grid. The illness or absence of 30% to 40% of these key workers at any point from the mine to the power plant could bring deliveries to a halt.4 These workers are highly trained, some require state or federal licensure to perform their duties, and none are easily replaced. With very little reserve coal on hand, this could result in the rapid shutting down of the affected plants. If enough US plants connected to the fragile power grid were affected in this way, brownouts or blackouts in large regions of the US would result.
Distillates, natural gas and LP gas
Gasoline, diesel fuel, and fuel oil are refined form crude oil. These products reach the consumer by flowing through a national pipeline system. Natural gas and LP gas are also transported by pipeline. The pipelines are pressurized using large electric pumps located along the path of the line. Some pumping stations have backup diesel fuel operated generators to support the flow through the line during short-term power outages but the quantity of fuel on hand to operate these systems is limited. Absenteeism or illness of personnel that operate the refineries or the pipelines could result in their dysfunction and an interruption in the flow of fuels. A failure of the electrical power grid would prevent the pipeline companies from moving their products to the marketplace.
The local natural gas utility operator may also be adversely affected by illness and absenteeism of their workforce that could affect public safety or the ability to make emergency repairs to the intercity pipeline. No gas utility company can assume the liability of operating an unsafe system. The prospect of proving service to customers in areas where their employees are unable to travel safely to monitor or repair their systems may compelled them to voluntarily interrupt service.
Allow the disinfecting solution to sit in the container for 1 hour then discard it. Do not rinse the container with water after decontamination because this reintroduces new contaminates. The container is ready for use. It can be filled immediately after decontamination or the top can be secured and it can be filled later. If latter, repeat the use of the bleach disinfecting steps just prior to filling the containers with water.
Water utility service
Most water utilities use electric power to pressurize their systems meaning that a failure of the electric power grid will lead to a shutdown of water service. Illness among the water utility staff could also play a role in water service reliability or safety during the pandemic. While many water utilities have backup diesel generators, they typically have only a week or two supply of fuel. There may be periods of rolling electrical brownouts and blackouts, where water service becomes available only intermittently. Therefore, if electricity service becomes unreliable, loss of water service will follow shortly. Under these circumstances, it is prudent to have an alternative source of clean water for use in an emergency.
US food production and security
US agribusiness has become so productive and reliable; there is very little incentive for anyone to grow their own food. This achievement is the result of the combined efforts of the farmers, farm machinery, diesel fuel, bank credit, the agricultural futures market, seed technology, herbicides and insecticides, subsidized water, deep wells, good soil, improved planning methods, favorable weather and low cost immigrant labor. The agribusiness sector of the US economy is more complex than ever before. Crop yield is dependent upon an uninterrupted supply of all these inputs. If any one of them is restricted, the operation falters lowering output.
In contrast to what many may think, farm production in the US is highly vulnerable to an interruption do to its highly complex structure and dependence on so many vital inputs. Food production in the US could become greatly constrained by the pandemic in the same way other sectors of the economy are affected. This analysis will come as a shock to most Americans who have been taught for generations that this countries agricultural prowess was second to none. If agricultural production in the US falters it will also have a major impact on those countries in Asia and Africa who depend on the purchase of US surplus food production to feed their population.
Food processing and distribution is also vulnerable to the illness of manufacturing workers, the electrical grid, truckers and loading dock personnel. Disruption in diesel fuel supplies could also affect transcontinental food shipments by truck. Absenteeism among railroad personal would have an impact on transportation of US imports and exports of agricultural products.
As the possibility of a Bird Flu pandemic becomes more of a reality, a natural reaction for many will be to begin stockpiling food. If widespread, this practice could result in local shortages of staples. Some consumers will panic when they see that empty shelves in grocery stores. Food production, processing, and delivery will continue in an uninterrupted fashion until the pandemic actually affects a critical number of inputs resulting in the system becoming dysfunctional. A sign that this has occurred will be when the food industry is no longer able to move food efficiently from the farm to the table. Food shortages typically translate into very high prices for what supply is available. For these reasons it would be prudent to prepare for the possibility that food production and delivery to American grocery stores could be temporarily interrupted by a severe pandemic.
Vulnerable police and fire services
Since the fire departments of most major urban areas also share the emergency medical response duty with the emergency medical services, both categories of first responders will have a significantly higher rate of exposure to influenza than other members of our society. A reduction in these critical first responders would have an important influence on public safety and the consequences resulting from routine emergency conditions.
The police forces stationed around hospitals controlling access to these facilities will also receive a high exposure to airborne and direct contact influenza virus. These conditions are likely to lead to an above average rate of infection in this critical group of public servants, with attendant higher rates of absenteeism and death than other groups of public sector workers during the pandemic waves. As law enforcement departments become understaffed, lack of effective policing could result in lawlessness or in some cases a collapse in civil order.
Macroeconomic effects of a severe influenza pandemic
Most national economies are more than resilient enough to withstand a mild or even moderate influenza pandemic although the shear number of sick people will leave an imprint on economic production and consumption. A severe pandemic of the scope and breath of the 1918 flu would be a human catastrophe leading to a concordant and equally severe economic one.5 It is not difficult to forecast that a severe pandemic will disrupt commerce. What is less clear is will this disruption lead to civil disorder and political instability? While the consequence of illness can be quantified to a degree the latter of civil disorder is not easy to predict given the highly variable and unforeseeable possible outcomes of anarchy. As a consequence of economic globalization large-scale civil disorder breaking out anywhere in the world is felt everywhere in the world to a lesser or greater extent.7
Economic contraction during and after a severe pandemic is likely due to a loss of production and consumption of goods and services.6 Future productive capacity will be impaired due to the death or incapacitation of a portion of the work force at all skill and professional levels. Demand for medical goods and services will rise to an unprecedented level during the pandemic but due to capacity and supply constraints, will not be met. Demand and spending for consumer durables and discretionary items will plummet. Of course there will be steady demand for food and electric utility services although these sectors will likely experience intermittent incapacity or inefficiency due to an interruption of production, transportation, processing and distribution of food on the one hand and mining and transportation of coal and power generation on the other. A vast number of economic sectors and governmental activities are dependent on a functional power grid. Their continuing operations literally hinge on the fate of the grid. If the gird goes down, normal economic activity will halt.
Once a global pandemic has clearly begun, the value of some asset classes will rise, while that of most other asset classes including real estate are likely to fall in value or not be able to be sold for anything near their price before the pandemic. Exactly which asset will go up and which will go down, is pure speculation ante-pandemic, so caveat emptor! In fact, many assets will not be able to be sold because there will be no market for them. This can happen even if the market is open in some instances. If market conditions become erratic, the US Securities and Exchange Commission (SEC) has the power to close them temporarily as happened recently in the 1987 Stock Market Crash and after 9/11 in September 2001. When the markets are closed, you cannot trade stocks, mutual funds, US Treasury bonds, Notes, or gold. When the markets reopen, prices of the various instruments will reflect the aggregate assessment of the effect the pandemic will have and will be much lower for some assets and higher for others. It is advisable then to position yourself defensively before the pandemic begins or as soon afterwards as possible since timing is critical in this regard.
The pandemic impact on education could be severe
Formal education at all levels will be interrupted should we experience a pandemic, even if it is only of the moderate variety.8 This prediction is based upon the DHHS PIP that calls for the practice of social distancing as a means to prevent spread of bird flu within the population. Practically speaking, what this public health policy calls for is a closure of all schools and colleges during the pandemic waves.
Distancing, to be effective, must be instituted early in each pandemic wave and extended for a week or two after each wave ends. During an 18-month pandemic characterized by 3 waves, the distancing policy will be in effect from between 6 and 9 months. Obviously this policy will disrupt the continuity of education leading to the loss of at least 1 but possibly 2 full semesters of course instruction.
Communications and the Internet
Most local and national TV and Radio broadcasts will probably cease for a while if there is a power failure in your area, as will cable TV. Satellite TV may remain active, but you will need an alternative source of power to operate your system to view it, since your power will be out.
Landline telephone systems have an excellent record of remaining operational even during power failures, although you will need to be using a phone that plugs directly into the wall rather than a cordless model. In the event of a widespread prolonged blackout, even the landline systems will not be able to continue to function for very long once their back-up power systems run out of fuel. Cell phone towers have a small backup power capability but this wonâ€™t last long. So if the grid fails, all phone service will as well.
In the event of a power grid failure, the Internet backbone may be functional in some areas if you could access it. Most service providers will not be operating and few server farms will have power. It is likely then to expect most fiber to be dark and remain so along the Internet until the power grid has become secure once more.
An important lesson from past pandemics
As discussed, all three 20th-century pandemics occurred in waves. While the length of time a pandemic takes to run its course may be a year or two, the action is compressed into 2 or 3 periods of lasting two or three months each. As you recall the waves characterizing the Spanish Flu varied greatly in severity. The lesson in all this for us is to remember that if the bird flu achieves pandemic status, its first wave could be severe compared with the seasonal flu but not at all as bad as the predictions made in this and other books or articles on the pandemic. That unfortunately does not get us off the hook. The severity of the first wave is no guide to the severity of subsequent waves. The all clear signal can not be sounded until the vast majority of the worldâ€™s population has immunity to the pandemic strain by virtue of having contracted the native infection and survived, or from the use of an efficacious vaccine.
â€¢ 1Dube RC Skeptics warn bird flu fears are overblown MSNBC 20Apr2006
â€¢ 2Bird Flu Drugs May Need Military Protection, WHOâ€™s Rodier Says., Bloomberg News 25Oct2005
â€¢ 3Elliott D., Bird flu could be 21st century Black Death., Guardian Unlimited 27Jan2006
â€¢ 4US National Strategy for Pandemic Influenza., DHS 2May2006 (Official Pandemic Plans)
â€¢ 5Cooper S, Special Report: Donâ€™t Fear Fear or Panic Panic. BMO Nesbitt Burns Research, 11Oct2005 (Pandemic Economics)
â€¢ 6Sikich GW, Stagl JM, Are we missing the point of pandemic planning? 2005 (Pandemic Economics)
â€¢ 7Avian Flu Working Group, The Global Economic And Financial Impact Of An Avian Flu Pandemic And The Role Of The IMF., International Monetary Fund February 28, 2006 (Pandemic Economics)
â€¢ 8Fox M., Bird flu plan stresses school closures. Reuters., 3May2006