New Fears, Old ER Crisis Ask Dr. Brian Johnston, an emergency room physician and state medical association trustee, whether hospitals in Los Angeles are prepared to treat an anthrax attack and he will tell you they will be lucky to make it through the flu season. He has been pointing to the problem for years, long before anthrax focused the nation's attention on its long-neglected public health system.

Dismiss Johnston's jeremiad at your own risk. Besieged emergency rooms regularly turn ambulances away, sending rich and poor alike in search of an ER that can squeeze in one more patient. Once in, patients can wait hours for treatment. This game of musical gurneys is being played across the nation as more hospitals close their money-losing emergency rooms for good, overwhelming the ones that remain.

Los Angeles County emergency rooms lost $98 million in the 1999-2000 fiscal year, according to a report by the California Medical Assn. released last week. Losses stem from the county's large uninsured population as well as from private health insurance and government programs like Medicare and Medi-Cal that try to "manage" expenses by reimbursing hospitals less than the full cost of care. The state Legislature in August came through with a $25-million bailout to keep the state's trauma centers--those equipped to treat the most serious injuries and illnesses--from closing. It was a much-needed tourniquet, but it is not enough to staunch the losses in Los Angeles County alone, much less the entire state.

A legislative committee examining terrorism preparedness cautions against expecting additional bailouts, given the state's looming budget deficit. But surely Sept. 11 and the anthrax cases catapult the state's emergency care crisis to the top of any priorities list.

More money may be available from the federal government if a bill sponsored by Sens. Edward M. Kennedy (D-Mass.) and Bill Frist (R-Tenn.) makes it through negotiations between the Senate and the White House. It would provide just under $1 billion nationwide to shore up the public health infrastructure, with about $400 million of that earmarked for improving hospital readiness. Grants would go directly to state and local health departments.

Much of that money would be used to upgrade surveillance of disease trends, improve reporting and communications, and staff laboratories, seemingly mundane tasks that are key to early detection of both bioterrorist attacks and everyday bugs.

Doctors, nurses, paramedics and other health care workers have risen to meet every challenge that California's geology and climate have thrown at them. They say they would do the same come a terrorist attack. Surely we can give them the tools to do the job.

http://www.latimes.com/news/opinion/editorials/la-000090127nov11.story?coll=la%2Dnews%2Dcomment%2Deditorials

http://www.latimes.com/news/opinion/editorials/la-000090127nov11.story?coll=la%2Dnews%2Dcomment%2Deditorials

-- Martin Thompson (mthom1927@aol.com), November 12, 2001

Answers

Vaccines work by giving the patient a very mild case of the disease itself, to activate and mobilize the patient's internal immunological defenses, given time and a low level of concurrent other stressors. Sometimes, this concept can be valid sociologically as well. This is not to condone 'mild' terrorism, but the mild Anthrax attacks in the U.S. (three mail envelopes total) may hopefully have such a 'vaccinatory' effect. If so, then when the Real McCoy comes later, (if there has been enough time for the vaccinatory social immunological response to be effective), preparedness will be better, and the damage hopefully greatly mitigated as a result. "Benign" computer viruses, the type that does "Gotcha, next time may not be so lucky" should have a similar effect on computer users without anti-virus programs installed.

The concept is the same, but it must be noted that the 'immunological response' is not automatic, but requires collective socal determination and perseverence. In this context, it must be noted that the energy crises of 1973, 1979, and 2001 have NOT had any such 'vaccine' effect at all.

-- Robert Riggs (rxr.999@worldnet.att.net), November 12, 2001.

Anthrax news has dried up. Has the threat been whipped or is this just old news?

-- David Williams (DAVIDWILL@prodigy.net), November 13, 2001.