“The world is crazy.”
So begins the song “Nature Boy” from the hip-hop duo Run-DMC, performing to fans at New York’s Apollo Theater in 1988. The song reflects at least three possible reality states. On the street you could easily encounter people “walking while black” (protestors allegedly wearing bumper stickers that say “Black and Dead Matter” during a protest in 1989). The back-seat of a car might be off-limits for those in wheelchairs. One of these possibilities is on the cusp of becoming a reality. On Monday, the Centers for Disease Control and Prevention announced that elevated rates of pneumonia had been reported in communities in rural America, causing health experts to ask if a deadly strain of influenza B — previously unseen in the U.S. — was out there. The announcement raises the specter of how easily a flusim could kill — and in doing so, create a whole new subpopulation of citizens susceptible to the virus.
A potent strain of Influenza B kills more than 100,000 people worldwide each year. It is carried by people who don’t appear to be sick, and sometimes relies on people’s loved ones. Washington Post medical writer Elizabeth Weise said in The New York Times that for those on traditional vaccination schedules, there are far fewer people killed by the flu each year than had been previously believed. In other words, the CDC is in a position of uncertainty. But there are reasons to be cautious. There is always a chance that some subpopulation of the population is potentially carrying a deadly strain of flu, and those chances are even higher in more isolated areas. Also, people who are immunocompromised may have a much easier time than others getting flu. The reasons are complex and there is a large amount of statistics experts must review before making an informed decision. But it is critical to understand why anyone involved in the decision-making process may need to be at least somewhat prepared to face personal risk.
Why some individuals may need to prepare themselves for possible risk
Among the decision-makers in a healthcare system are providers who have the most information. These are the people who meet patients between appointments and talk to them about their health conditions and their treatment options. Among these sources of information are doctors, nurses, counselors, experts and community and health educators. When decisions are made for health care, they often happen in a very different way than they would happen for political or social issues. That makes decision-making in a complicated area challenging for decision-makers. These leaders are confronted with a lot of practical considerations, and so it can be hard to make a “yes” or “no” call without totally missing the point.
On top of this, people have understandable concerns about maintaining or improving the lives of individuals who are under intense mental and physical stress. They need to think through how this work could impact their own health and personal wellness. If they lead patients or feel they should listen to the people who are experiencing unbearable mental or physical stress, maybe the best decision is to protect health in other ways. These factors can create a growing number of complicated conditions.
A growing population and crowded health care system are requiring the healthcare system to be accountable for more patients. Even one case of influenza can cause serious health complications. But many patients would much rather their physicians examine them, ask questions and make treatment decisions based on an individualized risk assessment. Patients typically seek health care when they have one problem and a simple fix is not immediately apparent. On the other hand, they may be at high risk of experiencing permanent effects from a potentially deadly illness, and not seek care until they are sicker than they are now. If the question is whether and how to protect patients, the need for care coordinators and medical assistance programs is the law of nature.