The Strategic Importance of Healthcare

And the perilous state of current preparedness

I was listening to this excellent podcast today, hosted by Aaron MacLean and featuring journalist/author Annie Jacobson. I was reminded not only of the potential apocalyptic nightmare of nuclear war, but of the way that we would be largely unable to provide medical response respond to even a small nuclear event, or many of the other potential strategic (or natural) disasters that could befall us as a nation. It turns out I had some thoughts on the topic a few years ago.

I was, for a while, a lecturer/consultant for was called the Domestic Preparedness Program. This was an initiative by the Department of Justice (and later Department of Defense) to ensure that first responders around the US were prepared to deal with the medical consequences of nuclear, biological, chemical and blast injuries. This was before the terrible events of 9/11.

Our job as instructors was initially to go to cities around the country and educate police, fire, EMS and medical personnel. We also engaged in table-top exercises, ‘war-gaming’ what mass casualty events might look like.

It was fun and fascinating. But it did cause us to have a uniquely dark way of looking at things. We engaged in a lot of ‘what if’ discussions, mostly about terrorism. We recounted terrorist events that had occurred and discussed lessons from military history. We studied events like the Tokyo Subway Sarin gas attack by the group, Aum Shiniykyo (https://www.britannica.com/event/Tokyo-subway-attack-of-1995, or the use of mustard gas in the Iran/Iraq war (https://en.wikipedia.org/wiki/Iraqi_chemical_attacks_against_Iran).

But one thing we often discussed was the vulnerability of populations if responders or medical facilities were targeted. (This had been a well known tactic of terrorists; the use of an explosive device, followed by a second once responders arrived.)

Without question, we see this today. Healthcare in Ukraine, healthcare in Afghanistan or Florida, healthcare in North Carolina after Hurricane Helene. We see that anywhere that war or natural disasters occur, healthcare is badly compromised.

Looking back on those discussions, and my time with the incredible experts with whom I worked, I am forced to consider our situation right now. American healthcare, post-Covid, is hanging by a thread. I am not trying to spin conspiracies. I am not trying to say that American healthcare has been intentionally attacked. I do think American health care has been criminally neglected.

What I want to do is point out our vulnerability. Because it wouldn’t take much to tip our already fragile balance.

One might think that COVID would have taught us something. However, hospital beds are still in short supply, we have too few nurses and physicians, too many sick patients and the things I have been writing about are not improving.

So what could happen?

America could suffer an dramatic natural disaster. More hurricanes like the one that devastated North Carolina. Earthquakes are always a possibility, as are meteor strikes or solar flares.

It’s hard to imagine a modern hospital without computers or the Internet. If cars won’t start, it’s likely much of our life-saving equipment won’t work either in response to the effects of solar flare.

(For what it’s worth, I’ve worked in hospitals without telephones or Internet and it was no fun. Hospitals have been compromised by ransomware attacks. My wife was hospitalized during Helene and people were discharged earlier than what would have been optimal because they couldn’t provide adequate food, water or sanitation to patients, visitors or staff.)

There could be the use of an improvised nuclear weapon by terrorist groups or a state actor.

Another new pathogen could emerge; perhaps one completely unlike COVID, requiring us to learn about it all over again. This could be accidental or intentional. It doesn’t take conspiratorial thinking to recognize that nations have worked with biological weapons for millennia. The US being no exception. We had a very active bioweapons program for a long time.

https://www.ncbi.nlm.nih.gov/books/NBK233494/

This isn’t crazy talk, it’s just history.

So to put this into focus, right now we struggle to find one or two intensive care unit beds for someone with relatively mundane problems (well, not for the patient but in the big picture). A patient who needs a ventilator for pneumonia. A patient who needs surgery for a complicated abdominal infection. A child with ongoing seizures.

Looking for one inpatient bed to transfer a patient to, looking for two intensive care unit beds, can be the labor of hours to days. Much less, as I have pointed out, the difficulty getting them transported once the beds are available.

Now, imagine looking for 50 ICU beds for patients with severe burns. Imagine trying to find 2000 hospital beds for patients with an unknown but life-threatening infection that (for example) causes dehydration from vomiting and diarrhea. Consider finding 10,000 beds for victims of an earthquake in an urban area where there were crush injuries and fire.

Those beds wouldn’t be available. Even national guard units would take days to ramp up capacity, and their use of deployed personnel would strip staff from their civilian jobs.

Any of these nightmare events, especially coupled with supply chain issues and diminished energy resources, would be incalculable tragedies with ripples and repercussions for a decade; or a century.

And they would result in deaths unnecessary if only we had planned ahead. If only we had built healthcare to be flexible and part and parcel of national defense. Perhaps if we really had small, pre-positioned contingency hospitals, or at least tents and supplies, across the country. Like armories of old, but with material prepared to save lives.

Maybe we’d be better off if our planning, at least in part, had been driven by a concern for the health of the nation rather than the profits of vast corporations or the political infighting of petulant parties.

These are perilous times. And we need to start acting like it if we care for the future of the republic.

And our leaders need to start acting like adults.