Multidisciplinary Insights into Health Care Financial Risk and Hospital Surge Capacity, Part 3: Outbreaks of a New Type or Kind of Disease Create Unique Risk Patterns and Confounds Traditional Trend Analysis

Abstract

Public health agencies have promoted a single pathogen view of infection which simplifies the message about vaccination. However, research over the past 20 years shows a far more complex set of interactions between multiple pathogens, the nose/throat microbiota, the gut microbiota, immune function, and ageing. Influenza vaccination is effective at reducing General Practitioner (GP) visits for influenza like illness (ILI), for reducing health care staff sickness absence, and in reducing hospital admission due to influenza.

The narrative regarding influenza mortality has been overly simplified and the levels of reported deaths are more correctly due to interactions between a mix of pathogens. There is no such thing as a single pathogen winter. There is mixed evidence that influenza vaccination protects against death from influenza. Influenza vaccination does not seem to diminish excess winter mortality (EWM) – with EWM being the complex outcome of the mix of pathogens interacting with metrological variables. In those likely to die in the next year, while influenza vaccination may protect against death from influenza per se, this merely creates space for another pathogen to trigger final demise. The central problem is that there is no 100% accurate method to determine who is in the last year of life. For this reason, all elderly should be vaccinated. The ratio of male to female deaths and admissions appears to be an indicator of which mix of pathogens predominate each winter.

Amid all the conflicting trends there is room for the action of a new type or kind of infectious disease. This new disease may be triggered by the novel action of a common pathogen or may be the outcome of the multiple interactions between pathogens throughout each year. While outbreaks of this new disease can occur throughout the year they seem to occur more commonly at the interface between winter and spring. These outbreaks cause deaths and medical admissions to suddenly shift to a higher level, stay at the higher level for most commonly 12 months but shorter and longer periods also occur, deaths then shift back to the usual levels while medical admissions seem to sustain a more lingering effect. The combined interaction of the mix of winter infections plus outbreaks of the new disease generate a complex set of cost and capacity challenges. This complex set of challenges is completely ignored in the funding formulas used to distribute resources between different populations.

Issues of population density discussed in Parts 1 and 2 are highly relevant. Steady state thinking and silo mentality is a hindrance when seeking to fully understand issues of financial risk and capacity surges. Part 4 investigates why deaths are serving as a wider proxy for morbidity and how the number of deaths can be used as a tool to determine the optimum size for insurers, HMOs, healthcare commissioners to achieve minimum volatility in costs.