Then and Now – Pandemics

Published in Spring 2020 in Historical Happenings

Written by Marilyn Fitzgerald, Honorary PA

In its 53-year history, the PA profession has experienced and provided healthcare during multiple “epidemics” (Hepatitis C, HIV/Aids, SARS, MERS, Zika, Ebola), but only three “pandemics.” The World Health Organization defines pandemic as “an epidemic occurring worldwide or over a very wide area, crossing international boundaries and usually affecting a large number of people.”

In September 1968, an influenza virus H3N2 (Hong Kong flu) triggered a pandemic resulting in approximately 100,000 deaths in the USA and 1,000,000 deaths worldwide (0.03% of the world’s population). Most of the deaths were patients 65 years and older. The PA profession had just graduated its first three PAs the previous year. Among them was Ken Ferrell, PA, 1967 graduate of Duke University PA program. He explained, “In 1968, I was working as a PA with a pulmonologist, but do not have any dramatic recollections of that pandemic. I don’t remember any cancellations or closings like we are experiencing now. People were not as consumed by the 1968 pandemic as they are today with COVID-19. All loss of life is tragic, but loss of livelihood is tragic also.”

In April 2009, a new H1N1 virus (swine flu) was identified in the US. In June, the World Health Organization officially declared the H1N1 outbreak a pandemic. Physicians used point of care rapid immunoassay tests to provide influenza test results within 15 minutes. The Centers for Disease Control began a complex and multi-faceted response to the H1N1 pandemic which lasted more than a year. The response included the CDC’s oversight in developing a virus to be used to manufacture vaccines to protect against the virus. In October 2009, the first doses of the H1N1 pandemic vaccine were administered. Between April 2009 and April 2010, CDC reported that there were 12,469 deaths in the USA and 151,700 – 575,400 deaths worldwide (0.001% of the world’s population). Unlike the H3N2 and COVID-19 pandemics, 80% of the H1N1 deaths occurred in people younger than 65 years old. PAs (70,000 certified PAs in 2009) were involved in providing healthcare to infected people.

William Stanhope, PA, who in the mid-2000s had developed and conducted pandemic preparedness drills and taught classes in the History of Epidemics and Disasters, Public Health and Medical Intelligence, explained, “I very much remember the fears surrounding the Swine Flu and watching with interest as the CDC struggled to vaccinate for that pandemic, which never took off. Unfortunately, CDC really took a beating because the world was lucky and dodged a pandemic. In fact … the CDC [was] discredited for being ‘alarmist,’ a culture of caution developed, which might in a very, very small way be responsible for the mess we have today.”

On March 11, 2020, the World Health Organization named COVID-19 a pandemic: “Deeply concerned both by the alarming levels of spread and severity, and by the alarming levels of inaction, WHO made the assessment that COVID-19 can be characterized as a pandemic.” No prior pandemics in the PA profession’s history have caused as much medical, societal, social, and economic havoc in the USA and the world as the COVID-19 pandemic. PAs have been at the front lines in treating COVID-19-infected patients.

The PA profession’s response to COVID-19, led by the American Academy of PAs, reflects the advancement of PA professional practice, technology and social media since the 1968 and 2009 pandemics. The AAPA website has a detailed COVID-19 resources page, professional guidance in the AAPA Advocacy division’s COVID-19 update, and details on its efforts to lighten the regulatory practice restrictions PAs face. AAPA and its constituent chapters have called on all state governors and the Department of Veterans Affairs to empower PAs in the COVID-19 fight by removing supervisory or collaborative agreement requirements, which unnecessarily complicate where and how PAs can practice during a disaster or emergency. In addition, AAPA has been successful in convincing The Centers for Medicare and Medicaid Services (CMS) to provide regulatory relief and temporary waivers so PAs may deliver care to COVID-19 patients without unnecessary administrative and regulatory roadblocks.

The Physician Assistant Education Association (PAEA) has also provided PA educational programs, faculty, and students with valuable resources in online education, personal wellness and other COVID-19 related topics. You can access the PAEA COVID-19 related resources here. As Historical Happenings goes to press in mid-May, a majority of states within the USA are still in social distancing lockdown, COVID-19 deaths are occurring daily, and vaccine development efforts are proceeding at full speed. We appreciate the healthcare provision and sacrifices PAs are making during this pandemic.

For a list of references used, please visit the newsletter issue the article was originally printed in: Historical Happenings, volume 14, issue 02