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Swine Flu Preparation, Projections for Autumn
 
 
  People with underlying conditions affecting the lungs or immune system will have priority to receive the swine flu vaccine, along with young people, pregnant women, caregivers and first responders....."We're concerned. Our staff is concerned. Our patients are concerned," said Janelle Goetcheus, medical director of Unity Health Care, which has 81,000 patients, most of them poor or homeless. "What we've been waiting for is to know when the vaccine is going to arrive so we can get our patients in."....the President's Council of Advisors on Science and Technology....."They are not a prediction, but they are a possibility,".....The virus could cause symptoms in 60 million to 120 million people, more than half of whom might seek medical attention....Although most of the cases probably would be mild, up to 300,000 people could require intensive care, which could tie up all those beds in some parts of the country at the peak of the outbreak....and possibly to 30,000 to 90,000 deaths....While the seasonal flu is associated with 30,000 to 40,000 deaths and 200,000 hospitalizations each year.....stressed that the outbreak could turn out to be milder.....the panel recommended clarifying how antiviral drugs should be used to fight the pandemic, speeding a decision about whether to approve intravenous antivirals in case they are needed.....We won't know until we're in the middle of the flu season how serious the threat is, but because it's a new strain, it's likely to infect more people than usual.....The report recommends that a portion of the vaccine be made available by mid-September for those at highest risk by asking the manufacturers to start filling vials with vaccine even though the studies to determine dosages and whether a booster will be necessary have not been completed.

"Administration officials said they are already taking action on the panel's recommendations. All five companies "have been asked to put their initially available vaccine in vials as soon as they are ready," for example. "This will move forward, even while awaiting results of clinical studies to confirm expected dosing, to ensure the earliest possible availability of initial doses of vaccine." "

Special Report: Swine Flu

Swine Flu Could Infect Half of U.S.

Swine Flu Strategy: Preparation, Not Panic

By Carol Morello

Washington Post Staff Writer

Sunday, August 30, 2009

Nurses at community clinics are being fitted for respirators. Universities are placing hand sanitizers in dormitory lobbies. Hospitals are preparing to screen and separate patients at emergency rooms. Businesses are setting up phone trees so they can operate with up to a third of their employees out sick.

All are signals that swine flu is expected to come roaring back with the cooler weather of autumn. Although the H1N1 strain of the influenza virus has proven to be mild to moderate so far, local officials are preparing in case it rebounds more strongly.

Urban areas such as the District, where about 100 people have been confirmed with the H1N1 virus since spring, face a distinct set of challenges.

Crowds, for instance, increase the chance of getting the flu.

"All urban areas are at risk,"
said John Williams, vice president for health affairs at George Washington University. "We're all huddled together -- on Metro, on the bus, in stadiums and theaters. That's a perfect breeding ground."

District residents, like those of most big cities, have high rates of asthma, diabetes, HIV and obesity, all of which can increase the severity of symptoms in patients who catch the flu, whether seasonal or H1N1. Several of the diseases, including diabetes and asthma, disproportionately affect minorities.

"There is a lot of poverty-associated illness in major cities," said James M. Chamberlain, chief of emergency medicine at Children's National Medical Center. "Asthma, diabetes, HIV are all more common in cities. The District is exactly like other cities."

Influenza can exacerbate asthma, particularly in children, because viral infections create mucus that clogs their narrow airways more severely than in adults. In Boston, for example, half of the 71 people hospitalized with swine flu in the spring had asthma. About 11,000 children and 40,000 adults in the District have asthma, more than 36,000 residents have diabetes, 15,000 have HIV or AIDS, 1,800 have end-stage renal disease and more than 11,000 have heart disease, according to Department of Health statistics.

The children with asthma visit emergency rooms up to five times more than the national average, said Stephen J. Teach, associate chief of emergency medicine at Children's.

"We don't know how it will unfold," Teach, a specialist in pediatric asthma, said about swine flu. "Right now, there's no reason for excessive worry. It's right to be concerned. It's right to plan. It's right to be informed. But it's not a time to be overly concerned until we have a little more data and experience."

People with underlying conditions affecting the lungs or immune system will have priority to receive the swine flu vaccine, along with young people, pregnant women, caregivers and first responders. About 225,000 of the District's 590,000 residents are estimated to be in priority groups. In Maryland, 2.9 million of the state's 5.6 million residents fall into such groups; Virginia estimates that 2.5 million of its 7.6 million residents have priority standing. Nationally, 159 million people do.

"We have plans in place to allow us to vaccinate the medically frail population in a timely manner as medication comes in," said Pierre Vigilance, D.C. Health Department director.

The department has provided N95 respirators, which filter 95 percent of particulates, to health care workers at primary-care clinics throughout the city, said Beverly Pritchett, head of the emergency preparedness administration. It also has stockpiled thousands of surgical masks and doses of the antiviral medications Tamiflu and Relenza. In a flu outbreak, callers to the 311 government services number seeking information on the flu would be directed to a unit specializing in advice on the flu and the vaccines, which will be available through private physicians and mass vaccination clinics.

"There will be enough vaccine eventually for every individual in the District of Columbia," said Pritchett.

This spring, the city updated its Pandemic Influenza Operating Plan, a 263-page blueprint first developed several years ago in response to avian flu. It envisions a worst-case scenario in which 12 percent of all hospital beds in the city could be filled with flu patients and 118 people would die of the flu every week. Government services and businesses would be crippled, with a 30 percent or higher rate of absenteeism because of employees who are ill or staying home to care for sick family members. Schools would be closed and converted to mass vaccination centers. If the mayor declares a public health emergency, he can order that mass gatherings, such as sports events and concerts, be canceled.

The situation is unlikely to be that severe, officials say.

"We'll be excerpting from it," Pritchett said of the doomsday plan. "So far, H1N1 has been a moderate disease, not a severe disease. If it becomes much more severe, we can fall back on the plan. There's no cause for alarm."

At Children's National Medical Center, the emergency preparedness committee that does planning for natural disasters and terror attacks has ordered more masks, gloves, hand gel and antiviral medications. Chamberlain said a patient surge in the spring underscored the need to isolate suspected flu patients coming to the emergency room so that vulnerable patients, such as children with cancer, would not be exposed.

"We learned very effective ways to do rapid screening and forwarding of patients in different areas," he said. "We expect another surge in the fall. We believe we're prepared."

Primary-care clinics are preparing to notify patients to get vaccinated.

"We're concerned. Our staff is concerned. Our patients are concerned," said Janelle Goetcheus, medical director of Unity Health Care, which has 81,000 patients, most of them poor or homeless. "What we've been waiting for is to know when the vaccine is going to arrive so we can get our patients in."

For now, the emphasis is on prevention. Health-care providers offer common-sense recommendations: Get a swine flu shot when the vaccine becomes available; wash your hands; cough into your elbows; stay home if you're sick; and contact a doctor at the first sign of illness.

George Washington University has eight flu clinics scheduled between September and November to administer routine seasonal flu shots and will add more if needed for swine flu vaccines, Williams said. The school has placed hand sanitizers in student centers and dormitory lobbies and has ordered N95 masks for housekeepers and university police. A campus Web site advisory tells students with symptoms to stay in place and that the school will bring them food and medicine.

Jim Dinegar, president of the Greater Washington Board of Trade, worries about swine flu spreading in Washington through infected tourists, on the Metro and at Washington Redskins games, as well as in offices. Adults over 24 are not in a priority group for vaccines -- in other words, Dinegar notes, most of the workforce.

The Board of Trade tells companies to establish H1N1 task forces to prepare for having 20 to 30 percent of the workforce home sick.

"You run a delicate balance telling people not to be panicked and to be aware," Dinegar said. "We don't want to be sitting on the sidelines as things crumble around us. If we put things in place and don't use them, that's great."

 
 
 
 
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