Swine Flu Vaccinations: 'We're in a Race Against Time'

The gathering of health care professionals at the NVHA offices in Fairfax on Oct. 21 was a mini-summit for the media on H1N1 “swine flu,” intended to share the latest information and provide a regional update on the spread of the disease..

Representatives of several of NVHA member hospitals were joined by health department officials from Prince William County and the City of Alexandria to discuss the progression of the pandemic, and their specific health system response.

In his introductory remarks, NVHA spokesman Zach Corrigan explained that the the group is now focused on emergency medicine and preparedness. “We have a plan in place to deal with H1N1 flu pandemic,” said Corrigan. “We are going back and tweaking it and mobilizing the assets” needed to deal with the disease

“H1N1 is similar to the seasonal flu, but it especially puts young people and pregnant women at risk,” said Dr. Lisa Kaplowitz, director of the Alexandria Health District. “Our health department has been monitoring emergency room visits and school absences, and putting out the word on how to prevent the illness.” The Virginia Department of Health is monitoring the spread of the disease at the statewide level, and communicating with the Center for Disease Control.

 

Dr. Kaplowitz noted that her department was no longer testing everyone who came in, as the “rapid test” for the disease is not reliable, and except for high-risk patients, most people will recover without special treatment. She described the current outbreak as “Just like January and March, when we are at the height of the flu season,” and that it is likely that most people are suffering from H1N1 this year, rather than the seasonal flu.

“The upswing began when school started,” she added. “We can’t tell when it will peak.”

 

Measuring, Treating the Pandemic

Dr. David Ascher, head of pediatric medicine at Inova Fairfax Hospital for Children, said that the number of confirmed cases of H1N1 had quadrupled in the past two weeks, and that emergency room visits at his hospital were up between 20 and 40 percent.

Dr. Ascher is concerned about the possibility that private practices might be overwhelmed by flu sufferers, resulting in even greater demands on hospital emergency departments. “Most of those who are admitted have underlying problems, like asthma,” he added. “We have three patients in the ICU on ventilators, and they are doing well.” Dr. Ascher also stressed that while most people think of H1N1 as a respiratory disease, it can also attack the gastro-intestinal tract, especially in children, with serious results.

Although Inova Fairfax Hospital for Children recently received a shipment of vaccine, the medical staff will still have to practice “triage,” treating the most high-risk cases first.

At Inova Alexandria Hospital, many of the people coming to the emergency room have not been to a doctor, according to Dr. Martin Brown, the hospital’s chairman of emergency medicine. And at the Virginia Hospital Center, ER visits are up from about 150 a day to 180 a day, according to Chief Nursing Officer Darlene Vrotsos, RN.

While many victims of the disease will recover on their own, precautions must be taken. “If you have a fever over 100 degrees, a cough and sore throat, you probably have the flu,” said Dr. Evelyn Felluca, a director of HCA Reston Hospital Center. “But if you are short of breath, you may also have viral pneumonia.”

According to Dr. Edwin Lewin of Inova Fairfax Hospital for Children, other children without apparent underlying medical problems may also suffer serious effects from H1N1, due to a hyper-response to the virus.”About 30 percent of the children who have died had no underlying medical reasons,” he added.

Dr. Lewin also stressed that anyone at risk – especially pregnant women - get the H1N1 vaccination. “Only 12 to 15 percent of pregnant women have gotten the vaccine so far,” said Dr. Lewin. He also recommends “cocooning,” or hyper-immunizing the pregnant woman and and her family during the flu season to prevent the mother from catching the flu. This benefits the unborn child as well, since the antibody is passed on to the fetus.

If a pregnant woman does get sick with H1N1, the anti-viral drug Tamiflu will help decrease the severity of the disease, but must be administered no more than 48 hours after the onset of sickness. It has been reported that pregnant women are six times more likely to suffer additional complications due to H1N1 as non-pregnant women, due to weakened immune systems and respiratory problems.

For adults that have been hospitalized with influenza, Dr. Lewin also recommended two relatively new drugs, intravaneous Peramivir or oral Oseltamir, as well as intravaneous Zanamivir, "which has been around about 10 years, according to Dr. Lewin.

 

 Wide-ranging Effects

One of the key ways to prevent the spread of H1N1 is to stay home from work or school if you are sick, but due to economic conditions, this recommendation may not be possible.

But according to Dr. Lewin, 59 percent of those polled were worried about the flu, and 29 percent were worried that if they stayed home due to illness or caring for a child would lose their job.

In order to address this situation, local health agencies, including the Loudoun County Health Department, have presented recommendations aimed at helping schools and businesses on how to deal with critical absences, and when to close and when to re-open, should the situation become severe.

Like schools and businesses, hospitals must be prepared to deal with increased absences.

Tracy Turman, vice president of Support Services for Fauquier Health in Warrenton, stated that Fauquier Hospital had just received 100 doses of the vaccine for its health care workers. But if there were a significant rise in absenteeism due to illness, it would be met by bumping elective procedures. “Right now, we are in a race against time,” said Turman.

This week, Fauquier Hospital began restricting visiting hours and prohibiting visitors under the age of 18, or with flu-like syymptoms. Inova Loudoun Hospital has similar restrictions, including even more stringent limitations in the Women's Unit in order to protect pregnant women and new mothers and their babies.

Although production of the H1N1 vaccine is not meeting demand, Dr. Lewin noted that Virginia is receiving its share of the medicine that is available. “We’re next, after New York, so we’re getting our allocation.”

But still, many health care providers - from the Virginia Department of Health to local physicians in private practice - are “…frustrated. Those who registered to receive the vaccine are only getting a little,” said Dr. Kaplowitz. “Ultimately, there will be plenty. The state is trying to be fair, but it's an enormous challenge.”

When asked when the disease would peak, she replied that the peak would come at varying times across the country, and even at different times within the state.

 What to Do in the Meantime

In addition to exercising patience until you can get vaccinated, observe common-sense precautions. Dr. Lewin, a pediatrician, had some suggestions on how to avoid catching the H!N1 flu:

• When washing you hands, scrub with soap and water at least as long as it takes to sing “Happy Birthday” two times.

• Sneeze into your elbow, not your hand.

• Stay at least six feet from anyone who is sneezing. The viral mist that spreads from a sneeze can reach that far.

• Keep in mind that the flu virus can live for up to eight hours on surfaces like desks and counter tops; on tissues for 15 minutes; and on your hands for eight minutes.

 Over the weekend, Pres. Barach Obama declared the H1N1 pandemic a national emergency, giving hospitals more authority and coordinating govenment response.