SWINE FLU: Part 1 – H1N1 already stressing the healthcare system

Part 1 Swine Flu could overwhelm county health caretakers

By Lisa Zahner

As reported in the Sept 17 issue of our sister publication Vero Beach 32963, even if swine flu remains a mild infection, the pandemic could be the tipping point for an emergency medical system teetering on the edge.

“The worry is, the health-care delivery system could be overwhelmed by people who are sick or think they are sick,” said Kim Elliott of Trust for America’s Health, a nonpartisan think tank and advocacy group.

John King, director of the Indian River County Emergency Services, said paramedics currently are responding to about 10 percent more calls per day than usual from patients displaying “flu-like symptoms” bad enough to dial 911. Since the August 1 to the 13th, 73 people have been transported to the Indian River Medical Center Emergency Room complaining of the flu – a 2,400 percent increase over the three patients who came with the flu during the same period a year ago.

While none of the 73 needed hospitalization, the swine flu virus, also known as H1N1, could ultimately infect up to half the U.S. population, making as many as 700 to 800 Vero Beach residents sick enough to require hospital admission, with as many as 130 of these needing intensive care, according to a presidential advisory council estimate. The Indian River Medical Center’s Intensive Care Unit has beds for 20 adult patients. The pressure on local hospitals may be even greater assuming the population of Indian River County swells with snowbirds – as it usually does – in late October or November, about the same time that flu cases are expected to spike.

“We have 44 beds in the Emergency Department, so we could take up to 53 patients in beds in the ED,” said Betsy Whisman, a hospital spokesperson. “We also have a plan that would evaluate, manage and treat flu patients who can return home in triage rooms.

“If more space would be needed, we would use our Minor Care area. If even more space were needed, we would rent an air conditioned tent and evaluate patients outside of the ED,” Whisman said. According to Eric Toner of the University of Pittsburgh’s Center for Biosecurity, “there will be millions and millions of people seeking care in a relatively short period of time,” noting that the nation has only about 85,000 critical-care beds.

“Only a small percentage of those people will require hospitalization and a small percentage will require intensive care. But it’s still an awful lot of people.” Whisman, who noted the Vero Beach hospital’s occupancy level is currently 82 percent, said available beds for flu patients would be “whatever is open at a given time.

“We do not have a finite number of beds set aside for flu patients so it would change on a daily basis,” she said. “If we had the need to admit many patients with the flu, we could try to place them on one unit, but these patients could also be cared for in patient rooms using proper isolation techniques.”

Even though scientists recently reported that the vaccine that has been developed to protect against H1N1 flu appears to work much better than hoped, the second wave of U.S. infections is expected to peak in October – well before the shots become widely available.

The first shipments of the H1N1 vaccines are expected to arrive in Vero around the end of October and those will be metered out to high-risk groups and healthcare workers, who will have greater exposure to infected people. Additional shipments are expected each week, but local public health officials are unable to even make the broadest estimate on how many doses will be allocated to Indian River County. It is also unclear whether people will need two doses of the vaccine or just one, as that’s still being determined as part of the clinical trials.

Perhaps the most amazing thing to many local officials is that the number of swine flu cases in Vero Beach is no longer being tracked or reported – so we have no hard data on whether a crisis is developing, and if so, how rapidly.

Miranda Swanson, administrator of the Indian River County Health Department, said everyone seeking medical help with flu-like symptoms is being treated on the assumption that they have swine flu.

“We’re not requiring physicians to report cases to the CDC because with H1N1, we know this is widespread,” Swanson said.

What is being tracked to determine the severity of the flu in various regions is the number of people actually admitted to the hospital, not just treated in the emergency room, and the number of people who have died from the flu. Those numbers for Indian River County thus far are zero.

“For overall influenza activity, we rely on data from the sentinel physicians,” Swanson said.

Indian River County has six sentinel physicians. Five of those are employed by the Florida Department of Health and work at the Indian River County Health Department Vero Beach and Gifford clinics. Only one sentinel physician, Dr. Dennis Saver, is in private practice and he is also in Vero Beach.

The statistics from the sentinel physicians Swanson refers to are about two weeks old when local public health officials receive the data.

On Friday, Sept. 11, Swanson received a report for flu data for the week of Aug. 23-29, and the numbers on the report were only the numbers of patients actually tested by a physician, so it underestimates the numbers, as many patients are not being tested for flu anymore because it’s so “widespread.”

This raises the question as to how useful this data is for practical, on-the ground management of the disease. The U.S. Centers for Disease Control and Prevention uses a system called the Pandemic Severity Index to determine what recommendations to make to local healthcare providers, schools, and governments. There are five categories in the system, which progress in ascending order of severity, similar to hurricanes.

For more information on how Indian River County is dealing with the H1N1 pandemic, see Part 2 of the story about swine flu in the workplace and Part 3 about how our schools are dealing with the “widespread” infection rate of swine flu in Indian River County Top Stories.

(Rob Stein of the Washington Post contributed to this story)

SWINE FLU: Part 2 – Employers “play doctor,” employees in tough spotSWINE FLU: Part 3 – H1N1 and our kids, how the school system is coping SWINE FLU: Part 4 – What happens if the H1N1 pandemic gets worse?

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