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Swine flu
August 10, 2010
H1N1 swine flu pandemic is over, WHO says
The World Health Organization said today that the H1N1 swine flu pandemic has fizzled out.
The virus is still circulating and could cause a serious illness in younger people, but “out-of-season” outbreaks of H1N1 are no longer being seen in the northern or southern hemispheres, according to the WHO’s emergency committee, said WHO Director-General Margaret Chan, speaking on a conference call with reporters today.
“Based on experience with past pandemics, we expect the H1N1 virus to take on the behavior of a seasonal influenza virus and continue to circulate for some years to come,” Chan said.
The world was fortunate the virus did not mutate to a more deadly form, she added. She warned, however, that there could be surprises because pandemics, like flu viruses, are unpredictable.
“Continued vigilance is extremely important, and WHO has issued advice on recommended surveillance, vaccination, and clinical management during the post-pandemic period,” Chan said.
The WHO said worldwide deaths from pandemic stood around 18,500 based on laboratory-confirmed cases. Dr. Keiji Fukuda, WHO’s leading flu expert, described the number as a “minimum,” including more than 8,500 deaths in the Americas.
The U.S. Centers for Disease Control and Prevention has reported 12,270 deaths in the United States using a mid-range estimate. In Texas, the Department of State Health Services confirmed 240 deaths, including seven in Travis County, two in Hays County and one each in Williamson and Bastrop counties.
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April 1, 2010
H1N1 swine flu ticking back up in Southeast; Texas alerting residents
Texas officials said they are watching a rise in swine flu cases in the Southeast and encouraging people who have not been vaccinated to get a shot in case a third wave of virus hits.
“What we’ve seen are upticks in other parts of the country, and we’re concerned because our illness has tended to follow what happens in the Southeast,” said Carrie Williams, a spokeswoman for the Texas Department of State Health Services. “We think it could affect Texas next.”
Last week, the Associated Press said health authorities in Georgia reported that hospitals there were seeing the largest influx of H1N1, or swine flu, cases since last fall when the illness peaked. “About 70 to 80 hospitalizations were reported in each of the past two weeks - the most since September, when a large wave of illnesses was hitting the South,” said the March 24 article in the Ledger-Enquirer in Columbus, Ga.
The state health department in Texas issued a news release encouraging H1N1 vaccinations Wednesday quoting Health Commissioner Dr. David Lakey who said that because flu is unpredictable, “we don’t know yet if it will follow any seasonal pattern. Activity might increase in the near future. It might not. People should be vaccinated because it’s better to prevent an illness than to have it.”
Lakey said there was plenty of vaccine to go around.
H1N1 flu activity in Texas has continued, although it has been relatively low. There was a wave in April 2009 when the pandemic began and again in the fall, Williams said.
“We’ve continued to have hospitalizations and deaths from H1N1,” she said.
In March, Texas had more than 50 hospitalizations and at least three deaths related to swine flu, according to the news release Wednesday.
Travis County has had seven swine flu deaths since the outbreak, according to state data. The most recent was reported to health authorities in late January. The death was of a 63-year-old woman in November, according to Carole Barasch, spokeswoman for the Austin/Travis County Health and Human Services Department. She had underlying health conditions, Williams said.
Hays County has had two swine flu deaths; Williamson and Bastrop have each had one; and Caldwell County has had two, a man and a woman who died in October. Each had underlying health conditions, Williams said.
Seasonal flu activity has been unusually mild this year in Texas and around the country.
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December 30, 2009
Researchers discover patterns in swine flu deaths
Brazilian researchers studying the bodies of 21 children and adults who died of swine flu infection report that all of the patients’ lungs were severely damaged, according to research published in the Jan. 1 issue of the American Journal of Respiratory and Critical Care Medicine.
This first-ever autopsy study of H1N1 patients, done by scientists at São Paulo University, sheds new light on precise changes in the body of patients with fatal infections.
Although most patients have a mild or moderate form of the illness, those with a fatal course came to the hospital most often with difficulty breathing, said Dr. Thais Mauad, lead author of the study. Those who died of H1N1 came to the hospital less frequently with fever and body aches.
“All patients have a picture of acute lung injury,” Mauad said in a news release posted on EurekAlert, a news site for journalists. “In some patients this is the predominant pattern; in others, acute lung injury is associated with necrotizing bronchiolitis (NB); and in others there is a hemorrhagic pattern.”
“Patients with NB are more likely to have a bacterial co-infection. Patients with heart disease and cancer are more likely to have a hemorrhagic condition in their lungs. It is important to bear in mind that patients with underlying medical conditions must be adequately monitored, since they are at greater risk of developing a severe H1N1 infection,” Mauad said.
Interesting, the researchers said they found that some patients’ immune systems over-reacted to the infection producing a “cytokine storm.” Such a vigorous response “may spill over to and damage lung tissue, thereby causing acute lung injury and fatal respiratory failure,” said Dr. John Heffner, past president of the American Thoracic Society, publisher of the critical care journal.
Mauad said that a better understanding of the immune system’s response to H1N1 could lead to more therapies for treating the swine flu.
State data, which hasn’t been updated since Dec. 12, says there have been 195 H1N1 deaths in Texas since the outbreak began in April, including six in Travis County.
Concerns about swine flu have ebbed as the spread of infections have slowed since earlier in the fall, although health authorities say the H1N1 could make a comeback this winter. They have urged people to get vaccinated, and while vaccine shortages were a big problem this fall, that problem also seems to have faded.
A Harvard poll posted on EurekAlert said that as of last week, three-fourths of parents who tried to get the vaccine for their children were successful.
I got my shot just before Christmas from the Austin/Travis County Health and Human Services Department, and it is offering two more free clinics in January to anyone who wants to be immunized. Appointments are required. To make one, call 972-5520.
Here are the dates and locations:
Jan. 9., 1 to 6 p.m., Burger Center, 3200 Jones Road
Jan. 21, 1 to 6 p.m., Delco Center, 4601 Pecan Brook Drive
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December 15, 2009
Texas gets top score in swine flu readiness
A national report released this morning gave Texas and seven other states the highest score for their capabilities in being ready to meet the challenges of the current H1N1 swine flu outbreak.
The seventh annual report, Ready or Not? Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism by the Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF) gave Texas a nine out of 10 based on 10 measures of emergency preparedness.
The seven other states tying with Texas were Arkansas, Delaware, New York, North Carolina, North Dakota, Oklahoma and Vermont. Nearly two-thirds of the states scored seven or less, and Montana scored the lowest, three out of 10.
“Overall, the report found that the investments made in pandemic and public health preparedness over the past several years dramatically improved U.S. readiness for the H1N1 outbreak,” says a statement about the report on the Web site. “But it also found that decades of chronic underfunding meant that many core systems were not at-the-ready. Some key infrastructure concerns were a lack of real-time coordinated disease surveillance and laboratory testing, outdated vaccine production capabilities, limited hospital surge capacity, and a shrinking public health workforce.”
The Texas Department of State Health Services had a severe backlog in its lab of testing flu samples early on in the pandemic, as did many labs in the nation until the U.S. Centers for Disease Control and Prevention issued guidelines against testing most flu samples. But Texas quickly added staff to its lab to chip away at the backlog, and the report says it has “enough staff to work the intense hours needed during an emergency, like H1N1 (five, 12-hour days for six to eight weeks).”
Texas also got points for:
Buying 50 percent or more of its share of federally subsidized antiviral medications.
Submitting data on available hospital beds each week.
Having labs with the capacity to assure the timely pick-up and delivery of disease samples 24/7.
Tracking diseases through an Internet system used by the CDC.
Identifying the pathogen responsible for food-borne disease outbreaks at a rate that met or exceeded the national average of 46 percent.
Requiring child care facilities to have a written evacuation and relocation plan for emergencies.
Having a law or legal opinion in place to limit liability against organizations that provide volunteer help during emergencies.
Increasing or maintaining funding for public health services in recent years.
The one indicator on which Texas did not score a point was its failure to meet “readiness criteria” set by the Medical Reserve Corps for medical volunteers during an emergency.
The National Association of County and City Health Officials just issued a statement on the report saying, “The report card on state readiness to respond to public health emergencies, issued today by the Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation, sounds a warning. Serious underlying gaps have been exposed in the nation’s ability to respond to public health emergencies. The economic crisis is straining an already fragile public health system.”
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November 11, 2009
UPDATE: First Williamson County swine flu death reported
Williamson County has reported its first death of a patient from the H1N1 swine flu virus, according to the Department of State Health Services.
The patient was a 30-year-old woman who had underlying health conditions, according to Dr. Chip Riggins, executive director of the Williamson County and Cities and Health District. She was hospitalized and died in late October.
So far, the state is reporting 141 swine flu deaths since the pandemic began in April.
Meanwhile, the U.S. Centers for Disease Control and Prevention has revised its estimate of H1N1 deaths to 4,000, from 1,200 deaths since April, according to an article published Tuesday in the New York Times.
In a normal flu season, the CDC says 36,000 Americans die of flu, but I have had a hard time understanding that estimate. A CDC spokesman told me the number is “based on statistical modeling estimates,” and not actual deaths.
The Times story says, “The new estimate will be a more accurate comparison to the 36,000 deaths from seasonal flu each year” and is “based on confirmed cases as well as hospital reports of people who appear to have died after a bout of flu.”
It does not mean the virus has become more dangerous but combines “deaths from laboratory-confirmed cases of the flu and deaths that appear to be brought on by flu, even though the patient may have ultimately died of bacterial pneumonia, other infections or organ failure,” the article says.
A reason I’ve recently wondered about 36,000 estimate is Travis County, home of Austin, the nation’s 15th or 16th largest city, depending on the year, generally has just a handful of flu deaths each year. And in Texas, the second largest state, flu was the primary cause of death in less than 100 fatalities every year between 2002 and 2006 — the latest year for which I could get data from the state health department. These figures do not include pneumonia deaths.
A CDC spokesman wrote this to me when I asked for clarification on seasonal flu deaths: “The study used statistical modeling to estimate that during 9 influenza seasons from 1990-91 through 1998-99, an annual average of 36,000 flu-related deaths occurred among people whose underlying cause of death on their death certificate was listed as a respiratory or circulatory disease.”
That suggests flu was present along with some other illness. Perhaps this re-calculation is an effort to make a more apples-to-apples comparison, but I still can’t help wondering about the accuracy of the 36,000 figure.
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November 4, 2009
First cat confirmed to have H1N1
It turns out cats can get H1N1, too.
A 13-year-old Iowa cat tested positive swine flu, making it the first time the current strain has been diagnosed in a cat, the American Veterinary Medical Association announced today.
The cat has recovered.
Before today, the veterinary association said the disease has been in humans, pigs, birds and ferrets. I didn’t know about ferrets; that’s also a recent finding.
The association said the cat probably caught the virus from someone it lives with.
“The American Veterinary Medical Association (AVMA) and the American Association of Feline Practitioners (AAFP) are reminding pet owners that some viruses can pass between people and animals, so this was not an altogether unexpected event,” the news release says. “Pet owners should monitor their pets’ health very closely, no matter what type of animal, and visit a veterinarian if there are any signs of illness.”
There’s a good Q&A about animals and H1N1 on the association’s site, and you might find it interesting reading.
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October 19, 2009
UPDATE: Dell Children's closing its flu tents
UPDATE: with comments from Dr. Pat Crocker
Dell Children’s Medical Center is shuttering its flu tents for emergency room patients today because of a continued slowdown in swine flu cases, the hospital says.
Dr. Pat Crocker, chief of emergency medicine at the hospital, said he is confident the staff can manage patient volumes for now without the tents. “The beauty of the tents are you can set them up in about four hours,” he said.
On Sept. 22, the hospital opened two tents outside the ER to handle less severe patients complaining of flu symptoms. An extra tent was added as patient volumes in the ER peaked at 404 patients on Sept. 30.
The tents gained national attention and proved to be “awesomely efficient,” doctors wrote on Twitter, an online site for communicating short bursts of information.
But on Oct. 6, a tweet on the hospital’s site noted a decline in patient volumes. Crocker wrote that he was “pretty sure flu has peaked in kids in our region.” This morning the site said that in the past 24 hours, volumes had dropped to 257 ER patients. And while that number was still about 20 percent higher than average for this time of year, ER staff is seeing fewer patients with flu.
The tents had enabled staff to treat most patients within 30 minutes of arriving at the hospital, according to Crocker.
Crocker said that just because swine flu cases were declining does not mean the outbreak is over.
“People should not assume they’re not going to get sick,” he said. “It’s not gone. Get immunized.”
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October 8, 2009
UPDATE: Sister of UT employee also dies of swine flu
UPDATED
The sister of a University of Texas employee who died Sept. 27 of swine flu has also succumbed to the same H1N1 virus, the Austin/Travis County Health and Human Services Department has confirmed.
Sylvia Duran, 35, died yesterday. She had been in the intensive care unit at a local hospital with pneumonia during the funeral for her sister, Linda Duran, their sister, Olga Duran, had said last week.
Olga said in a message she left on my phone Thursday night that Sylvia had obesity and sleep apnea, which might have complicated her H1N1 flu case. She had further complications in the hospital and died with respiratory failure and congestive heart failure, Olga said.
She added that Sylvia’s first quick test for swine flu at the hospital came back negative but a re-test later confirmed the virus.
Barasch said Sylvia Duran was morbidly obese, which preliminary studies suggest may increase the risk of hospitalization and death in people with H1N1, according to U.S. Centers for Disease Control and Prevention. “Patients with morbid obesity, and perhaps obesity, often have underlying conditions that put them at increased risk for complications due to 2009 H1N1 influenza infection, such as diabetes, asthma, chronic respiratory illness or liver disease,” the CDC says.
Sylvia Duran’s death brings to four the number attributed to the H1N1 virus in Travis County, Barasch said.
As of last week, there were 52 swine flu deaths in Texas, said Doug McBride, spokesman for the Department of State Health Services.
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October 6, 2009
Has swine flu peaked in kids?
Judging by a drop in emergency room visits in last few days, doctors at Dell Children’s Medical Center think that the H1N1 virus, or swine flu, might be peaking — in kids locally, said Dr. Pat Crocker, the hospital’s chief of emergency medicine.
“I’m starting to feel pretty confident that flu has reached a peak in the 15 and under age group,” Crocker said. “We’ve had a few days when we were up to 400 (ER visits per day), now we’re back down to 350. That’s where our mathematical model shows us hanging … for the next couple of weeks.”
The hospital’s Twitter site reported 338 patients came through the ER Monday, and while high volumes are expected for the next month or so, Crocker doesn’t think they’ll be as high as they once were. Last Wednesday, the ER hit an all-time of 404 ER visits, with most patients complaining of flu.
Although the kids’ ER is seeing less flu traffic, the Seton Family of Hospitals is reporting an uptick in older patients reporting flu symptoms. The H1N1 virus, which is accounting for 99 percent of flu currently circulating, is similar to regular flu but might include gastrointestinal issues. “For the first time this last weekend, we saw a significant spike in adult influenza illness,” Crocker said.
Most people have mild to moderate illness with swine flu and recover easily at home without needing a doctor or a hospital. On average, six Seton hospitals in the Austin area, including Dell Children’s and Seton Medical Center Williamson, admit four to seven patients a day with flu illness, Crocker said. The rest are treated and sent home.
Although regular flu season officially started Sunday, Crocker said he’s not worried about the H1N1 virus overlapping significantly with seasonal flu. Texas doesn’t typically see a lot of cases of regular flu until after Thanksgiving, and Crocker said he had no reason to think this year would be much different.
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October 1, 2009
UT staff member dies of swine flu
A University of Texas staff member died of swine flu over the weekend, UT has just announced.
UT officials declined to name the person. Bob Harkins, associate vice president for campus safety and security, said the person was a woman in her 40s who did not work in education but rather “in one of our service units — anything from housekeeping to working at counter in some kind of retail operation.”
The woman’s last day at work was Sept. 22, Harkins said.
She was hospitalized at St. David’s Medical Center, but he did not know if she died there. He also did not know whether she lived in Travis County.
Two other people have died in Travis County and 21 have been hospitalized since the outbreak began in April, according to Carole Barasch, spokeswoman for the Austin/Travis County Health and Human Services Department.
“It’s very tragic and tries to point up the severity this illness can have,” Harkins said. “We’ve been fortunate we have not have had hospitalizations and deaths” in the campus community.
The H1N1 swine flu virus has caused mild to moderate illness in most cases. The UT person who died had underlying medical conditions that contributed to her death, Harkins said.
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New report projects a third of Texans would fall ill from flu
A new report says Texas should have sufficient hospital beds if 35 percent of its residents fall ill during the swine flu pandemic this fall and winter, but the state has only enough antiviral medicines to prevent or treat flu in 20 percent to 25 percent of its population.
The report by the Trust for America’s Health, a Washington, D.C., nonprofit, said it based the projections on a relatively mild pandemic using calculations from the U.S. Centers for Disease Control and Prevention.
The CDC’s FluSurge model anticipates that 8.5 million Texans would become ill from the H1N1 virus, or swine flu, and that 105,287 might need to be hospitalized. This would cause 66 percent of the state’s hospital beds being filled during the height of the outbreak, according to the Texas-specific report, released this morning.
Fifteen states would be at capacity or would run out of hospital beds, the report says.
Swine flu is widespread in Texas, but so far, it has proven to be a mild to moderate illness. Doctors say most people recover at home and do not need medical treatment.
Texas is one of 11 states that has only enough antiviral medicines, such as Tamiflu, to cover between 20 percent and 25 percent of its population. That could be a problem if significant portions of people with underlying conditions that put people at risk of complications from flu became sick. Those conditions include asthma, diabetes, cancer, HIV/AIDS, and heart or kidney disease, according to the report.
“Our point is not to cry chicken little but to point out the potential a mild pandemic can have,” said Jeffrey Levi, executive director of the Trust for America’s Health.
He added that “the situation may not be as dire as it seems if we can get vaccine to people as quickly as possible.”
The H1N1 vaccine will be coming in to states more slowly than expected, and Texas will get just half of the 3.4 million doses it anticipated by Oct. 15, state officials announced Wednesday. And the first vaccines going out will be FluMist, a nasal spray that can’t be used in pregnant women or people with chronic conditions. It is for people ages 2 to 49.
The report also says that local health departments lost 8,000 staff positions in the first half of this year on top of 7,000 jobs lost in 2008. In addition, the report says federal public health preparedness funding was cut by a fourth from 2005 to 2009.
Levi says those cuts can weaken the public health response to a pandemic.
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September 29, 2009
Third flu tent opens at Dell Children's as volumes stay high
Doctors and nurses are now seeing patients in a third tent outside the emergency department at Dell Children’s Medical Center to handle steady high volumes of children complaining of flu.
Two tents, which went up Sept. 21 after swine flu cases spiked at the hospital, have proved to be “awesomely efficient,” hospital officials said, with the average patient being treated and sent home in about 30 minutes. The third opened today.
Most patients who come to the ER complaining of flu are not very ill and do not end up being hospitalized at Dell Children’s or at most hospitals in the Austin area, doctors said. For most people, the H1N1 swine flu virus causes a mild to moderate illness and can be treated at home. But there are times when a person needs a doctor or a hospital (more on that later).
With three tents now open, the hospital is using one to triage patients and two for treatment. There are six cots in each of the two treatment tents, said Matilda Sanchez, a spokeswoman for the Seton Family of Hospitals, which owns Dell Children’s.
Less severe patients are seen in the tents, and Seton is putting out brief reports on what’s happening there on Twitter, a Web site for sharing short blasts of information.
A Tweet today says that the ER is detecting a “slight decrease in elementary students and a slight increase in high school student illness.”
Sanchez said it’s too early to tell whether there is a trend in older patients becoming ill. By far, most patients coming to the ER at Dell Children’s are between the ages of 2 and 7, she said.
In the past 24 hours, the ER saw 353 patients with more than 70 percent with flu or flu-like illness, according to Seton.
Schools in the Austin-area say their attendance is in the 90-something percent range and not unusual. No schools in the area have closed because of flu, but some in Texas have, including the following school districts: Huntsville, New Boston, Chisum and Lovejoy, according to the Texas Education Agency’s Web site. North Hopkins school district closed this month because of H1N1 but has reopened and so has Alief Montessori Community School, according to the TEA.
Now, back to the question about when to seek medical treatment with swine flu. I’m stealing this from a Q&A we ran Sunday.
Adults should go to an ER if they have trouble breathing; purple or blue lips; persistent vomiting; dizziness when standing; inability to urinate; seizures; loss of consciousness; altered thinking; or chest pains. Take a child who has fast or labored breathing; has bluish or gray skin; is not drinking enough fluids; is not waking up or interacting with others; is too irritable to be held; has symptoms that won’t go away; has a fever with a rash; or more illness than seems reasonable for flu.
Call a doctor if the sick person is under age 2; is pregnant; is over 65; has a fever more than three days; has a chronic health condition; or is on chronic aspirin therapy or other medicine that can affect the immune system.
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September 22, 2009
Doctors to answer swine flu questions at town hall meetings
Got a question for a doctor on swine flu?
Scott & White Healthcare is hosting four town hall meetings on the H1N1 virus starting tonight in Round Rock with a member of its medical staff fielding questions from the public. Tonight’s meeting will be held from 6 to 7:30 p.m. at Allen R. Baca Center, 301 W. Bagdad Ave. Dr. Jon Belsher will answer your questions.
Additional meetings are set for 6 to 7:30 p.m as follows:
Sept. 24, Pflugerville Lions Club Hall, 500 N. Railroad Ave., with Dr. Susan Perera.
Sept. 24, Scott & White Clinic - Taylor, 403 Mallard Lane, Taylor, with Dr. Franklin Chang.
Sept. 29, Cedar Park Public Library, 550 Discovery Blvd., Cedar Park, with Dr. Chris Stewart.
For more flu information, visit Scott & White’s Web site.
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September 21, 2009
Swine flu brings out the tents at Dell Children's
For much of the past week, Dell Children’s Medical Center has been swamped with patients complaining of flu. The hospital was so inundated that it set up tents outside and expects to open them tomorrow afternoon.
Hospital officials are holding a news conference this afternoon to discuss the situation.
Testing on most flu patients to confirm the type of flu they have has not been done for several months because of the time and cost involved, but because flu season in Texas doesn’t normally start until October, about 97 percent of flu being seen now is swine flu, according to the U.S. Centers for Disease Control and Prevention.
Swine flu, or H1N1 virus, began circulating in April and never went away. Once schools opened last month, the virus continued to transmit easily among kids. The good news, according to health authorities: most of the illness is mild to moderate.
We’ll run a more complete story in tomorrow’s newspaper about what’s happening at Dell Children’s.
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September 8, 2009
Nearly 2 percent of Rice students have flu-like illness
Add Rice University in Houston to the schools dealing with an outbreak of flu.
As of Friday, Rice’s Student Health Services had seen 107 students with flu-like symptoms, nearly 2 percent of its more than 5,500-student enrollment, according to university spokesman B.J. Almond. Of those patients, 47 were confirmed as having influenza based on a rapid test that does not indicate which type of flu virus the students had.
Most flu circulating right now is the H1N1 virus, or swine flu, and students who did not test positive for flu with a rapid test still might have some type of flu.
Texas and many other states quit routine testing of flu specimens a few months ago because of the time, cost and resources it consumed.
Rice, which was closed for the holiday weekend, did not have more up-to-date numbers, Almond said. The illnesses have not affected classes. Sick students were advised to go home or stay in their rooms and have a friend deliver meals.
At the University of Texas, staff at the University Health Services saw more students complaining of flu last week than the preceding week. A report on the health center’s Web site said medical staff saw 133 students between Aug. 30 and Saturday with flu-like illness, up from 118 between Aug. 23 and Aug. 29.
The numbers don’t include everyone who was ill with flu on campus by any means. They only reflect patients seen at University Health Services. Faculty, staff and students who sought care somewhere else — or not at all — are not counted, according to the site.
Over the weekend, Washington State University in Pullman, which has about 19,000 students, had one of the nation’s largest swine flu outbreaks: 2,000 ill students, according to The New York Times. The Times said the outbreak started around Aug. 21, during fraternity and sorority rush but before classes started.
Texas State University’s health center reported on its Web site that an outbreak of flu-like illness was reported by a sorority on campus. Two other sororities had isolated cases. Like elsewhere, most of the illness was mild to moderate, with most students quickly recovering.
“University officials met with Greek organizations and a temporary halt to large social activities was recommended in an attempt to prevent further spread of the flu,” the site said. “Unless there is evidence of significant spread of flu within Greek organizations, it is anticipated that Rush activities will proceed as planned.”
By the way, the Statesman is hosting a live chat on swine flu tomorrow at 11 a.m. You’re invited to join us. Just log onto to the Statesman’s home page and go to my blog if you want to ask a question of me or Dr. Pat Crocker, chief of emergency medicine at Dell Children’s Medical Center. We’ll try to give you an answer.
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September 2, 2009
UPDATE: CenTex schools, hospitals reporting flu; Alabama hospital bans visitors under 12
Since students returned to schools and universities in the Austin area last week, so has swine flu.
Dell Children’s Medical Center is seeing about five to seven possible cases of H1N1 flu a day, up from zero to two a day before school started, said Dr. Pat Crocker, chief of emergency medicine at the hospital.
“We had been seeing 180 patients a day, but in last four or five days with school back in session, we’ve been seeing 230 or more patients a day, a 20 percent increase,” Crocker said.
The hospital also is seeing a large number of patients with a cold virus that looks like flu but isn’t, he said.
Officials at the University of Texas said that between Aug. 24 and 28 UT’s clinic saw 112 patients with flu-like illness.
“Not all patients with influenza-like illness are confirmed as flu, but it’s worth noting when you consider that (University Health Services) saw no patients with this illness during the same week in 2008,” said Sherry Bell, senior program coordinator, in a news release on UT’s Web site. Of course, the number does not include staff, faculty or students who sought care off campus.
Meanwhile, a hospital in Alabama, which has been swamped with flu cases, has banned children under 12 from visiting.
“We’re in a pandemic situation in our area, and we’re we’re asking that children 12 and under not be brought to the hospital unless they’re brought in as patient,” said Steven Pearce, spokesman for the 400-bedSoutheast Alabama Medical Center in Dothan. “That’s for the safety of those children and to reduce the spread of this disease.”
No local hospital is asking kids younger than 12 to stay away — yet.
“We’re not officially banning kids,” said Dr. Steve Berkowitz, chief medical officer for St. David’s HealthCare. “Obviously, a lot can change if a lot of people are coming down with it.”
Berkowitz said the situation was relatively calm at St. David’s hospitals, which are providing masks to patients in waiting areas to reduce the spread of flu. Other Central Texas hospitals are doing the same thing. Dell Children’s separates patients with respiratory illnesses, such as flu, from children with sprained ankles and other emergency conditions. The Southeast Alabama Medical Center offers masks but also built a wall in its waiting room to segregate flu patients from others, Pearce said.
Austin school district officials are holding a news conference this afternoon to update the public on swine flu in the schools. They don’t plan to give out confirmed numbers of cases or report which schools have kids sick with flu, but they will have health authorities on hand to discuss what they are seeing and the precautions they are taking.
We’ll post the details from that briefing as they become available.
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August 26, 2009
CDC seeking public comment on swine flu vaccine
I know you have an opinion on the swine flu vaccine. But have you told the CDC?
Over the next few days, the U.S. Centers for Disease Control and Prevention is polling the public on its opinions about the H1N1, or swine flu, vaccine. “In this web-based dialogue the public will discuss, deliberate, and offer input as the CDC considers whether to take a ‘full-throttle’ or a ‘go-easy’ approach to mass vaccination, or a moderate approach somewhere in-between,” says the site where you can weigh in and have your voice heard.
The first round of public comments lasts until 11 a.m. Central Time (noon Eastern time) Thursday. The next opportunity to comment is Monday and Tuesday.
Have at it. The CDC is planning the vaccination program that will guide state and local officials and says it wants to hear from you.
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UPDATE: CDC says it will have a mercury-free swine flu vaccine option
UPDATE: CDC expresses skepticism on illness/death projections; state health department weighs in
A woman who is two months pregnant and concerned about mercury exposure to her developing fetus just sent an e-mail asking whether the swine flu vaccine would include a mercury-free option.
The U.S. Centers for Disease Control and Prevention says that it makes available vaccines with mercury, and without. Although the government has phased out thimerosal from childhood vaccines, most flu vaccines contain small amounts of thimerosal, a mercury-containing compound that acts as a preservative.
“Both kinds will be available in the fall … around Oct. 15,” a CDC spokeswoman said.
Pregnant women are considered a high-risk group for the H1N1 virus, or swine flu, and because there won’t be enough vaccine for everyone, the government has recommended that high-risk groups be offered shots first. On the CDC’s priority list are pregnant women, younger people (who have been especially hard hit by the virus) and health care workers.
Now that schools are reopening, health officials are bracing for a second wave of infections from swine flu. A presidential panel this week said that “the plausible scenario” based on previous pandemics is that half of the U.S. population will be infected this fall and winter, resulting in up to 1.8 million hospitalizations and 90,000 swine flu deaths.
The estimate from the President’s Council of Advisors on Science and Technology said the virus could cause 60 million to 120 million people to fall ill and more than half of them to seek medical attention, according to a Washington Post article we published Tuesday.
These estimates are if the virus continues to cause a relatively mild to moderate form of disease and does not mutate into a more serious strain, according to the article.
But the CDC in an article the Statesman published today downplayed the data and said the numbers should be taken cautiously.
“We don’t necessarily see this as a likely scenario,” said Dr. Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases. An expert who helped prepare the report said the numbers probably tilted to the high side.
I called the Texas Department of State Health Services earlier today to see what it thought of the advisory group’s report and whether it had projections of Texas hospitalizations and deaths for the upcoming flu season. Spokesman Doug McBride said, “It seems significant that CDC has some concerns about the projections, but we want to take a look at the report ourselves.”
He said the department has not done projections at this time.
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August 24, 2009
Welcome back, students, but first, sanitize your hands
At least some Central Texas kids were welcomed back to school today with hand sanitizer — before they even sat down.
A co-worker said her child’s kindergarten teacher corralled him and the other kids before they were allowed to enter their classroom at Negley Elementary School in Kyle this morning so they could clean their hands with gel before starting the day.
“At first I thought it was odd, but clean hands are good,” my co-worker said. “So, we just kind of went with the flow.”
My colleague said she didn’t ask questions but assumed the sanitizer was to prevent the spread of swine flu, which is still circulating and is expected to mix this fall with seasonal flu.
Health experts are expecting a tough flu season. They are urging kids and adults to get regular seasonal flu shots. Vaccines for swine flu, or H1N1 flu, won’t be available until mid-October, and even then, it will be limited. (The Washington Post ran an interesting story Sunday that said only a third of the supply is expected to be ready by then.)
Regular flu season in Texas generally runs from October through May, so almost all of the flu cases doctors are seeing now are the H1N1 virus.
Julie Jerome, spokeswoman for the Hays school district, said officials are concerned about the spread of germs and have stepped up the placement of sanitizers in all the district schools. Austin officials said they have done the same thing.
“Some of the target areas are around the cafeteria and … we worked to get sanitizers in as many classrooms as we could,” Jerome said. “We’re talking about a contest at the elementary schools to design posters about washing hands. That’s our emphasis — clean hands, clean hands, clean hands.”
The teacher of my friend’s son evidently took that message to heart. My co-worker sent me a photo of the teacher kneeling in front of the door so she could inspect the children as they cleaned their hands.
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August 19, 2009
Swine flu shuts down Burnet club
With public schools across Texas opening next week — Austin students go back Monday — and swine flu still circulating, the experience of the Boys & Girls Club of the Highland Lakes provides a cautionary tale. The club announced today that it closed its unit at 704 Northington Street this morning through the end of the week to contain the spread of H1N1 flu there.
“We received a report this morning from a local pediatrician that lab results have come back positive for the H1N1 strain of the flu among five young people between the ages of 6 and 12 who attend the facility,” Executive Director Brian Jones said in a news release. “… Although we have not been required to do so, we have sent all club members home to allow their parents to monitor their children’s health as well as give our staff the opportunity to clean and disinfect the facility.”
Jones said the club, which provides daily activities for kids, was informed of a suspected case 10 days ago and informed parents. It plans to reopen to members Aug. 31.
Around the country, swine flu has hampered summer camps and other programs where children and students gather. Normally, flu fades in the summer, but the H1N1 virus has persisted and is expected to accompany seasonal flu this fall, making for a tough flu season.
Health officials advise anyone who is ill to stay home, including for 24 hours after a fever. Frequent hand washing is the best defense against germs, and people should avoid touching their faces.
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August 18, 2009
Travis County teen dies of swine flu
A 14-year-old Austin boy has died of swine flu — the second Travis County swine flu death, according to Dr. Philip Huang, medical director of the Austin/Travis County Health and Human Services Department.
Huang said the boy died in a San Antonio hospital but did not know the circumstances that led to his out-of-town hospitalization. Huang said he believed the boy had underlying health conditions that could have contributed to the death, but that was still under investigation.
The health department did not issue a news release about the death like it did when a 49 year-old Pflugerville man died of swine flu, but it mentioned the death in an update on its Web site. In addition to the two deaths, 14 county residents have been hospitalized because of swine flu since the outbreak began in April.
Huang said he did not know the child’s date of death and confidentiality laws prohibited him from disclosing additional details, including the name.
The Texas Department of State Health Services said in its latest flu update for the week ending Aug. 8 that “a 14-year-old resident of Health Service Region 7,” which includes Travis County, had died during the first week of August. The report said it was not yet known “whether the child had significant underlying medical conditions; however, the child had a methicillin-sensitive Staphylococcus aureus infection during his influenza illness.”
Staph and flu can be a deadly combination if the staph infection has invaded the lungs.
Texas has reported 14 flu-related deaths in children during the 2008-09 influenza season, including from seasonal and the novel H1N1 swine flu.
So far, 33 Texans have died of swine flu, according to Emily Palmer, spokeswoman for the Department of State Health Services.
Nationally, the U.S. Centers for Disease Control and Prevention reported 477 deaths and 7,511 hospitalized cases as of Friday. It updates the site once a week.
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August 7, 2009
Swine flu deaths slowing in Texas, not so in other big states
Swine flu deaths in Texas have been holding steady at 28 since the state’s July 29 case report, but they are accelerating in other big states, namely California and Florida, according to news reports.
Nationally, deaths rose by 83 in a week, from 353 to 436, a big jump of 24 percent.
Flu usually goes away in the summer, but novel H1N1 swine flu virus has stuck around. It continues to circulate in Texas and around the country, but some spots are ‘hotter’ than others.
The U.S. Centers for Disease Control and Prevention is reporting widespread flu activity — the highest level — in California, Hawaii, Maine, New Jersey and Puerto Rico. Activity in Texas is local, meaning that outbreaks of influenza or increases in flu-like cases are occurring in a single region of the state.
The Texas Department of State Health Services no longer is reporting cases or deaths on its its swine flu site, but the number of deaths has been holding steady for the first time since earlier in the epidemic, department spokeswoman Emily Palmer said. Before the July 29 report, the department reported 27 H1N1 deaths in its July 22 report. Before that, deaths in Texas increased each week by three or four people going back to early June.
Does that mean flu cases also are declining in Texas?
“For me, it would be difficult to speculate what’s happening,” Palmer said. She could not say for sure whether the number of deaths is a reflection of the number of cases.
Most states and local health departments around the country have stopped testing most people with flu for the H1N1 virus at the advice of the CDC except in certain circumstances, such as hospitalizations, pregnant women (who are especially at risk of complications from swine flu) and deaths. Texas’ guidelines for testing people are posted on its Web site.
Overall this week, the CDC is reporting 6,506 swine flu hospitalizations and 436 deaths.
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July 29, 2009
Government recommends vaccinating 159 million people first against swine flu
The government group that makes vaccine recommendations in the United States has recommended that 159 million high-risk people get the H1N1 swine flu vaccine first.
The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices said when vaccine becomes available — possibly in October — the people at the top of the list should be:
Pregnant women. (An AP story says that pregnant women make up 1 percent of the population but account for 6 percent of swine flu deaths.)
People who live with or care for children younger than 6 months of age.
Health care and emergency workers.
People 6 months to 24 years old.
People ages 25 to 64 who are at higher risk for H1N1 because of chronic health disorders or a compromised immune system.
All of those folks added together account for half of the U.S. population.
First, it’s a tall order: The government expects to have 120 million to 160 million doses available in October. And if everyone needs two doses, as expected now, that won’t be nearly enough. Dr. Anne Schuchat, director of the CDC’s National Center for Immunization and Respiratory Diseases, told reporters today that just 40 percent of those recommended to get flu shots actually get them so “we may have plenty of vaccine right away.”
Secondly, swine flu has been hitting young people especially hard, but it’s still a relatively mild virus. No one knows if it will become more severe in the fall, so it’s too early to know if people will shun the vaccine or if it will be in hot demand.
The committee said it does not expect a shortage of H1N1 vaccine, but added that availability and demand can be unpredictable. If supply is limited, the committee issued, a second, narrower set of priorities for vaccinating: pregnant women; people caring for children younger than 6 months; health care and emergency workers who have direct patient contact; children 6 months to 4 years old; and children ages 5 to 18 years with chronic medical conditions.
Once those high-risk groups get vaccinated, then everyone between the ages of 25 and 64 should, the committee said. Only then should older people be eligible, it said.
The committee also said that people should also get the regular seasonal flu vaccine. Seasonal flu will be circulating alongside the novel H1N1 virus this fall, requiring separate vaccines.
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July 28, 2009
One in six public health workers say they'd stay home in pandemic, survey says
One in six public health care workers responding to a new survey says they would not report to work in case of a flu pandemic emergency, according to new survey published in PLoS One (an online journal of the Public Library of Science).
That’s of interest to health departments as they brace for a worse than usual flu season. Health department staff would manage a health care emergency and likely vaccinate people.
The study done by researchers at John Hopkins Bloomberg School of Public Health and Ben-Gurion University of the Negev in Israel surveyed 1,835 public health workers in Minnesota, Ohio and West Virginia from November 2006 to December 2007. The researchers found that workers who were “concerned” about the threat of a pandemic but “confident” they could respond effectively were 31 times more likely to say they’d show up than those who said they perceived the threat was low and reported having less confidence in their abilities.
The researchers believe the findings could be helpful in planning staffing during a pandemic. “The unwillingness of some health workers to place themselves at risk of exposure to emerging infectious diseases was observed during the 2003 SARS epidemic and the early years of the HIV/AIDS epidemic,” they wrote, adding that was a reason they wanted to study the topic.
The demands would be so high during a pandemic emergency “that ‘all hands on deck’ will be required to tackle the resulting challenges, and significant changes in roles and responsibilities will be required,” the study said.
In the current pandemic, no one knows whether swine flu, or the H1N1 flu, will mutate into a worse virus this fall. Experts expect the virus to be circulating along with regular flu this fall, and a swine flu vaccine probably won’t be available until October. Health authorities are recommending that people get regular flu shots and once a swine flu vaccine is available, the Centers for Disease Control and Prevention has suggested that children, health care workers, pregnant women and other people at risk of complications get it first.
The researchers recommend that officials better educate public health workers about their roles during an emergency, and then motivate them to understand why they would make a difference.
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July 23, 2009
Three more die of swine flu; is there a pattern?
Three more Texans have died of swine flu, and once again, the victims are from the border. All were women — two from Hidalgo County and one from El Paso County.
Those are the two hardest-hit counties with swine flu, or H1N1, deaths. Hidalgo County now has nine, or one-third, of the state’s 27 deaths; El Paso County has seven. Most of the other deaths are scattered among counties in South and Southeast Texas.
What’s going on?
I put the question to Emily Palmer, spokeswoman for the Department of State Health Services, which tracks deaths and swine flu cases. Her agency thinks there are two key factors: the region’s young population and the proximity to Mexico, where there are a lot of swine flu cases and travel between countries, she said.
By the way, we no longer are reporting case counts because the data are meaningless. Most people who have swine flu are not being tested unless they are hospitalized, have died or have a specific reason for being tested. That means only a fraction of the cases are being reported, so no one knows how many cases actually are circulating.
Palmer said that in the Valley, where swine flu has claimed the most lives, the median age is very low. The virus is “hitting teenagers and young adults harder than our usual people at risk” of complications from the flu, Palmer said. “Sixty-seven percent of the confirmed cases are between 5 and 18.”
That is one reason officials are very concerned about what will happen when schools reopen next month. (See my story on this topic in an upcoming edition of the Statesman.)
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July 10, 2009
Fall swine flu: Don't panic, get prepared, officials say
President Obama’s warning to Americans to expect a bad swine flu season this fall outlined in today’s New York Times prompted health officials to talk about ways you and I can prepare now.
We should consider stocking a two week’s supply of water and food for the family, according to the U.S. Department of Health and Human Services and the Centers for Disease Control and Prevention. Both sites include many other tips on what we should do in case the supply chain is disrupted during the coming fall flu season, which typically runs in Texas from October to May.
“Some people are talking about high absenteeism,” said Dr. Pat Crocker, chief of the emergency department at Dell Children’s Medical Center in Austin. “If you took away 20 percent of the workforce for six weeks it’s going to make a big dent in things. It could cause some significant delivery problems.”
Crocker said while no one knows whether the H1N1, or swine flu, virus will mutate into a more severe strain this fall, it doesn’t hurt to take precautions. The problem is, he said, the government urges people to take steps without offering specific ideas on how to keep food on hand if you’re on tight budget, like many people today are.
Here are some tips from Crocker, who has a graduate degree in nutrition, including for buying reasonably priced foods with a long shelf life:
Many Web sites promote dried and dehydrated foods, but they often are costly. Instead, stock up on beans, rice and flour.
You can fill a large plastic tub with dried beans about inch from the top and drop in a lit wooden match, close the lid and the match will consume the oxygen in the tub, protecting your beans from bugs.
Bake your own bread.
Buy large tub of peanut butter, canned meats and tuna.
Keep a month’s supply of medications on hand.
Buy water in 2.5 gallon jugs, rather than more expensive individual bottles.
Military MREs (Meals Ready to Eat) can be ordered online and can last seven years.
Keep a daily vitamin like Centrum available.
These tips also can help people survive a natural disaster, like a hurricane, Crocker said.
“I don’t want anyone to think there is going to be a collapse of civilization next fall because I don’t think there’s going to be,” he added. “But there could be a stress on the health care system and the delivery system that we haven’t seen before.”
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July 8, 2009
Swine flu claims four more Texans
Four more Texas are confirmed to have died of swine flu, the Department of State Health Services is reporting today, bringing the total to 21.
The most recent deaths are a woman from El Paso County, two women from Hidalgo County a woman from Cameron County — all of whom died in June, said Emily Palmer, spokeswoman for the health department.
The state is now reporting swine flu infections in nearly half of Texas’ counties — 120 of 254.
The state health department says there are 4,287 confirmed cases of H1N1, or swine, flu and 177 probable cases for a total of 4,464.
The U.S. Centers for Disease Control and Prevention, which updates its numbers on Friday, is reporting 33,902 cases and 170 deaths. Those numbers were last updated Thursday because of the July 4 holiday.
I continue to hear of summer camp closings, although the state health department is not tracking those.
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July 2, 2009
Three more Texans die of swine flu as deaths rise to 17
Three more Texans have died of swine flu, bringing to 17 the number of known deaths in the state, according to the Department of State Health Services.
The Statesman earlier this week reported the death of a Pflugerville man, but since then, the state has confirmed three more: two men from El Paso and a man from Hidalgo County. They died in June.
The state health department’s latest update, done weekly, includes 3,818 confirmed cases and 174 probable cases for a total of 3,992.
The U.S. Centers for Disease Control and Prevention won’t update its count until Friday and has posted 27,717 confirmed and probable cases and 127 deaths nationally. A top official there said those cases are “the tip of the iceberg,” and she suspects there are well over 1 million people in the United States infected.
Right now, the swine flu, or H1N1 flu, is believed to be milder than seasonal flu, which kills an estimated 36,000 Americans every year, generally from complications such as pneumonia. But because flu mutates, health authorities are watching what is happening with this novel virus in the Southern Hemisphere, where influenza season is just starting. It could provide valuable clues about our fall flu season; some fear a return of a stronger virus.
Steps to develop a possible vaccine are underway.
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June 29, 2009
Travis County reports first swine flu death
A 49-year-old man from Pflugerville is the first person in Travis County to die of swine flu, the Austin/Travis County Health and Human Services Department reported this afternoon.
The health department said in a news release it did had not have more details on the death at this time.
The Department of State Health Services is reporting 13 deaths in Texas, not counting this one, according to its most recent update — from Wednesday.
Dr. Phil Huang, medical director for the health department, said in a statement: “Given the fact that several deaths in Texas and hundreds globally have occurred due to this illness—this is not an unexpected event. We continue to coordinate with local, state and national partners to monitor the spread of this illness.”
The health department has more information about swine flu, or H1N1 flu, on its Web site.
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June 25, 2009
Swine flu kills Bexar County adults; flu cancels church camp
The Department of State Health Services reported this week that three more people — all adults from Bexar County — have died from swine flu in June. That brings to 13 the number of swine flu deaths in Texas. In all, the state health department is reporting 2,982 confirmed and probable cases of swine flu.
Nationally, the U.S. Centers for Disease Control and Prevention is reporting 21,449 confirmed and cases 87 deaths as of June 19.
Meanwhile, flu among campers from a San Antonio church caused an early end to their stay at Camp Tejas near Giddings, the camp’s CEO said today.
Community Bible Church called off its final session of camp last week because children began falling ill during the church camp’s third session while those arriving for fourth session also were reporting flu and strep, CEO David Jones said. Department of State Health Services spokeswoman Emily Palmer said one swine flu case was confirmed at the camp. Jones said 24 others had regular flu.
Camp Olympia in Trinity County also reported children with swine flu, Palmer said. She did not know how many or if that camp was closed.
At Camp Tejas, a Christian camp and retreat that is rented out to churches and others, the illness began on June 12, Palmer said.
Jones said the camp’s final session was reset for August. The health department came in and assisted and made sure the camp was thoroughly cleaned, Jones said. It is back to normal now.
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June 18, 2009
Woman from Victoria, man from El Paso latest swine flu deaths
A woman from Victoria County and a man from El Paso County are the most recent swine flu deaths in Texas, bringing the state’s total to 10, according to the Department of State Health Services.
The pair died in early June, as did a boy and a woman from Hidalgo County. Their deaths were reported earlier this week. No other details on the four are available, health department spokeswoman Emily Palmer said.
Based on this week’s update, Texas is reporting 2,520 confirmed and probable cases of swine flu.
Nationally, the U.S. Centers for Disease Control and Prevention is reporting 17,855 cases and 44 deaths, but the numbers are don’t reflect all of the cases and won’t be updated until tomorrow.
Health authorities urge the public to take the following precautions:
Stay home when sick.
Cover coughs and sneezes to avoid spreading illness.
Wash hands frequently or use an alcohol-based hand sanitizer.
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June 12, 2009
Houston area girl dies of swine flu, bringing state's total to 6
A girl in Fort Bend County has died of swine flu, bringing the state’s total to six H1N1 flu deaths.
The girl died at the end of last month, according to the Department of State Health Services.
The department’s Web site is reporting 2,050 confirmed and probable cases of swine flu as of Wednesday, but there are many more than that. That’s because late last month the state began testing far fewer flu samples for the unique virus. Department spokeswoman Emily Palmer said that unless a patient with type A flu meets certain criteria, such as being hospitalized or being part of a special medical investigation, additional testing of flu patients isn’t done to determine whether the person has swine flu.
The reason is most swine flu cases are mild and resources are being focused on those at greatest risk of complications, she said.
Nationally, the U.S. Centers for Disease Control and Prevention is reporting 17,855 confirmed and probable cases and 45 deaths. Because of lag time in reporting, those numbers don’t include all of the counts from every state, including Texas.
State and local health department spokespeople said the World Health Organization’s declaration of a pandemic this week won’t change what they are doing in response to swine flu right now.
“We will continue to monitor Austin/Travis County through our surveillance process— working with our various partners in the community and providing information and educational awareness on seasonal flu and pandemic preparedness,” Carole Barasch, spokeswoman for the Austin/Travis County Health and Human Services Department wrote in an e-mail.
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June 4, 2009
Pandemic dress rehearsal shows we aren't ready
A new report today Pandemic Flu: Lessons From the Frontlines says that while coordination on responding to the swine flu outbreak went well, the health care system was easily overwhelmed. Considering the outbreak has been as mild — if not milder than regular seasonal flu — that’s not reassuring.
Researchers are concerned about a possible second wave of flu in the fall. They have reason to worry. In the 1918 Spanish flu pandemic, a mild wave of flu was followed by a highly lethal second wave that fall. That second wave killed about 90 percent of the 50 million people who died worldwide.
Today’s report of 10 lessons learned from this year’s outbreak is put out by the Trust for America’s Health, a nonprofit disease prevention organization; the Center for Biosecurity at the University of Pittsburgh Medical Center, which seeks to improve national security by reducing threats from biological attacks, epidemics and other events; and the Robert Wood Johnson Foundation, a nonprofit focused on health care.
Here are lessons:
• Investments in pandemic planning and stockpiling antiviral medications paid off
• Public health departments did not have enough resources to carry out plans
• Response plans must be adaptable and science-driven
• Providing clear, straightforward information to the public was essential for allaying fears and building trust
• School closings have major ramifications for students, parents and employers
• Sick leave and policies for limiting mass gatherings were also problematic
• Even with a mild outbreak, the health care delivery system was overwhelmed
• Communication between the public health system and health providers was not well coordinated
• WHO (World Health Organization) pandemic alert phases caused confusion
• International coordination was more complicated than expected
The report makes recommendations, including making sure hospitals could handle an influx of patients; ensuring enough medications and vaccines to protect Americans; and providing adequate funding for those responding to the outbreak. Paying for the improvements would cost hundreds of millions, if not billions. I did not see a grand total in the report.
Although flu season has officially wound down, the swine flu still is spreading. So far, the Texas Department of State Health Services is reporting 1,671 confirmed and probable cases. Five people have died in Texas.
The U.S. Centers for Disease Control and Prevention is reporting 11,054 U.S. cases and 17 deaths, not including all of the Texas cases and deaths.
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April 29, 2009
Swine flu cases mounting in Texas as governor declares disaster
Gov. Rick Perry has issued a disaster declaration for all of Texas, and state health officials are now reporting 16 confirmed cases of swine flu, up from six.
At a news conference where Perry made the announcement, state health officials said they are concerned about two other seriously ill patients.
The first is a 23-month-old child, a confirmed case of swine flu. The second is a pregnant woman who had to have an emergency C-section. Her child is doing fine, but the mother is in critical condition, said Dr. David Lakey, commissioner of the Department of State Health Services.
He said there was “a high likelihood” that the woman’s illness would be confirmed as swine flu.
Officials did not disclose the counties where the critically ill patients live, but a spokeswoman for the Department of State Health Services identified five of the counties in which the 10 newly confirmed cases reside. Two are from Guadalupe County, two are from Starr and one is from Cameron. The department is still working to determine the counties of residence of the other five cases, spokeswoman Emily Palmer said.
Of the six previously known cases, three patients are from Guadalupe County and three from Dallas County. They have recovered, health department officials said.
The critically ill patients“demonstrate to us that there is the potential for severe disease in certain populations,” including the very young, Lakey said.
He also said that pregnant women are at increased risk for severe influenza.
The United States is reporting one swine flu death: a 22-month old boy from Mexico who was visiting relatives in Brownsville. He died Monday night after being taken to a hospital in Houston, the health department reported today.
The disaster declaration enables the state to enact emergency measures and to seek federal money for protective measures.
“Texans can be confident that we’re making every effort to stay ahead of the curve, to keep them and their families as safe as possible,” Perry told reporters today.
Perry said that though the virus has not been detected in every county, the proclamation will “move Texas to a higher state of alert and release resources to address the spread of the virus.”
Meanwhile, the state health department has other possible swine flu samples to test and is sending on any that merit final confirmation to the U.S. Centers for Disease Control and Prevention. The CDC is on the ground in Texas, California and Mexico to assist with with the outbreak investigation.
Ten states are now reporting cases, for a total of 91 in the United States, up from 66 yesterday, according to the CDC Web site.
We expect that as this outbreak continues, we’ll find more hospitalized patients,” Lakey said. He added: “We expect that there will probably be some additional deaths in the United States.”
Lakey said that people who got a regular flu vaccine may not be protected.
“I can’t trust the vaccine that I received this year necessarily to prevent this swine flu,” Lakey said.
What’s the big deal with swine flu? It’s a novel virus that hasn’t been seen before, and no one has immunity to it. However, it can be treated with Tamiflu and Relenza, and Perry said at the news conference the CDC has approved 850,000 courses of antiviral medication from the Strategic National Stockpile. Another 840,000 courses of medication are on hand that Perry and the Legislature authorized in 2007.
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Central Texas schools not planning to close at this time, officials say
No Travis, Williamson or Hays county school districts have reported cases of swine flu and none have plans to close schools at this time.
Several tri-county districts have said that they would make any decisions about school closures in consultation with local and state health department.
Georgetown superintendent Abbe Boring said: “We would make any decision working in partnership with the county health department, based on an actual confirmed student situation.”
Officials in several districts have said that they are stepping up their campus and bus custodial efforts and establishing procedures for dealing with the possible cases with school nurses and county officials.
The Cleburne school district about 30 miles south of Fort Worth announced at 10 a.m. this morning that it will be closing all campuses at least through the rest of this week. Campuses are currently calling parents to pick up students, district officials said. Earlier this morning, the district cancelled classes at Cleburne High School, Cleburne TEAM School and the Phoenix Campus based on reports of four probable cases of swine flu involving Cleburne High School students.
Every campus in both New Braunfels and Comal independent school districts has been closed until May 11, and New Braunfels-area private schools have agreed to do the same.
The New Braunfels Herald-Zeitung reports that New Braunfels and Comal County leaders also have recommended that area day cares close and that residents avoid public gatherings, including church.
“All of this is being done out of an abundance of caution,” New Braunfels Mayor Bruce Boyer told the Herald-Zeitung on Tuesday night. “Right now this has not gotten to an epidemic stage, and we want to make sure that it doesn’t. We want to be proactive and make sure we do everything we can for the health and safety of our residents.”
The three probable swine flu cases were collected from students at New Braunfels High School, Freiheit Elementary and Memorial High School, an alternative school in Comal Independent School District, according to the Herald-Zeitung.
President Barack Obama said Wednesday morning that public health officials recommended schools with confirmed or suspected cases of swine flu “should strongly consider temporarily closing so that we can be as safe as possible.”
If the situation becomes more serious and we have to take more extensive steps, then parents should also think about contingencies if schools in their areas do temporarily shut down, figuring out and planning what their child care situation would be,” he said.
If we ended up having a school closure, a child was sick, just sending a child from the school to a day care center is not a good solution. So we would have to think through, and each parent, I think, would have to think through what options would be available to them in the event that this became more serious,” he said.
