Updates: Swine Flu

UPDATES ON SWINE FLU FROM MULTIPLE RESOURCES:

Podcasts:
May 1st Swine Flue update from EMRAP



April 26th update from EMRAP

University of New Mexico



Links to more podcasts:

• Studio A - Great resource
• Medline
• Johns Hopkins Medicine

News Columns:

'Walking Well' Flood EDs with Flu Fears By Madison Park (CNN)
CNN.com

A runny nose. A cough. A sore throat. And even pork eaten a week ago.

After a week of headlines about the H1N1 virus, or swine flu, many emergency rooms and hospitals are crammed with people, many of whom don't need to be there.

The visits by the "worried well" have triggered concerns of overburdening the nation's hospitals and emergency departments, several health care professionals told CNN.

This week, some hospitals saw record numbers of patients. A few emergency departments shut down to paramedics because of overcrowding.

"We have had a lot of nervous patients with minimal respiratory tract symptoms," said Dr. Mark Bell, principal of Emergent Medical Associates, which operates 18 emergency departments in Southern California. "It has caused signficiant amount of delays in emergency care. They're all walking well."

"I haven't seen such a panic among communities perhaps ever," Bell said. "We are spending significant time in the emergency department, calming people down. Right now, people think if they have a cough or a cold, they're going to die. That's a scary, frightening place to be in. I wish that this hysteria had not occurred and that we had tempered a little bit of our opinions and thoughts and fears in the media. It just went haywire."

In California, triage tents were set outside. Clinics doubled their traffic in major cities like Dallas, Texas, and Chicago, Illinois. In the Los Angeles area, some Emergent Medical Associates locations shut down their paramedic traffic.

"We're closing to the real emergencies that may be befalling our community," said Bell. "There is a little sense of hysteria among the community about the H1N1 virus."

Emergency rooms are usually crowded and "if you increase that volume, you're throwing them right over the edge," said Bill Briggs, president of the Emergency Nurses' Association.

"This has the potential to clog the system and emergency departments already facing serious crowding issues throughout the U.S.," said Briggs, a registered nurse at Tufts Medical Center, in Boston, Massachusetts.

Some came to the hospital because they reported eating pork and having a cough, and thought this meant they had H1N1 virus. Though commonly known as swine flu, this virus is not contracted through eating pork products.

Even in cities that have yet to have a confirmed case of H1N1, health care workers have noticed an uptick in the number of patients. The Minute Clinic, a walk-in health care chain that has 500 offices around the country, saw a 50 percent increase in flu-related visits Thursday.

Chicago Children's Memorial Hospital's emergency department had more than double their average number of patients this week.

"It was a lot of 'worried well' people," said Cathleen Shanahan, the nursing director for the emergency department at the hospital. "A lot of parents who were worried they about the flu."

The anxiety is understandable, but Shanahan cautioned, "At some point, they need to realize it's still flu season and it could be a normal flu season, and have nothing to do with [H1N1] flu." CNN.com: Regular flu has killed thousands since January

"The situation is that people get the flu all the time," said Dr. Nick Jouriles, president of the American College of Emergency Physicians. "H1N1 flu is just a bad strain of that. If you have flu symptoms and you ordinarily see the doctor for that, go ahead. If you would not ordinarily go to the doctor, don't."

If a person has no symptoms, then he does not need to seek emergency care, said Jouriles, an emergency room doctor at Akron General Medical Center in Akron, Ohio. And if the person does not have a fever or cough, it is extremely unlikely it's the H1N1 virus.

"Very often when this happens, people naturally become afraid and overinterpret every symptom as a harbinger of the flu or what the epidemic is," said Dr. Jeffrey Steinbauer, professor of family medicine and the medical director of the Baylor Clinic in Houston, Texas. "That's part of providing care to patients and it's kind of expected."

Rather than panicking when you have a cough or runny nose, Steinbauer advised finding more objective measures.

"A temperature is very objective," Steinbauer said. "If the temperature is normal, the allergens in the world and other viruses in the world can give you cough and runny nose. But if you don't have a fever, chances of it being a flu is very low."

While, the symptoms of the current swine flu and seasonal flu are very similar, reports suggest that this flu virus may result in nausea, vomiting and diarrhea more often than the typical flu. Symptoms include excrutiating body pains, difficulty breathing, significant nasal congestion and high fever. Doctors in Mexico have reported seeing sudden dizziness as well.

Health care workers find themselves trying to balance caution while allaying fears and panic about the virus.

"We recognize this as an infectious disease, this is moving," Dr. Robert Salata, the chief of Infectious Diseases at the University Hospitals Case Medical Center in Cleveland, Ohio. "For the general population, we're trying to calm the fears of people and the worried well, by stressing other elements like cough and sneezing etiquettes, and that you shouldn't go to work if you're feeling sick. If there is a concern, working through this with your physicians would be very important."

But dashing into the emergency department because of a runny nose is not helpful.

"We have a tendency in the U.S. to abuse our emergency departments," Salata said. "If this escalates, you want to use them for people that are not having mild or moderate symptoms."

Swine Flu Cases Pass 100 in US, Vaccine Pursued
Lauran Neergaard
Associated Press
2009 May 1

WASHINGTON -- U.S. authorities are pledging to eventually produce enough swine flu vaccine for everyone but the shots couldn't begin until fall at the earliest.
Worries about the spread of the virus mounted Thursday as the nation's swine flu caseload passed 100, and nearly 300 schools closed in communities across the country. Federal officials had to spend much of the day reassuring the public it's still safe to fly and ride public transportation after Vice President Joe Biden said he wouldn't recommend it to his family.
"There's not an increased risk there," Dr. Richard Besser, acting director of the Centers for Disease Control and Prevention, said Friday. "If you have the flu or flu-like symptoms, you shouldn't be getting on an airplane or you shouldn't be getting in the subway, but for the general population that's quite fine to do," he said.
Clinics and hospital emergency rooms in New York, California and some other states are seeing a surge in patients with coughs and sneezes that might have been ignored before the outbreak.
Scientists were racing to prepare the key ingredient to make a vaccine against the never-before-seen flu strain - if it's ultimately needed. But it will take several months before the first pilot lots begin required human testing to ensure the vaccine is safe and effective. If all goes well, broader production could start in the fall.
"We think 600 million doses is achievable in a six-month time frame" from that fall start, Health and Human Services Assistant Secretary Craig Vanderwagen told lawmakers.
"I don't want anybody to have false expectations. The science is challenging here," Vanderwagen told reporters. "Production can be done, robust production capacity is there. It's a question of can we get the science worked on the specifics of this vaccine."
Until a vaccine is ready, the government has stockpiled anti-viral medications that can ease flu symptoms or help prevent infection. The medicines are proving effective.
Reassurances from top health officials didn't stop the questions from coming.
An estimated 12,000 people logged onto a Webcast where the government's top emergency officials sought to cut confusion by answering questions straight from the public: Can a factory worker handling parts from Mexico catch the virus? No. Can pets get it? No.
And is washing hands or using those alcohol-based hand gels best? Washing well enough is the real issue, Besser said. He keeps hand gel in his pocket for between-washings but also suggested that people sing "Happy Birthday" as they wash their hands to make sure they've washed long enough to get rid of germs.
Although it is safe to fly, anyone with flu-like symptoms shouldn't be traveling anywhere, unless they need to seek medical care.
The swine flu outbreak penetrated over a dozen states and even touched the White House, which disclosed that an aide to Energy Secretary Steven Chu apparently got sick helping arrange President Barack Obama's recent trip to Mexico but that the aide did not fly on Air Force One and never posed a risk to the president.
The Washington Post identified the aide as Marc Griswold, a former Secret Service agent who was doing advance work for Chu. It said that Griswold has complained about the infection placing his family in an awkward position with family and neighbors.
"We're not the Typhoid Mary family, for goodness sake," he said. "We've been told that we're not contagious. We're already past the seven-day mark for that."
So far U.S. cases are mostly fairly mild with one death, a Mexican toddler who visited Texas with his family - unlike in Mexico where more than 160 suspected deaths have been reported. Most of the U.S. cases so far haven't needed a doctor's care, officials said.
Still, the U.S. is taking extraordinary precautions - including shipping millions of doses of anti-flu drugs to states in case they're needed. The World Health Organization is warning of an imminent pandemic because scientists cannot predict what a brand-new virus might do. A key concern is whether this spring outbreak will surge again in the fall.
The CDC confirmed 109 cases Thursday, and state officials confirm 22 more. Cases now are confirmed in New York, Texas, California, South Carolina, Kansas, Massachusetts, Indiana, Ohio, Arizona, Michigan, Nevada, New Jersey, Delaware, Maine, Colorado, Georgia and Minnesota.
Besser appeared Friday morning on ABC's "Good Morning America" and NBC's "Today" show.

Officials provide outlook on swine flu for EMS providers
By Maveric Vu
EMS1 News Editor

It has been more than seven days since reports began of the first major outbreak in swine flu. Since then, more than 360 cases have been confirmed in 13 countries, with thousands of suspected cases.

As reports of possible infections and school closures continue to surface, many EMS officials are relaying one message.

“Now is not the time for anyone to panic,” said Gary Wingrove, president of the National EMS Management Association.

The Centers for Disease Control and Prevention released interim guidelines for EMS providers Thursday that assist in the treating and transport of potentially infected patients.

“The problem is you just never know who’s going to be impacted,” Wingrove said. “Having plans ready on the shelf, and having reviewed them and knowing they’re current…those are all critical for everyone to do right now.”

For American Medical Response employees, pieces of information started circulating from managers last Friday evening, the first day swine flu reports became public.

Since then, safety and assessment guidelines have been disseminated to regional chief operating officers and on the AMR employee portal, said Scott Bourn, director of clinical programs for AMR.

“Our greatest risk in the patient arena is probably in the period before the patient has influenza,” Bourn said. “There are things we can do to protect our crews.”

The first step in protecting EMS providers — identified by the CDC — is for 911 dispatchers to get as much information as possible when dealing with a potential influenza call and to inform the first responder.

The CDC guidelines offer the following precautions for EMS providers entering a call with a suspected swine flu patient:

EMS personnel should stay more than six feet away from patients and bystanders with symptoms and exercise appropriate routine respiratory droplet precautions.
Wear fit-tested disposable N95 respirator and eye protection, disposable non-sterile gloves, and gown, when coming into close contact with the patient.
Some providers were concerned that the recommended distance away from patients would hinder proper assessment.

“If this is out of your realm of comfort, put a N95 mask on before you even approach the patient,” Bourn said. “You need to have a conversation at a distance or a conversation behind the relative safety of a N95 mask.”

CDC guidelines also say to assess all patients for symptoms of acute febrile respiratory illness, which is fever with nasal congestion/ rhinorrhea, sore throat, or cough.

Considered a “hallmark” indicator of influenza, Bourn said providers should ask if the patient has a fever as part of the initial assessment if there is no thermometer available.

Since swine flu, or Influenza A (H1N1) can be spread through the air, the CDC recommends infection control precautions in any areas that the suspected patient inhabited.

This includes proper ventilation and decontamination of the ambulance, as well as informing the receiving facility, which may have a designated area established for influenza cases.

“There is a fairly decent likelihood that some other people (in the household or school) have the flu as well,” Bourn said. “In addition to putting a mask on the patient, put a mask on anyone riding in the ambulance.”

Bourn said that an extra level of consideration is necessary for paramedics and EMTs to protect themselves against swine flu, especially since health officials are still unsure of the severity of the situation.

“You don’t know what the disease will be exactly or how it will progress,” Bourn said. “You can’t really know what you need, or what it really is, until you get in the middle of it.”

According to Wingrove, he has encouraged EMS managers from around the globe to share best practices on the NEMSMA Web site in hopes of approaching a solution “globally.”

“Talking to people this past week, I was amazed at the number of services that haven’t done any planning so far,” he said.

Wingrove said it is the responsibility of impacted EMS departments to seek out resources in these initial stages, until the federal government decides how it will act.

“I know people are frustrated with not getting things faster from their state EMS office,” Wingrove said, “[But] what I see going on is a real attempt on the part of the federal government to be comprehensive and to be accurate.”

As cases continue to sprout up in countries around the world, EMS providers should continue to rely on information from the CDC and the World Health Organization.

“The hard thing is that [swine flu] looks so pedestrian. People may look at the symptoms and ask, ‘what’s the big deal?’” Bourn said. “The blessing is that it’s not hard to protect against.”

For more information on Influenza A (H1N1), including tips for EMS providers, visit the Centers for Disease Control and Prevention at http://www.cdc.gov/h1n1flu/.