Tracking H1N1 shots, in Texas and beyond
Filed under: Health data, Hot Health Headline, Public health
Jeffrey Weiss of The Dallas Morning News reports that he was able, via an open records request, to get a full list of organizations in Texas that have requested H1N1 vaccines, as well as list of all shipments ordered. The list doesn’t include any public health departments, and is led by large hospitals and mass vaccinators.
On a national scale, the HHS-maintained flu.gov has an updated list of the number of doses of H1N1 vaccine that have been shipped to states, territories and regions thus far. And for your readers or viewers who are trying to get the shots, Google has a flu shot finder map for both H1N1 and seasonal flu vaccines.
6-foot rule separates San Diego paramedics, H1N1
Voice of San Diego’s Randy Dotinga explains exactly how the fear of H1N1 has transformed every step of the health care delivery process in the Southern California city, which has been hit particularly hard by the virus. Dotinga focuses on how paramedics’ routines have changed. “To protect themselves,” Dotinga writes, “paramedics are essentially using the same precautions they would against infectious tuberculosis – something they hardly ever see.”
Dotinga says the changes become evident as soon as the paramedics arrive on the scene. Before H1N1, they’d walk right up to the patient. Not anymore.
Now, paramedics across the county adhere to a “Six-Foot Rule” when they suspect a patient has a respiratory illness. “If you’re six feet away even without your protective equipment for a short period of time, you’re not likely to get infected,” said Haynes, the county official.
If a patient has possible flu symptoms, the paramedics put on N95 respirators. They began wearing the respirators instead of ordinary masks about a month ago. Paramedics will put on eye shields too. Many paramedics hate to wear them, and forget to put them on.
In this environment of extreme care, not even the ambulances are left to go on as usual. These days, in addition to their regular regimen of extreme sanitation, they visit a nearby fire station a few times a month. There, they are nailed with a super-powered germicidal fog that ensures no microbes, nefarious or otherwise, are going to linger for long.
Does the six-foot rule really work? What about masks?
Maybe. Your view of the effectiveness of social distancing likely depends on where you stand on a particularly contentious issue: airborne vs. droplets. If influenza is spread primarily through droplets (as the CDC says it does here, and here), then it’ll have a tough time spreading beyond three feet unless it’s smeared on a surface. In this case, then, the six-foot rule is an effective way to slow the spread of the virus, as are masks.
If, however, you believe the virus is airborne then it would be able to cross the six-foot gap and you would need, at the very least, an N95 respirator (a mask which filters out at least 95 percent of airborne particles) to protect yourself. In this case, though, it’s important to note that according to some recent research, an N95 won’t offer any more protection than a regular mask.
According to the Institute of Medicine, we haven’t yet heard the final word on influenza transmission and further research is required (PDF). In the meantime, most providers are erring on the side of caution. Check out AHCJ’s primer on controlling pandemic flu for further information.
(Hat tip to AHCJ board member Maryn McKenna for pointing us in the right direction.)
NPR answers H1N1 questions
With H1N1 and the mini-pandemic of rumors that seem to follow it on the rise, NPR brought out the big guns in an attempt to answer reader/listener questions and get the facts straight.
NPR’s health editors, Joe Neel and Anne Gudenkauf, teamed up with Dr. Andrew Pekosz and Dr. William Schaffner to tackle your questions.
Pekosz is an expert on viruses and immunology and a professor at Johns Hopkins Bloomberg School of Public Health. Schaffner is an infectious disease expert and professor at Vanderbilt University.
They answer questions like “Do H1N1 and other flu vaccines work?”; “Are they dangerous?”; “Who’s immune?”; “Should I be vaccinated for both H1N1 and typical seasonal flu?” and more.
Heisel: H1N1 reporters should get out the test tubes
Antidote’s William Heisel recommends that journalists looking to dive deeper in H1N1 issues pull out their test tubes, put on their lab coats and perform a few original acts of science.
In particular, Heisel focuses on possible tests of the link between H1N1 and swine. In that spirit, he adds a list of six recommendations for enterprising reporters to produce original news research on H1N1.
Resources for journalists covering flu
Filed under: Health journalism, Health policy, Tools
AHCJ member Stefanie Friedhoff has led a Nieman Foundation effort to bring together as much pandemic flu material as possible in one spot. The CoveringFlu.org guide not only helps reporters with the science, historical context and journalism involved, but also with practical safety considerations.
Much of the content came out of a 2006 conference, The Next Big (Health) Crisis - And How to Cover It, presented by the Nieman Foundation and cosponsored by AHCJ. It brought journalists together with scientists, public health officials, medical experts, academic researchers, law enforcement officers, public policy experts, and Homeland Security officials to talk about how best to prepare for the possible arrival of pandemic flu.
Read edited excerpts from a lengthy transcript from the event:
- Interactions of journalists and sources
- A focus on the science
- Understanding the risk - What frightens rarely kills
- Reacting to the crisis
- Press lessons from the 1918 pandemic flu
- Preparing for pandemic flu
- Reporting from the frontlines
- The many dimensions of the avian flu story
- Communicating news of an outbreak
- Preparing for the crisis
- Books about influenza
AHCJ also has these resources for journalists covering flu stories:
- Avian and pandemic influenza tip sheet, by Maryn McKenna
- Covering avian flu and pandemics: Tips for smaller newspapers/broadcast operations
- Pandemic preparedness: Tips to cover recent supplemental funding to states
- Avian & pandemic flu resources
- Bringing international stories home
- Resources for covering H1N1 flu, pandemics and preparedness
- Preparing your community for pandemics
- Pandemic/avian influenza: Epidemiology and challenges
- Pandemic influenza: Planning and coordinating the response
- Public health crisis preparation: Linda Rosenstock
CBS questions CDC’s H1N1 prevalence estimates
CBS’s Sharyl Attkisson reviewed state and federal data (collected through FOIA and other open records requests) and found that H1N1 may not be as prevalent as the Centers for Disease Control and Prevention have estimated. The story turns on a July 24 memo announcing to states that the CDC would no longer count H1N1 cases and statistics from state tests taken before the memo that show that even tests of the most likely patients usually came back negative for H1N1.
The high level of misdiagnosis of “probable” or “presumed” H1N1 could result inaccurate reports of outbreaks as well as in people assuming they’ve survived H1N1 and are now immune when they’ve actually suffered something that may or may not even be influenza.
Related: The CDC talked a bit about reporting and data in its Oct. 20 news briefing. Read the rough transcript of that briefing, provided by the CDC. And, The Associated Press’ Mike Stobbe, an AHCJ board member, offers more explanation about the surveillance of H1N1.
Attkisson’s report:
Bioethicist: Health workers must get H1N1 vaccine
Filed under: Hospitals, Hot Health Headline, Public health
On MSNBC.com, University of Pennsylvania bioethics professor Arthur Caplan takes a tough stand on flu vaccines for health professionals, imploring them to stop “whining” and “moaning.” “Doctors, nurses, respiratory therapists, nurses’ aides, and anyone else who has regular contact with patients ought to be required to get a flu shot or find another line of work,” Caplan writes. According to Caplan, a 100 percent workers’ vaccination rate can cut patient flu deaths and worker sick days by about 40 percent, and thus health workers who claim mandated flu shots are an infringement of their rights are forgetting a key ethical tenet of their profession, that they put the interests of the patient above their own.
Photo by llu_lu via Flickr
It’s the idea of rights infringement that really sets Caplan off:
Excuse me? What rights might those be? The right to infect your patient and kill them? The right to create havoc in the health care workforce if swine flu hits hard? The right to ignore all the evidence of safety and efficacy of vaccines thus continuing to promulgate an irrational fear on the part of the public of the best protection babies, pregnant women, the elderly and the frail have against the flu? Those rights?
Caplan’s a fellow and former associate director of the Hastings Center, a nonpartisan bioethics think tank.
Related
A just-released survey conducted by the American Society of Health-System Pharmacists finds that health workers are asking pharmacists the same questions (PDF) that patients are asking:
- Is the H1N1 vaccine safe? (Patients: 52%, Hospital Employees: 54%)
- Do I need to get the H1N1 vaccine? (Patients: 33%, Hospital Employees: 43%)
- Will there be enough H1N1 vaccine to around? (Patients: 27%, Hospital Employees: 27%)
The ASHP also says that “While pharmacists are authorized to administer vaccinations to adults [in most states], the survey also finds that most hospitals are not planning to utilize pharmacists for this service. ” The organization - made up of 35,000 members who include pharmacists, pharmacy technicians and pharmacy students - is encouraging hospitals and health systems to use pharmacists to administer vaccines to increase vaccination rates. The survey also looks at other H1N1 influenza preparedness issues as well.
The anonymous folks who test swabs for H1N1
The Baltimore Sun’s Stephanie Desmon profiled the crew of state workers laboring behind the scenes to test and identify samples of H1N1 and other strains of influenza.
Maryland is one of a dozen states testing to make sure the virus hasn’t mutated and become drug resistant. It’s labs such as these that will be the first to sound the alarm when H1N1 has returned with a vengeance, Desmon writes, and the data they forward to the CDC is crucial in the fight against flu.
Dr. Robert A Myers, deputy director of the state public health laboratory, explained some of the lab’s testing processes, saying that “I try to dispel the ‘CSI’ fact that everything takes 15 minutes.”
Flu plan includes withholding ventilators
Filed under: Government, Health policy, Hot Health Headline
Sheri Fink, M.D., of ProPublica, is reporting that state and federal officials are drawing up guidelines on who would get ventilators should there be a severe flu outbreak, including “procedures under which patients who weren’t improving would be removed from life support with or without permission of their families.”
On Thursday morning, the Institute of Medicine is expected to release guidelines to help planners create standards of care in extreme emergencies, according to Fink.
Many of the draft guidelines, including those drawn up by the Veterans Health Administration, are based in part on a draft plan New York officials posted on a state web site two years ago and subsequently published in an academic journal. The New York protocol, which is still being finalized, also calls for hospitals to withhold ventilators from patients with serious chronic conditions such as kidney failure, cancers that have spread and have a poor prognosis, or “severe, irreversible neurological” conditions that are likely to be deadly.
Update
The IOM has released its report on “Standards of Care During Disaster Situations.”
OIG: Are we ready for a flu pandemic?
The Department of Health and Human Services’ Office of Inspector General has released two reports assessing just how prepared Americans are for a flu pandemic. Their findings? Communities are on the right track when it comes to preparing for a surge in patient numbers, but they’re not as ready as they could be. Likewise, there’s still more to be done before local organizations will be ready to distribute vaccines and antiviral drugs.
A surge of flu victims
In the Southern Hemisphere, where the flu season has already struck, the biggest systemic issue was lack of space in intensive care units overwhelmed by H1N1 victims. Are American communities doomed to more of the same? After reviewing the coordination, volunteer recruitment/organization, medical equipment, alternate care and triage and admission guidelines of 10 localities as of late summer 2008, the OIG’s answer is a resounding “not quite.” (Get the full 37-page report here.)
The OIG’s to-do list for the assistant secretary for preparedness and response?
- Keep emphasizing those five areas that we evaluated
- Make sure that, when states and localities do medical surge preparedness exercises, they then document and address the lessons they learned from those activities.
- Those lessons everyone just documented? Make sure they share them with everyone else too. Preferably through the CDC. Then the feds can work to address specific local issues.
- Consider working with states (or even the federal government) to “develop appropriate legal protections for medical professionals and volunteers who respond to public health emergencies and who may need to alter standards of care.”
Getting vaccines/antivirals to the right place, at the right time
According to HHS, “even a mild pandemic could cause between 2 million and 7.4 million deaths worldwide” and H1N1 looks to be a “moderate” one. Vaccination is a key component of the prevention plan, which is why the OIG evaluated the pandemic flu plans of 10 communities in the categories of “Receiving & Staging, Dispensing, Tracking, Vulnerable Populations, Priority Groups, Security, Storage, and Transportation.” In general, they found that the communities need to practice more, plan for all eight categories and make those plans “actionable.” In general, folks were best at planning for receiving/staging and dispensing and worst at planning for security, storage and transportation.(Read the whole 57-page report here.)
Based on those findings, the OIG recommended that the CDC:
- Work with states to figure out why folks are still in the “early stages” of planning and help them make some progress
- Prioritize which of the eight areas states should focus on in order to improve local readiness as quickly as possible.
- Emphasize “actionable” plans that “identify the organizations or individuals responsible for carrying out specific actions and the sources that would be necessary to staff distribution and dispensing positions” that are “supported by valid, detailed formal agreements with partnering agencies.”
- Again, make sure locals keep track of what they’ve learned in preparedness exercises and that they make plans to correct any deficiencies. Also, make sure they share plans and “emerging promising practices.”
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