The H1N1 influenza virus, formerly known as Swine Flu, could spread rapidly even before a vaccine is made available in October, and hospitals are bracing for what they anticipate will be a heavier than usual flu season that could potentially challenge an already strained healthcare system in new and complicated ways. Although no more serious than a case of seasonal flu, H1N1 is a very endemic strain of influenza that targets a younger population – those between 6 months and 25 years of age- and because no vaccine has been made available so far, there will be many people susceptible to the virus. As many as one in four Californians may be sickened this year by H1N1, according to The California Department of Public Health. The virus could spread quickly, especially as kids get back to school and get into crowded situations. Parents might then catch the flu and pass it on to their co-workers, potentially creating a costly ripple effect for employers. Hospitals are quickly preparing to deal with greater volumes of patients, and increased visits to the emergency room. Most importantly, they are setting strategies in place to prevent the spread of the virus within the hospitals to other patients as well as to the staff and doctors themselves. “Unfortunately a lot of people still use the emergency room as their primary source of care, and so we’ll end up seeing more patients come in through the emergency room which could create a problem because they could expose others,” said Providence Health & Services Chief Medical Officer, Myron T. Berdischewsky, M.D. When the swine flu first hit in April, hospitals like Providence Saint Joseph Medical Center saw daily volume of emergency room visits go up 45 percent, he said. That number could be even higher this upcoming season. Like other hospitals, Providence Saint Joseph is making preparations to have all staff immunized with the vaccine as soon as it becomes available and is stocking up its inventory of masks, protective gloves and alcohol based hand sanitizer. The hospital has set in place a screening process to quickly identify flu patients and is also making preparations to convert two vacant floors to be used for extra bed space, if needed. Connie Lackey, emergency preparedness manager for Providence Health & Services’ Valley service area, is helping further coordinate H1N1 preparedness efforts at Providence Holy Cross in Mission Hills and Providence Tarzana Medical Center. “We are planning now so we can be a dependable source of accurate information and care for our patients using the most current public health guidelines,” she said. At Valley Presbyterian Hospital, nurse Tom Viall and Quality Management Director Dan Price are leading flu preparedness efforts with a taskforce, which has grown to 25 people from across all hospital departments. “This is one of our main priorities at the hospital,” said Price, adding that the issue of H1N1 preparedness is also a priority item for all regularly scheduled meetings at the hospital. “In order to be prepared we always look at the worst case scenario. We are keeping a close eye on all incoming guidelines provided by the Department of Public Health.” The hospital, he said, is setting in place an epidemiological strategy largely focused on education. Through marketing materials and newsletters sent to 44,000 San Fernando Valley residents, the hospital is urging visitors with flu-like symptoms as well as all children under 16, to stay away. Valley Presbyterian is also securing hospital entryways and screening visitors with a questionnaire to identify flu symptoms and asking those that have them to return when they are feeling better, encouraging them to send their good wishes with a phone call, card or “Get Well” e-mail through valleypres.org. A ‘Cover and Clean’ marketing campaign is also educating patients that have cold or flu-like symptoms to ask for a mask, cover their coughs and sneezes with a tissue and wash their hands frequently or use alcohol based hand sanitizer. Additionally Valley Presbyterian’s emergency room visits, which regularly range from 150-170 per day, could jump to upwards of 200 as they did this past April. Nurse Viall said in order to accommodate greater volume at the ER, the hospital will set up a Fast Track area that will essentially function as an “urgent care’ area, where patients will be screened, treated and dismissed depending on the case. The hospital, which is equipped with 27 Negative Airflow Rooms that prevent the spread of the virus, has also identified a unit with 32 beds to be used strictly for H1N1 flu patients if needed. Other area hospitals are taking similar steps. “One of the most important jobs for every employee at Glendale Adventist Medical Center and Simi Valley Hospital is to help control the spread of infection within our facilities,” said spokeswoman Alicia Gonzalez also emphasizing education and active management of all public entrances to curb the spread of the flu at healthcare facilities. Among the biggest priorities for healthcare providers when it comes to preparing for the flu season is getting all medical staff vaccinated, followed closely by getting the public vaccinated in an effort to curb the spread of the disease. “We wish we could get the vaccine sooner, the sooner the better,” said Jonathan Fielding, LA County Director of Public Health. The first batch of the vaccine, which is still being tested, is expected to be released mid October, he said. The Department of Public Health is working with health care providers, coordinating the allocation and distribution of the vaccine as it becomes available. Although the numbers have not been finalized, Fielding said preliminarily the County could receive over a million doses of H1N1 flu vaccine initially to be distributed to all hospitals in the County. Unlike the regular flu shot, which only requires one dose, the H1N1 vaccine will require two shots, further complicating things and potentially causing logistical problems at doctor’s offices, drugstores and clinics that typically give out only one shot, said Fielding. This season, people will require three flu shots for full protection, one for the regular flu and two for the swine flu. The two swine flu shots would be given three weeks apart. Although clinics offering flu shots will be located at some school campuses, Fielding said due to these logistical problems larger school systems have said it will be too difficult for them to administer the vaccine on campus. “The County is telling folks to go to their usual places of care to receive the vaccine,” he said. Fielding said the Department is working with state and local governments in flu preparedness efforts. In the past three years, the state of California has spent more than $400 million to upgrade its readiness, including purchasing three fully equipped mobile hospitals and nearly 7,200 ventilators to respond to an outbreak of respiratory illness.
