Anticipating a potential resurgence of the H1N1 influenza virus this fall, HHS in the past few weeks has invested more federal dollars to try to ensure the nation is well-prepared to manage the disease.
HHS increases funding for H1N1 preparedness
Last week, HHS Secretary Kathleen Sebelius said the department will commit $884 million to purchase additional supplies of the two key ingredients for a potential vaccine for H1N1, also known as swine flu. Just days before, Sebelius announced $350 million in available grants to helps states and territories gear up for both seasonal and H1N1 preparedness efforts. And on July 6, the American College of Emergency Physicians released a detailed plan for emergency departments to manage the disease. Known as the National Strategic Plan for Emergency Department Management and Outbreaks of Novel H1N1 Influenza, the plan was developed under contract to HHS’ Office of the Assistant Secretary for Preparedness and Response and HHS’ Emergency Care Coordination Center to help emergency departments prepare for and respond to the pandemic.
“We recognize that preparedness is (a) shared responsibility between federal, tribal, state, local governments, private organizations and individuals,” Sebelius said in a statement after announcing the vaccine-supply funding. “We are doing our part to be as prepared as possible for the impact that this infectious disease could have on our country,” she added. “Vaccines may serve an important role in that preparedness. The action we are taking today will provide flexibility in a future immunization program, if a program is recommended.”
Last week, the World Health Organization—which announced H1N1 outbreak as the first global flu pandemic in more than 40 years in June—said the Strategic Advisory Group of Experts on Immunization, also known as SAGE, held a meeting in Geneva earlier in July to discuss issues and make recommendations related to a vaccine for the 2009 pandemic. First among the recommendations given to WHO Director-General Margaret Chan was a suggestion that all countries immunize their healthcare workers as a first priority to protect the essential health infrastructure.
This was a major issue recently for Greensboro, N.C.-based Moses H. Cone Memorial Hospital, which was placed in immediate jeopardy after a respiratory therapist—who had cared for a patient later diagnosed with H1N1—contracted the virus in mid-June and had exposed 33 infants to the disease in the hospital’s neonatal unit. After consulting with the state and local health departments, hospital officials decided to treat the infants with Tamiflu, given that the infants had been exposed to H1N1 and that the virus has primarily affected a young population.
Of those patients, 20 have been discharged and the other 13 have remained in the hospital for other reasons, said Joan Wessman, chief nursing officer of the Moses Cone Health System. None contracted the virus. Wessman said the hospital was transparent about the incident and communicated with the infants’ parents in person and by phone about recommended treatment.
A division of the North Carolina Health and Human Services Department had notified the CMS of the incident, which led to the facility’s “immediate jeopardy” status.
After issuing a plan of correction, and an additional visit from 18 state surveyors, the hospital learned on July 10 that it was out of immediate jeopardy, according to Wessman.
“The employee acted in good faith and had no idea that the patient had H1N1 and we had not been seeing it,” Wessman said. “We are educating the workforce about the epidemic. We have an electronic system that we use for reporting,” she said, adding that one change to that system is now all employees must report the reasons for any absences.
Educating a hospital’s workforce is a crucial issue in a pandemic, according to Stephen Cantrill, an emergency physician at 379-bed Denver Health Medical Center and member of the ACEP task force that developed the plan. One concern “is dealing with staff issues. We have to worry about an absenteeism rate by about 30%, that is, if we have the severity of 1918-1919,” he said.
The 16-page plan begins with certain assumptions, including one that says the fall 2009 wave will follow the 20th-century pandemics by having a greater virulence than the first wave. Those who developed the plan also assume that children and young adults will experience the highest attack rates, and that a well-matched vaccine will not be available until at least mid-October, and will not be effective until weeks after the final doses.
In addition to absenteeism, the other significant challenges for emergency departments will be supplies and staff education. Cantrill said hospitals will “burn through masks, gowns and gloves” at a huge rate, and then could face disruption in supply lines.
“Right now, the last estimate—there are about 105,000 ventilators in the U.S.,” he said. “If we have a pandemic on the order of 1918, the estimates are that we’d need more than 700,000 ventilators.”
Hospitals like Moses H. Cone Memorial will have to manage these and other problems. Wessman’s advice for other hospitals is to prepare for a high volume of H1N1 cases, but not a high level of morbidity and mortality.
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