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Source: http://www.honoluluadvertiser.com/ar...+H1N1+outbreak
Posted on: Friday, May 29, 2009
Hawaii's official flu hunters trying to keep up with H1N1 outbreak
Burnout's a concern, with outbreak in its fourth week
# Special Report: Swine flu resources
By Dan Nakaso
Advertiser Staff Writer
Six health inspectors are working long nights and weekends tracking down swine flu victims on O'ahu and then doing the tedious detective work of notifying hundreds of friends, family and co-workers that they, too, might have been exposed to the disease sweeping around the world.
The work also requires state health inspectors to play the roles of community health educators, counselors and sometimes mediators.
With 73 confirmed cases since May 5, state epidemiologist Dr. Sarah Park worries that the small team of investigators is tiring before the outbreak may reach its peak in the Islands.
"It's the fourth week now and we can't keep up this pace," Park said. "They're already getting to burn out."
Behind the public concern that has greeted the emergence of swine flu in the Islands, the work of Hawai'i's health inspectors — six on O'ahu, two on Maui, two on the Big Island and one on Kaua'i — has gone on with no public fanfare as they try to control the spread of swine flu.
They had to intervene when Honolulu police were called to forcibly remove an employee whose child was ill with seasonal flu, not swine flu. They have patiently explained what's known about the disease officially called H1N1 Influenza A to households hit with seasonal flu or swine flu — and sometimes both at the same time.
And they've tried to get business owners to accommodate employees who need to keep working during economic hard times, even though they might have been exposed but tested negative for swine flu.
"It's been a lot of hand holding, a lot of education," said Joe Elm Jr., who supervises the Health Department's overworked field investigators. "There's some people that are head of family that can't afford to be out of work. We have to say, 'How can you go to work and protect others around you — social distancing, maybe wearing a mask.' "
Nothing routine
O'ahu's six health inspectors normally focus on investigating 52 reportable illnesses, such as measles, mumps, meningitis and hepatitis A.
But since an Army couple and an unrelated child were confirmed with O'ahu's first swine flu cases on May 5, the inspectors have focused only on tracking down more H1N1 patients and the people they might have exposed to swine flu.
Their former, routine cases have been picked up by the Health Department's sanitation branch, which normally handles restaurant inspections. The state's veterinary medical officer is now handling investigations of non-swine flu cases among humans.
State public health nurses and immunization branch workers are also contacting people who have tested positive for influenza A and are answering phone calls from people with flu questions.
The state laboratory is stretching a dozen workers to cover two shifts to keep up with all of the swine flu testing, said Dr. Chris Whelen, administrator of the state laboratory.
Every day, health inspectors then review an average of 90 positive flu tests looking for new swine flu cases.
"Can I continue to operate at the level that I am? Absolutely not," Whelen said. "I've got guys that want to tough it out. I'm like, 'Guys, this is not going to be over any time soon. I can't have you hit the wall and not be able to handle Phase II, Phase III, Phase IV and whatever else develops.' "
"It's not just the inspectors," said Health Department spokeswoman Janice Okubo. "A lot of parts of our departments are pitching in."
That still leaves lots of long days and nights for the six inspectors on O'ahu.
Whelen has called investigators at midnight with up-to-date swine flu test results "just to make sure they're still at work," he joked.
They usually are.
Just tracking down a single patient who has tested positive for swine flu can take long hours because doctors who order the tests usually don't include a phone number for the patient, said Michele Nakata, chief of the Health Department's disease investigation branch.
Results typically come in after doctors' offices close but some physicians can access patients' records remotely, Nakata said. Others have opened up their offices to get patient information.
But investigators like Nakata often have to scour databases and phone books — and sometimes drive out to the patient's last known address on a weekend — because they don't want that person going to school or to work and exposing dozens of others.
"It's just getting to the person that's the hard part," Nakata said.
Investigators are not interested in finding the original source of swine flu in Hawai'i. Instead, they want to identify as many patients as soon as possible and keep them from spreading it further, Nakata said.
After interviewing a swine flu patient using an eight-page medical questionnaire, the hard work begins.
Investigators have to go back seven days before the symptoms first appeared and trace every person who came in contact with the swine flu patient. Sometimes, as many as 100 people need to be identified and questioned, Nakata said.
"Some people we reach are very blase," Nakata said. " 'Do I have to stay home? I have this and that to do.' Some people are quite devastated and really upset. They're worried about getting sick. For some, there has been a stigma."
A mother of a child sick with the flu was escorted from work by police who were called by her boss, Nakata said.
"She wasn't sick. Her child wasn't confirmed" with swine flu, Nakata said. "The workplace wanted her to leave because they didn't want her at the office."
Elm said the investigator had to talk to everyone involved, including the police, to calm the situation.
"We educated the police, educated the bosses," Elm said.
'Anuenue school
The philosophy of trying to contain the spread of the swine flu appears to have worked at 'Anuenue School in Palolo, the hardest-hit school on O'ahu. Overall, 18 children and two adults with swine flu have been linked to public schools.
Health inspectors received the first confirmed tests of an 'Anuenue third-grade teacher and a student in a different 'Anuenue class the night of May 12.
With an incubation period of seven days for swine flu, "we knew going into this that they probably exposed classmates and what not," Park said. "There was nothing we could do for those people, but we knew (other cases) would pop up. Closing the school at that point wouldn't serve a purpose. You've been exposed already and you're incubating."
Over the next week, the number of cases connected to the Hawaiian immersion school grew to include nine more 'Anuenue children.
Health inspectors made three separate visits to 'Anuenue to educate faculty, staff and parents about controlling the spread. And suddenly, eight days after the first cases were reported at 'Anuenue, the spate of swine flu cases connected to the school suddenly ended on May 20.
"We hoped we wouldn't see any more cases," Park said, "which is kind of how it's turning out."
But the statewide scare is far from over.
Yesterday, as swine flu continued to spread through 48 countries, Mexico reported six more deaths for a total of 95 swine flu fatalities, according to The Associated Press. Illinois reported another swine flu death for a total of three, according to the AP.
The new fear in Hawai'i is that the relatively mild version of swine flu afflicting the United States will suddenly mutate into a more dangerous strain.
And that would overwhelm a system already groaning under the weight of so much detective work by so few health investigators, Park said.
"I know our investigators are not claiming half of their overtime they're putting in and it just kills me. ... It's because they really care," Park said.
Reach Dan Nakaso at dnakaso@honoluluadvertiser.com.
TRACKING A VIRUS
Step 1: Swine flu patient is confirmed after reviewing an average of 90 positive swine flu tests each day by the state lab, Clinical Laboratories of Hawaii, Diagnostic Laboratory Services, Kaiser Permanente or Tripler Army Medical Center.
Step 2: Find the patient. This can be as simple as a phone call or as complicated as finding their last known address and showing up on their doorstep after hours or on a weekend.
Step 3: Interview patient using an eight-page medical questionnaire. Interviews typically last 20 to 30 minutes.
Step 4: Now the hard work begins. Investigators have to track backward seven days before the symptoms appeared and trace every person who came in contact with the swine flu patient. As few as five people and as many as 100 are typically identified.
Step 5: People who came in contact with the initial patient and exhibit flulike symptoms are urged to notify their physician, get tested and stay home from work or school.
Step 6: Start over again with the next person who tested positive for H1N1.
The Honolulu Advertiser
Posted on: Friday, May 29, 2009
Hawaii's official flu hunters trying to keep up with H1N1 outbreak
Burnout's a concern, with outbreak in its fourth week
# Special Report: Swine flu resources
By Dan Nakaso
Advertiser Staff Writer
Six health inspectors are working long nights and weekends tracking down swine flu victims on O'ahu and then doing the tedious detective work of notifying hundreds of friends, family and co-workers that they, too, might have been exposed to the disease sweeping around the world.
The work also requires state health inspectors to play the roles of community health educators, counselors and sometimes mediators.
With 73 confirmed cases since May 5, state epidemiologist Dr. Sarah Park worries that the small team of investigators is tiring before the outbreak may reach its peak in the Islands.
"It's the fourth week now and we can't keep up this pace," Park said. "They're already getting to burn out."
Behind the public concern that has greeted the emergence of swine flu in the Islands, the work of Hawai'i's health inspectors — six on O'ahu, two on Maui, two on the Big Island and one on Kaua'i — has gone on with no public fanfare as they try to control the spread of swine flu.
They had to intervene when Honolulu police were called to forcibly remove an employee whose child was ill with seasonal flu, not swine flu. They have patiently explained what's known about the disease officially called H1N1 Influenza A to households hit with seasonal flu or swine flu — and sometimes both at the same time.
And they've tried to get business owners to accommodate employees who need to keep working during economic hard times, even though they might have been exposed but tested negative for swine flu.
"It's been a lot of hand holding, a lot of education," said Joe Elm Jr., who supervises the Health Department's overworked field investigators. "There's some people that are head of family that can't afford to be out of work. We have to say, 'How can you go to work and protect others around you — social distancing, maybe wearing a mask.' "
Nothing routine
O'ahu's six health inspectors normally focus on investigating 52 reportable illnesses, such as measles, mumps, meningitis and hepatitis A.
But since an Army couple and an unrelated child were confirmed with O'ahu's first swine flu cases on May 5, the inspectors have focused only on tracking down more H1N1 patients and the people they might have exposed to swine flu.
Their former, routine cases have been picked up by the Health Department's sanitation branch, which normally handles restaurant inspections. The state's veterinary medical officer is now handling investigations of non-swine flu cases among humans.
State public health nurses and immunization branch workers are also contacting people who have tested positive for influenza A and are answering phone calls from people with flu questions.
The state laboratory is stretching a dozen workers to cover two shifts to keep up with all of the swine flu testing, said Dr. Chris Whelen, administrator of the state laboratory.
Every day, health inspectors then review an average of 90 positive flu tests looking for new swine flu cases.
"Can I continue to operate at the level that I am? Absolutely not," Whelen said. "I've got guys that want to tough it out. I'm like, 'Guys, this is not going to be over any time soon. I can't have you hit the wall and not be able to handle Phase II, Phase III, Phase IV and whatever else develops.' "
"It's not just the inspectors," said Health Department spokeswoman Janice Okubo. "A lot of parts of our departments are pitching in."
That still leaves lots of long days and nights for the six inspectors on O'ahu.
Whelen has called investigators at midnight with up-to-date swine flu test results "just to make sure they're still at work," he joked.
They usually are.
Just tracking down a single patient who has tested positive for swine flu can take long hours because doctors who order the tests usually don't include a phone number for the patient, said Michele Nakata, chief of the Health Department's disease investigation branch.
Results typically come in after doctors' offices close but some physicians can access patients' records remotely, Nakata said. Others have opened up their offices to get patient information.
But investigators like Nakata often have to scour databases and phone books — and sometimes drive out to the patient's last known address on a weekend — because they don't want that person going to school or to work and exposing dozens of others.
"It's just getting to the person that's the hard part," Nakata said.
Investigators are not interested in finding the original source of swine flu in Hawai'i. Instead, they want to identify as many patients as soon as possible and keep them from spreading it further, Nakata said.
After interviewing a swine flu patient using an eight-page medical questionnaire, the hard work begins.
Investigators have to go back seven days before the symptoms first appeared and trace every person who came in contact with the swine flu patient. Sometimes, as many as 100 people need to be identified and questioned, Nakata said.
"Some people we reach are very blase," Nakata said. " 'Do I have to stay home? I have this and that to do.' Some people are quite devastated and really upset. They're worried about getting sick. For some, there has been a stigma."
A mother of a child sick with the flu was escorted from work by police who were called by her boss, Nakata said.
"She wasn't sick. Her child wasn't confirmed" with swine flu, Nakata said. "The workplace wanted her to leave because they didn't want her at the office."
Elm said the investigator had to talk to everyone involved, including the police, to calm the situation.
"We educated the police, educated the bosses," Elm said.
'Anuenue school
The philosophy of trying to contain the spread of the swine flu appears to have worked at 'Anuenue School in Palolo, the hardest-hit school on O'ahu. Overall, 18 children and two adults with swine flu have been linked to public schools.
Health inspectors received the first confirmed tests of an 'Anuenue third-grade teacher and a student in a different 'Anuenue class the night of May 12.
With an incubation period of seven days for swine flu, "we knew going into this that they probably exposed classmates and what not," Park said. "There was nothing we could do for those people, but we knew (other cases) would pop up. Closing the school at that point wouldn't serve a purpose. You've been exposed already and you're incubating."
Over the next week, the number of cases connected to the Hawaiian immersion school grew to include nine more 'Anuenue children.
Health inspectors made three separate visits to 'Anuenue to educate faculty, staff and parents about controlling the spread. And suddenly, eight days after the first cases were reported at 'Anuenue, the spate of swine flu cases connected to the school suddenly ended on May 20.
"We hoped we wouldn't see any more cases," Park said, "which is kind of how it's turning out."
But the statewide scare is far from over.
Yesterday, as swine flu continued to spread through 48 countries, Mexico reported six more deaths for a total of 95 swine flu fatalities, according to The Associated Press. Illinois reported another swine flu death for a total of three, according to the AP.
The new fear in Hawai'i is that the relatively mild version of swine flu afflicting the United States will suddenly mutate into a more dangerous strain.
And that would overwhelm a system already groaning under the weight of so much detective work by so few health investigators, Park said.
"I know our investigators are not claiming half of their overtime they're putting in and it just kills me. ... It's because they really care," Park said.
Reach Dan Nakaso at dnakaso@honoluluadvertiser.com.
TRACKING A VIRUS
Step 1: Swine flu patient is confirmed after reviewing an average of 90 positive swine flu tests each day by the state lab, Clinical Laboratories of Hawaii, Diagnostic Laboratory Services, Kaiser Permanente or Tripler Army Medical Center.
Step 2: Find the patient. This can be as simple as a phone call or as complicated as finding their last known address and showing up on their doorstep after hours or on a weekend.
Step 3: Interview patient using an eight-page medical questionnaire. Interviews typically last 20 to 30 minutes.
Step 4: Now the hard work begins. Investigators have to track backward seven days before the symptoms appeared and trace every person who came in contact with the swine flu patient. As few as five people and as many as 100 are typically identified.
Step 5: People who came in contact with the initial patient and exhibit flulike symptoms are urged to notify their physician, get tested and stay home from work or school.
Step 6: Start over again with the next person who tested positive for H1N1.
The Honolulu Advertiser