Dark Horse
In Memoriam
State flu response faces critical test
Officials say they can handle an outbreak. Medic: ?Most doctors probably have no clue? how to report cases.
By Alan Judd, Margaret Newkirk
The Atlanta Journal-Constitution
http://www.ajc.com/services/content/printedition/2009/05/03/swineflu0503.html
Sunday, May 03, 2009
Public health officials sent Georgia physicians a barrage of faxes and e-mails last week, asking for their help in stopping a potential menace: swine flu.
Get cultures from patients with suspicious symptoms, the doctors were told, and quickly get those samples to the state health laboratory.
But the messages didn?t include the proper way to obtain the cultures. Or how to store them. Or how to ship them to the lab. And if the shipment wouldn?t arrive during weekday business hours, never mind.
?Most doctors probably have no clue,? said Dr. James Roth, a family practitioner in Suwanee. ?There?s no way there could be very good surveillance.?
Yet this is how Georgia ?- the state that federal officials say has the nation?s second-weakest preparedness plan for a pandemic flu outbreak ?- is trying to head off the spread of a virus blamed for one death and some 160 illnesses in the United States, and scores more in Mexico.
Georgia, which recorded its first case of the flu last week, relies heavily on physicians and other health care workers to detect whether the virus is spreading across the state.
In turn, federal officials say they cannot contain the flu without help from states.
?We do rely on the states so much,? said Von Roebuck, a spokesman for the Atlanta-based Centers for Disease Control and Prevention, which is coordinating efforts to contain the outbreak. ?They know their individual states and how to reach people a lot better than the CDC here in Atlanta does.?
With more swine flu cases suspected, Georgia?s ability to respond to an outbreak is poised for its first real test.
State officials say they?re ready to handle any outbreak. Already, said Patrick O?Neal, the state?s preparedness director, the state has assembled a supply of anti-viral drugs and is tracking whether hospitals and pharmacies have adequate stockpiles.
Last week, federal officials allowed states to tap 25 percent of their strategic stockpile allotments in response to the flu threat. Georgia is receiving 325,000 ?courses? of anti-viral medications, each with enough doses to treat one case of flu from start to finish.
The state already had 460,000 courses of the medication, purchased with a federal grant last year.
O?Neal?s assessment: ?We?re in pretty good shape.?
From worst to 49th
When the CDC graded states? plans for handling emergency flu supplies last year, New Mexico ranked dead last.
The second-worst state: Georgia.
Still, Georgia?s score for planning how it would handle supplies from the Strategic National Stockpile ?- 73 out of 100 ?- is good enough, the CDC says. The state passed the review with four points to spare.
Reaching 49th place actually required a dramatic improvement, officials said.
In 2007, the CDC gave Georgia a score of just 24, the lowest of any state.
The CDC found that the state?s plan stretched public health workers too thin and into jobs they didn?t need to be doing. That plan put state and local health departments in charge of locating and staffing warehouse space for supplies shipped in by the CDC. Now the state is leaving that job to private warehouse operators.
Still, state officials said last week they don?t know why other states continue to rank higher.
?I?ve asked that question myself and never gotten a clear answer,? said Leticia Mathis, who oversaw the plan.
But she said the state deserves credit for its progress. Other health experts agree.
?What matters is that the plan passed,? said Jeffrey Levi, executive director of the Trust for American Health, which advocates for better public health policy. ?That?s incredibly important, that they got a passing grade.?
The CDC?s review of state plans was part of a larger assessment of state readiness for a range of health disasters, including flu epidemics, E-coli outbreaks and bioterror attacks.
The stockpile supplies include ?push packets,? each with 130 drugs to handle unknown health threats or anthrax. They also include more targeted supplies for known threats, such as the swine flu that is now emerging as a serious threat.
CDC officials declined to say whether Georgians should be concerned over the state?s relatively low rating.
?It?s just a point-in-time look at the plan in place at that particular time for that particular state,? Roebuck said. ?We?re never going to be at the point where we?re completely prepared.?
?Proper? handling
State officials were pleased with the handling of Georgia?s first swine flu case, involving a 30-year-old Kentucky woman who was hospitalized while visiting LaGrange.
The woman?s treatment and the investigation of her symptoms followed guidelines drafted by the state, officials said late last week.
The woman, whose name has not been released, traveled to Cancun, Mexico, on April 17. The following day, she began experiencing chills and a fever. But she and her traveling companion at first attributed the symptoms to too much sun. The woman flew back to the United States on April 21.
Two days later, she drove to Atlanta with her 5-year-old daughter, then on to LaGrange to attend a wedding. After the wedding, on April 26, family members took the woman to the emergency room at West Georgia Medical Center in LaGrange, about 65 miles southwest of Atlanta.
The same day, a preliminary test showed the woman had a form of Influenza A, which includes swine flu as well as other strains. Because of her trip to Mexico, the woman fit a profile for swine flu. So the hospital shipped cultures from the preliminary test to the state?s public health lab in Decatur.
By Tuesday, lab technicians concluded the woman had swine flu. But only the CDC can make the final determination; its technicians confirmed the finding on Thursday.
Everyone involved in the woman?s case, said Dr. Mike Brackett, head of the district public health office in LaGrange, ?notified the proper authorities.?
?Special packaging?
A suspected flu case in Suwanee didn?t go so smoothly.
Roth, the family practitioner, first got an e-mail about the potential outbreak last Monday. The next day, he said, a patient came to his office with flu symptoms: a temperature of 102 degrees and a cough. The man works for a company that frequently sends other employees overseas, so Roth was suspicious.
But when he called a medical liaison from a district public health office for guidance, he said, he reached her voice mail. Then, Roth said, he called an emergency line listed in the first e-mail; he went into voice mail again. He swabbed the patient?s nasal cavity and saved the sample in his office refrigerator.
The next day, Roth said, he reached the medical liaison, who told him to get the sample to the state health lab within 48 hours of when it was collected; otherwise technicians would be unable to analyze it. But he said she instructed him to ship the culture in ?special packaging.?
?I asked her, ?What special packaging?? ? Roth said.
The liaison directed him to a Web site where he could order the proper materials. The materials ?- and shipping costs ?- would be his to cover, Roth said. Regardless, by then, getting the sample to the state lab within the critical period would be impossible. The culture was never tested.
Dave Palmer, a spokesman for the public health district office in Gainesville, said the agency depends on a network of volunteer physicians who monitor all types of flu and are provided kits to collect and ship cultures for testing. But the district, he said, has run out of the kits.
?We?re trying to get more,? Palmer said. ?It is just kind of tough. We?ve had budget cuts in public health, and money doesn?t flow freely for us.?
State health officials said Friday they have distributed kits only to doctors in the volunteer network. They are still available in most regions.
Regardless, ?we are confident we are getting a good sample,? Palmer said. ?If the private physician really wanted the test done, he could have referred the patient to a hospital or a larger clinic that might have the supplies.?
Late Friday, Roth and other physicians got another e-mail from the state. This one gave a few more details on collecting and storing samples.
But the e-mail offered doctors no assistance with getting samples to the state lab. Instead, an attachment directed them to companies where they could buy testing and shipping materials themselves.
Officials say they can handle an outbreak. Medic: ?Most doctors probably have no clue? how to report cases.
By Alan Judd, Margaret Newkirk
The Atlanta Journal-Constitution
http://www.ajc.com/services/content/printedition/2009/05/03/swineflu0503.html
Sunday, May 03, 2009
Public health officials sent Georgia physicians a barrage of faxes and e-mails last week, asking for their help in stopping a potential menace: swine flu.
Get cultures from patients with suspicious symptoms, the doctors were told, and quickly get those samples to the state health laboratory.
But the messages didn?t include the proper way to obtain the cultures. Or how to store them. Or how to ship them to the lab. And if the shipment wouldn?t arrive during weekday business hours, never mind.
?Most doctors probably have no clue,? said Dr. James Roth, a family practitioner in Suwanee. ?There?s no way there could be very good surveillance.?
Yet this is how Georgia ?- the state that federal officials say has the nation?s second-weakest preparedness plan for a pandemic flu outbreak ?- is trying to head off the spread of a virus blamed for one death and some 160 illnesses in the United States, and scores more in Mexico.
Georgia, which recorded its first case of the flu last week, relies heavily on physicians and other health care workers to detect whether the virus is spreading across the state.
In turn, federal officials say they cannot contain the flu without help from states.
?We do rely on the states so much,? said Von Roebuck, a spokesman for the Atlanta-based Centers for Disease Control and Prevention, which is coordinating efforts to contain the outbreak. ?They know their individual states and how to reach people a lot better than the CDC here in Atlanta does.?
With more swine flu cases suspected, Georgia?s ability to respond to an outbreak is poised for its first real test.
State officials say they?re ready to handle any outbreak. Already, said Patrick O?Neal, the state?s preparedness director, the state has assembled a supply of anti-viral drugs and is tracking whether hospitals and pharmacies have adequate stockpiles.
Last week, federal officials allowed states to tap 25 percent of their strategic stockpile allotments in response to the flu threat. Georgia is receiving 325,000 ?courses? of anti-viral medications, each with enough doses to treat one case of flu from start to finish.
The state already had 460,000 courses of the medication, purchased with a federal grant last year.
O?Neal?s assessment: ?We?re in pretty good shape.?
From worst to 49th
When the CDC graded states? plans for handling emergency flu supplies last year, New Mexico ranked dead last.
The second-worst state: Georgia.
Still, Georgia?s score for planning how it would handle supplies from the Strategic National Stockpile ?- 73 out of 100 ?- is good enough, the CDC says. The state passed the review with four points to spare.
Reaching 49th place actually required a dramatic improvement, officials said.
In 2007, the CDC gave Georgia a score of just 24, the lowest of any state.
The CDC found that the state?s plan stretched public health workers too thin and into jobs they didn?t need to be doing. That plan put state and local health departments in charge of locating and staffing warehouse space for supplies shipped in by the CDC. Now the state is leaving that job to private warehouse operators.
Still, state officials said last week they don?t know why other states continue to rank higher.
?I?ve asked that question myself and never gotten a clear answer,? said Leticia Mathis, who oversaw the plan.
But she said the state deserves credit for its progress. Other health experts agree.
?What matters is that the plan passed,? said Jeffrey Levi, executive director of the Trust for American Health, which advocates for better public health policy. ?That?s incredibly important, that they got a passing grade.?
The CDC?s review of state plans was part of a larger assessment of state readiness for a range of health disasters, including flu epidemics, E-coli outbreaks and bioterror attacks.
The stockpile supplies include ?push packets,? each with 130 drugs to handle unknown health threats or anthrax. They also include more targeted supplies for known threats, such as the swine flu that is now emerging as a serious threat.
CDC officials declined to say whether Georgians should be concerned over the state?s relatively low rating.
?It?s just a point-in-time look at the plan in place at that particular time for that particular state,? Roebuck said. ?We?re never going to be at the point where we?re completely prepared.?
?Proper? handling
State officials were pleased with the handling of Georgia?s first swine flu case, involving a 30-year-old Kentucky woman who was hospitalized while visiting LaGrange.
The woman?s treatment and the investigation of her symptoms followed guidelines drafted by the state, officials said late last week.
The woman, whose name has not been released, traveled to Cancun, Mexico, on April 17. The following day, she began experiencing chills and a fever. But she and her traveling companion at first attributed the symptoms to too much sun. The woman flew back to the United States on April 21.
Two days later, she drove to Atlanta with her 5-year-old daughter, then on to LaGrange to attend a wedding. After the wedding, on April 26, family members took the woman to the emergency room at West Georgia Medical Center in LaGrange, about 65 miles southwest of Atlanta.
The same day, a preliminary test showed the woman had a form of Influenza A, which includes swine flu as well as other strains. Because of her trip to Mexico, the woman fit a profile for swine flu. So the hospital shipped cultures from the preliminary test to the state?s public health lab in Decatur.
By Tuesday, lab technicians concluded the woman had swine flu. But only the CDC can make the final determination; its technicians confirmed the finding on Thursday.
Everyone involved in the woman?s case, said Dr. Mike Brackett, head of the district public health office in LaGrange, ?notified the proper authorities.?
?Special packaging?
A suspected flu case in Suwanee didn?t go so smoothly.
Roth, the family practitioner, first got an e-mail about the potential outbreak last Monday. The next day, he said, a patient came to his office with flu symptoms: a temperature of 102 degrees and a cough. The man works for a company that frequently sends other employees overseas, so Roth was suspicious.
But when he called a medical liaison from a district public health office for guidance, he said, he reached her voice mail. Then, Roth said, he called an emergency line listed in the first e-mail; he went into voice mail again. He swabbed the patient?s nasal cavity and saved the sample in his office refrigerator.
The next day, Roth said, he reached the medical liaison, who told him to get the sample to the state health lab within 48 hours of when it was collected; otherwise technicians would be unable to analyze it. But he said she instructed him to ship the culture in ?special packaging.?
?I asked her, ?What special packaging?? ? Roth said.
The liaison directed him to a Web site where he could order the proper materials. The materials ?- and shipping costs ?- would be his to cover, Roth said. Regardless, by then, getting the sample to the state lab within the critical period would be impossible. The culture was never tested.
Dave Palmer, a spokesman for the public health district office in Gainesville, said the agency depends on a network of volunteer physicians who monitor all types of flu and are provided kits to collect and ship cultures for testing. But the district, he said, has run out of the kits.
?We?re trying to get more,? Palmer said. ?It is just kind of tough. We?ve had budget cuts in public health, and money doesn?t flow freely for us.?
State health officials said Friday they have distributed kits only to doctors in the volunteer network. They are still available in most regions.
Regardless, ?we are confident we are getting a good sample,? Palmer said. ?If the private physician really wanted the test done, he could have referred the patient to a hospital or a larger clinic that might have the supplies.?
Late Friday, Roth and other physicians got another e-mail from the state. This one gave a few more details on collecting and storing samples.
But the e-mail offered doctors no assistance with getting samples to the state lab. Instead, an attachment directed them to companies where they could buy testing and shipping materials themselves.
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