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NYC officials struggle for balanced response to A/H1N1

Shiloh

Editor, Senior Moderator
Source: http://www.latimes.com/news/nationworld/nation/la-na-ny-swine21-2009may21,0,6349095.story


New York City officials struggle for balanced response to swine flu
Mayor Bloomberg has been giving matter-of-fact updates and practical advice, but some say he needs to do a better job of reassuring 'the worried well' in the face of the potentially fatal H1N1 virus.

By Tina Susman
6:29 PM PDT, May 20, 2009

Reporting from New York -- At a hospital in New York's south Bronx, 187 children flooded the emergency room in a 12-hour period. Only two had flu-like symptoms, and those were mild. At a hospital in Queens, officials erected a tent outside to handle the crowd of visitors fearful of the H1N1 influenza virus, even though none had obvious symptoms.

They are part of what New York Mayor Michael R. Bloomberg and other city officials have dubbed the "worried well," whose epidemic of panic amid the swine flu outbreak is proving more problematic than the illness.

As of Wednesday afternoon, New York had one confirmed death from H1N1 -- that of a school administrator from Queens. Across the state, there have been 284 confirmed cases, with 201 of those in New York City.

The numbers, reported by the Centers for Disease Control and Prevention, are small in comparison with some other states: 553 in California; 794 in Illinois; 766 in Wisconsin; 556 (including three deaths) in Texas.

But in a teeming city where millions ride nose-to-nose in crowded subways, where people literally rub shoulders in bustling delis, corner markets and on street corners, and where sneezing, coughing and spitting are as much a part of the background noise as the honking of taxicab horns, the idea of a potentially fatal virus on the loose is bound to spark fear.

The problem confronting city officials is how to quell that fear without seeming insensitive to normal parental concerns or out of touch with New Yorkers in the mainly working-class, immigrant-heavy communities that appear most worried. One assemblyman on Wednesday compared the situation to the fear that gripped New York after the Sept. 11 attacks and said it was the mayor's duty to do a better job of calming people.

Bloomberg's approach has been to deliver matter-of-fact flu updates -- heavy on practical advice about the virtues of hand-washing and covering the mouth while coughing, and light on fear-mongering.

A briefing Wednesday at City Hall was no different. The mayor began by announcing that a pair of local newspaper reporters had had a baby. He went on to discuss an upcoming fashion event aimed at stimulating the retail industry. Ninety minutes later, Bloomberg turned his attention to H1N1, focusing on the problems that city officials say are being created by the "worried well."

"While there are an abnormal number of people going to the hospital who are worried, a very tiny percentage have any symptoms whatsoever," said Bloomberg, who was flanked by the city's health commissioner, Dr. Thomas Frieden, who was just nominated to lead the CDC; and Alan Aviles, president of the city's Health and Hospitals Corp.

The mayor offered condolences to the family of Mitchell Wiener, New York's H1N1 victim who was buried Wednesday. He also noted the death of a 16-month-old boy, Jonathan Zamora, Monday night in Queens. Both Frieden and Bloomberg said that initial tests on the toddler were negative for H1N1, but that more testing would be done at the CDC.

The New York Daily News quoted the baby's father, Zeferino Zamora, as insisting his son did not have the flu. "People should not panic. It's not what people think," he said.

But some people are panicking. Aviles said that hospital emergency rooms were seeing a 20% jump in adult patients and a 50% increase in children. The preponderance of those showing up are 5- to 17-year-olds, herded there by parents.

"What we've seen . . . is a lot of concern, but very few sick kids," Frieden said.

On Tuesday, the situation became so bad at the Queens Hospital Center that the tent was set up outside, allowing doctors inside to treat patients who really needed help, Bloomberg said. The tent was dismantled Wednesday morning.

Frieden and Bloomberg rejected arguments that it would be best to close New York schools, or at least provide detailed absentee figures so that parents would know whether their children's schools might be affected by the flu.

Absentee rates say little about actual illness trends because so many parents are keeping children home for fear they could get sick, not because they are, Frieden said. Only one school in New York -- IS 238 in Hollis, Queens, where Wiener worked -- has confirmed H1N1 cases. At least 26 schools across the city, including IS 238, were closed Wednesday.

As for mass school closures, Bloomberg bristled at the idea, saying that it would interrupt the educational process and create economic hardship for many parents forced to take time off work. "Parents have the right to keep their kids at home, but we have the obligation to provide an education to those who want to send their kids to school," he said.

Bloomberg, who is up for reelection in November, reiterated the main points of his flu briefing in Spanish. But his critics clearly see H1N1 as an opportunity to gain political mileage and cast the mayor as being detached from many of his constituents.

Assemblyman Jose R. Peralta, whose district includes fear-gripped sections of Queens, has called a town hall meeting tonight to discuss the flu outbreak -- and criticized Bloomberg and city health officials for not taking part.

A spokeswoman for Peralta, Damaris Mone, said the mayor's assumption that all New Yorkers read newspapers and watch television news showed his disconnect with an ethnically diverse population. For New Yorkers for whom English is not necessarily a first language, she said, direct communication is the best way to assuage fear.

"This is the first crisis we've had since 9/11," Mone said, "and you're telling me you don't talk to the community?"

tina.susman@latimes.com
 
Re: NYC officials struggle for balanced response to A/H1N1

http://www.nytimes.com/2009/05/21/health/21diagnosis.html?_r=2

A 16-month-old boy is brought to Elmhurst Hospital Center?s emergency room blue and motionless, and is pronounced dead 40 minutes later. A preliminary swine flu test is performed within hours ? and turns out negative.

An 8-year-old, the son of a flu expert at Weill Cornell Medical College, runs a high fever and starts coughing heavily at 4 a.m. His mother, the flu expert and also a pediatrician, diagnoses it as swine flu without testing him.

These two moments, which played out within 24 hours of each other, illustrate the difficulties pediatricians all over New York City face as worried parents of sniffling children ask for the swine flu test ? which most times cannot be done and which the Centers for Disease Control and Prevention says there is no need for.

They also illustrate how important the tests can be.

In the case of the boy who died, Jonathan Zamora Castillo of Corona, Queens, it was crucial to establish the cause of death. His rapid decline ? from a generally healthy child in the morning to cyanosis and death by evening ? matched reports from the 1918 Spanish Flu epidemic of patients who drowned in their own lung secretions. Although a few dozen children die that way in the United States each year from seasonal flu, said Dr. Anne Moscona, the flu expert, having such a rapid death in the middle of a generally mild swine flu outbreak would have been very worrying.

In the case of her son, Ari, Dr. Moscona had every reason to suspect swine flu. His school, Horace Mann in Riverdale, shut down on Tuesday after positive cases were found, and he had the same symptoms as schoolmates.

?Medically, it was the right thing to do,? Dr. Moscona said when asked whether she would have treated a patient who was not her son the same way. ?If I?d thought it might be seasonal influenza, I would have ordered a test. But there were 40 kids sick in his school.?

Rapid flu tests are right only 70 percent of the time when they are positive anyway, she added.

The C.D.C.?s position is that if a child?s symptoms are serious and exposure to the swine flu is likely, a doctor should prescribe the antiviral drug Tamiflu without waiting. If the symptoms are mild, neither a test nor Tamiflu is called for.

Some states cannot even perform the new test that the C.D.C. created only three weeks ago. It has been shipped to all 50 state laboratories, but only 44 have been certified to perform it thus far, Thomas Skinner, a C.D.C. spokesman, said.


Dr. Max Kahn, a Manhattan pediatrician, says his office performs a simple nasal swab test that can distinguish influenza from more than 100 other viruses that can cause cold symptoms.

?We can?t do anything more,? he said. ?If the child is significantly ill, we?ll give an antiviral medication.?

If the parent asks for the new swine flu test, he tells them that the only laboratory performing it is the state?s, ?and they?re swamped and only doing people who are hospitalized or have underlying disease.?

Asked whether that satisfied all his worried parents, he paused, then said, ?People are different.?

Several diagnostics companies, like Diatherix Laboratories and Quest Diagnostics, have developed their own tests for the new swine flu. Only the C.D.C.?s test is approved by the Food and Drug Administration, but an F.D.A. spokeswoman said that if other tests are done in a laboratory certified by the Department of Health and Human Services as having met a 1988 law governing clinical labs, it is legal for doctors to order them.

Dr. Diane Hochlerin, a Manhattan pediatrician, said she had had only one parent insist on a test.

?I told him I couldn?t do it, but if he wanted to go to Elmhurst Hospital in Queens, they might,? she said. ?He said, ?Oh, it?s not worth it.? ?
 
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