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Editor, Senior Moderator
Source: http://www.thestate.com/local/story/792596.html
News - Local / Metro
Tuesday, May. 19, 2009
What S.C. learned from swine flu cases
State plans to tweak its plan for handling a pandemic
By JOEY HOLLEMAN - jholleman@thestate.com
State health officials say the lessons learned dealing with the swine flu this spring leave them better prepared to deal with what could be Swine Flu II next winter.
The state?s pandemic flu plan, put together during the bird flu scare earlier this decade, worked with only minor hiccups, according to health professionals.
The plan merely needs a few tweaks, those officials say.
Those tweaks include:
? Specifics on when to close schools and, more importantly, reopen them
? Deciding who is responsible for dealing with patients quarantined in their homes
? Working out the mechanics of separate entrances at medical facilities for people with flu-like symptoms
?We had a nice, basic framework for dealing with it, but until you?re under stress, you don?t know how that framework holds up,? said Dr. Steve Shelton, an emergency physician at Palmetto Health Richland. ?It held up fine.?
The swine flu has been slow to spread in South Carolina.
There were 36 confirmed cases as of Friday, according to the federal Centers for Disease Control and Prevention. Because the symptoms have been similar to standard seasonal flu, hundreds of cases probably have gone unreported, said state epidemiologist Dr. Jerry Gibson.
South Carolina hasn?t had any swine flu-related deaths, and only six have been reported in the United States. Since flu viruses don?t thrive in warm weather, the spring outbreak should begin to slow down soon in South Carolina, Gibson said.
But in three of four previous flu pandemics ? in 1890, 1918, 1957 and 1968 ? the viruses hit their deadly peak in their second season. So health officials caution that the H1N1 virus could be a real problem next winter.
?We?re at the beginning of the story on this,? said Max Learner, director of the S.C. Department of Health and Environmental Control?s Office of Public Health Preparedness. ?And this is a novel, not a short story.?
So what did health officials learn in dealing with the relatively mild strain of the swine flu if it mutates into a more potent form next winter?
?WE WERE VERY CONCERNED?
The story of the 2009 swine flu in South Carolina began shortly after the virus reared its head in Mexico. A private physician alerted DHEC that students from Newberry Academy had returned April 20 from a trip to Cancun with flu-like symptoms.
The students agreed to go to the county health clinic for testing on April 26, a Sunday. Before the results were known, Newberry Academy officials canceled classes for Monday.
DHEC suggested people who had come into contact with suspected cases stay home for several days to see whether they developed the standard symptoms ? runny nose, sore throat, body aches and high fever.
?At that point, what we knew is the virus had all the characteristics of a pandemic virus,? Gibson said. ?We were very concerned based on its behavior in Mexico ? high hospitalization rates and high death rates.?
The state pandemic plan calls for quarantining people involved in clusters early in an outbreak. School officials and family members in Newberry did their part without being forced into quarantine by health officials, Gibson said.
In addition to Newberry Academy?s closing for a full week, Newberry County public schools closed for two days. The precautions appear to have worked.
?The goal is to slow the spread,? Gibson said. ?And I think it did slow down the spread.?
Of the 36 confirmed cases in the state, at least 27 are connected to the Newberry outbreak. But almost half of those had symptoms before the virus was identified.
While dealing with the Newberry cluster, state health officials:
? Made sure there was plenty of antiviral medicine available if the virus began to spread rapidly
? Ensured private doctors, school nurses and hospitals were clear on the guidelines they needed to follow
? Kept the public informed on precautions people should take
After the bird flu scare in 2002, the state began to stockpile the antiviral drug Tamiflu, which can be used as a defense against catching flu or, if taken early, can lessen severity of the symptoms. The state has enough Tamiflu to treat about 1 million people. About 20,000 treatment packages were doled out to regional health offices early this month, but Gibson suspects only a couple of hundred were used.
Doctors and hospitals report they were swamped with calls but not with patients. People who were mildly ill stayed home.
?I think the patients I encountered were pretty well-informed,? said Dr. Tim Wallace at Twelve Mile Creek Family Medicine in Lexington ?There was good, accurate information out there from the (Centers for Disease Control and Prevention) and DHEC.
?We weren?t getting people saying, ?I sneezed three times, and I had a taco last week, do I have swine flu???
RESPIRATOR OR MASK?
But there were problems.
At the height of the early concern, CDC and DHEC guidelines for physicians were changing almost every hour.
For instance, early guidelines called for health care workers to wear respirators around suspected swine flu patients. But less than a day after issuing those guidelines, health officials changed the rules to allow use of surgical masks. The masks were effective and more practical, Gibson said.
The constant changes created some confusion and frustration, Palmetto Richland?s Shelton said. But technology made it easier to get the updates to doctors.
Palmetto Richland sent out blast faxes and e-mails to doctors? offices. At USC?s Thomson Student Health Center, director Deborah Beck frequently refreshed the CDC and DHEC Web sites on her computer and had her contact at DHEC on speed dial.
Early in the process, guidelines called for all patients with flu-like symptoms to be separated from other patients.
Palmetto Richland put up signs at entrances, explaining the symptoms and telling patients who had them where they needed to go. Concern never reached the point where hospital officials tried to catch people who were sick as they walked through the door. Now, officials realize how difficult that would be, Shelton said.
At its health center, USC set up separate entrances and processed patients at the back entrance for the first time. ?We discovered we need to get computer lines to our back entrance,? Beck said.
For school nurses, the reaction was almost routine, said Jessica Porter, past president of the S.C. Association of School Nurses. The swine flu protocol differed only slightly from efforts to slow chicken pox or whooping cough.
?It?s like we?ve had several rehearsals,? Porter said.
School nurses were asked to send daily reports of students with flu-like symptoms to DHEC, helping identify clusters of the virus. They also do that with seasonal flu and chicken pox.
The nurses also filled an important public relations role, answering questions from parents confused by what they were hearing on the streets, Porter said.
KUDOS TO DHEC
DHEC officials had to maintain a balance between raising awareness and stoking fear in the early days of the outbreak.
Gibson did daily news briefings timed for noon television newscasts. While the sight of a state official on live TV talking about swine flu might have heightened concern for some, Gibson spent much of his screen time talking about simple ways to slow the spread of the disease ? washing hands, coughing into your elbow, staying home if sick.
?You try to tailor the message to the severity of the disease,? Learner said. ?The first few weeks, we didn?t know how bad it was.?
The daily news briefings stopped after a week.
While still dealing with the virus, DHEC staffers are beginning to tweak the state plan. They recognize cautious school officials need more guidance on when to open schools than when to close them. And they need to make sure someone takes responsibility for checking on people who have been asked to quarantine themselves in their homes.
?Is a phone call enough?? Gibson said. ?What happens if they don?t answer the phone??
Some changes should be expected, Gibson said, noting the military truism: ?No battle plan survives the first contact with the enemy.?
But for the most part, the plan worked.
?DHEC deserves credit,? Lexington physician Wallace said. ?On a systemic level, they?re certainly prepared for something worse than happened.?
Reach Holleman at (803) 771-8366.
#
Keeping count
The Centers for Disease Control and Prevention and S.C. Department of Health and Environmental Control have changed the way they publicize flu statistics.
CDC: Instead of state-by-state H1N1 virus numbers, the agency now posts numbers for all flu strains by multi-state region. South Carolina is in Region IV, which has an ?elevated? level for all flus. The incidence of all flus in South Carolina, however, is considered ?localized.? The outbreak is considered worse in Georgia (widespread) and Florida (regional).
DHEC: Instead of daily updates in H1N1 virus numbers by county, the state agency now posts numbers once a week. New numbers will be released on Tuesdays.
News - Local / Metro
Tuesday, May. 19, 2009
What S.C. learned from swine flu cases
State plans to tweak its plan for handling a pandemic
By JOEY HOLLEMAN - jholleman@thestate.com
State health officials say the lessons learned dealing with the swine flu this spring leave them better prepared to deal with what could be Swine Flu II next winter.
The state?s pandemic flu plan, put together during the bird flu scare earlier this decade, worked with only minor hiccups, according to health professionals.
The plan merely needs a few tweaks, those officials say.
Those tweaks include:
? Specifics on when to close schools and, more importantly, reopen them
? Deciding who is responsible for dealing with patients quarantined in their homes
? Working out the mechanics of separate entrances at medical facilities for people with flu-like symptoms
?We had a nice, basic framework for dealing with it, but until you?re under stress, you don?t know how that framework holds up,? said Dr. Steve Shelton, an emergency physician at Palmetto Health Richland. ?It held up fine.?
The swine flu has been slow to spread in South Carolina.
There were 36 confirmed cases as of Friday, according to the federal Centers for Disease Control and Prevention. Because the symptoms have been similar to standard seasonal flu, hundreds of cases probably have gone unreported, said state epidemiologist Dr. Jerry Gibson.
South Carolina hasn?t had any swine flu-related deaths, and only six have been reported in the United States. Since flu viruses don?t thrive in warm weather, the spring outbreak should begin to slow down soon in South Carolina, Gibson said.
But in three of four previous flu pandemics ? in 1890, 1918, 1957 and 1968 ? the viruses hit their deadly peak in their second season. So health officials caution that the H1N1 virus could be a real problem next winter.
?We?re at the beginning of the story on this,? said Max Learner, director of the S.C. Department of Health and Environmental Control?s Office of Public Health Preparedness. ?And this is a novel, not a short story.?
So what did health officials learn in dealing with the relatively mild strain of the swine flu if it mutates into a more potent form next winter?
?WE WERE VERY CONCERNED?
The story of the 2009 swine flu in South Carolina began shortly after the virus reared its head in Mexico. A private physician alerted DHEC that students from Newberry Academy had returned April 20 from a trip to Cancun with flu-like symptoms.
The students agreed to go to the county health clinic for testing on April 26, a Sunday. Before the results were known, Newberry Academy officials canceled classes for Monday.
DHEC suggested people who had come into contact with suspected cases stay home for several days to see whether they developed the standard symptoms ? runny nose, sore throat, body aches and high fever.
?At that point, what we knew is the virus had all the characteristics of a pandemic virus,? Gibson said. ?We were very concerned based on its behavior in Mexico ? high hospitalization rates and high death rates.?
The state pandemic plan calls for quarantining people involved in clusters early in an outbreak. School officials and family members in Newberry did their part without being forced into quarantine by health officials, Gibson said.
In addition to Newberry Academy?s closing for a full week, Newberry County public schools closed for two days. The precautions appear to have worked.
?The goal is to slow the spread,? Gibson said. ?And I think it did slow down the spread.?
Of the 36 confirmed cases in the state, at least 27 are connected to the Newberry outbreak. But almost half of those had symptoms before the virus was identified.
While dealing with the Newberry cluster, state health officials:
? Made sure there was plenty of antiviral medicine available if the virus began to spread rapidly
? Ensured private doctors, school nurses and hospitals were clear on the guidelines they needed to follow
? Kept the public informed on precautions people should take
After the bird flu scare in 2002, the state began to stockpile the antiviral drug Tamiflu, which can be used as a defense against catching flu or, if taken early, can lessen severity of the symptoms. The state has enough Tamiflu to treat about 1 million people. About 20,000 treatment packages were doled out to regional health offices early this month, but Gibson suspects only a couple of hundred were used.
Doctors and hospitals report they were swamped with calls but not with patients. People who were mildly ill stayed home.
?I think the patients I encountered were pretty well-informed,? said Dr. Tim Wallace at Twelve Mile Creek Family Medicine in Lexington ?There was good, accurate information out there from the (Centers for Disease Control and Prevention) and DHEC.
?We weren?t getting people saying, ?I sneezed three times, and I had a taco last week, do I have swine flu???
RESPIRATOR OR MASK?
But there were problems.
At the height of the early concern, CDC and DHEC guidelines for physicians were changing almost every hour.
For instance, early guidelines called for health care workers to wear respirators around suspected swine flu patients. But less than a day after issuing those guidelines, health officials changed the rules to allow use of surgical masks. The masks were effective and more practical, Gibson said.
The constant changes created some confusion and frustration, Palmetto Richland?s Shelton said. But technology made it easier to get the updates to doctors.
Palmetto Richland sent out blast faxes and e-mails to doctors? offices. At USC?s Thomson Student Health Center, director Deborah Beck frequently refreshed the CDC and DHEC Web sites on her computer and had her contact at DHEC on speed dial.
Early in the process, guidelines called for all patients with flu-like symptoms to be separated from other patients.
Palmetto Richland put up signs at entrances, explaining the symptoms and telling patients who had them where they needed to go. Concern never reached the point where hospital officials tried to catch people who were sick as they walked through the door. Now, officials realize how difficult that would be, Shelton said.
At its health center, USC set up separate entrances and processed patients at the back entrance for the first time. ?We discovered we need to get computer lines to our back entrance,? Beck said.
For school nurses, the reaction was almost routine, said Jessica Porter, past president of the S.C. Association of School Nurses. The swine flu protocol differed only slightly from efforts to slow chicken pox or whooping cough.
?It?s like we?ve had several rehearsals,? Porter said.
School nurses were asked to send daily reports of students with flu-like symptoms to DHEC, helping identify clusters of the virus. They also do that with seasonal flu and chicken pox.
The nurses also filled an important public relations role, answering questions from parents confused by what they were hearing on the streets, Porter said.
KUDOS TO DHEC
DHEC officials had to maintain a balance between raising awareness and stoking fear in the early days of the outbreak.
Gibson did daily news briefings timed for noon television newscasts. While the sight of a state official on live TV talking about swine flu might have heightened concern for some, Gibson spent much of his screen time talking about simple ways to slow the spread of the disease ? washing hands, coughing into your elbow, staying home if sick.
?You try to tailor the message to the severity of the disease,? Learner said. ?The first few weeks, we didn?t know how bad it was.?
The daily news briefings stopped after a week.
While still dealing with the virus, DHEC staffers are beginning to tweak the state plan. They recognize cautious school officials need more guidance on when to open schools than when to close them. And they need to make sure someone takes responsibility for checking on people who have been asked to quarantine themselves in their homes.
?Is a phone call enough?? Gibson said. ?What happens if they don?t answer the phone??
Some changes should be expected, Gibson said, noting the military truism: ?No battle plan survives the first contact with the enemy.?
But for the most part, the plan worked.
?DHEC deserves credit,? Lexington physician Wallace said. ?On a systemic level, they?re certainly prepared for something worse than happened.?
Reach Holleman at (803) 771-8366.
#
Keeping count
The Centers for Disease Control and Prevention and S.C. Department of Health and Environmental Control have changed the way they publicize flu statistics.
CDC: Instead of state-by-state H1N1 virus numbers, the agency now posts numbers for all flu strains by multi-state region. South Carolina is in Region IV, which has an ?elevated? level for all flus. The incidence of all flus in South Carolina, however, is considered ?localized.? The outbreak is considered worse in Georgia (widespread) and Florida (regional).
DHEC: Instead of daily updates in H1N1 virus numbers by county, the state agency now posts numbers once a week. New numbers will be released on Tuesdays.