On Thursday, November 19, and Saturday, November 21, 2009, I spent about five hours each day working as a volunteer at a vaccination clinic run by the Monroe County Public Health Department (DPH). It was one of five each day held to vaccinate at risk groups for pandemic H1N1, the Swine Flu. I worked at the one held at the former Medley Center Mall in Irondequoit.

The DPH did a great job publicizing the clinics, with the cooperation of the local media. Attendance on Thursday was somewhat overwhelming, while that on Saturday was more even in flow.

The DPH contracted with private companies for the actual vaccine administration. DPH personnel and volunteers were used for crowd control.

The observations in this piece apply only to the location I worked at, unless otherwise stated.

The Mall is empty. That meant no heat either day, and somewhat uneven hallway lighting. It also meant sparse sanitary facilities, and the men’s room had been damaged by vandalism prior to the clinic. In fact, it was flooded on Saturday. The Irondequoit Kiwanis had coffee and donuts earlier on Thursday and through about 2 on Saturday. There were no other sources for food and drink in the Mall.

On Thursday, there were four to six people giving the vaccines at any one time. The private contractors made sure that they got all their breaks in. In the late afternoon there were some 400 people in line, and a four hour wait. I was told by DPH staff that the holdup was that the providers were having to answered questions. While that may have been the case, it was clear that there were far too few providers for the demand.

Just before 5 p.m. we were told to refuse entry to any additional patients, even though the clinic had been advertised as open until 8 p.m. Most people took the news with some grace, though several self-important individuals chose to create a problem.

I had begun work at 2:30. Throughout the afternoon it was obvious that the five clinics did not seem to be talking to each other. We were getting news from patients who had been turned away from other clinics and came to the Mall. We were not the first clinic to close its doors, as far as I can determine.

On Saturday, some changes had been made. There were now about eight to ten providers, and a separate line for people with children. We were given handouts to provide patients that would answer many of the common questions.

We closed at six on the dot. During the time I was working, there were no lines beyond the clinic area, and the only real wait was in the children’s line in the clinic, perhaps 15 minutes.

Both days, we took patients with movement or other issues straight to the clinic, about 50 yards from the Mall entrance, rather than ask them to make the much longer trek around to the clinic entrance. Even then, the distance was a little daunting for some.

Signage was poor. There were two manufactured signs, one that said “Clinic here” and another that gave the target groups for the clinic. The remaining signs were made on a computer, did not last well in the rain on Thursday and did not look at all professional.

We had no handouts on Thursday and ran out of the handouts on Saturday.

Far too many adults over 65 came. Whether they thought it was the seasonal flu vaccination or not, I do not know. The clinic was not intended for them and those doses could have gone to more at-risk populations. The only people turned away had valid medical reasons for the denial, such as an allergy to eggs or being ill with a fever.

On Thursday, the clinic closed before the hour advertised. There seemed to be no interest on the part of the DPH staff in continuing to give vaccinations while they had demand.

The Monroe County DPH has about 239 employees. It would seem logical that the department would be able to staff these clinics without volunteers from other county departments and from the public. In fact, other departments did have volunteers there, and those county employees will receive comp time for the hours that they worked past their normal quitting time.

Most of the public probably is not aware that clinics like this have been planned and discussed for years, as the potential for bioterrorism arose. A great deal of time and effort has been devoted to the problem of dispensing vaccinations to a large population in a short period of time. Sites have been selected, and plans made. I cannot determine if the clinic I participated in was the result of this planning. If so, a lot of people wasted their time in the last seven years.

Why was it necessary to use contractors to give the vaccinations? The DPH employs many people with the training and qualifications to give injections. They also have, in their plans for this eventuality, other groups of people they could have called upon, such as paramedics or hospital staffs.

Why were volunteers needed? The DPH had a couple hundred employees at work on Thursday who could have worked at a clinic. Those same employees could have been used on Saturday, as well. If it was all about overtime pay or union contracts, then just how would the clinics have worked if smallpox had been used in a terrorist attack as all of those folks planned for?

Thursday was cold and rainy. Saturday was cold. I kinda resent being cold and wet while DPH secretaries sat in warm offices and surfed the Web. If the department charged with preserving and protecting public health in Monroe County cannot generate an “all hands” response for a project like the Swine Flu vaccine clinics, I have to wonder just what they would do in a more serious situation.

The Irondequoit clinic vaccinated many, many people in the hours that I worked. In that respect, it achieved its goals. More clinics are being discussed for December.

For the future clinics to be successful, there must be:

• More communication among the sites
• Site locations suitable for large crowds, to include heat, lighting, bathrooms and refreshments
• More communication with the media, especially when it comes to closing sites early
• Professional signage – it can be reused
• a perception that the Monroe County Department of Public Health, as an organization, takes the matter seriously

New York State follows the example of the CDC and its reporting is at least a week behind at any given time. In the week ending November 7 2009, flu activity continued to explode in upstate New York.

New York State is reporting the level of this pandemic in several ways. In labs statewide for the week ending November 7, over 4,000 specimens tested positive for the A flu virus, 99% of those testing positive for flu. At the state laboratory, 43 of 45 specimens tested positive for Swine Flu.

The state is also tracking visits to hospital emergency departments for influenza like illnesses (ILI). In the Western Region, including the cities of Buffalo, Rochester, Corning and Elmira, the rate was 19.8% of all emergency department visits. This was a 10% increase from the preceding week and a new peak for the year.

The Central New York Region, including the large military base at Fort Drum and the cities of Syracuse and Binghamton had a 19.1% ILI rate. That is an 8% increase from the preceding week and a new peak for the year.

The Capital Region is the area with the highest reported ILI visit rate in the state, 22.5%. That is a 15% percent increase from the previous week and nearly double the rate from two week prior.

The Hudson Valley Region and Long Island have much lower rates though the Hudson Valley is now just above a 10% rate. During the Spring wave of Swine Flu, this region reached a peak of 14% of visits to emergency departments for ILI.

Click for a larger image

The latest report from the New York State Department of Health on the influenza situation outside of New York City shows a dramatic increase in visits to hospital emergency rooms for flu like illnesses in Upstate New York. The October 24 report shows nearly a 50% increase in such visits from the October 17 report. The Hudson Valley and Long Island regions show a much smaller increase.

Here is the article

Here are some of the colleges and universities in Upstate New York, and the latest information they have on their websites about Swine Flu. It is good to see that several of them have received the H1N1 vaccine and are distributing it.

• University at Buffalo (UB):
  

  So far, UB officials are aware of only a small number of cases of influenza-like illnesses on campuses—probably instances of swine flu, Raab says. Still, some offices are taking such precautions as cross-training employees and receiving briefings from information technology specialists on how staff can work and access files on UB servers from home.

• The College at Brockport:
  

  The number of Brockport students with influenza-like illness (10 today) reflect the general trend of increasing flu activity on campus and in the community. Information on vaccine clinics will be available as soon as we receive the vaccine, which is expected in the near future. Symptom severity is unchanged; mild to moderate illness. There have been no known hospitalizations. There have been no particular patterns regarding students’ residences or academic majors. Students who have symptoms of fever, cough and/or sore throat are requested to call the Student Health Center at 585.395.2414 to talk with a nurse.

• Houghton College:
  

  H1N1 remains the prominent circulating influenza strain, and continues to be a significant issue on many campuses. During the week of Oct 3–9 nearly 6,000 new cases of influenza like illness (ILI)—presumed to be H1N1—with 8 hospitalizations, were reported by 259 colleges across the country (ACHA surveillance data). While we have had a handful (or two) of people who have had symptoms consistent with ILI, so far no one on campus (that we are aware of) has tested positive for influenza.

  The Allegany County Department of Health will be on campus this Wednesday, October 21, between 1:30 and 5 p.m. to administer the H1N1 vaccine to all interested students age 24 and under, and to anyone else who meets CDC priority criteria. I strongly encourage you all to take advantage of this opportunity.

• SUNY College at Geneseo:
  

  It is important that we keep an accurate count of our students with Influenza-Like-Illnesses, so please keep us informed!

  SUNY Geneseo has a dedicated team of professionals who have been working closely together for several years to establish an effective plan for handling a pandemic flu outbreak. This team has been monitoring the recommendations of the CDC, WHO, State, and local government health departments to stay current on updated information regarding the HINI virus.

  Although the H1N1 influenza outbreak has not proven to be as severe as expected, Geneseo will continue to take additional precautions to prevent the spread of the flu as much as possible.

• University of Rochester:
  

  The University recorded its first case of influenza-like illness among students this semester on Sept 8th. Three new cases was identified today. The total number of cases identified is now 62. Five students are confined to their rooms at present.

  There are no changes to University of Rochester operations or activities because of public concern worldwide about novel H1N1 influenza.

• Rochester Institute of Technology:
  

  The RIT Student Health Center reported it treated five students with an influenza-like illness between Oct. 12 and Oct. 19. It is difficult to distinguish between seasonal and H1N1 flu. The center has advised these students to recover in their rooms. Students who are ill must self-isolate until they feel well and have had no fever for 24 hours (with out fever-reducing medicine).

• St. John Fisher College
• Elmira College:
  

  At this time there are no students or employees with confirmed cases of H1N1. However, due to the increase in reported Influenza-Like Illness cases in Chemung County and no further testing being done for confirmation of H1N1Flu unless a person is hospitalized, EPIC is initiating the Flu Protocol at this time. The information in the link below provides specific guidelines concerning how Elmira College will respond to the H1N1 Flu on our Campus. Included is a list of expectations of students, parents and employees.

• Syracuse University
• Cornell University:
  

  The first, limited, shipment of H1N1 influenza vaccine arrived at Gannett Health Services late on Friday, Oct. 16. Following CDC guidelines for situations in which vaccine supplies are limited, these initial doses will be targeted to STUDENTS at greatest risk of complications from the flu, including: those with underlying health conditions, those who are pregnant, and/or those who care for infants under 6 months old.

  There is no doubt that your vigilance and thoughtfulness are making a difference in reducing spread of the virus in our community. The number of students with H1N1 influenza has dropped dramatically since the early weeks of the semester. At Gannett, we have been diagnosing 5 to 10 students per day for the past couple of weeks (as compared to 50 to 100 during in early September). Levels of illness in the communities surrounding Cornell are also reported to be low.

Latest Upstate New York data

Local media nationwide have been reporting the cancellation of seasonal flu vaccine clinics as well as the limited availability of vaccine for the Swine Flu. The limited number of doses of vaccine for both types of influenza is due to several factors.

Dr. Ann Schuchat, the director of the National Center for Immunization and Respiratory Diseases, spoke to reporters on October 13. Several of the questions related to the short supply of seasonal influenza vaccine and the distribution of the Swine Flu vaccine. 77 million doses of seasonal vaccine have been distributed and nearly 10 million doses of Swine Flu vaccine were available for order.

For the rest of this article, please visit the Rochester Infectious Disease Examiner.