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.

First, the latest on the Ukraine:

17 November 2009 — Preliminary tests reveal no significant changes in the pandemic (H1N1) 2009 virus based on investigations of samples taken from patients in Ukraine. Analyses are being performed by two WHO influenza collaborating centres as part of the global influenza surveillance network.

Preliminary genetic sequencing shows that the virus is similar to the virus used for production of the pandemic influenza vaccine, reconfirming the vaccine’s efficacy at this time.

Additional questions about the pandemic virus circulating in Ukraine will be answered as more data is available.

WHO commends the government of Ukraine for its open sharing of samples to inform global monitoring of the virus for signs of change.

A total of 34 samples were analysed independently by the WHO Collaborating Centre for Reference and Research on Influenza, Mill Hill in London, UK, and the WHO Collaborating Centre for the Surveillance, Epidemiology and Control of Influenza in Atlanta, Georgia, USA.

WHO

As of 8 November 2009, worldwide more than 206 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 6250 deaths.

As many countries have stopped counting individual cases, particularly of milder illness, the case count is likely to be significantly lower than the actual number of cases that have occurred. WHO is actively monitoring the progress of the pandemic through frequent consultations with the WHO Regional Offices and member states and through monitoring of multiple sources of data.

The winter influenza season, which began unusually early across much of the Northern Hemisphere, shows early signs of peaking in parts of North America but is intensifying across much of Europe and Central and Eastern Asia.

In North America, Canada reported sharp increases in rates of influenza-like-illness (ILI), detections of pandemic H1N1 virus, and school outbreaks over the past three weeks as pandemic activity continues to spread west to east. In the United States, influenza transmission remains geographically widespread and intense but largely unchanged since the previous reporting week; rates of hospitalizations among persons aged 0-4 years, 5-17 years, and 18-49 years have now exceeded those seen during recent previous influenza seasons. Disease activity may have peaked in the earlier affected southern and south eastern parts of the United States. In Mexico, influenza activity remains geographically widespread with a significant wave of cases reported since early September, most notably from central and southern Mexico.

In Europe and Central Asia, overall influenza transmission continues to intensify throughout the continent as pandemic activity spreads eastward. At least 10 countries of Western Europe (Iceland, Poland, Romania, Belgium, Germany, the Netherlands, Norway, Spain, Sweden and the United Kingdom) now report that the proportion of sentinel samples testing positive for influenza exceeded 20% consistent with active circulation of pandemic influenza viruses. High to very high intensity of respiratory diseases with concurrent circulation of pandemic H1N1 2009 was also reported in the Netherlands, Italy, much of Northern Europe, Belarus, Bulgaria, and in the Russian Federation (particularly in the Urals). Disease activity may be peaking in a few countries, notably Iceland, Ireland, and parts of the UK (Northern Ireland) that experienced intense transmission during early autumn. Because of a sharp rise in pandemic influenza cases one week ago in Ukraine, the Ministry of Health requested assistance from WHO European Regional Office to evaluate and respond. The initial analysis of information indicates that the numbers of severe cases do not appear to be excessive when compared to the experience of other countries and do not represent any change in the transmission or virulence of the virus.

Over 99% of subtyped influenza A viruses in the Europe were pandemic H1N1 2009 with the exception of the Russian Federation where <10% of viruses subtyped were seasonal influenza subtypes, H3N2 and seasonal H1N1.

In Western Asia, increasing activity has been observed in several countries. In Israel, sharp increases in rates of ILI and pandemic virus detections have been observed over the past 3 weeks. In Afghanistan, the proportion of sentinel visits for acute respiratory infections (ARI) has increased over the past 3-4 weeks, but more dramatically in the last 1-2 weeks.

In East Asia, very intense and increasing influenza activity continues to be reported in Mongolia with a severe impact on the healthcare system. In China, the proportion of sentinel hospital visits for ILI and the proportions of respiratory samples testing positive for influenza, continued to increase over the past 3-4 weeks. More than 80% of influenza viruses isolated in China were pandemic H1N1 2009. In Hong Kong SAR, rates of ILI have returned baseline after a recent wave of predominantly pandemic H1N1 influenza in September and October. In Japan, sharp increases in influenza activity continue to be reported nationally. On northern island of Hokkaido, which to date has been the most heavily affected, disease activity may have recently peaked.

Although active, predominantly pandemic influenza transmission persists in the Caribbean region, disease activity may have recently peaked in some places as evidenced by recently declining rates of ARI and severe acute respiratory infections (SARI) in the Caribbean Epidemiology Centre (CAREC) countries. Most other countries in the tropical region of Central and South America continue to report declining influenza activity.

With the exception of Nepal and Sri Lanka, overall transmission continues to decline in most parts of South and Southeast Asia.

In the temperate region of the southern hemisphere, little pandemic influenza activity has been reported in recent weeks. Of note, a cluster of pandemic influenza cases been reported in Argentina in the capital area.

WHO

Europe:

Seventeen countries have reported increases in influenza-like illness (ILI) and/or ARI consultations (defined as countries with increases in the previous three weeks). These increases are particularly notable in the group aged 5–14 years. In eight of these countries (Germany, the Netherlands, Norway, Republic of Moldova, Romania, Slovakia, Spain and Sweden), the positivity rate of sentinel swab specimens exceeded 20% (minimum number of tested sentinel specimens: 20).

The intensity of clinical activity was described as very high in Norway, Sweden, Bulgaria and the Republic of Moldova for the first time. Other countries reporting continued very high intensity this week were Iceland, Ireland and the Russian Federation (Urals region and far eastern region). Eight countries/regions described high clinical activity: Belarus, Finland, Kazakhstan, Poland, Russian Federation (central, north-western, Siberian and Volga region), Turkey, Ukraine and Northern Ireland. The clinical incidence of ILI and/or ARI was reported as widespread in 19 countries. The Republic of Moldova reported very high intensity, widespread clinical incidence and severe impact of influenza on health services. Impact was reported as moderate in nine countries, including Ukraine, and low in 17 others.

EuroFlu

The CDC continues to release data on Fridays for the previous week. The data in this report is for the week ending November 7 and was released November 13, 2009.

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1. Visits to doctors for influenza like illness: second week that rates have declined. Now 6.7% and the seasonal baseline is 2.3%. Note, however, that many doctors are telling patients who call with ILI symptoms not to come in to the office unless it is serious.
2. Hospitalizations for lab confirmed influenza: still climbing.
3. Deaths from pneumonia and influenza: still increasing.
4. 46 states report widespread flu activity. That is down two states since the last weekly report.
5. Virus typing continues to find nearly all specimens are pandemic H1N1, swine flu.

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Don’t miss my television interview on the Time Warner local new channel, YNN. I was asked to counterpoint the county medical society president.

Is the Vaccine Production Process Broken?

Swine Flu is caused by one of the hundreds of influenza viruses that exist in nature. At this time there is no cure for any form of influenza. It can be treated in a number of ways that may shorten the length of the illness or reduce its severity.

The primary medical treatment is the use of anti-viral medications. The drugs oseltamivir or zanamivir are normally prescribed in the United States. These drugs are better known under the trade names Tamiflu and Relenza.

Read the rest of the article here.

Swine flu, pandemic H1N1, is spreading once again in the United States and the Northern Hemisphere. It continues to be infecting young people under the age of 24 in the highest numbers, closing schools and forcing cancellation of various events.

The Centers for Disease Control report 128 influenza associated pediatric deaths at this point in the 2008-2009 flu season. That number is 50% higher than last year and the highest in the last four years. Hospitalization rates for patients in the under age 2 and the age 5-17 categories also exceed the multi year average.

Read the rest of the article here.

A comparison of the current swine flu outbreak to the annual seasonal flu shows many similarities and a few important differences. The many strains of the influenza virus produce the same symptoms and the same effects, as a general rule, but certain strains such as Swine Flu do behave slightly differently.

Seasonal influenza and the Swine Flu share a great many symptoms. They produce fever, lung congestion and cough, a stuffy or runny nose, body aches and extreme fatigue. Influenza is a “whole body” illness, unlike the common cold which affects the upper respiratory system alone.

Read the rest of the article here.

The symptoms of swine flu are very similar to those of seasonal flu. The different strains of influenza seem to affect people in pretty much the same ways.

The first key symptom is a high fever. The fever may be mild but can also rapidly increase to a dangerous temperature. In an adult, an oral temperature over 100 degrees F is considered a fever, and in children a rectal temperature over 100.4 degrees F. Fevers over 103 degrees begin to be dangerous. A spiking fever, rapid onset and rapid increase to a high temperature, is also a sign of danger. Headache and chills may accompany the fever. CDC WebMD Mayo Clinic

Read the rest of the article here.

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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

CBS News Exclusive: Study Of State Results Finds H1N1 Not As Prevalent As Feared

Chuck Simmins states:

I looked at the story and my jaw dropped. Without any research at all, I could tell something was wrong with their numbers.

CBS graphic for story on confirmed H1N1 testing

These numbers are supposed to be through late July, when the CDC asked the states to change their reporting. As we have shown in our prior reports, many of the states had ceased reporting case numbers long before.

Florida:

• Florida had stopped publicly posting case counts before Memorial Day in May, 2009. The numbers in the table were updated with the CDC’s count.
• CBS states that by the end of July, Florida had examined 8,853 specimens and only 17% were positive for H1N1. That means the CBS number of confirmed cases at that point is 1,505.
• However, based on the cases reported to the CDC by July 17, Florida had 2,188 confirmed cases.

California:

• CBS is reporting that California had examined 13,704 specimens and only 2% were H1N1. That makes the CBS case count 274.
• On July 16, 2009, California was reporting 2,655 confirmed cases and 513 probable cases of swine flu.

Alaska:

• CBS is reporting that Alaska had examined 722 specimens and only 1% were H1N1. That makes the CBS case count 7.
• As of August 31, a month after the apparent cutoff for the CBS data, Alaska reported 460 confirmed cases of swine flu.

Georgia:

• The final state that CBS selected to graph was Georgia. CBS says 3,117 specimens and only 2% were H1N1. That gives CBS a confirmed case count of 62.
• Through July 15, 2009, Georgia reported 178 confirmed cases of swine flu.

From the beginning, we raised questions about the data on swine flu. We noted, and were the media source responsible for correcting, the nearly three week delay in updating California’s numbers. We noted the “lost” cases, where the numbers on the state site were higher than those reported by the CDC.

We have editorialized about the lack of preparedness on the part of public health authorities to handle a large disease outbreak. Their unwillingness to divert resources from other areas such as lead paint abatement and childhood obesity has been noted.

We agree that the decision to stop widespread testing was unwise. We agree that there are a number of influenza like illnesses (ILI) circulating.

But this story by CBS does nothing to advance the cause. The numbers are just plain wrong. The selection of the four states they chose for their graph is also misleading. Alaska and Georgia did not suffer a major outbreak of swine flu in the spring. California’s was mid sized and Florida’s was, as well. If CBS wanted to look at states, Wisconsin, Illinois, Massachusetts and Washington would have been ideal picks. That is where the pandemic took hold the worst.

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.

New York regions defined by NYS Dept of Health

Swine flu continues to spread in New York State. Data compiled by the NYS Department of Health suggests that this fall’s wave of pandemic flu will be larger and affect more people than the spring wave did.

The graph above illustrates the numbers for Flu-like Illness in NYS hospital emergency departments as percentage of total emergency department visits, by Region (3 month snapshot). FLI is the primary indicator being used in NYS, and all of the testing being done demonstrates that pandemic Swine Flu is the overwhelming influenza virus making people sick.

In New York City, the situation seems to be different at this point. After large numbers of Swine Flu cases this past spring, the indicators for the illness are well within normal expectations for this time of year.

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

Just a brief summary of various closings and other news about the swine flu pandemic.

• 400 cases at West Virginia University
• 175 cases at Dartmouth
• Tucson charter school closed due to illness
• Cases in public schools near Tucson
• Catholic high school in Maryland closes due to illness
• Outbreak at school in Central Pennsylvania
• Watertown, NY area school with outbreak

And, then there is this piece of crap from Communist China:

CHINA reported its first death from swine flu on the mainland yesterday, an 18-year-old woman in the Tibet Autonomous Region’s capital Lhasa. The government said it was rushing tens of thousands of doses of flu vaccine to the western city.

The woman in Maizhokunggar County in Lhasa died of the H1N1 virus at about 3:20am on Sunday at the county hospital. She was admitted the previous day after experiencing coughing, a sore throat and muscular stiffness.

Her body temperature was as high as 40 degrees, a Tibetan regional health department official said yesterday.

The Ministry of Health sent 200,000 doses of vaccine to Lhasa by air yesterday to help contain the virus.

Meanwhile, Beijing reported its first swine flu case “with heavy symptoms” yesterday, a municipal health bureau official said.

A 72-year-old man is on a breathing machine in Beijing Ditan Hospital. He had suffered from chronic obstructive lung diseases for about 20 years and was confirmed to be infected with the H1N1 virus last Friday with a body temperature as high as 38.5 degrees, the official said.

The Chinese mainland had reported 21,453 confirmed cases by yesterday, about 78.7 percent of whom had recovered, according to the Ministry of Health.

Does anyone believe that this is the first death, much less the first case in the Chinese capital? China rushed a Swine Flu vaccine into production faster than any of the Western nations. Any bets on the safety of that vaccine?