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.

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.

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

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?

The official end of summer is this week along America’s North Shore and that means schools from pre-K to college level are in sessions. This also signals the expected second wave of pandemic influenza, pandemic swine flu. The CDC report on influenza and influenza like illnesses (ILI) is for the week ending September 12, 2009.

Percentage of Visits for Influenza-like Illness (ILI) Reported by the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet), National Summary 2008-2009 and Previous Two Seasons for Week Ending September 12, 2009 - CDC

Traveling across the northern tier of states, the New England region had a very low incidence of ILI from reporting doctors and facilities.

New York and New Jersey are significantly different. Over five percent of the visits to reporting doctors were for ILI. That approaches the numbers seen during the spring wave of pandemic swine flu. This week, week 36, fall into the same levels as weeks 21-25 as the CDC records the year.

The Midwest region is the peak for ILI reporting for the last 52 weeks. The percentage, 3.1%, is higher than during the sprint wave of pandemic flu. Since the Chicago metro area and the Milwaukee metro area led the United States in recorded H1N1 cases last spring, this datum suggest that the illness has returned and is even more widespread.

The Northern Rockies are near their peak from the late winter.

The Northwest had its reports of ILI climb in the week ending September 12. The percentage is still below the spring peaks, and the next few weeks should tell us if this was a spike or the pandemic has returned in strength. the Seattle metro area was among the nation’s leaders in the spring.

Here’s what the CDC has to say about the week ending September 12.

• Visits to doctors for influenza-like illness (ILI) are increasing nationally. Visits to doctors for influenza-like illness are higher than what is expected during this time of year and have increased for five consecutive weeks now. This is very unusual for this time of year.
• Total influenza hospitalization rates for adults and children are similar to or lower than seasonal influenza hospitalization rates depending on age group, but are higher than expected for this time of year.
• The proportion of deaths attributed to pneumonia and influenza (P&I) was low and within the bounds of what is expected at this time of year.
• Twenty-one states are reporting widespread influenza activity at this time. They are: Alabama, Alaska, Arizona, Arkansas, Florida, Georgia, Illinois, Kansas, Kentucky, Louisiana, Maryland, Minnesota, Mississippi, Nevada, New Mexico, North Carolina, Oklahoma, Pennsylvania, South Carolina, Tennessee, and Virginia. Any reports of widespread influenza activity in September are very unusual.
• Almost all of the influenza viruses identified so far are 2009 H1N1 influenza A viruses. These viruses remain similar to the viruses chosen for the 2009 H1N1 vaccine, and remain susceptible to the antiviral drugs oseltamivir and zanamivir with rare exceptions.

All military personnel will be vaccinated against the H1N1 flu virus, and the vaccine will be available to all military family members who want it, a Defense Department health affairs official said today.

The H1N1 vaccination program will begin in early October, said Army Lt. Col. (Dr.) Wayne Hachey, director of preventive medicine for Defense Department health affairs.

The vaccine, which has been licensed by the Food and Drug Administration, will be mandatory for uniformed personnel, the colonel said. “What we want to do is target those people who are at highest risk for transmission,” he said.

Health-care workers, deploying troops, those serving on ships and submarines, and new accessions are at the top of the list. “Any place where we take a lot of people, squash them all together and get them nice and close and put them under stressful conditions will get the vaccine first,” he said.

The department will use the usual seasonal flu vaccine distribution chain for the H1N1, Hachey said, noting that while the mass H1N1 vaccinations are new to the general population, the process for vaccinating against seasonal flu is old hat for the Defense Department. “We’ve been doing this for decades,” the colonel said. “The system is tried and true.”

The department initially will receive 1 million doses of the H1N1 vaccine, and another 1.7 million doses later in October.

Officials don’t know yet whether people will need one dose or two, Hachey said. “The assumption right now is that people will need two doses, 21 days apart,” he said. “That may change.”

FDA officials still are studying H1N1 and the vaccine, and the results should be known by the end of the month.

Seasonal flu vaccine already is available, and the Defense Department will begin giving those shots shortly, Hachey said. “That has been our message to immunizers: to try and get as many people as they can immunized against the seasonal flu early,” he said.

Guidelines for giving priority to family members will follow those for the general population, Hachey said. The Department of Health and Human Services is buying millions of doses of the vaccine.

“Installations are going to register with each state as an immunizer,” Hachey said. “They will tell how many people they care for. This includes dependents, retirees and so on.”

The Centers for Disease Control will place the order and will ship the vaccine where needed. Family members will have multiple opportunities to get the vaccine, whether at Defense Department medical facilities or off post, Hachey said.

The CDC has established target groups for those at greatest risk for transmitting or being affected by the H1N1. They include pregnant women, health-care workers, those younger than 25 or older than 65, and those with pre-existing health conditions.

Hachey said previous plans are serving the Defense Department well. “We have been preparing for pandemic flu because of its potential impact on the mission,” he said.

The symptoms of the H1N1 flu are almost the same as the seasonal flu: fever, sore throat, runny nose, nausea, muscle aches and feeling rundown. The 2009 H1N1 virus – formerly known as swine flu – is a pandemic virus, according to the World Health Organization. U.S. officials call the virus “troubling” and urge communities across the United States to take actions to mitigate the effects of it. The federal government is urging states and municipalities to begin preparing now for the fall flu season.

President Barack Obama addressed the H1N1 pandemic following a White House meeting today.

“As I said when we saw the first cases of this virus back in the spring, I don’t want anybody to be alarmed, but I do want everybody to be prepared,” he said. “We know that we usually get a second, larger wave of these flu viruses in the fall, and so response plans have been put in place across all levels of government.”

But government cannot do it all, and the American people have a responsibility to stop the spread of the disease, Obama said. “We need families and businesses to ensure that they have plans in place if a family member, a child or a co-worker contracts the flu and needs to stay home,” he said.

“And most importantly, we need everyone to get informed about individual risk factors, and we need everyone to take the common-sense steps that we know can make a difference,” the president said. “Stay home if you’re sick. Wash your hands frequently. Cover your sneezes with your sleeve, not your hands. And take all the necessary precautions to stay healthy. I know it sounds simple, but it’s important and it works.”

The H1N1 is a never-before-seen combination of human, swine and avian flu viruses, officials said. First detected in Mexico in February, it quickly spread around the world. According to July WHO statistics, there have been 94,512 H1N1 cases worldwide, and 429 people have died from it. In the United States, 33,902 contracted H1N1, and 170 have died.

DVIDS
Story by Jim Garamone

University of Alabama

University of Alabama officials say 54 cases of influenza were reported on the first day of school.

John Maxwell of the Student Health Center says most of the cases are likely the swine flu and says health officials believe the outbreak started with sorority rush last week.

Anderson University (S.C.)

Two students at Anderson University have tested positive for the H1N1 flu virus, the school confirmed Tuesday. H1N1 was formerly known as swine flu.

The positive tests came back Friday, according Barry Ray, the school’s director of marketing and communication. “They tested positive for the five-day flu, which is an 80 percent chance the illness is H1N1,” Ray said. Conclusive results won’t be back for a few more days, he said.

Carnegie Mellon University

Eighteen suspected cases of H1N1 influenza have prompted Carnegie Mellon University to take action to reduce exposures and prevent a full-fledged outbreak.

In a university e-mail yesterday, officials said 18 students have contacted Student Health Services about having flu-like illness.

Classes will continue.

Penn State University

Eight new cases of swine flu were confirmed at Carnegie Mellon University yesterday, bringing the total to 26 students with H1N1 influenza, and the number is expected to climb.

Penn State University also confirmed several cases, while other local universities reported no problems to date.