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

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?

NYS Department of Health
Statement from Richard F. Daines, M.D., Commissioner

Governor Paterson’s decision to activate New York State’s health emergency preparedness plan has enabled us to quickly respond to the H1N1 swine flu outbreak. The Governor has pledged all necessary resources for New York State’s response to this outbreak to mitigate its impact on New Yorkers.

The Centers for Disease Control and Prevention (CDC) received last night the specimens from the three suspect cases of H1N1 in Suffolk, Orange, and Cortland counties.

The State Health Department (the Department) does not yet have confirmatory results from those specimens. We also are waiting for validation of the accuracy of the testing performed by the Department’s Wadsworth Laboratories. Once our testing is validated, New York no longer will need to send specimens to CDC for confirmatory testing, and confirmatory testing for H1N1 will be performed in Wadsworth Laboratories.

Yesterday 23 suspect H1N1 specimens were tested at our Wadsworth Laboratories. Of those, five specimens tested probable for cases of H1N1, with one case each in Suffolk, Nassau, Orange, Monroe, and Chautauqua counties.

These five cases bring the total number of probable cases in New York State outside of New York City to eight.

Of the five new probable cases, the ones in Suffolk and Nassau counties have links to St. Francis Prep School in Queens. The other three cases from Orange, Monroe, and Chautauqua counties have links to Mexico.

Also among these 23 specimens tested yesterday, three were positive for seasonal influenza, two were inconclusive and will be repeated, and 13 were negative for any type of influenza.

Today, New York City reported an additional 16 probable cases. The number of confirmed cases in New York City remains at 49.

These results indicate that seasonal influenza is still circulating in the state. But more than half the suspect specimens submitted for testing were negative for any type of influenza.

Local health departments continue to investigate many suspect cases of H1N1. In fact, outside of New York City, there currently are 89 suspect cases of H1N1 in New York State. As this outbreak continues to evolve, increases in the numbers and location of cases of H1N1 are to be expected.

Not all suspect cases will be sent to the Wadsworth Laboratories for testing. As the outbreak evolves and reports of suspect cases continue, the criteria for testing will change. For example, if H1N1 is identified in a particular county, then no longer will specimens be tested on mildly ill patients in that county.

There are three definitions of cases:

Confirmed cases

Laboratory testing has determined that these are cases due to H1N1.

Probable cases

Lab testing has determined that these are cases likely due to H1N1, but they need confirmatory testing.

Suspect cases

These cases have not been tested but are suspicious for H1N1. Many suspect cases are never tested because it is not necessary for managing mild illness.

The Fabius-Pompey School District in Onondaga County has been closed for the remainder of this week as a result of a student from Cortland County testing positive for H1N1. The district expects to reopen on Monday.

To address the evolving situation with schools, the Department is working with the State Education Department to finalize criteria in the next day or two for school districts to use to evaluate the need for closures.

Yesterday, a health care worker at a nursing home in Orange County was confirmed to have H1N1. That facility is providing anti-viral prophylaxis treatment to all patients and staff and conducting surveillance for additional illness. One ill patient is currently being tested.

The Department continues to work closely and coordinate with CDC and city and county health departments to address the possible spread of H1N1 in New York State. Because of effective planning, the Department has been able to move swiftly to respond to this situation.

All influenza can be serious — and deaths can be expected. Each year on average there are 36,000 seasonal influenza-related deaths in the U.S. – including approximately 2,000 deaths in New York State.

Symptoms of swine flu may include fever, cough, sore throat, congestion, body aches, headache, chills, and fatigue. Diarrhea and vomiting have been reported as symptoms, as well.

Anyone experiencing severe symptoms, such as difficulty breathing, should seek immediate medical attention. For anyone experiencing mild or moderate symptoms, it is best to consult with a health care provider and recover at home.

The best protection against any influenza is to follow common-sense precautions such as frequent hand-washing, staying home from work or school if you are ill, and covering your mouth when you cough or sneeze.

For questions about swine flu, call the Department’s hotline at 1-800-808-1987. New York City residents should call 311. Resources are available at www.nyhealth.gov/swineflu.

Health officials said today Monroe County has one probable case of swine flu.

The case involves a young woman who had been to Mexico. She’s had limited contact with people since her return and health officials have told her to stay at home until further notice. The health department has also contacted her household members, who will not be tested unless they show symptoms.

The probable case was tested at the state level and is now being sent to the federal Centers for Disease Control and Prevention for further testing. Local health officials expect results as early as tomorrow.

The county still has seven suspected cases of swine flu. Two of the cases sent to the state for testing earlier this week had negative results, but three new suspected cases were added today.

A suspected case of swine flu was also reported in Genesee County today, as was one in Wyoming County, according to health officials there. But two of four suspected cases in Ontario County tested negative, official said today. These latest reports bring the number of suspected cases in the area to 13, including two in Wayne County.

Democrat & Chronicle

Monroe County may know Friday if it has its first “confirmed” case of H1N1, or the swine flu. Right now there is one probable case and seven other suspected cases.

A young woman who traveled to Cancun, Mexico is the county’s first probable case of the flu. She is at the second step in testing for H1N1 strain. The next step is confirmation.

The Centers for Disease Control is now testing her nose swab to confirm or deny that she indeed has H1N1. The woman is recovering at home from mild symptoms of the flu. She and the 7 other people with suspected cases of swine flu were never hospitalized.

All of them traveled to Mexico or Texas or New York City, places already affected by the flu.

R News

Two Chautauqua County schools will remain closed through the weekend due to a confirmed case of swine flu in a child, while samples from two Niagara County adults are being analyzed at a state laboratory.

Wyoming County health officials said they expect to know by Friday night whether a sample submitted this morning is found to be a strain of swine flu spreading throughout the country.

As of 3 p.m. today, the Erie County Health Department had sent two samples of possible swine flu to the state for further testing. Department spokesman Kevin Montgomery said neither sample appeared probable as of this afternoon.

Genesee County health officials said late this afternoon they have a suspected case and another possible case. [snip]

The Bemus Point Central School District announced that its two schools — Bemus Point Elementary and Maple Grove High — would be closed through the weekend after “a local student has been reported with “probably’ diagnosis of this H1N1 flu virus,” Superintendent Albert M. D’Attilio said in a letter sent home to parents and posted on the district’s website.

The schools were closed to all activities at the end of the school day today and are expected to reopen on Monday.

Buffalo News

The Fabius Pompey School District – 10 miles from Syracuse is closing for the next two days as a precautionary measure after preliminary testing showed a female student with the swine flu.

It’s latest in several suspected cases in New York State.

State officials say they are awaiting final confirmation on their preliminary tests form the federal centers for disease control.

However, local health officials say the student did not need hospitalization and is recovering.

Locally, four possible cases being tested in Lewis County, and three in Oneida County. No reported cases in Herkimer or Otsego Counties.

WKTV Utica

Here are the media reports on possible and probable swine flu cases in upstate New York, outside of New York City.

Probable cases: 1 each in Orange, Suffolk and Cortland counties

75 potential cases are being investigated outside of New York City, Rochester area has 13 suspected cases, including seven in Monroe County, four in Ontario County and two in Wayne County.

Democrat & Chronicle

WHO from yesterday:

The situation continues to evolve rapidly. As of 19:15 GMT, 28 April 2009, seven countries have officially reported cases of swine influenza A/H1N1 infection. The United States Government has reported 64 laboratory confirmed human cases, with no deaths. Mexico has reported 26 confirmed human cases of infection including seven deaths.

The following countries have reported laboratory confirmed cases with no deaths – Canada (6), New Zealand (3), the United Kingdom (2), Israel (2) and Spain (2).

The CDC case number site is unchanged at this time.

AP is claiming CDC confirmation of a swine flu related death in Texas, a toddler. The Texas Health Department site does not have this information.

AHN is reporting additional swine flu cases in Canada. The Canadian Public Health Agency has nothing at this time.

Along America’s North Shore there are a number of suspected cases. Concerning Rochester and Western New York State, 13 WHAM states:

Of the eight suspected cases of swine flu in the Rochester area:
–Five cases in Monroe County. The patients are all in their early 20s and have traveled to Mexico. None of them are students.
–One suspected case in Wayne County. That person has not been hospitalized, but recently traveled to Mexico and returned home feeling ill.
–Two suspected cases in Ontario County in two people who traveled to New York City.