Monday, August 31, 2009
The White house is predicting that the swine flu will affect 20 to 40 percent of all Americans - that's between 600,000 and 1.2 million people in San Diego County. These Days takes an updated look at how San Diego is preparing.
MAUREEN CAVANAUGH (Host): I'm Maureen Cavanaugh. You're listening to These Days on KPBS. We've seen some eye-opening headlines recently about the re-emergence of swine flu expected this fall. White House advisors say the nation should be ready for a serious health threat from the H1N1 virus. There are estimates that as many at 90,000 Americans could die from the flu this season; that's compared with the 35,000 to 40,000 who die each year from complications from the flu virus. Since the H1N1 virus was first identified in a random screening process here in San Diego, our county has had more than 1,100 confirmed cases of the flu, 19 of those flu patients have died. So how prepared are we for this fall's expected swine flu outbreak here in San Diego? Will we all be wearing masks? Will schools be closed? Will we have enough vaccine? Helping us answer these questions is my guest Dr. Dean Sidelinger, Deputy Public Health Officer for San Diego County Health and Human Services Agency. And Dean, welcome to These Days.
DR. DEAN SIDELINGER (Deputy Public Health Officer, San Diego County Health & Human Services Agency): Thank you for having me.
CAVANAUGH: Now based on the White House prediction that 20 to 40% of all Americans could get this H1N1 virus this fall, that's – breaks down to roughly 600,000 to over a million people here in San Diego County. So what is the county doing to prepare for this expected outbreak?
DR. SIDELINGER: I think communication has been one of our most important things, getting the word out to the general public, our media partners have been great at helping us do that, and then working with various sectors across the community to help them prepare and make specific preparations whether it's a community clinic, a hospital, a business, schools and universities, there are specific things they can do to help minimize the impact of the disease in our community.
CAVANAUGH: Now I want to talk more specifically about some of those things but first I want – I saw that the California Nurses Association said recently that there are not enough masks in hospitals for health workers. So you are working with area hospitals then on these shortages that they're finding perhaps in masks and perhaps in isolation rooms. What are you doing – Are you having ongoing discussions with them about what they see as problems in preparation?
DR. SIDELINGER: We are. We have a continuing dialogue with our hospitals and healthcare providers. There are certain personal protective equipment that employees, healthcare providers, need to prevent them from getting infected with this disease. A big part of it is a certain type of mask and, you know, we've been working with providers to assure that they order those masks and have those on hand and have the guidelines for using those. And we do have some masks at the County that we are responsible for our first responders who are often the first point of contact with individuals who are medically ill and need more attention, and we're working with that. And we do have continuing discussions about the masks and the personal protective equipment that we need to protect our healthcare providers because they're going to help get us through this.
CAVANAUGH: And what about just ordinary people and masks? I think that was one of the most enduring images of the first outbreak of this virus in the springtime, all those people in Mexico City wearing masks. Is that a good idea if there is as severe an outbreak as they predict? Should people start wearing masks?
DR. SIDELINGER: In general, wearing masks in the community out doing your regular errands isn't a great protective strategy. What we do is, for individuals who have symptoms who show up in a clinic or a hospital, or at work and have symptoms and are on their way home, using a surgical mask to cover them to prevent them from spreading the illness to others around them is often very effective. Specialized masks are used by healthcare providers with – in certain situations in doing certain procedures to protect themselves. But in general, we're encouraging people who are sick to stay home so there's not a need for them to be wearing masks in the community and that surgical mask at the mall or in school isn't offering a lot of protection to the individual wearing it.
CAVANAUGH: Let's start talking about vaccine. When do we expect to get some H1N1 vaccine, and then who should be vaccinated?
DR. SIDELINGER: We expect, in San Diego, to be seeing this pandemic H1N1 vaccine in the middle to late October. The supplies will be smaller initially but manufacturing will continue so we'll see increased supplies throughout the next few months. When we get this vaccine, the target populations are those who are most at risk for complications so we talk about pregnant women who seem to be hit more severely by this disease. Caregivers and those who are around infants under six months of age, they can have serious complications and they can't be vaccinated themselves. We talk about our first responders and our healthcare providers, children and young people, six months of age to 24 years old. And then adults from 25 years old to 64 years old who have underlying medical conditions such as diabetes, lung disease, including asthma, and heart disease. They're at increased risk so they should be getting this vaccine as well.
CAVANAUGH: That's interesting because that is not exactly the population that usually gets – is in a high priority to get the flu vaccine. So once again, it's between 6 months and 24 years of age, and people who have underlying conditions between 24 and 65 years of age.
DR. SIDELINGER: Correct.
DR. SIDELINGER: And I think that's what's going to be very important, is this year many people should be receiving two flu vaccines, their regular seasonal flu vaccine and then this pandemic H1N1 vaccine of which many people will need two vaccines. But you're right, with our seasonal flu vaccine, it's our elderly population who often has the most severe disease and the greatest risk of death so seasonal flu vaccine is something we push out to our senior population very early in the season and try and get them all vaccinated. For this particular infection, they're not seeing as big a burden of disease, not as much disease in our elderly population, so they're not in the first tier to get vaccinated. But as supplies become more prevalent, we certainly will try to vaccinate them but they should be out getting their seasonal flu vaccine which is in some clinics and doctor's offices now and is arriving shortly to those that don't have it.
CAVANAUGH: Now, you would agree–I'm speaking with Dr. Dean Sidelinger. He is Deputy Public Health Officer for San Diego County Health & Human Services Agency—it's a little confusing. Okay, so the seasonal flu, which is not the H1N1 should – people should get – who normally get flu vaccines should get that one. And then this other population, the at-risk population, should get the H1N1 flu vaccine first but they also need perhaps a second vaccination of the H1N1 flu virus. Tell us about that.
DR. SIDELINGER: Correct. This is a new vaccine. This is a new strain of virus that we hadn't seen in humans until this spring. So in order to get the body to make a response with the vaccine that we're giving, it's thought that we're going to need two doses. Those doses are separated in the clinical trials by about three weeks and we think that's what's going to happen when we release the vaccine, that people will need one dose of the shot and then have to come back for a second dose. And, again, they also need to get their seasonal flu vaccine if that's something they usually get.
CAVANAUGH: Now let's say they only get one. Will they – One dose of that H1N1 flu vaccine. Will they have some protection from the flu virus?
DR. SIDELINGER: They likely will have some protection. We don't have the results of the full studies yet to see how much protection they have. But in order to assure full protection from this vaccine, they should follow the guidelines and get the two-dose series.
CAVANAUGH: And how much is the vaccine going to cost, do you know?
DR. SIDELINGER: The new pandemic H1N1 influenza vaccine is free. The federal government has purchased the entire supply so the vaccine will be given to healthcare providers, schools and colleges that choose to vaccinate, other people that choose to vaccinate, for free. That will include the vaccine and then the supplies and materials that are needed to give that vaccine and dispose of it. Those providers who need to have staff time to administer that vaccine will be able to charge that administration fee but that should be payable by most private insurers as well as public assistance. MediCal providers should pay for that administration fee but there is no charge at all for the vaccine itself.
CAVANAUGH: Well, that at least is good news. What about schools? We saw a lot of schools closing down if just one child got the – was diagnosed with the H1N1 flu. Will schools shut down this fall if there is the outbreak as expected?
DR. SIDELINGER: I think, you know, we have some contingency plans in place. With the current mild situation we see where most people get a mild illness and fully recover, we anticipate no school closures in the fall. We hope that students who are ill, staff members who are ill, will stay home while they're sick. And once their fever goes away, stay home another 24 hours before returning to school, that students and staff will practice good hand washing, they'll use a hand sanitizer if soap and water's not available, and that if they cough or sneeze, they'll sneeze into a tissue, cough into a tissue or into their elbow and then wash their hands appropriately. Those measures will help mitigate the spread of the disease in schools and allow us to keep schools open and keep kids in their desks, learning from talented teachers. If the disease becomes more serious, we are seeing more people hospitalized or increased deaths from this disease or it becomes even more widespread in the community with 10 to 30% or more of students or staff being absent, we'll revisit the need to work with individual schools and dismiss students and close those schools. But we hope that in this current situation, we'll be able to prevent that and keep kids in school learning and keep them healthy as well.
CAVANAUGH: And let me talk to you about businesses as well. Are you dealing – What is the message that you're getting out to area businesses about workers who take time off because they may have come down with swine flu. From what I understand, you're asking those businesses to allow the patients, the victims of the flu, to stay home until they get better.
DR. SIDELINGER: Correct. Currently, a lot of businesses have practices in place where if you're out for a certain number of days you need to have a note from your doctor to return to work. Well, with people who have this flu, they have no underlying medical conditions and they have a mild illness, we're encouraging them to stay home, recuperate at home, and return back to work 24 hours after their fever goes away. And so we're trying to get that word out to businesses that that is a policy that should be allowed to happen. Also, too, for employers to work with their employees that if they have sick leave available that they should look at their sick leave balance and see do they have sick leave so that if they get ill themselves, they're able to stay home and still get paid, or if they have children that they care for who need to be home from school, that they can stay home with them, so a little thinking ahead for those employers. And then some routine messages for the employers to clean commonly touched surfaces to help prevent the spread of disease, and asking employers or employees themselves to take charge of their own work area, to clean up their desk area, their work space, and keep that area clean and, again, that'll prevent the spread of this virus that can live on surfaces for a few hours.
CAVANAUGH: And what about part time workers who normally don't have sick leave? Are you asking businesses to be a little bit more indulgent about that for the – for, really, for public health reasons?
DR. SIDELINGER: I think it's certainly up to the own businesses and they know their workforce and the economies in their workplace of whether that is possible to have increased – or to offer paid sick leave if they don't have it. But we certainly do encourage people who are sick to stay home and that'll prevent the spread to other employees, to customers, and allow them to recover and get back to work as soon as possible. So we do encourage employers that, you know, if they can be flexible and the work can get covered and they can allow staff to stay home, that that's what they should be doing. But the policies on how that's implemented in various workplaces is up to those employers.
CAVANAUGH: And in the short time we have left, Dean, I just wanted to – another concern is that people who feel sore throat, who have a little fever, are going to run to the emergency room and we're going to have clogged emergency rooms and that's going to be a real problem. What advice are you giving people if they feel a little bit sick?
DR. SIDELINGER: I think if you're a healthy individual without any underlying conditions and you're feeling sick, you're not having trouble breathing, you're able to still drink, these are symptoms you've had before when you've had the seasonal flu, we encourage you to stay home, get plenty of rest, drink plenty of liquids, and as you start to feel better, again, when your fever goes away you'll be able to return to work or to school 24 hours after. If you're a person who's having any trouble breathing, not able to keep liquids down, your symptoms are getting much worse, we certainly encourage you to seek medical care and that may be emergent care or urgent care, depending on your symptoms. For children and adults with underlying conditions, so people who are – women who are pregnant, people with diabetes, people with lung disease or heart disease, we encourage them to call their physician if they start getting flu-like symptoms, discuss with them whether they need to come in or whether they need to be getting on anti-viral medication to treat that flu because they're at risk for increased – or, they're at risk for having complications, they really do need to talk to their provider and see if they need to get seen. But a young, healthy individual who's having mild symptoms really should stay home until they recover.
CAVANAUGH: And there is no reason for everyone to be tested for swine flu, right?
DR. SIDELINGER: That's correct. What we're seeing right now because it's not flu season or traditional flu season here in San Diego, that 99% of cases that are positive for Influenza A throughout California are currently this pandemic strain of H1N1. As we get into the flu season, that's certainly not going to be the case but what we're seeing in the southern hemisphere right now where this pandemic strain of influenza and seasonal flu are both in the community, that this pandemic strain really is the predominant strain. So most of the illnesses are this pandemic H1N1 strain and, certainly, for most people, we treat, whether you have seasonal flu or this pandemic H1N1 flu, the same so they – the testing itself doesn't offer a lot of benefit and it can often take three to five days or even longer to get the test result back so we're working with our healthcare providers that if they see a person, they're talking to one of their patients, they should offer the treatment that's best based on the situation they see and not wait for the lab results to come back.
CAVANAUGH: We have to end it there but I'm sure we're going to be talking a lot more about this as time goes on. Dr. Dean Sidelinger, Deputy Public Health Officer for San Diego County Health & Human Services Agency, thanks so much for coming in and speaking with us today.
DR. SIDELINGER: Thank you for letting us get the word out.
CAVANAUGH: And I want everyone to know for the latest news and information about the swine flu virus situation in San Diego County and around the world, you can visit www.kpbs.org/swineflu.
Dean Sidelinger, Deputy Public Health Officer for San Diego County Health and Human Services Agency.