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Flu Death Toll Continues To Rise In San Diego County

A sanitizing station with adult and child masks awaits patients at Sharp Grossmont Hospital in La Mesa, Jan. 3, 2018.
Susan Murphy
A sanitizing station with adult and child masks awaits patients at Sharp Grossmont Hospital in La Mesa, Jan. 3, 2018.
Flu Death Toll Continues To Rise In San Diego County
Flu Death Toll Continues To Rise In San Diego County GUEST:Dr. Jonathan Grein, director of hospital epidemiology, Cedars-Sinai Sammy Totah, chief operating officer and former director of pharmacy, Kaiser Permanente

>>> This is KPBS Mid-Day Edition, I am Maureen Cavanaugh. San Diego County health officials are downplaying the significance of the rising influenza cases, but the numbers themselves are eye-opening. According to data released by the county this week, the number of diagnosed flu cases this season now stands at 10,324. That is about age times higher than the number -- eight times higher than the number last year. The number of deaths stands at 91, which is already higher than last year's total, and we are only halfway through the traditional flu season. Joining me is Dr. Jonathan Graham, director of Hospital epidemiology at Cedars-Sinai Hospital in Los Angeles. We are speaking to him via Skype. And Dr. Graham, welcome. >> Thank you for having me. >> This flu season is not only that in San Diego, this is happening all over California, isn't it? >> Well, it has been our experience here in Los Angeles, that we are certainly seeing a high level of flu activity in our community. Absolutely. >> There is speculation that this is only the flu season peaking early, could that explain it? >> It certainly could be the case of course, it is always hard to predict with any flu season, so it is hard to know when we are going to peek, but what I can say is -- over the last couple of weeks, we have certainly seen a very high volume of activity, higher than we see in most typical years. >> What is -- for a typical year, what is the flu season? When does it start and Southern California specifically, and sort of when does it trail off? >> Well, every year is, of course, a little bit different. It is not unusual for flu activity to really begin to pick up in December or January, and we will often see activity continue or peak in January, February. But, we will also see cases extend into March or April or sometimes later. Every year is little bit different. >>> Most people coming down with the flu have what is called the H3 letter and to strain. Can you tell us about that? >> That strain is well known from prior flu seasons to cause the most severe disease in those at the extremes of age, the very young or old. And also those with underlying medical conditions. I think that that is reflective of what we are seeing in our medical center as well. >> Is it a more dangerous strain of the flu than usual? >> I think it is a little early to say if that is the case or not. What I can say, is we have seen a high volume of flu patients. The good news at least is that the vast majority of people that we are seeing do not have illness. We certainly have seen some severe cases, which would be in the types of patients that we would expect, those who are more elderly and with underlying medical conditions. >> This year's flu shot is said to be only about 30% effective against this strain of the flu. Is that unusual? >> Well, we know every year that of course, the flu shot is not 100% effective. It is still possible to get the flu even if you have had the shot. I have not seen any data from the US, in terms of the effectiveness this year. It is literally to say. What I would emphasize though, even though the flu shot may not prevent you completely from getting the flu, it can reduce your risk of getting more severe illness. For that reason, even though it may not be completely effective against preventing illness, it is certainly helpful in preventing or reducing how severe of an illness you can develop. >> Since we seem to be right in the middle, if not peaking for this flu season, is it too late to get the shot? >> Absolutely not. Although we see a high volume of flu activity at this time, it is important to remember that the flu will continue to circulate for several more weeks, and perhaps into April or May. So, it is not too late to get vaccinated if you have not been already. >> What other precautions can people can -- take to avoid getting the flu? >> It is important to wash your hands frequently, particularly, before or after touching your mouth or face. Of course, stay away from others that are sick that may have the flu. And of course, if you are sick, please stay at home, and do not be around others if you do not have to be. >> To that point of staying away from people who have the flu, when are people most contagious? Is it when they actually have symptoms, or is it before? >> The challenge with the flu is that you can be contagious even slightly before you develop symptoms, so it has been well described that you can be infectious about a day before symptoms develop. This is why getting vaccinated is one of the most important things you can do. People are probably the most infectious for those first 2-3 days during the illness when they have the most severe symptoms. >> I have been talking to Jonathan Graham who is director of epidemiology. Thanks a lot. >> Thank you for having me. >> No flu health crisis has been declared, but San Diego hospitals are seeing more and more people coming in with the flu. In some areas of the state, pharmacies have run out of flu medicines. ERs are packed and ambulances in Riverside face severe backlogs. We will find out what it is like in local hospitals, joining me is Sammy Toda, he is chief operating officer and former director of pharmacy at Kaiser Permanente. And Sammy, welcome. >> Thank you for having me. >> How bad does this year's flu season look in your emergency room? >> Well, it is certainly one of the worst flu here's we have had in quite a while. Certainly, in my 20 years in San Diego, this is among the worst we have seen. Just the virulence of the flu strain that we are seeing predominantly, and just the number of people seeking help is exceeding capacity in multiple hospitals and clinics around the county. >> How is Kaiser Permanente physically dealing with this influx of patients? Is your ER crowded? Are you triaging patients? What is happening? >> Well, we have a surge plan. And most hospitals do have some sort of a surge plan. And, that prepares us for what we would normally expect during a cold and flu season. This year, it is more severe and we just escalate our surge plan to higher levels. So, we do have opportunities to create beds, or do some things to be able to accommodate more patients. Our emergency departments are very busy, we are asking people that if they know that they have the flu, the best thing to do -- and it is mild for them, just stay home. They feel like they are in an emergent situation to visit the emergency room. But, you can expect a long wait. We have also restricted visitors in an effort to contain the outbreak of the flu. So, anyone who has active flu, or flulike symptoms, so fever, coughing, chills, things like that. We are asking them to stay out of the hospital and not send their patients. >> We have seen reports from Riverside and San Bernardino that ambulance services have been overwhelmed, in part because ERs are so busy, there is no room to drop off the patients. Is San Diego seen any of that? Is Kaiser Permanente seeing any of that? >> We have not seen that in San Diego. I will say the ambulance services are extremely busy. And as emergency departments become more impacted, the offload times become higher. But, we try to address those as quickly as we can. So, we have not seen specifically what they are seeing in Riverside and San Bernardino here in San Diego yet. >> Want to ask you specifically about something you mentioned earlier. If a relatively healthy person comes down with the flu, is there any reason for them to go to the hospital? >> Not specifically. I mean, we would tell them to treat their symptoms at home. Probably the best thing for them to do is rest. If they have a fever, they would take acetaminophen or Tylenol, if they have body aches or muscle pain, Motrin or ibuprofen. Just fluids and rest. It is a virus, so there is no antibiotic that we would be able to give to treat the flu. And, at Kaiser Permanente we have the option of telephone appointments, or being able to have the doctor call them back within an hour. In most cases, if any Tamiflu, or one of those medications, we can prescribe it right over the phone, and have them be able to pick it up at the pharmacy. >> When it comes to Tamiflu, there are some areas in California where pharmacies are saying they have run out basically. Do your family seek -- to your pharmacies have enough Tamiflu? >> We do. We have been tracking our Tamiflu inventory daily. We have multiple calls per day to track and manage the surge of patients. While we are seeing about five times more prescriptions than normal, we are still able to manage and provide an ample Tamiflu supply to everyone who needs it within Kaiser Permanente. >> Suppose someone is sick in their home resting. They are taking their acetaminophen and so forth -- what might they look for as a sign that the flu is getting worse? >> Certainly, if they are experiencing severe vomiting or diarrhea, we primarily see that in children. If they are getting dehydrated, if there temperature is elevated above a certain level. Or, if they just feel that they cannot take care of themselves at home, they said -- should take treatment. >> The flu usually resolves itself fairly quickly, within three days or so, but we are asking people if they have had the flu, you want to be symptom three -- free for three days before you visit anyone, because you can still be infectious. >> I have been speaking with Sammy Toda Emma chief operating officer and former director of the pharmacy with Kaiser Permanente. Sammy, thank you. >> Thank you. [ Music ].

The number of reported influenza-related deaths in the San Diego region doubled last week, bringing this season's total to 91, while the number of lab-confirmed flu cases was down, county health officials reported Tuesday.

Eleven percent of all emergency room visits in San Diego County last week were for treatment of flu-like symptoms, according to the county Health and Human Services Agency. There were 2,992 lab-confirmed flu cases in the region during the same time period compared to 3,354 the previous week. The season's total now stands at 10,324 — about eight times higher than the number of cases at this time last year.

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Dr. James Watt, chief of the division of communicable disease control for the California Department of Public Health, said it is unclear why this year's death toll is so high.

RELATED: County Supervisors To Review Flu Severity

“It’s possible that that number is higher because the season just started earlier, it’s also possible that this is going to be a higher year for deaths," he explained. "That’s something we’re going to need to continue to monitor.”

Despite the skyrocketing number of cases, health officials told the Board of Supervisors it hasn't yet reached emergency status.

"It is very important to note that the (U.S. Centers for Disease Control and Prevention) and the state have not declared an emergency, at present, as resources have not been exhausted," said Dr. Nick Yphantides, the county's chief medical officer.

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Public health officials say it is not too late to get vaccinated.

"The flu vaccine is the best public health tool we have, and an annual flu shot is recommended to everyone over 6 months," said Dr. Wilma Wooten, director of the county's public health services. "The vaccine helps your body develop protection in two weeks and can lessen severity if one gets the flu. The vaccine is matched with all four circulating strains."

A chart by the San Diego County Health and Human Services Agency shows flu trends from 2008-2017, Jan. 8, 2018.
San Diego County
A chart by the San Diego County Health and Human Services Agency shows flu trends from 2008-2017, Jan. 8, 2018.

Flu vaccines are available at the following locations:

Central Region Public Health Center

Ongoing

Mon., Wed., Thurs., 8:30-11 am and 1-4 pm

5202 University Ave.

San Diego, CA 92105

Flu vaccine for 6 months and older is available beginning on Oct. 6 on a walk-in basis, Monday, Wednesday and Thursday, from 8:30-11 a.m. and 1-4 p.m. Closed weekends and holidays. No appointment is needed, but if desired, appointments can be made online at https://onlineappts.hhsa-sdcounty.org. Tdap (tetanus, pertussis and diphtheria) and pneumococcal pneumonia vaccines are also available to eligible persons.

VIP Immunization Trailer

Ongoing

Mon.-Fri., 8-11 am and 1-4 pm

3177A Ocean View Blvd.

San Diego, CA 92113

Flu vaccine for 6 months and older is available beginning on Oct. 6 on a walk-in basis, Monday through Friday, from 8-11 a.m. and 1-4 p.m. Closed weekends and holidays. No appointment is needed but if desired, appointments can be made online at https://onlineappts.hhsa-sdcounty.org. Tdap (tetanus, pertussis and diphtheria) and pneumococcal pneumonia vaccines are also available to eligible persons.

East Region Public Health Center

Ongoing

Mon., Tues., Wed., Fri., 8-11 a.m. and 1-4 p.m. and Thurs., 1-4 p.m.

367 N. Magnolia Ave., Ste. 101

El Cajon, CA 92020

Flu vaccine for 6 months and older is available on a walk-in basis, Monday through Wednesday and Friday, from 8-11 a.m. and 1-4 p.m., also on Thursday, from 1-4 p.m. Closed weekends and holidays. No appointment is needed. Please call the Center at 619-441-6500 for information about Tdap (tetanus, pertussis and diphtheria) and pneumococcal pneumonia vaccines.

North Central Public Health Center

Ongoing

Mon.-Fri., 8-11 a.m. and 1-4 p.m.

NOTE: Clinic closed the second Thurs. of every month from 8-11 a.m.

5055 Ruffin Rd.

San Diego, CA 92123

Flu vaccine for 6 months and older is available on a walk-in basis, Monday through Friday, from 8-11 a.m. and 1-4 p.m., except the second Thursday of every month, when flu vaccine is only available from 1-4 pm. Closed weekends and holidays. No appointment is needed. Please call the Center at (858) 573-7300 for information about Tdap (tetanus, pertussis and diphtheria) and pneumococcal pneumonia vaccines.

North Inland Public Health Center

Ongoing

Mon. & Fri., 8-11 a.m. and 1-4 p.m.

649 W. Mission Ave., Suite 2

Escondido, CA 92025

Flu vaccine for ages 6mos and older is available Mondays & Fridays. Adults may also call for availability Tuesday through Thursday. Closed weekends and holidays. No appointment is needed. Tdap (tetanus, pertussis and diphtheria) and pneumococcal pneumonia vaccines..

Ramona Public Health Office

Ongoing

Second Wed. of every month from 1-3 p.m.

1521 Main St.

Ramona, CA 92065

Flu vaccine for 6 months and older is available on a walk-in basis, on the second Wednesday of every month, from 1-3 p.m.

Closed weekends and holidays. No appointment is needed. Tdap (tetanus, pertussis and diphtheria) and pneumococcal pneumonia vaccines are also available to eligible persons.

New Hope Church

Ongoing

Third Wed. of every month from 8:30-11 a.m.

10330 Carmel Mountain Rd.

San Diego, CA 92129

Flu vaccine for 6 months and older is now available on a walk-in basis, on the third Wednesday of every month, from 8:30-11 a.m.

Closed weekends and holidays. No appointment is needed. Tdap (tetanus, pertussis and diphtheria) and pneumococcal pneumonia vaccines are also available to eligible persons.

North Coastal Public Health Center

Ongoing

Mon. & Fri., 8-11:30 a.m.and 1-4 p.m.

3609 Ocean Ranch Blvd., Suite 104

Oceanside, CA 92056

Flu vaccine for 6 months and older is available beginning Oct. 6 on a walk-in basis, Monday and Friday, from 8-11:30 a.m. and 1-4 p.m. Closed weekends and holidays. No appointment is needed. Tdap (tetanus, pertussis and diphtheria) and pneumococcal pneumonia vaccines are also available to eligible persons.

Fallbrook Community Resources Center

Ongoing

Second Mon. of every month from 10 a.m.-4 p.m.

202 W. College Ave.

Fallbrook, CA 92028

Flu vaccine for 6 months and older is available on a walk-in basis, on the second Monday of every month, from 10 a.m.- 4 p.m. Closed weekends and holidays. No appointment is needed. Tdap (tetanus, pertussis and diphtheria) and pneumococcal pneumonia vaccines are also available to eligible persons.

Solana Beach Presbyterian Church

Ongoing

Second Tues. of every month from 1-4 p.m.

120 Stevens Ave.

Solana Beach, CA 92075

Flu vaccine for 6 months and older is available on a walk-in basis, on the second Tuesday of every month, from 1-4 p.m. Closed weekends and holidays. No appointment is needed. Tdap (tetanus, pertussis and diphtheria) and pneumococcal pneumonia vaccines are also available to eligible persons.

South Region Public Health Center

Ongoing

Mon.-Fri., 8 a.m.-4 p.m.

690 Oxford St., Suite H

Chula Vista, CA 91911

Flu vaccine for 6 months and older is available on a walk-in basis, Monday through Friday, from 8 a.m.-4 p.m. Note that the clinic may close earlier than the listed time if clinic capacity is reached. Closed weekends and holidays. No appointment is needed, but if desired, appointments can be made online at https://onlineappts.hhsa-sdcounty.org. Tdap (tetanus, pertussis and diphtheria) and pneumococcal pneumonia vaccines are also available to eligible persons.

Vaccination is especially important for those who are at high risk of developing serious complications from the flu. They include people with chronic illnesses such as asthma, diabetes and lung disease; pregnant women; those over 65; and people who live with or care for those who are at higher risk, health officials said.

Vaccines are available at doctors' offices and retail pharmacies. Those without insurance can go to a county public health center to get vaccinated. For a list of locations, visit www.sdiz.org or call 211.

Flu Death Toll Continues To Rise In San Diego County
Flu Death Toll Continues To Rise In San Diego County

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