Whether it’s H1N1 or another strain, we’re sure to see a worst-case flu season sooner or later. Will the Sacramento region be ready?
It might start as a persistent tickle in your throat, or perhaps a headache. Then you may feel your skin prickle because your body temperature has risen enough to make a comfortable room feel cold.
Congratulations. You’ve got the flu.
The flu—influenza—is a viral respiratory illness that brings fever, headache, chills, coughing, sneezing, achingand whining. It hits you where you breathe; get it, and you’ll be hacking up phlegm and blowing out snot.
You’ll likely feel the sickest during the early stages of the disease. It’s as if you’d been whacked multiple times with a giant meat-tenderizing mallet, then thrown on a grill to sizzle. Oh, and the headache gets worse. You’d really like to use an automatic weapon on whoever is running the jackhammer in the front of your skull.
“But it’s just the flu,” you say.
Well, wake up and smell the NyQuil! The flu is nothing to mess around with, whether it’s the H1N1 strain or a more standard variety of influenza. That’s why public-health experts and officials throughout the Sacramento region—representing everything from schools to hospitals to major event venues—have plans in place for a sliding scale of flu-related scenarios.A very efficient little bug
In 1918, what came to be known in the United States as the “Spanish flu” killed more people than died in World War I that year. A whole lot of them were young, healthy adults. It tore through Army barracks and training camps like a tornado, and there were otherwise healthy young men that were healthy at breakfast and dead by dinner.
That kind of flu tends to worry people. And right now, we’re worried about the H1N1 flu.
We’ve been calling it “swine flu” since it first surfaced last spring, but according to the Centers for Disease Control and Prevention, the national agency dedicated to America’s public health, this strain actually contains genetic material from two different types of influenza common to our porcine friends. On top of that, it’s got genes from bird flu and human flu. It’s what the scientists call a “quadruple reassortment” virus.
You might call it a superflu, if you really wanted to scare yourself.
It has a number of things that make it unusual, including the way that older people, usually very susceptible to the flu, seem to have some resistance to this bug, and the way that it seems to hit young adults harder than most flus. But in spite of all the scary scenarios (many of which seem to have been drawn from a certain famous Stephen King novel), H1N1 seems to mostly be just another nasty case of the flu.
That’s the dish, at least, from Sacramento County’s No. 1 public health officer. Dr. Glennah Trochet, of the Sacramento County Department of Health and Human Services, calls the shots when it comes to public health in the Sacramento region, which makes her the top dog when the whole town comes down with kennel cough. According to Trochet, H1N1 isn’t about to initiate the sort of plague that makes a good movie—though it might provide an opportunity to stay home and watch movies for a few days.
“Right now, the H1N1 bug seems to be behaving pretty much like the seasonal flu bug,” she said. “H1N1 was the primary bug that was circulating in the Southern Hemisphere as their seasonal flu, and it was behaving like a strong flu bug, but not exceptionally bad.”
The rate of death and complications in the Southern Hemisphere, where the flu season is wrapping up, did not exceed the usual seasonal flu rate—which the CDC puts at less than .04 percent of those infected.
But that doesn’t mean it’s nothing to worry about.
Put it in perspective: In 2008, according to the National Highway Traffic Safety Administration, drunk-driving accidents killed 11,773 people in the United States. That’s enough to keep Mothers Against Drunk Driving busy and the billboards and TV public-service announcements working.
Now compare that 11,773 to the roughly 36,000 people who, according to the CDC, died of the flu or flu-related complications in 2008. That’s right, more people died of the flu.
Just because we all get sick with the flu at one time or another doesn’t mean we all get better. And while the people most likely to die of the seasonal flu (usually from complications like pneumonia and other lung infections) are the very old, the very young and people with other chronic illnesses, it can pose problems for anybody.
The CDC reports that between 5 and 20 percent of Americans get the flu each season; it varies depending on the strength of the virus. In real numbers, that’s between 70,000 and 279,000 people in Sacramento County alone. That’s a lot of people burning through Tylenol, Kleenex and chicken soup.
Now, what about the swine flu? Is it really a superflu?
There’s some evidence that the H1N1 strain of influenza is particularly hard on otherwise healthy young adults and pregnant women, said Trochet. What’s more, it seems that a larger number of us may be susceptible to it, although she also notes, “We’ve got thousands of folks here in Sacramento that have had H1N1 [flu] already last spring. If the virus doesn’t mutate, we may have a whole lot of people who are already immune.”
The main concern with H1N1 is the apparent strength of the virus in children and pregnant women. There are already reports of serious complications for pregnant women, and the rate of death and complications for children is much higher than usual. As we went to press, 73 pediatric deaths from flu or flu complications had been reported in the United States, and a Journal of the American Medical Association article had identified those between the ages of 10 and 50 as being at higher risk of complications from the H1N1 strain.
At least there will be somebody around to hand the tissues out. Anthony Fauci, the head of the National Institute of Allergy and Infectious Diseases, told reporters earlier this month that the H1N1 virus may infect as many as 30 percent of Americans.
It’s a very efficient little bug.Sacramento’s worst-case scenario
So will a third of us really get sick this season?
“It is certainly a possibility,” said Trochet. “The scenarios would differ depending on how the flu season develops.” She pointed out that, if a third of the people in Sacramento County are sick, but all at different times, “it is a different thing than the worst-case scenario, [where] all of us get sick at once.”
“If we’re all sick at once,” she said, “that of course would be a huge disruption. It would be an economic and logistical emergency.”
Imagine vacant classrooms across town. Or light-rail cars rolling by empty because state offices are closed down by illness instead of furloughs. What if you had to wear a surgical mask to go to the pharmacy and the grocery store? Would there be enough space in the emergency rooms for the exceptionally sick, the people who have some complications—even those who get so sick they need a respirator?
And hey, what about those Kings? Nobody wants to waste their season tickets, but what will happen if a third of the fans have the flu?
Never fear. Plans, we’ve been told, are in place to deal with a major outbreak.
At the Sacramento City Unified School District, the emphasis is on prevention. Maria Lopez, communications officer for the district, told SN&R that all students would be taught the primary methods for preventing influenza infection. That includes lesson plans on hand washing and covering coughs and sneezes with tissues or the famous “batwing” into-the-sleeve move, which, she said, kids seem to adapt to pretty quickly.
Messages to parents have asked for reinforcement of the hand washing and coughing practices at home and, Lopez said, “We’ve asked parents to please keep children home if they have a temperature of 100 degrees or more, and not to send them back to school until they are well.” That means fever-free without medicines for at least 24 hours.
What about those kids who get sick at school? Lopez said that information about each school establishing a “a special room for students who are sick, so that they’re isolated from students who are well” was distributed to teachers and principals prior to the school start date this year, as well as information about the appropriate cleaning practices to use to prevent the spread of the disease.
“We’re also working on procedures for transportation,” Lopez said. That’s in case children who are sick and need to go home are usually scheduled to ride the buses.”
Lopez said that the school district has “been working closely with Dr. Trochet for a comprehensive program,” including lesson plans for the teachers and contingency plans for administrators. If the decision to close a school needs to be made, it will come from the principal, in consultation with the superintendent, Jonathan P. Raymond.
If the flu season looks like it might get so bad that a school—or schools—are closed down, parents need to be prepared. Trochet firmly believes that the public health officer isn’t the only one who needs to plan for the flu.
“People need to think about what will happen,” she said. “Who is going to look after your children, even if they’re not sick, if the school is closed?” Parents need to be prepared to pick kids up at school if they get sick, and to have child care scheduled or time-off arrangements made to care for them, but they also have to plan for school closures even if their children are still healthy.” On top of that, employers also need to make a plan, she said, both for the possibility of absenteeism due to illness and for employees who may need to take time off or work from home to care for sick family members.
At the area’s community colleges, it’s the college’s president, in concert with the chancellor, who makes the decision about closure. But Susie Williams, the Los Rios Community College District’s associate vice chancellor of communications and research, told SN&R that a campuswide closure would be highly unlikely, even if the flu reaches the widest epidemic status.
“Individual classes might be canceled because a professor is out ill and a substitute can’t be found,” Williams said. “But closing down an entire campus would only happen if we got to the point that there were not enough staff [members] available to keep the campus open.” Williams also noted that the community college system works with the Sacramento County health department, “so, of course, if things became so bad that they asked public schools and colleges and universities to close, we would.”
But each campus is taking action, offering flu clinics for students, faculty and staff, Williams said, as well as promoting prevention measures, such as making hand sanitizer readily available. But all the community colleges are likely to hold classes, even if attendance is thin.
But what about other places where people gather, say, Arco Arena? When the Kings are in town, the place is chock-full of people, and many of them aren’t going to let their sneezes and coughs keep them from the game. So what would the Kings do in the event of a major influenza epidemic?
“The safety of our guests is our No. 1 priority,” Jaime Morse Mills told SN&R. The director of public relations for Maloof Sports & Entertainment explained that, if flu becomes a threat to public health, the Kings would make a decision about closing up “based on the recommendation of our local public health agencies.”
That’s back to Trochet again.
In the meantime, the Kings operation is taking steps to keep the flu an annoyance rather than a serious problem. Workers at Arco have been offered flu shots, provided with educational materials about influenza prevention, and have hand sanitizer readily available.
And if you’re going to see the Kings, Morse Mills wants you to know that, in addition to soap and water in the restrooms, they’ve got hand sanitizer for sale at the courtesy desk on the concourse.
It’s time for tipoff—but don’t sneeze on your neighbor!
The sickest of the sick
Most of the people who get the flu, even if it’s a third of the region’s residents, will get better within a week to 10 days. They’ll hack, cough, shiver and whine, and eventually be just fine.
But there’s a subset of people who are at risk for serious complications, and there are a lot more of them than you might think. Asthmatics, for example, and diabetics. Anyone with an autoimmune disease, like AIDS or lupus, or who is taking immunosuppressant medications, as one might to treat cancer, and anyone with a heart or respiratory illness.
Those are the people who typically end up in the hospital with the seasonal flu, and it can be life-threatening. If those numbers swell because of an even more widespread flu season, the hospitals could be inundated with people who are severely ill.
The top advice, as always, is vaccination, and not just of the high-risk people. It’s what’s called “herd immunity” that is most effective in preventing a major epidemic, and it’s the reason for vaccinating against childhood illnesses like the measles. If key members of a group who are most likely to pass on the disease are vaccinated against it, the odds are against an epidemic outbreak and tend more toward isolated cases.
That’s why children, child-care providers, and people who care for the elderly and disabled are at the top of the list for influenza vaccination. “If those groups are vaccinated, there’s less chance they will pass the virus to members of high-risk groups,” said Trochet.
The public health offices at both the state and county levels are working now to distribute the vaccine, and it’s expected to be available, at least in limited amounts, as you read this. And it is, as Trochet makes clear, “our first line of defense.”
Now, in a worst-case scenario, either the vaccine doesn’t work or there’s not enough of it to provide “herd immunity.” Instead of isolated cases, we’ve got two out of every five people too sick to work or go to school. And with the flu come the complications.
The people with high fevers, secondary infections or trouble breathing—pneumonia or even acute respiratory distress—will need hospitalization.
Trochet’s office has been working with the regional hospitals to plan for a potential upswing—what Trochet calls a “surge”—in admissions due to the flu.
“They all have surge plans for dealing with adding beds, and for how they would deal with the situation if a large number of their staff were sick.” The various hospitals and medical facilities in the region have worked with Trochet’s office to identify and prepare alternate care sites for patients in non-life-threatening conditions, which would leave the acute care beds for the sickest patients, she said.
The county also has access to a stockpile of masks for health-care workers to use to prevent becoming infected. Bruce Wagner, chief of the Sacramento County Emergency Medical Services, told SN&R that EMS has roughly 90,000 masks suitable for protecting against the airborne flu virus stored in their warehouse. His department, which manages 911 and ambulance services, would be working at the direction of Trochet should there be a medical emergency.
And each individual hospital has contingency plans for all sorts of emergency situations, said Bryan Gardner, public information officer for Catholic Healthcare West, which operates several local facilities, including Mercy San Juan Medical Center. These plans “are not necessarily specific to the flu,” Gardner said, “but they cover all types of events that could happen.” If the hospital is suddenly faced with a large number of people suffering from the flu, it will work with Trochet, and other area hospitals and medical facilities, to make sure that all patients receive the care they need. He also noted that CHW hospitals, “on a routine basis, have drills to practice” these emergency procedures.
Depending on how severe the respiratory complications from H1N1 are, respirators could be “a huge problem,” according to Trochet. “We know that there are respirators available in the strategic national stockpile, but we don’t know how we’ll get them,” she said. “And then there’s the problem of people to operate them. We also don’t know if they’ll be compatible with the equipment we already have. So we’re working with hospitals and with the federal program to get all of this organized.”
If there is an emergency need for personnel to run respirators or handle other specialized public-health tasks, “we can get personnel through NIMS,” Trochet said. That’s the National Incident Management System, part of the Federal Emergency Management Agency. NIMS will help stage, train and put emergency health-care workers into place in the event that local facilities and departments become overwhelmed.
But the county health department, including Trochet’s office, is currently hampered by county budgetary constraints.
“We do have a real issue this year with the emergency rooms,” Trochet said. “Our emergency rooms are overextended right now, and often are filled up with the mentally ill, because of the budget cuts.” In a worst-case scenario, a sudden surge of people with the flu who need emergency-room care in already-full emergency rooms “could present some problems.”
Those same budget problems affect the county’s public health workers, too. “We’ve lost almost 30 percent of our staff in this division,” said Trochet. Nonetheless, she’s confident that Sacramento would manage the worst-case scenario pretty well. “All the hospitals have made their own plans, and they’ve worked with us as well,” she said.
And about the worst-case scenario?
That would be if “the virus mutates and we have a massive epidemic,” said Trochet. “But we have plans for that as well. We just hope we don’t have to use them.”
The best defense
The best way to beat the H1N1 virus—and any seasonal flu, for that matter—is not to get it. Start with vaccination, if at all possible. Then follow a prevention plan. “Every place that people are, we need to have tissues for coughing and sneezing, as well as hand sanitizer and supplies for washing hands,” she said. Just because someone has the flu, there’s no reason to pass it around.
If you—or your family members—do end up coughing, sneezing, wheezing and whining? Well, best have a plan for that, too.
“Plan to be able to stay home for two weeks,” Trochet said. “Plan for enough food and medicine, so if you’ve got regular prescriptions, make sure you have a two-week supply.” Include cleaning supplies and pet food. You’ll want to make sure that the bathroom is cleaned daily if sick people are using it, and your pets don’t care if you’re sick, they still need to be fed.
“People need to have an emergency kit for flooding, with items like water and food,” Trochet suggested. Take advantage of that, and add flu preparedness items. “Add gloves in case you have to care for children or other family members, plenty of tissue, Tylenol and other fever-reducing medicines, a thermometer, perhaps some surgical masks.”
Still, this might not be the year for the bad one after all.
“Our flu season here in Sacramento tends to peak around February, so if we get the vaccine early we may not have a very bad season.” The Southern Hemisphere didn’t have a vaccine for H1N1, but we will, she pointed out. Supplies are expected to begin arriving later this month, and Trochet’s department will be coordinating with the state department of health to distribute the vaccine.
But a bad year will come, sooner or later (see “Go ahead, vaccinate,” page 26). Like any good Boy Scout, Trochet thinks we should be prepared, even for the worst-case, scary-movie apocalyptic scenario. She doesn’t want to use those plans, but she’ll have them ready.
Just don’t expect her to prognosticate. “Ask me in June, and I’ll be able to tell you about the flu season!”
Meanwhile, get your vaccination. And if you feel like gambling in the stock market, Kleenex and Purell seem like good bets.