Pandemic Prep: Hospital staff studies past outbreaks to prepare for H1N1 virus

Kalispell Regional Medical Center staff is looking to the past to plan for the H1N1 'swine) flu or other future pandemics.

At a recent continuing education class, pulmonologist Dr. Brent Pistorese underscored the killing potential of a virus such as the Spanish flu, which infected over half the world's population between 1918 and 1920.

More than a million Americans died. Worldwide, 50 million to 100 million people died of Spanish flu.

"One to 5 percent of all the young people 20 to 50 died," he said. "There were more deaths in two years than from AIDS and the plague combined."

Although health care has vastly improved since 1918, Pistorese pointed out that other changes - population growth, fewer hospital beds, rapid transportation - pose greater risks with a pandemic.

Each year, flu complications continue to kill 36,000 people in the United States, according to Dr. Michael Spence, a specialist in epidemiology and quality management and former state medical officer.

Spence described the birth of a potential pandemic when a virus shifts, mixing up genetic materials to create a new form like the novel H1N1, to which few people have immunity.

"This is the Evander Holyfield of the flu - we have a virus no one has seen before," he said.

Spence advocated vaccinations as the best defense against any influenza. In good years, the vaccine fights off 70 to 90 percent of the circulating flu viruses.

"Even in bad years, the vaccination is a good thing," he said, adding that it fends off 45 to 75 percent of the flu viruses.

Spence and the other speakers strongly encouraged all health-care workers, as well as others, to have both the seasonal flu vaccine along with the H1N1 vaccine as soon as they become available.

Responding to concerns about vaccine reactions, Spence said the H1N1 vaccine has been administered to 10,000 people in the United States with no adverse reactions other than a sore arm.

By signing a form listing the risks to themselves and others, hospital employees may decline vaccinations, but may be required to wear surgical masks or transfer to another work site. If workers contract the virus, they could infect others for four days before they develop symptoms and seven days after they've been infected.

According to Spence, the number of sick people impacts the opportunities viruses have to combine into a potentially more treacherous form of flu.

"We can prevent this with vaccinations," he said.

When novel viruses become virulent, Spence said they take the greatest mortality toll on those 20 to 50 years old. Experts believe this happens because younger healthy immune systems overreact to the new enemy, mounting an inflammatory response with deadly results for the patient.

Pistorese said the flu virus has a predilection for the lower respiratory tract, starting out as pneumonia.

"People should think about the pneumonia vaccine," he said.

The pattern of younger people dying in greater numbers from swine flu was revealed by the Aug. 28 totals from the Centers from Disease Control.

So far, H1N1 has hospitalized 8,843 people and accounted for 556 deaths with the largest group of 235 deaths in the 25 to 49 age group and the second largest of 158 fatalities in people between 50 and 64.

This compares to 50 deaths in people 65 and older and 101 deaths of people under 25. No age was reported in 12 fatalities.

Spence said H1N1 now accounts for 90 percent of flu activity in the Southern Hemisphere and two-thirds of flu cases in the Northern Hemisphere. He said flu counts may be off since the rapid flu test has proved less than 60 percent accurate for detecting H1N1.

"That means we're missing 40 percent of the cases in the office," Spence said.

Other bad news emerging at the pandemic educational session was that flu viruses have become increasingly resistant to antivirals like Tamiflu.

Spence had some good news about mercury-free vaccines now available, but said those with thimerosol pose little threat. Thimerosol is a mercury-containing preservative used in vaccines since the 1930s to prevent bacterial contamination.

"You get more mercury when you eat a can of tuna fish than you get from 10 vaccinations," he said.

He also said that no human tissue or blood products were used to produce vaccines.

Pistorese described the hospital's work with the Flathead Valley Mass Casualty Working Group that formed in 2006. One accomplishment was the passage of House Bill 362, which protects licensed health-care providers from lawsuits when appropriately responding to a declared disaster.

"It allows us to use paraprofessionals to help in a situation where manpower is very important," he said.

Planning for a surge of patients, Pistorese said the hospital needs to accommodate three times the usual patient capacities and continue to care for them for 10 days without outside assistance.

They took into account needs for beds, staffing, support services, medications and fluids. Triage systems have been developed to save as many patients as possible should resources become scarce.

"We'll do the best we can for all patients," Pistorese said.

The hospital's chief of staff, Dr. Gwen Jonas, an obsetrician/gynecologist, reviewed the hospital's incident command system for a pandemic or disaster and its place in community planning. Flathead City-County Health Department takes the central role.

Jonas said the hospital designed a command system to determine what needs to happen, how it's to happen and assigns the correct people to do it without duplication of effort.

She said this structure presents a new concept to medical professionals who normally work independently. An emergency changes that to a "top down" decision-making structure.

Jonas said outpatient medical offices also need to make contingency plans covering issues such as working with 20 to 40 percent absenteeism from flu and separating care areas in their offices for flu patients.

Pandemic/disaster planning at the hospital continues for a medical staff intensive care substructure; ways to use outpatient clinics; phone triage systems; security and alternate care and triage sites.

The three physicians wrapped up by affirming that a pandemic is coming, if not this year then in the near future. They advocated maximizing vaccinations and asked Flathead City-County Health Director Joe Russell to speak about supplies this year.

Russell said the department was concerned for awhile about shortages but now feels the supply will be adequate for all people who want vaccinations for both seasonal and the H1N1 flu.

"It's so important - don't forget you need the season vaccination on board," he said.

The department expects the H1N1 vaccine to arrive later in the fall.

Reporter Candace Chase may be reached at 758-4436 or by e-mail at cchase@dailyinterlake.com.