“We have been planning for the worst but hoping for the best,” says Julia Wright, MD, FHM, head of the section of hospital medicine at the University of Wisconsin Hospitals in Madison and a member of Team Hospitalist. “Our task group for the upcoming flu season includes all critical-care services, nursing, supply-chain management, and human resources, as well as other appropriate specialties, such as infection control.”
Another Wild Card
How well the vaccination campaign works will have an impact on the incidence of novel H1N1 influenza. Some have expressed concerns about compliance issues in the community, as individuals will need an extra flu shot in addition to the yearly vaccination for seasonal flu strains. The concerns could double if current ongoing clinical trials suggest that two vaccine administrations are required for full protection from the H1N1 virus.
There also is concern about the availability of vaccines, especially in the early stages. As of early September, Robin Robinson, PhD, director of the Biological Advanced Research and Development Authority (BARDA) at the U.S. Department of Health and Human Services (HHS), announced that manufacturing problems would mean only 45 million doses would be available by Oct. 15, compared with the 120 million doses originally projected. However, HHS says the 195 million doses the U.S. government ordered should be available by the December deadline for final delivery.1
Nevertheless, physicians should expect large-scale vaccination initiatives at their hospitals this fall. Additionally, hospitals are expected to require that healthcare workers, including hospitalists, receive their shots during the first wave of inoculations. “At our facility, we have the potential to give 100,000 or more vaccinations over a very short period of time,” says Patty Skoglund, RN, administrative director for disaster preparedness at Scripps Health in San Diego. “This is in addition to supporting vaccination efforts in the community.”
Southern Hemisphere
The Southern Hemisphere is wrapping up its flu season, and often, experiences south of the equator are a harbinger of what might come in the Northern Hemisphere. So far, the WHO says the Southern Hemisphere’s flu season has been characterized by normal respiratory disease numbers. The impact and severity is still being
evaluated, but it appeared only slightly worse than normal in most places. Hospitals did see increased admissions (see Figure 1, p. 5) requiring respiratory critical care.2 Yet the lack of firm guidance has made planning difficult for HM groups and the U.S. hospitals they work in.
It will be important for hospitalists to stay up to date with a potentially developing situation, especially in the early stages of the flu season. Many current CDC guidelines for treatment, prevention, and control are in interim stages, with more guidance to come as the science firms up. (see “Vaccination Priorities,” right)
“As we get closer to the flu season, we should be able to make specific suggestions and get a better idea of the probable incidence,” says Gilliard. “Novel H1N1 has caused significant illness outside of the regular season. When the temperature changes, will the incidence increase or decrease? We have to get more experience before we will know.”
Information Hotline
Hospitals are working to ensure that there are open lines of communication with key personnel, an important first step in infectious-disease control. It will be necessary to facilitate the timely dispersal of new information on guidelines and treatment considerations to multiple audiences throughout the hospital as they are released. In addition, flu incidence and severity updates will be vital.
“It is imperative that physicians know what is going on in their community and beyond,” says Dr. Schiopescu. “The CDC and the Infectious Disease Society of America (IDSA) are resources for treatment guidelines and information on the spread and severity of both the novel H1N1 and seasonal virus strains. Closer to home, both state and local health boards can help with a more focused view of what is happening in the community.”