WASHINGTON (Reuters) - Health department staffers scrambling to answer 100 calls a day. Harried hospital workers rushing to swab hundreds of sore throats. Out of practice school nurses learning how to give vaccines all over again.
City and state health department officials from across the United States say that while the H1N1 swine flu pandemic may be mild in terms of mortality rates, it is killing them in terms of workload.
And they are dreading the task of vaccinating tens of millions of people against the new virus beginning in October.
“We do not have the resources we need and we haven’t for a while,” Dr Jeffrey Duchin of Public Health in Seattle & King County and the University of Washington said in an interview.
“The problem is we don’t have a coordinated healthcare system in this country. We don’t have a national framework that allows these interventions.”
Duchin said the first wave of the pandemic, which swept across the United States in May and June, is just a foretaste of an unpleasant autumn flu season.
“We needed over 200 staff and 40 volunteers for our outbreak response,” he told a meeting of flu experts sponsored by the Institute of Medicine this week. The office was receiving 100 calls a day with reports of cases and requests for testing.
The U.S. Centers for Disease Control and Prevention and the World Health Organization gave up keeping a precise tally of H1N1 cases, saying merely that there have been more than a million in the United States alone.
Instant flu tests do not detect H1N1 swine flu very well and there was a shortage of them, anyway, Duchin said.
“We discovered that many clinicians are just totally unfamiliar with influenza virus testing,” he said.
Dr Annie Fine of the New York City Department of Health said her office had to keep tightening requirements for who would get a flu test. “It was extremely labor-intensive, requiring hundreds of people in the health department to count hospitalized cases,” she told the meeting.
“We realized we could not keep doing it.”
A 2008 survey by the National Association of County and City Health Officials found 53 percent of local health departments had laid off workers and a third expected more layoffs in 2009, in part due to the recession.
And now these same health departments will have to mass-vaccinate millions of people.
Another problem -- it is unclear which vaccine will be available when. Five companies make vaccine for the U.S. market -- Sanofi-Pasteur, CSL, GlaxoSmithKline, AstraZeneca’s MedImmune unit, and Novartis.
MedImmune said it will have 5 million doses of its nasal spray vaccine ready by the end of this month. But the vaccine is not approved for people with asthma, people over age 50 or very young children.
Some of the vaccines contain a mercury-based preservative called thimerosal that cannot be used in infants and pregnant women in the state of Washington, Duchin added.
“The question about just what type of vaccine is available when is a very good one and one that we are asking every day,” said the CDC’s Dr Jay Butler.
“The vaccine will be available for ordering in early October.”
The United States has ordered 195 million doses of vaccine, with about 50 million expected for delivery by mid-October. It will be up to state health departments, pharmacies, companies and private doctors’ offices to order vaccines, which the U.S. government is providing for free.
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