Worst-case flu scenario spurs county officials

Health experts detail planning

Friday, Oct. 2, 2009

During the Charles County commissioners meeting Wednesday, the county's health officer, Chinnadurai Devadason, and Director of Emergency Services William Stephens outlined some of the early actions taken to promote education and prevention of the H1N1 flu — also known as the swine flu — among them applying for the vaccine and training emergency services personnel to deal with anticipated calls concerning infection.

Devadason said upward of 200 million vaccinations are in production and 31 medical entities across Maryland — many of them hospitals and group practices — have applied for a portion of them.

The vaccines will come in nasal mist and injection forms, Devadason said. Though not officially confirmed, it is expected that only one dose will be required for protection if the person is older than 10.

"Basically [the H1N1 flu and seasonal flu] are very similar except in one very important factor," Devadason said. "The new virus seems to affect younger people … more than people of other age groups. One might ask what's the reason for this, and that is not fully understood. The only theory is … people who are older in their lifetime have had some experience with the virus remotely related to this H1N1 and therefore carry some mild form of … immunity that gives them that added protection."

Once the vaccine becomes available, high-risk groups such as pregnant women and younger children will be put at the top of the list for the medicine, Devadason said.

The health officer said that while injectable forms of both seasonal and H1N1 vaccines can be dispensed on the same day, the nasal types cannot.

"We planned a flu mist program … starting this week in the schools, but because the H1N1 virus has sort of preceded — or overtaken — the seasonal flu, the secretary of health has asked us not to do that at this time but rather … to focus our efforts on H1N1," Devadason said. "As of [Tuesday] we're not administering the seasonal vaccine in schools ..."

Parents were notified of this cancellation via a letter from the health department sent earlier in the week.

According to public schools spokeswoman Katie O'Malley-Simpson, around 40 percent of the school system's elementary school children had signed permission slips to take part in the flu mist vaccine program.

O'Malley-Simpson said letters are being sent home starting with the first schools that were scheduled to have the flu mist available.

William Leebel, spokesman for the health department, said once the health department gets a better idea of when and how much of the H1N1 vaccine will be available, a schedule of clinics and additional actions will be released to the public.

"We're going to have it available at regular scheduled clinics," Leebel said of the county's ongoing encouragement for vaccination against the seasonal kind.

With or without the vaccines, the county's emergency services department has already begun to react to the impending influenza season, Stephens said.

The emergency services director said he is looking into putting together a temporary call center where volunteers can answer nonemergency calls diverted from the county's 911 hot line.

"We have determined the cost, the location … we'll staff it with community response emergency response team volunteers with a track they can follow … to answer questions," Stephens said. "I anticipate if this becomes as bad as everyone is talking about, our 911 center will be inundated with calls. I'd like to be able to redirect those nonemergency calls."

Stephens said his department has conducted community outreach, posted information online and included facts and figures in paycheck envelopes for county employees.

"We're going to conduct a tabletop exercise for the department heads to get this in front of them and familiar with the implications of 40 percent of their work force being gone. We have to start thinking outside the box, to staff that," Stephens said. "Also today I signed a transmittal letter forwarding a memorandum of understanding … to Maryland Institute of Emergency Medical Systems to develop a protocol that will allow our EMS personnel — on both the career and volunteer side — to administer vaccines to help the health department if they have widespread outages of personnel."

As for county staffers, Stephens said the commissioners' earlier decision to adopt a teleworking plan will help keep sick employees at home and away from their offices, but he suggested they reconsider a temporary change to the human resources requirement of a doctor's note for more than three days of work missed for an illness.

Commissioners' Vice President Edith J. Patterson (D) voiced her concern for residents who do not have access to television or an Internet connection and might not get information about prevention or treatment.

She was informed fliers had been distributed at senior centers and community centers throughout the community, as well as ads placed around the county.

Stephens said the county's 911 center has been developing a special needs population database. A person can be flagged for physical or transportation special needs so they will not be passed over when the time comes for vaccinations.

For county employees, the commissioners voted unanimously to suspend the requirement for a doctor's note in the case of a three-day absence due to illness.

"If we don't move now, we're going to miss the whole thing of trying to control the virus. What we're trying to do is keep the employees at home," said Charles County commissioners' President F. Wayne Cooper (D). "My recommendation to the commissioners is to take action for our own employees on the doctor excuse. They'll be taking med leave which they are entitled to. … We don't want them spreading the virus more than it needs to be."

The school system is continuing to monitor the schools, paying close attention to spikes in absenteeism and reasons why students are being sent home from school by school nurses.

O'Malley-Simpson said that school maintenance personnel use medical grade cleaning supplies and disinfect heavily used items such as desktops and doors.

When a case of flu like illness is prominent in a school, such as a recent spike in absenteeism at La Plata High School, additional school service personnel are sent to the school to ensure the school is cleaned just as thoroughly in a timely manner.

Last Friday, La Plata High School began noticing a spike in absences and many students were sent home with flu-like symptoms. On Monday, more than 329 students were reported absent and 34 were sent home early from the nurse's office. Of those 34, 23 had flu-like illness.

A spike in absenteeism was also noticed at Milton M. Somers Middle School with more than 100 students absent and being sent home Tuesday. On Wednesday, the school system reported attendance rates steadily increasing at both schools however, both the freshmen and junior varsity football games against North Point High School were canceled last night due to La Plata not having enough players.

School officials are now watching Lackey High School which has reported five flu-like-symptom absences in recent days.

Staff writer Gretchen Phillips contributed to this story.

msomers@somdnews.com