Flash FAX : 2009-10-26 - H1N1 UPDATE

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Flash FAX

October 26, 2009

      H1N1 UPDATE FOR THE WEEK: I actually had some misgivings about sending
      this, since most of you won’t have the time to read it, given the surge in
      activities in your offices and clinics. But, here it comes anyway, with
      some specifics for our area:

        Census —We continue to see up to 400 children daily in our emergency
        department, the two urgent care centers and our “flu clinic.” Sunday
        through Wednesday have been the worst days. Our inpatient census
        includes as many as a dozen children at a time with documented
        influenza, including some admissions to the PICU. Many of our specialty
        clinics as well as Children’s Health Clinic are also seeing more flu
        patients. Since August of 2009, 78 percent of all hospital admissions in
        Montgomery County for the flu have been children under the age of 14.

        Vaccine —We received two separate shipments of vaccine on October 9 and
        13. We have received none since. We have given nearly 400 doses of
        intranasal vaccine to our employees and residents. We have administered 
        300 doses of injectable  vaccine. We are targeting pregnant employees
        and health care workers with direct patient contact. Those who are not
        caring for patients have not been eligible. OHA met with ODH on Friday
        to discuss vaccine distribution and communication. For the record, as of
        October 21, 2009, Ohio has received 434,500 doses of vaccine. We have
        also sent many of our employees to the Montgomery County Health
        Department for vaccine. See today’s Dayton Daily News for a clinic to be
        held Thursday.

        Beware of the scams —As of October 23, 2009, the FDA had identified 139
        products that are available for sale and placed these items on a
        fraudulent product list. In one case, the FDA ordered a product labeled
        as Tamiflu. Upon receipt from India, it was found to contain talc and
        acetaminophen, but no oseltamivir. Please warn your patients to be very
        careful of what they order online. There are claims out there for a new
        supplement that will cure the flu in four to eight hours, a spray that
        leaves ionic silver on your hands that kills the flu, an electronic
        instrument that delivers “photobiotic energy” and “deeply penetrating
        mega-frequency life force energy waves” that strengthen the immune

        Oseltamivir —We have exhausted all  the Tamiflu  we had in stock and
        have been using supplies from the PODS for the past three weeks. Our
        goal is to stick with the CDC guidelines as much as we can for
        treatment. Remember that Tamiflu capsules can be converted to suspension
        by most pharmacies. Tamiflu capsules can also be opened and mixed with
        some foods (see the CDC website for precise instructions). Remember,
        there are dosing recommendations for Tamiflu down to infants (at least
        for treatment). We are using very little prophylaxis at this time.

        Testing —We continue to see requests for influenza testing on over 200
        patients a day. Our internal algorithm recommends testing in very
        limited circumstances such as all admissions or if the test is truly
        going to affect decision-making. Remember that if you plan to treat an
        at-risk patient, you should not wait for testing results.

        HICS activated —About 10 days ago we activated our Hospital Incident
        Command Structure (HICS) and we have declared an internal disaster. This
        allows us to bring together the experts we need, at least twice a week
        in a structured environment. We are able to evaluate our status and make
        decisions very quickly. This group is responsible for communication, for
        vaccine decision-making, for supply issues and, importantly, for
        manpower allocations. Stay tuned for more details.


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