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
system.
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.
CME online
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