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Report from the Trenches: H1N1 is the Real Deal

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By DoctorOptimist
October 7, 2009

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Sit down for this one. This is the real deal.

I just got out of a 2 hour hospital board meeting with our region's only infectious disease specialist giving an update. This is major news.

We are close to going from Level 1 to Level 2 of H1N1 pandemic level. This kicks in restrictions about bed utilization, triage of patients, requirements for isolation. On a practical level, it may need surgeons and anesthesiologists doing anything elective may have their practice shut down for 12 weeks. Ouch - for their business but more importantly for the patient that may have needed breast cancer surgery, for example. 70% of pediatric visits are for febrile illnesses and when they were screening, 100% of these were positive for H1N1

Our hospital is the largest in our state. One fourth of all of our ventilators are currently in use for middle age patients with H1N1. They had no identifiable risk factors and aren't expected to survive. Even if they do survive it usually requires 10-14 days on the ventilator. We have ordered 5 more ventilator units which was all we could get. Then we're full at capacity.

We were making plans for stopping elective surgeries. Our state is implementing policies that would allow EMT's to go into homes and make triage decisions about people who need hospital admission. If we hit >40% staff absenteeism then EMTs would also be given emergency nurse licenses to help work.

Anyone with fever will be out of work for minimum of 7 days. There are real possibilities that we would have major work shortages.

Our county just got the nasal vaccine for H1N1 - all 500 doses of it. We have record cold temps this weekend, down to 8 degrees. So flu season hit too early here. We don't even know how effective vaccines will be anyway. Our infectious disease expert said we are running about five weeks behind Salt Lake City.

This is the real deal, it's here. It is going completely unreported in our local media and not much on national media. It is very sobering to realize that one fourth of our ventilators are already in use for adults who were previously healthy without risk factors and who wouldn't even have met the criteria for our vaccine priority administration. This is just the leading edge of infections - the first signs of a surge in admissions. We are already extremely close to having to triage who will get a chance on the ventilator and who will be sent home to likely die because of having serious chronic medical illnesses that reduce their likelihood of surviving. I am the palliative care director so those cases will be turned over to me to be kept comfortable.

The major takeaway I got tonight is that it doesn't take a big surge in cases to overwhelm the medical system. You may not get serious H1N1 but if you are in a serious accident or have a heart attack, this could still affect you by having limited number of ICU beds or a severe shortage of medical and nursing staff because they are out the mandatory 7 days because of febrile illness. That's the cause for concern. The medical system has so little slack capacity that the small fraction of severe H1N1 cases can overwhelm are ability to care for routine things.

8 to 12 weeks is the suspected pandemic duration. The good news and the bad news is that everyone susceptible will have been exposed by then unless you're in a area with later flu season and get the vaccine in time. With record cold temperatures (8 degrees F) headed here tomorrow night, the vaccine didn't get here in time. Obviously, the disease is mild in the vast majority of cases but it can also be unpredictable, based on what I'm learning tonight.

I was amazed to get this update and to have heard so little about it in the media. I always thought I kept up with news but the severity of this caught me by surprise. It is not hype. There are people dying right now in my community and the upsurge in cases has just started. If this is going on elsewhere in the country, you will be hearing a lot more about it.