Forgotten but not gone
Dr. Jason Eberhart Phillips - www.kdheks.gov
A Column by Jason Eberhart-Phillips, MD Kansas State Health Officer
and Director of Health Kansas Department of Health and Environment

July 27, 2009

As the H1N1 flu epidemic enters its fourth month in Kansas, the lurid headlines and cable news frenzy that marked the early stages of the outbreak are over. Gone are the scenes of subway riders wearing face masks, of school doors closed because of the flu, of bewildered travelers unsure if they should take a vacation in Mexico or New York.

 As the springtime alarm about the so-called “swine flu” has given way to summertime complacency, it may seem that the threat is gone, that we Americans have dodged the pandemic bullet.

 But in fact the virus has never left us.

 Here and around the world the H1N1 pandemic is gaining momentum, and sooner or later it will likely figure big in your life and the life of every Kansan. Collectively we need to start thinking about it again, and get ourselves prepared.

 For a completely new organism, the novel H1N1 flu virus has a remarkable capacity to transmit itself among human hosts. In only 100 days it has spread from two countries in one continent to 160 countries in every continent of the world.

 Most disease has been mild, or without any noteworthy symptoms. But for a significant minority of hosts the disease has been severe. Already the pandemic strain has claimed about 800 lives worldwide, three times the number lost to the “bird flu” virus since 2003.

 The Centers for Disease Control and Prevention estimates that in the next two years 20 to 40 percent of the US population will be stricken, with many of the cases compressed into “waves” of infection lasting eight to 12 weeks. The number of pandemic-related deaths will range from 90,000 to “several hundred thousand,” according to the CDC.

 In Kansas, as many as 10,000 cases have already occurred, with confirmed disease now reported in 35 counties throughout the state. Ordinarily flu is not seen during summer months, but more counties have been newly confirmed with H1N1 disease during July than in any previous month.

 The pattern of cases here, as in other states, points to a distinctly higher risk for the young. The average age for confirmed cases in Kansas is just 17 years, with about 80 percent of cases occurring before the age of 35 years. Although the elderly would comprise a majority of severe cases in a normal flu season, cases of H1N1 flu are relatively rare in people over 65 years of age.

 For public health agencies like mine, and those health departments serving every county in Kansas, our objectives in the coming months are simple: to reduce illness and death from the pandemic, while minimizing social disruption.

 Together we will carefully monitor the spread of the disease, advise health care providers on treatment and prevention, educate the public on “social distancing” and other techniques to slow down transmission, and, if necessary, release publicly held stockpiles of antiviral drugs that can speed recovery in cases of severe disease and reduce the risk of fatal complications.

 At the same time this fall, we will work with local public health departments to administer the largest single vaccination campaign our state has ever seen, if federal health authorities decide to make an H1N1 vaccine – currently under development – available for use in the whole population.

 Clinical trials are just beginning now on human volunteers to determine if initial lots of the new vaccine can generate a sufficient immune response to protect against infection. The trials will also determine if the new vaccine is safe.

 If the vaccine is deemed safe and effective, and if its use is authorized in the general population, vaccine manufacturers will ramp up production and begin deliveries to Kansas and other states as early as mid-October. As you read this, your local health department is working with health care providers, schools, community groups and others to prepare for mass immunization clinics to get the vaccine to as many people as possible.

 Priority groups for the initial shipments of the H1N1 vaccine will be determined soon by a federal committee, so that those most at risk of severe disease and death, and members of the nation’s “critical workforce,” are first in line for protection. Fortunately, supplies of the new vaccine are expected to be sufficient to begin immunizing persons in lower priority groups within the first several weeks of the campaign.

 As public health departments prepare for mass vaccinations, hospitals and other health care providers are now making sure they are ready for a surge in demand for their services in the months ahead. Likewise, businesses around the state are preparing for continuity of operations in the event of high levels of absenteeism.

 Schools, which will soon open their doors for a new academic year, are preparing their teachers and parents for heightened vigilance, strict exclusion of ill students, and possible school-wide dismissals in the event of an outbreak. Schools may also become venues for immunization clinics.

 The media spotlight may be off of H1N1 flu at the moment, but throughout Kansas you can see that work is underway to make sure the state is ready for an escalation of viral activity at any time.

 That’s because the threat is credible. It has to be taken seriously.

 If you have gotten out of the habit of careful hand washing, covering your coughs and staying in when you’re ill, it’s time to take such reasonable precautions again.

 It’s also time to stay informed about pandemic flu. For up-to-date information on H1N1 flu activity in Kansas, go to www.kdheks.gov.

 In a pandemic, neither alarm nor complacency is very helpful. But by understanding the risks, by taking reasonable steps to prevent transmission, and by working together on solutions we will get through this and we will keep each other safe.