Flu prep for all - anticipating flu season
Information outreach aimed at Brazilian community
By Nelson Sigelman
Published: September 24, 2009
Anticipating the onset of the flu season, and with it the potential for the more dangerous strain of H1N1 flu to spread here, Martha's Vineyard Hospital officials hope for the best, but they are busy preparing for the worst.
File photos by Ben ScottTim Walsh, hospital chief executive officer, said there is no way to predict how the flu season might affect the Island population. But the hospital needs to be prepared for every possible level of intensity, he said.
A high level of incidence might result in an influx of patients whose numbers could exceed the hospital's 25-bed capacity, which would require accommodating flu patients in other parts of the building. And there's the question of how to fill the gaps left if front-line health care workers fall ill.
Limiting the spread of infection through the community by the use of basic preventive measures, such as hand washing and vaccination, will be a key, Mr. Walsh said.
Meanwhile, health care officials are worried that members of the Island's Brazilian population, many of whom do not speak or read English, may not receive the information and advice they need to protect themselves. Mr. Walsh said the hospital will provide information in English and Portuguese as part of its outreach efforts, and speak to church leaders in the Brazilian community also.
A full-page easily removed advertisement, placed by the hospital in The Times today and published in English and Portuguese, describes how people can reduce the risk of flu infection.
Mr. Walsh said the hospital is cooperating extensively with public health officials. "Island-wide people are meeting weekly," he said. "I think the health agents are doing a good job of trying to be prepared, sharing information, and laying out plans."
The hospital is part of the effort to stage an Island-wide flu immunization clinic on Wednesday, November 11. Although that vaccination will not protect against the H1N1 flu strain.
A separate clinic will be held once the Island receives delivery of the newly developed H1N1 vaccine. Mr. Walsh said the hospital is part of the team that will provide vaccinations.
Despite the planning, the hospital chief remains concerned about the potential should the flu affect the nation and the Island severely. As part of the hospital's overall planning effort, he said Dr. Tim Tsai, director of emergency medical services, and Carol Bardwell, chief nurse executive, are considering various "what ifs," including the possibility that a large number of cases puts a strain on available resources.
"Unless it really gets out of hand I think the Island, with all of us working together, can handle it," Mr. Walsh said.
Recent death highlights need
Last month, senior hospital managers met to discuss a response to the flu season. The meeting came in the wake of the death of a young Brazilian man from H1N1.
Dr. Tsai said senior managers agreed that it was important to conduct an information campaign that also targeted the hospital's Brazilian patients.
On August 14, Elton Barbosa, 26, of Oak Bluffs became the first confirmed H1N1-related death on the Island, and the 11th death in Massachusetts, according to state public health officials. He was a native of Brazil and worked on the Island as a painter. The Massachusetts Department of Public Health (DPH) confirmed the H1N1-related death, but released no other information about the case.
The death was unusual because it occurred in an apparently healthy young man with no known pre-existing medical complications. State and federal medical privacy laws prohibit officials from providing any medical information to the public.
While many in the Vineyard's Brazilian community were aware of and concerned about Mr. Barbosa's death, few would say anything about him publicly, and his story went largely untold. That raised concerns that other members of the community might be unaware how to avoid the spread of infection.
ER is the front line
The hospital emergency room will likely become the front line in any battle against a flu outbreak. "My biggest concern about the emergency room is that it is going to be a very, very busy winter," Dr. Tsai said, "not just flu season but illness season."
One goal is to protect patients and health care workers. Signs in the emergency department now let patients know what they can do to help prevent the spread of infection.
The hospital has also stocked up on gloves, masks, and alcohol wash.
Dr. Tsai said that in addition to a resurgence of H1N1, the seasonal flu will certainly occur, along with other common illnesses and pediatric viruses.
The confluence has Dr. Tsai worried. "Specifically, I am concerned that the emergency room will be overwhelmed with patients," he said. "Toward that possibility, Carol Bardwell has done a lot of work developing emergency staffing plans and I am in the process of developing a physician emergency staffing plan to account for the possibility that some of the staff are going to become ill."
Dr. Tsai said that the Centers for Disease Control (CDC, cdc.gov/H1N1FLU/) recommends that if a health care worker comes down with the flu he or she remain home for at least one week, or longer depending on the severity of the symptoms. "If we have an outbreak of any significant number of any duration it could put a real strain on those of us who are still up and around," he said.
For the H1N1 virus, public health officials are initially focusing on vaccinating health care workers, pregnant women, individuals with chronic conditions, and children between six months and 18 months old.
Another effort will be education. The CDC and Massachusetts Department of Public Health (DPH) have waged an information campaign that describes what steps people can take if they think they are sick. That includes a recommendation to stay home rather than go to the emergency room, in order to avoid spreading infection if the symptoms are mild and the patient does not fall into an at-risk group.
Planning began early
"We started close to four years ago working with the health agents and emergency managers to work on dealing with any kind of flu pandemic that may or may not happen," Ms. Bardwell said, "or anything that would cause a surge of patients going to the hospital or the outpatient clinics."
As the chief nurse, Ms. Bardwell said she works closely with Island health and emergency officials. She said the planning is not new.
The difference with the H1N1 is that the age groups the virus affects are a bit different than those the seasonal flu affects, according to Ms. Barwell. H1N1 appears to affect children more severely than adults.
If frontline health care workers are affected, the hospital would turn to a volunteer group Ms. Bardwell has been working with, members of the Medical Reserve Corps (MRC).
The federal government founded the national group shortly after 9/11. The national system brings together people who have skills related to health care, as well as citizen volunteers. They serve as a reserve team during times of emergency or need in their own communities, according to a press release.
In an emergency, the hospital could call on a local and statewide pool of volunteers to help with support services.
There is also a plan to use rooms that are now devoted to office space for patients. "We have a set number of supplies in storage that we can use if we have a massive number of patients coming in," Ms. Bardwell said. "And that includes bedpans and gowns, the normal things you have to use on a patient."
Basic precautions
Ms. Bardwell added that it is important that people stay up to date with current information.
The DPH has issued simple precautions that help stop the spread of the H1N1 virus, and other infectious diseases.
Washing hands frequently with soap and warm water or an alcohol-based hand sanitizer.
Cover coughs with a tissue or cough into your inner elbow and not into your hands.
If you or your child is sick with the flu, stay home from work or school. If you do need medical attention, call first so that your health care provider can make arrangements for your visit and minimize the chances that you'll spread the flu to others.
Stay informed about the latest developments on the H1N1 flu, by visiting mass.gov/dph.
