Hospitals Get Ready for New Flu Epidemic

By DARYL KELLEY

Oct. 10, 1998 12 AM PT

TIMES STAFF WRITER

Southern California is girding for an early flu season that could rival last year’s Christmastime epidemic, but health and hospital officials say that they are better prepared to handle a rush of patients and to prevent the worst illnesses.

Although predicting influenza outbreaks is as chancy as forecasting the weather, Southland health officials say that signs are pointing toward a flu season as bad as the one that filled many of the region’s hospitals to overflowing nine months ago.

“It will be a big year, a banner year,” said Dr. Shirley Fannin, director of disease control for Los Angeles County. “We’ve seen it unusually early. Alaska has already been hit with a big breakout. And all of a sudden we’ve begun to see outbreaks of flu throughout the state. And it’s all happening right now.”

Locally, numerous doctors have reported influenza-like illnesses in recent days, and health officials in Southern California counties are testing to confirm what they suspect are early outbreaks of a virulent Australian strain of the flu, a variety that sprang up suddenly last winter.

The A/Sydney virus caused so many serious illnesses after Christmas that hospitals declared a crisis and diverted patients from overflowing emergency rooms and general care wards to other facilities. Fannin declared the epidemic the worst locally in at least 15 years.

This time, the region, state and nation are better prepared, officials say.

That is partly because the flu vaccine approved by the Centers for Disease Control and Prevention in Atlanta for distribution nationwide includes the A/Sydney virus. Inoculations last year did not protect against the Australian virus.

Health clinics in Ventura and Orange counties began giving flu shots Oct. 1, principally to the elderly and chronically ill patients most threatened by the flu. Los Angeles County plans to begin inoculations of the same groups Tuesday.

Dr. Laurene Mascola, chief of acute communicable diseases for Los Angeles County, agreed that the flu appears to have struck early this year, but said that an early start does not necessarily portend a harsher season.

Mascola said there has been only one confirmed case of influenza in Southern California, in San Diego County, but said other cases apparently were cropping up without being confirmed through a culture.

“I could swear my daughter had it,” she said.

Flu shots keep healthy adults from becoming ill 70% to 90% of the time, according to the CDC’s influenza branch. But the shots are more critical for groups most in jeopardy: the elderly, young children, the chronically ill and women in their final six months of pregnancy, officials said.

More than 90% of the nation’s estimated 20,000 flu-related deaths each year are senior citizens, especially those who are enfeebled. If inoculated, however, feeble elderly people with the flu can stay out of the hospital in more than half of cases, said Lynnette Brammer, an epidemiologist at the center.

Southland officials say that they also are preparing emergency plans for use of facilities and equipment to better deal with severe outbreaks.

New strategies are aimed at quickly detecting an increase in flu cases and giving hospitals greater flexibility in dealing with a flood of patients, said Virginia Hastings, director of emergency medical services for Los Angeles County.

“Last year, we were all caught with our pants down, really,” said Hastings, a leader of a flu task force of hospital and health officials. “And what happened was that even [outlying] hospitals were filled to the gills. Hospitals filled up and panicked and started turning patients away. The staff was out on holidays or sick themselves, and the nursing shortage was beginning.”

This year, Los Angeles County’s Emergency Medical Services Agency will electronically monitor the availability of beds and critical care equipment at all 83 local hospitals with emergency rooms.

“We’re preparing a mini-disaster plan in the face of a flu crisis,” Hastings said. “What we want to do is get the crisis out of it through planning.”

Hastings said her agency will constantly monitor hospitals for overload and send out alerts.

“Let’s say a hospital is out of respirators,” she said. “We’ll go out on the net and poll hospitals to find what we need. Or say we run out of beds in Long Beach; we can route patients out to where there are empty beds. But it sounds a lot easier than it’s probably going to be.”

State hospital regulators have also been brought into the picture, said Monty Clark, a regional vice president for the hospital industry’s Healthcare Assn. of Southern California.

Hospitals are seeking advance permission to treat flu patients in wards licensed for other uses, Clark said. For example, adult flu patients could be kept on hospital floors usually reserved for newborn babies. Mandated nursing ratios for very sick patients might also be waived in times of emergency.

Acting alone, hospitals could cancel elective surgeries and use the surgery recovery areas for flu patients, as they did last year, Clark said. Hospitals are already encouraging employees to get their flu shots, he said.

Clark, who is based in Ventura, said that all of the eight general hospitals in that county were full at one time or another during the two-week flu crisis after last Christmas.

“So what we’re doing throughout the state is preparing hospitals for a possible flu epidemic,” Clark said.

It’s already started, said Marilyn Billimek, epidemiologist in Ventura County’s Public Health Department.

“We have people who had the flu while on vacation in Alaska, and it’s started to generate a problem here.”

Times staff writer Julie Marquis contributed to this story.

(BEGIN TEXT OF INFOBOX / INFOGRAPHIC)

Preventive Medicine

Influenza, like common cold viruses, is an airborne virus that can be caught anywhere. There are three strains circulating worldwide. Type A influenza is more severe than Type B.

Flu Facts

Flu strains expected this season:

Type A/Beijing

Type A/Sydney

Type B/Harbin

Symptoms

Common

Influenza

Fever, usually sudden

Fever

Chills

Sweating

Aches and pains

Weakness

Loss of appetite

Headache

Common Cold

Fever

Chills

Stuffy nose

Sore throat

hoarseness

Aches and pains

Loss of appetite

A flu shot will not protect against the common cold.

When to Call a Doctor

* if your symptoms are worsening

* if you have a high fever

Flu Shots

Flu shots should be administered now to give the body time to build antibodies. Flue season typically runs from December through March.

The Los Angeles County Health Department will be offering free flu shots to some county residents from Tuesday through Dec. 4

For a free shot the resident must be:

* 60 years or older;

* under age 60 with a chronic health condition such as heart or lung disease, diabetes, asthma or a compromised immune system such as those suffering from AIDS;

* a pregnant woman in her second or third trimester.

Flu shot phone numbers for clinics in Los Angeles County

* Department of Health Services Hotline: (800) 427-8700

* Los Angeles County Department of Community and

Senior Citizens Services: (213) 738-4004

* County Info-Line: (800) 339-6993

* Los Angeles (213) 686-0950

* San Gabriel Valley (626) 350-6833

* San Fernando Valley (818) 501-4447

* Burbank/Glendale (818) 956-1100

* West Los Angeles (310) 551-2929

* L.A. Airport Area (310) 671-7464