Expect Flu Bug to Bite Early

By DARYL KELLEY

Oct. 10, 1998 12 AM PT

TIMES STAFF WRITER

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

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

“We expect a repeat of last winter,” said Marilyn Billimek, epidemiologist in Ventura County’s Public Health Department. “It’s already started. We just have to expect the worst. Then, whatever happens it doesn’t seem so bad.”

The story is the same in Los Angeles County, said Dr. Shirley Fannin, director of disease control there.

“It will be a big year, a banner year,” Fannin said. “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, doctors have reported influenza-like illnesses, Billimek said.

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

Health officials 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/Sidney 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. Billimek and Fannin said the epidemic was among the worst two or three in the last 20 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/Sidney virus. Shots last year did not protect against it.

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

Flu shots keep healthy adults from becoming ill 70% to 90% of the time, according to the CDC’s Influenza Branch. The shots are more critical for groups most in jeopardy--senior citizens, young children, chronically ill patients 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 with flu can stay out of the hospital more than half the time, said CDC epidemiologist Lynnette Brammer.

Officials in Ventura County and across the Southland say they are also implementing emergency plans to use facilities and equipment better during severe outbreaks.

Strategies are aimed at quickly red-flagging an uptick in flu cases and giving hospitals greater flexibility in dealing with a flood of patients, officials said.

As flu cases begin to rise, the office of Emergency Medical Services in Ventura will alert ambulance companies and hospitals of available rooms and equipment at the county’s eight general hospitals.

And when a hospital approaches overload, warnings will be faxed immediately to other area hospitals to expect patients diverted from the full hospital, said Barbara Brodfuehrer, administrator of the local EMS office.

Every major local hospital had to divert patients during the Christmastime epidemic, she said.

“It wasn’t to the point where it was a disaster,” Brodfuehrer said. “It was just real intense, and the hospitals had to go to their internal plans to handle the patients.”

State hospital regulators have also been brought into the picture, said Monty Clark, a Ventura-based 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 children. Mandated nursing ratios for very sick patients might also be waived during emergencies.

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

“So what we’re doing throughout the state is preparing hospitals for a possible flu epidemic,” Clark said. “And we have to keep our employees as healthy as we can. This is a hands-on business. We can’t just put patients in a bed and have no one to take care of them.”

Virginia Hastings, director of Emergency Medical Services for Los Angeles County, said a weakness in planning was highlighted by last year’s confusion.

“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.”

The plan this year in Los Angeles County is for the Emergency Medical Services Agency to monitor electronically the availability of beds and critical care equipment at all local 83 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.”

On a personal level, people can fight a flu outbreak with common sense, Billimek said. Hand-washing is the best defense, she said. And sneezing into a cloth is the best offense.

“So buy stock in Kleenex,” she said.

(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