Health Officials Ready for Fierce Flu Season

Southern California 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 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 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.”

Doctors in some Southland counties have been treating influenza-like illnesses in recent days, though there have been no confirmed cases in Orange County, said Dr. Hugh Stallworth, Orange County director of public health.

Once notified, county health officials typically test to determine the strain of the virus. Of particular interest is an Australian variety that sprang up 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.

The fault lay partly with last year’s vaccine, which did not protect against the A/Sydney virus, health officials said.

“The vaccine this year has the A/Sydney as a component along with two other strains, and that would seem to indicate we should be in pretty good shape for that strain of the flu,” said Dr. Gerald Wagner, medical director for adult and child health at the Orange County Health Care Agency.

The Centers for Disease Control and Prevention in Atlanta selects the mix in the vaccine each year after analyzing the strains of flu appearing in Asia and Australia in spring and summer, he said.

“It’s always a crapshoot in trying to predict what strains to put in the vaccine, and last year they blew it,” said another health care official.

Health care agencies in Orange and Ventura counties began giving flu shots Oct. 1, principally to those older than 60 and chronically ill patients most threatened by the flu. Los Angeles County plans to begin inoculations of the same groups Tuesday.

Orange County runs flu-shot clinics in association with more than 100 community sponsors, Wagner said, adding that vaccination is also reimbursable under Medicare. People in risk groups can find out where to get a shot by calling the county Health Care Agency hotline: (800) 564-8448.

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.

Flu shots are generally given in October through mid-November, and it takes two to three weeks to develop immunity to the strains in the vaccine, Wagner said.

Southland officials say they are also preparing emergency plans to better deal with severe outbreaks, including how to maximize bed space in hospitals and find alternative sources of critical equipment, such as ventilators.

“We are planning like crazy and hoping for the best,” said Janice Worth, program director for emergency medical services for Orange County.

New strategies are aimed at quickly detecting an increase in flu cases and giving hospitals greater flexibility in dealing with a flood of patients, officials said.

“We brainstormed with providers and came up with the best ideas from hospitals and others so everyone will have a full arsenal if we get another saturation situation,” Worth said.

For instance, Orange County health officials recommended this week that all health care workers who are exposed to patients should be considered for immunization.

Dr. Bruce Haines, medical director of emergency medical services, said last year’s in-patient overload was made worse by health care workers getting sick themselves.

“A lot of people who historically aren’t immunized should be if we have a bad flu season,” he said.

Orange County’s plans include having the emergency medical services agency monitor emergency room and ambulance use to track any crisis in medical services at any of the 27 hospitals or countywide, officials said.

“We have an action plan going into effect to more closely monitor that and react more quickly when volume starts building,” Haines said.

Under the plan, overloaded hospitals can be aided, and those with room can take patients they otherwise wouldn’t serve.

“Some hospitals that don’t get paramedic traffic can take patients that are quite ill and open space for emergency cases elsewhere,” Haines said. “Perhaps hospitals can transfer people who just need antibiotics to nursing homes. There is a whole spectrum of things to do to have the system work more effectively, if we have a bad year.”

State hospital regulators have also been approached, said Haines and others, about temporarily relaxing state license requirements on the number of nurses in an intensive care unit or allowing beds in the hallway of an emergency room during a crisis.

Hospitals also are seeking advance permission to treat flu patients in wards licensed for other uses, said Monty Clark of the hospital industry’s Healthcare Assn. of Southern California.

Acting alone, hospitals could cancel elective surgeries and use the surgery recovery areas for flu patients, as they did last year, Clark said.

Hospital officials remember last year as a crisis and want to prevent a repeat. In Orange County, all 27 hospitals were overtaxed.

“There was no room at the inn,” said John Gilwee, Healthcare Assn. vice president in Orange County. “There were several days around New Year’s and the first week of January when the hospital system was operating at maximum capacity.”

In Ventura County, all eight general hospitals were full at one time or another during the two-week flu crisis.

“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.”