Return of the swine flu

YAKIMA, WASH. -- With a summer to update emergency plans and stock up on hand sanitizers and masks, hospitals, clinics and schools around Yakima County say they're ready for the swine flu.

Now they're trying to communicate urgency to the public without causing panic.

"We have to plan and we have to be judicious, and at the same time it's important to remain calm," said Altaf Ibrahim, director of quality and accreditation at the Yakima Valley Farm Workers Clinic.

At 36,000 deaths a year nationally, the seasonal flu is still far more deadly than the H1N1 virus, the proper name for swine flu, which has taken 556 lives in the United States so far this year.

But federal health officials haven't exactly been clear in their public message. Last week, a presidential panel said the virus could peak in October before the vaccine is ready, sending as many as 1.8 million people to the hospital with up to 90,000 deaths.

But a day later, the federal Centers for Disease Control and Prevention (CDC) tamped down that scenario, calling it unlikely.

But the projections are based on the relatively simple logic of a novel virus: Most of us haven't been exposed to this new strain, so we don't have the antibodies to fight it. Therefore, more people will catch it.

About the only certainty in the coming fall flu season is a considerable degree of uncertainty about whether the new virus will be fierce or -- as most experts believe -- much the same as it was last spring: a typical influenza that's best treated at home with bed rest and plenty of fluids.

One development worth noting, said Dr. Raul Garcia, an emergency room physician at Yakima Regional Medical and Cardiac Center, is that the regular seasonal flu has developed some resistance to treatment with the antiviral medications while H1N1 has not.

"The H1N1 is still very sensitive to Tamiflu (one antiviral medicine) so we can treat it with very good success rate," Garcia said.

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Whatever the case, because children are more contagious than adults, schools are on the front lines of the defense. Their main message is being stated in no uncertain terms.

"We have never said so adamantly that if your child is ill, they must stay home," said Becky Scholl, executive director of student services and director of health services for the Yakima School District.

The CDC estimates the flu could affect up to 30 percent of the student population.

Schools say parents need to arrange for back-up child care with neighbors, relatives or friends, and they know that's difficult. With the tough economy, they know parents can't afford to miss a lot of work to stay home and take care of their children.

"We know it's not easy, but this is something that parents generally understand. If your child is sick, you've got to keep them at home," said Amy Blondin, spokeswoman for the state Department of Early Learning, which regulates child-care centers.

Toppenish school superintendent Steve Myers said the district is prepared to offer some online learning in the event that lots of students begin missing school.

To prevent the virus from spreading, many schools have installed hand-washing stations in areas of high foot traffic by children, such as from the playground to the cafeteria. Scholl said chlorine-based wipes will be plentiful at counters in school offices where students tend to congregate.

If several students in a class fall ill, the room will be thoroughly cleaned before the next school day. Scholl said the district had a practice run on how to sanitize a classroom.

Masks will be available but only as a last resort, she said.

"We will have masks for kids who have a temperature and symptoms, but we're not encouraging them unless a child appears contagious and is in the office while waiting for their parents," Scholl said.

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News earlier this week of the death of a Yakima County man in his 30s who had the H1N1 virus heightened awareness among the public and prompted emergency room officials to expect visits from people complaining of flu symptoms.

At Yakima Regional Medical and Cardiac Center, anyone showing up at the ER or the hospital for general admission is asked to don a mask, said Deb Westland-Graham, a registered nurse and infection preventionist.

She explained that many people with the virus aren't symptomatic in the first 24 hours, so they can transmit it without being sick.

"We're strict on close contacts with patients coming in," Westland-Graham said.

But the ER isn't the place to go unless the symptoms don't respond to rest and fluids and worsen to include listlessness, trouble breathing, uncontrolled fever or dehydration.

At Yakima Valley Memorial Hospital, an H1N1 task force began meeting last spring, said Valerie Hennessy, assistant vice president of nursing services. Existing disaster protocols were reviewed, and the discussion focused on the question that all hospitals are required to answer: What is the response when more people begin showing up than normal?

"Basically the response is always the same. You determine how to set up triage, how to route traffic, how to provide security, how to separate people. These are all things we know how to do," Hennessy said.

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The CDC has since revised its guidelines regarding transmission of the H1N1 virus to be the same as those that apply to regular flu.

For example, at the start of the outbreak, medical personnel were advised to switch from using regular yellow surgical masks to the more fitted "N95" masks. Now the yellow surgical masks are deemed sufficient to stop transmission.

If the flu season turns out to be heavy, and the staff itself experiences absences due to illness, Memorial can call in extra staff on overtime or cancel elective surgeries. Personnel who aren't sick could stay overnight at the hospital to make sure staffing is adequate, Hennessy said.

Staffing could be a challenge, however, because the CDC has not changed its guidance on the amount of time health-care workers should stay at home if they are sick.

While most people with influenza can go out after 24 hours if they are free of a fever, the CDC says those who work in a health-care setting should stay home for at least seven days.

The flu season will require health-care workers to adjust as the virus changes. "Since it's kind of an unknown, we're going to have to respond as things change," Westland-Graham said.

* Leah Beth Ward can be reached at 577-7626 or lward@yakimaherald.com.

FLU TESTING

A question and answer with Tim Church, spokesman for the state Department of Health.

Q: Can I ask my doctor for a swine flu test?

A: You can ask, but in most cases they probably not going to be able to do it. Regular seasonal flu is treated the same way you treat H1N1, so the most important thing to get started is treatment. Knowing which kind of flu it is not going to make a difference.

Q: If I'm willing to pay for it, can I get a swine flu test?

A: Not at the state lab, but there are some private labs who are doing that now. At the state level, we're not designed to provide individual information.

Q: Is the state not testing everyone because of the cost and a manpower issue? Would the demand be overwhelming?

A: A little of both. We're not designed to be a lab that diagnoses patients. I would hate for people to differentiate between these kinds of viruses and think one is more dangerous than the other.

Symptoms of H1N1 virus: Fever, cough, body aches and sore throat. Occasionally vomiting and nausea.

Prevention: Cover your mouth with sleeve, elbow or tissue. Wash hands often.

Source: Yakima Health District