H1N1: A new flu, a new level of defense

Talk about it

Like tax day or a big and unwelcome birthday, we knew that this, too, would come.

For years, health officials here and across the country have been preparing for a pandemic that history says is overdue. We don’t know how bad it will be, or how widespread, but the potential for disruption is sobering, the worst-case scenarios chilling.

And now, it’s here.

First detected in humans in April, the 2009 H1N1 influenza virus — often referred to as swine flu — was declared a pandemic June 11 by the World Health Organization.

While most people who have become sick with the new virus have not required medical treatment, authorities worry about the new strain’s potential severity through mutation.

“I’m not kept awake at night worrying about swine flu,” Don Shields, director of the Grand Forks Public Health Department, said in a recent interview. “I’m confident we can handle this because we’ve been planning and preparing for it.

“But it’s time to implement some of those plans,” he said. “We encourage people to have a personal family plan, and businesses should have a business plan. There could be a very rapid onset of this disease, and we may have two or three waves. Folks need to protect themselves.”

Could Grand Forks get through this threat without major disruption?

“I would be happy as a lark if that happened,” Shields said. “But that would not be my bet.”

And now, Round 2

Researchers monitoring H1N1 have called it a “mild” strain so far, but Shields said that’s misleading. He would prefer the term “moderate” to describe H1N1 in terms of its ability to lay victims low, especially people with such underlying conditions as asthma, diabetes or cardiovascular problems.

“I know of a man, age 60, who came down with H1N1 in July and had a 103-degree temperature for four days. He was not hospitalized, but his illness was not what I would call mild,” Shields said. “He said it was 2½ weeks after his fever left before he could work an eight-hour day.”

Since April, when authorities warned of a potential pandemic, about 1 million Americans have been infected with the disease. More than 9,000 have been hospitalized and more than 600 have died, according to the U.S. Centers for Disease Control and Prevention.

In Minnesota, 267 people had been hospitalized as of last week. Three died. No deaths have been reported in North Dakota, where six people were hospitalized from April 1 to Sept. 15.

Of 606 samples tested by the North Dakota Department of Health from April through August, 107 were confirmed cases of H1N1. Of those, eight were from Grand Forks County, five from Walsh, two each from Ramsey and Traill and one from Pembina. Many more H1N1 cases likely were never recorded, as most victims required no medical treatment and recovered at home.

But that was Round 1. With the regular flu season approaching and masses of people coming together in schools and other public places, what will Round 2 bring?

"No one knows the future,” Shields said. “Influenza viruses can be very unpredictable. To date, this virus has not been as deadly as the virus of 1918,” the so-called Spanish flu that claimed 50 million lives worldwide.

“We’re preparing for the worst case, but so far, what is unrolling is not the worst case,” he said. “Unless it mutates and becomes more deadly, this virus has about a 30 percent attack rate. That is, if you had 10 people together in this (small) room, three would be infected. And of people infected, about 7 percent end up in the hospital. Our medical facilities are able to take that on.”

Even in that cautious scenario, the health care system could face challenges. Pregnant women who are infected likely would require hospitalization at a much higher rate, about 32 percent, Shields said, and “the real bottleneck” would be for people getting in to see family-practice physicians.

Even if the virus does not mutate and become more deadly, “that doesn’t mean there won’t be disruption,” he said.

“Every disease targets a different set of people. This one is targeting our youth, so there is significant potential for disrupting schools and day care operations.” That could have ripple effects on business, entertainment and all other aspects of community life.

Planning at home, work and school

Everyone has a plan — or should be working on one, authorities say.

In Minnesota’s Beltrami County, for example, the sheriff’s office of emergency management formed a Community Health Planning Group months ago to plan responses to various flu scenarios. The group promises to issue informational bulletins as the flu season unfolds.

Last December, Shields and other Grand Forks health officials met with more than 80 people representing area businesses and encouraged them to develop workplace plans. Some indicated they already had such plans in place, “but others said, ‘We don’t know where to start,’ ” Shields said.

With guidance from the CDC, local and state health authorities are developing H1N1 preparedness plans for schools, day care centers, churches and hospitals, as well as businesses — and just about any other place people gather.

“We’ve put a lot of things in place in the schools, from establishing hand-washing routines to student tracking programs,” Shields said. “We know the greatest likely impact of an outbreak will be on kids.”

The Grand Forks School District reported early last week the first confirmed student case of H1N1. The infected high school student, whose symptoms were reported as mild, was kept home until 24 hours after the symptoms subsided, as the school’s plan directs.

Using materials supplied by the CDC, schools have sent mailings to staff, students and parents, hammering away at core themes: Stay home if you’re sick. Cover your cough. Wash your hands.

“If we all do that, it will go a long way toward protecting us,” Shields said.

Grand Forks plan

Grand Forks County has a 142-page master plan that provides guidelines and protocols in the event the pandemic strikes hard locally.

In its “prepare for the worst” detail, it can be scary reading, with references to temporary morgues, mass displacement and the collapse of social interaction.

A severe flu outbreak could result in more than 400 deaths here and 2,200 additional people requiring hospitalization, according to the county plan, which also anticipates great potential challenges in logistics, equipment, infrastructure and personnel needed to contain the disease.

In a severe case, government functions not involved in responding to the pandemic would be suspended, and local agencies likely would be without state or federal help. Transportation, utilities, public safety, communications and other critical functions could be disrupted.

Other counties have developed similar plans, and people have been planning on a regional basis, as well.

Shields and John Bernstrom, a communications specialist for the city of Grand Forks, are members of the Northeast Biological Planning Coalition, which includes representatives from Walsh, Pembina, Nelson and Griggs counties, the Grand Forks Air Force Base, UND and the school district, plus local emergency personnel.

In addition to the detailed master plan, Grand Forks County has drafted guidelines for “lines of succession” if sickness knocks out certain key staffers. The guidelines set service priorities, give department heads authority to send people home and lay out steps to keep the 911 center, fire department and other critical functions operating, possibly through sequestration of some personnel. It also establishes procedures concerning the use of masks, “social distancing” and other preventive measures for contact among employees and visitors during a severe outbreak.

Bernstrom, who has been assigned half time to H1N1 planning and preparation, said city government is developing similar guidelines.

Also, “We’ve done several exercises locally to see how quickly we can provide swine flu vaccines,” he said, including drive-through clinics at the public works garage and a walk-through clinic for Flood of 1997 tetanus booster shots at the Alerus Center in 2007.

A vaccine, but when will it come?

Authorities urge people to get vaccinated both for the seasonal flu and for the H1N1 virus.

Vaccine for the seasonal flu is available now, and Molly Sander, immunization program manager for the North Dakota Health Department, urges people to get the seasonal vaccination early to allow providers to concentrate on H1N1 when that vaccine becomes available next month.

Supplies of H1N1 vaccine will be distributed by the federal government through state health departments to hospitals, clinics, pharmacies and public health agencies, which may organize mass immunizations in schools or clinics, Sander said.

“Initially, there will be limited amounts of the vaccine, but I do think it will be coming in quickly and we’ll have enough,” she said.

Michael Osterholm, a health researcher at the University of Minnesota, said last week that swine flu cases could surge in the next six to eight weeks, outpacing initial deliveries of vaccine. “I’m afraid too little vaccine is going to get here before the peak hits,” he said at a flu summit organized by the state health department.

There will be no charge for the H1N1 vaccine, Shields said. Health care providers who administer it may or may not charge a fee.

Authorities had been recommending a two-dose series of H1N1 vaccinations, at least 21 days apart, but researchers in the U.S. and Australia announced recently that a single dose may be strong enough to protect adults and could be effective within 10 days. Studies of the new vaccine’s effectiveness in children are continuing.

Shields said he expects an initial shipment of H1N1 vaccine, about 20 percent of the stocks to be available locally, will arrive in Grand Forks by mid- to late October. (Separate allocations will go to Grand Forks Air Force Base and to Indian Health Service offices.)

The vaccine will go first to established high-priority groups: pregnant women, health care workers and emergency personnel, parents and caregivers of children younger than 6 months, young people (6 months to 24 years), and adults with such chronic diseases as diabetes.

“After that initial shipment, we should receive another 10 percent per week,” Shields said, and plans are to cover all city residents, including those at the Grand Forks Mission and other temporary housing, by the end of the year.

If circumstances require, “we may initiate mass vaccinations,” he said.

In the event of severe infection rates, the governor, mayor and local or state health officers have the authority to close schools and prohibit large public gatherings.

“We would not do that without a lot of discussion,” Shields said. “Before we’d close things, we’d look at things like whether the virus’s attack rate is increasing.”

Reach Haga at (701) 780-1102; (800) 477-6572, ext. 102; or send e-mail to chaga@gfherald.com.

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