During a recent press conference on the H1N1 influenza in California, Center for Infectious Diseases Chief Dr. Gilberto Chavez addressed H1N1 and the state’s overall preparation for a pandemic.
California expects to order 20 million doses of the H1N1 vaccine for the entire flu season, but as of early November, the Centers for Disease Control and Prevention had only provided the state with 3.5 million nasal and injectable doses — the expected amount was 6.25 million doses by then. Chavez said delays in production at the national level initially prevented all states from receiving requested amounts.
Chavez also noted that California has spent the past five years planning for a pandemic, part of which included stockpiling supplies, such as antivirals, and building mobile hospitals. Of the 70 million N95 respirators available in the nation, California had 50 million (purchased in 2006), but the California Department of Public Health (CDPH) recently released 25 million to hospitals in response to a shortage. The California Occupational Health and Safety Administration is developing standards on respirator reuse so hospitals and other health agencies in the state will observe proper use.
After the press conference, Emergency Management magazine sat down with Chavez for a one-on-one interview:
What's the likelihood of H1N1 mutating, and will there need to be adjustments to the vaccine? Would that add to vaccine production delays?
What's your recommendation for college campuses and other large organizations as far as mitigating the spread of H1N1?
We know that there’s increased risk of infection at schools since students spend so much time in close proximity. The CDPH recently released guidance for colleges and universities. It’s designed for students in dorms and residence halls to deal with outbreaks in a school setting. One of the keys for reducing the risk for outbreaks in college campuses is ensuring that students who are ill with a fever and respiratory symptoms stay away from others on campus. We absolutely need to emphasize good hygiene; frequent and thorough hand washing; covering of coughs and sneezes; avoiding touching eyes, nose and mouth; and very importantly, vaccination as the most effective means of prevention.
Are you concerned that the number of sick individuals needing hospitalization could cause a surge of patients that hospitals won't be able to handle?
We actually have an extensive process in California where we developed a structure for hospitals and local government to care for a surge in patients, in a way that they, for example, could free up beds for more urgent cases, if needed. We continue to closely work with hospitals to monitor their surge capacity.
In case of a surge, do you think the capacity for mutual aid will diminish, and if so, what could be done to prevent that?
In 2007, the state invested in medical supplies and antivirals for use in a pandemic. We are now distributing these supplies across the state as they are needed. We know in the event of a pandemic, mutual aid can be a challenge just because we responders are involved and may become victims of the pandemic ourselves. The challenge is to use our present assets wisely. The issue of having enough masks, respirators or beds is a considerable one. And so I think one of the things we can do — what we’re trying to do — is make sure that we signal those things and really get to the issue of conserving our strength.
You said at a recent Disaster Planning for Hospitals conference that there needs to be better communication between the public and private sectors to make sure the supply chain is sustained. How can we improve in that area?
In the early stages, there was real miscommunication regarding guidance and reporting. Now there’s routine communication — with weekly calls with hospitals, clinics and counties — so that they all have the same information in a California context. We constantly review data for changes in race, population, etc., to better target the highest-risk groups. In October, California made 25 million N95 respirators available from its stockpile. We’ve spent five years planning for a pandemic, stockpiling supplies like antivirals and masks to supplement the federal supply. We also created mobile hospitals.
Since response has to be long term, is there a chance we could get complacent and then get hit when we don't expect it?
That’s a good question, and that’s why I think that it’s an issue of just being vigilant and looking at data regularly. We go to great lengths to collect data from the community, from hospitals and from patients to see what’s happening in the state. And I think that all the things we’re doing there are helpful. We know there’s more influenza in the community, but we know there’s also more efficiency. So that really alerts us to the fact that we shouldn’t let our guard down and we really have an active way of appropriate response. And we — through surveillance — can exactly know where there are ups and downs, and we’ll know how to respond according to the level of particular need.
