July - August 2009

Bracing for fall’s novel flu

URMC plans for what could be a busy flu season

With global health authorities predicting that 2009 H1N1 flu (originally called “swine flu”) could return in the fall, URMC scientists and clinicians alike are paying close watch.

“There’s equal possibility that the virus could mutate into a weaker or more lethal form,” said David Topham, Ph.D., a scientist with URMC’s New York Influenza Center of Excellence who is working to engineer long-lived immunity that protects across a spectrum of flu strains. “To be frank, we cannot predict which.”

Nevertheless, recent headlines suggest plenty of reasons to take this new flu seriously. A national vaccine campaign is being planned, but shots aren’t likely to be available until October. What's more, a few Tamiflu-resistant H1N1 cases have already cropped up, meaning that the virus has displayed at least some potential to evade one of the few available flu medicines.

Other scientists also have reported that H1N1 shares at least two other hallmarks of previous flu pandemics: a nettlesome preference for settling deep in the lungs (where it can cause greater damage than usual influenza), plus a penchant for infecting young people (older people seem to have some residual protective immunity – an idea that Topham said is really shaking up traditional thinking about how “permanent” some types of immunity can be).

“We’re literally watching this situation evolve,” Topham said. “It’s so new. There's a chance that a lot of people could get sick.”

Preparedness plans in place

While no one knows what this fall will bring, the possibility of a pandemic is “sobering,” according to Strong Memorial Hospital Epidemiologist Paul Graman, M.D.

“Rochester hospitals typically operate at or above capacity, leaving little room for a pandemic surge,” he said. “But space isn’t the only concern – in a real crisis, there could be a shortage of health care staff, too.”

Many nurses, technicians and physicians could become ill themselves; others might be hard-pressed to find childcare for sick kids – or even childcare for healthy children, should schools and daycares be cancelled.

“That’s why we’re insisting that clinical staff make vaccination a priority,” Graman said. “It’s not perfect, but it’s our best preventive tool.”

Last year, 77 percent of clinical staff received vaccine, according to data from University Health Service. Graman and the hospital’s Infection Prevention Team want to bring that number closer to 100 percent.

“We’re not only concerned about shielding staff from infection, and blocking them from transmitting illness to patients or their families at home – we’re also depending on them to stay healthy enough to be here working.”

Many questions remain as preparedness plans take shape – for instance, will one or two doses of H1N1 vaccine be necessary? If two, how far apart must they be spread, and could at least one of them be paired with the regular vaccine health care staff already receive annually?

 “Logistically, this could get a bit messy, and the recommendations could change on us midstream. That’s why we’re going to need clear, fluid and frequent communication with clinical staff,” Graman said.

Several hospital planning committees are already working to stock additional personal protective equipment, like masks and gloves.

“The Centers for Disease Control has preparedness calculators that forecast how many supplies we’d need on hand, given several different scenarios,” Graman said. “That’s informing our decisions. And thankfully, we also have a solid preparedness plan laid out. We’ve even mapped a grid detailing how we could retrofit space and operations to accommodate an influx of patients.”

Smart adjustments – such as converting single rooms into doubles, and cancelling elective surgeries and utilizing operating rooms and recovery areas for bed space and flu units – show how the hospital could stretch capacity, gaining 200 beds in a pinch.

“If the need arose, we could be flexible in staffing, asking some nurses to move from one unit to another, or tapping retired or non-medical personnel with previous clinical experience,” he said. “The bottom line is that we’ve thought long and hard about how to keep nimble, ready for whatever challenge we’re met with, just in case. And really, it’s impossible to plan perfectly, since we don’t know what the virus will do. But we’ve learned to plan.”

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