Health officials are expressing concerns about California's preparedness for the upcoming flu season, in which an already strained healthcare system will have to cope with seasonal influenza as well as the swine flu.
The California Department of Public Health on Thursday warned that as many as one in four Californians may be sickened this year by swine flu, officially known as the H1N1 strain.
Officials are racing to prepare for what is expected to be a large increase in the number of people seeking flu shots because of growing public unease about the swine flu. Interviews with hospital officials this week indicate that medical facilities, doctor's offices and pharmacies still have a way to go to be ready, particularly if this year's flu season is severe.
"We don't have a long time," said Dr. Gil Chavez, deputy director of the California Department of Public Health's Center for Infectious Diseasesas many as one in four Californians may be sickened this year by swine flu. "It's requiring very intensive efforts."
Among the biggest problems:
* The public will probably need three flu shots for full protection, one for the regular flu and two for the swine flu. The two swine flu shots would be given three weeks apart. That, combined with an expected greater demand, is probably going to cause logistical problems at doctor's offices, drugstores and clinics that typically give out only one shot.
* Emergency rooms are bracing for big crowds. ERs often get filled to capacity during bad flu seasons, but the addition of H1N1 could make the situation even worse. Hospitals are already looking at creating alternate care sites to handle flu patients and imploring those with mild symptoms to stay home, leaving ER space for the critically ill.
* The supply of masks and antiviral drugs is in question. According to the California Department of Public Health, there was an "early and inexplicable collapse of the private industry pipeline for antivirals and masks" as private hoarding began in the spring, requiring the state to tap its reserve supplies.
* Vaccine availability remains another major question. The H1N1 vaccine is expected to be first widely available in mid-October, but it is unclear whether it will arrive soon enough before the swine flu strain becomes more widespread, officials said.
The population that should receive that vaccine first -- children, pregnant women, the frail and others -- totals about 159 million people, more than half of the U.S. population. But only about 45 million to 50 million doses will be ready by mid-October. An average of an additional 20 million doses are expected to be available every week thereafter, according to the U.S. Centers for Disease Control and Prevention.
Unlike the seasonable influenza, which usually hits during late fall or winter, H1N1 has been infecting people in the spring and summer as well.
Southern California hospitals experienced a surge in H1N1 cases in the last few months, but at levels that would be typical for a regular winter flu season. Doctors are preparing for a resurgence of cases this fall and winter -- during the start of the regular flu season -- but don't know when an H1N1 outbreak will arrive or how severe it will be.
A bad flu season combined with the rapid spread of H1N1 has widespread implications. Under this worst-case scenario, if enough workers got sick that companies and agencies couldn't fulfill basic operations, key services could be threatened, Dr. Mark Horton, California's health officer, told a House committee last month.
Horton warned that "without adequate planning, we can also experience collapse of the supply chains for gasoline, food and water."
Health officials have urged employers to train more employees to carry out other duties to fill in for infected workers. The California Department of Public Health, for example, is already training staff inside and outside the agency to be able to cover duties including disease investigations and accounting should existing employees fall ill.
One of the first orders of business for officials has been to create a system for getting the swine flu vaccine to those who are most at risk for illness and complications. So the state is working on a plan that would identify doctors and healthcare providers who serve high-risk patients and make sure they get the shots first. Hospitals are already preparing for what they expect to be high demand for services.
Providence Saint Joseph Medical Center in Burbank, Ronald Reagan UCLA Medical Center in Westwood and Long Beach Memorial Medical Center are planning to set up separate treatment areas for flu patients who arrive at the emergency room.
Providence Saint Joseph is making preparations to convert two vacant floors to be used for extra bed space, if needed. Kaiser will be messaging its patients reminders to get the seasonal flu shot, which should be available in September, and the swine flu shots as they become available.
Hospitals are also urging patients with mild flu symptoms to stay away from emergency rooms.
"If they're only mildly ill and can care for themselves at home, that's fine," said Dr. Jim Leo, associate chief medical officer at Long Beach Memorial.
Leo said those with a fever under 100 degrees, a mild cough and feeling reasonably well can probably stay home. For those with a fever of, say, between 100 and 102 degrees, he said it's worth a call to a primary care physician or an urgent care center.
For the seriously ill -- such as those with a fever of, say, 102 -- or those with shortness of breath or vomiting, a trip to the emergency room is warranted, Leo said.
Despite the work to be done, California's hospitals and public health system have made significant strides in preparing for a pandemic flu, prompted in part by worries about the avian flu several years ago. Federal government grant money has allowed hospitals to purchase more ventilators, and the state and Los Angeles County have purchased mobile hospitals that can be deployed.
Still, much of how California enters into the flu season depends on how individuals act.
"We really want people to know that we all as individuals have a major role to play," said Chavez of the Center for Infectious Diseases.