Outbreak of swine flu a national emergency in US

President Barack Obama has declared the swine flu outbreak a national emergency, allowing hospitals and local governments to speedily set up alternate sites and procedures if needed to handle any surge of patients, the White House has announced.

The declaration came as thousands of people lined up in cities across the country to get vaccinated, and as federal officials acknowledged that their ambitious vaccination programme has gotten off to a slow start. Only 16 million doses of the vaccine were available, and about 30 million were expected by the end of the month. Some states have requested 10 times the amount they have been allotted.
Flu activity — virtually all of it the swine flu — is widespread in 46 states, a level that federal officials say equals the peak of a typical winter flu season. Millions of people in the United States have had swine flu, known as H1N1, either in the first wave in the spring or the current wave.

Although there has been no exact count, officials said the H1N1 virus had killed more than 1,000 Americans and hospitalised more than 20,000. The emergency declaration, which Obama signed Friday night last, has to do only with hospital treatment, not with the vaccine.
Government officials emphasised that the declaration was largely an administrative move that did not signify any unanticipated worsening of the outbreak of the H1N1 flu nationwide. Nor, they said, does it have anything to do with the reports of vaccine shortages.

“This is not a response to any new developments,” said Reid Cherlin, a White House spokesman. “It’s an important tool in our kit going forward.”
Obama’s declaration was necessary to empower Kathleen Sebelius, the secretary of health and human services, to issue waivers that allow hospitals in danger of being overwhelmed with swine flu patients to execute disaster operation plans that include transferring patients off-site to satellite facilities or other hospitals.

Revision

The department first declared a public health emergency in April; Sebelius renewed the emergency for a second time on Oct 20. But that declaration was insufficient to waive federal laws put in place to protect patients’ privacy and to ensure that they are not discriminated against based on their source of payment for care, including Medicare, Medicaid and the states’ Children’s Health Insurance Programme.
As a practical matter, officials said, the waiver could allow a hospital to set up a makeshift satellite facility for swine flu patients in a local armoury or other suitably spacious location, or at another hospital, to segregate such cases for treatment. Under federal law, if the patients are sent off site without a waiver, the hospital could be refused reimbursement for care as a sanction.

A few hospitals, including some in Texas and Tennessee, have set up triage tents in their parking lots to screen patients with fever or other flu symptoms. A Health and Human Services official said no hospitals had requested a waiver. David Daigle of the Centres for Disease Control and Prevention said he had not heard of any hospital that has faced a surge of patients so large that it had to set up a triage area or a treatment unit off site.

In Chicago, health officials have begun giving free vaccinations at six city college locations, and within hours hundreds of people were turned away because supplies had been exhausted. The city distributed 1,200 vaccines to each site, immunising more than 7,000 people, said Tim Hadac, spokesman for the Chicago department of public health. All but two of the sites ran out of the vaccine.
At Truman College on the North Side, lines formed at 7 am, two hours before the doors opened. Mary Kate Merna, 28, a teacher who is nine months pregnant, arrived too late to get a vaccination. “I thought I'd be a priority being nine months pregnant,” she said. “You hear it’s a national emergency and it scares you.”

In Fairfax County, Virginia, officials had planned to have swine flu clinics at 10 different locations on Saturday. But the county did not receive the number of doses it requested, and was forced to offer the vaccinations only at the government building. People began lining up with camping gear the night before to get vaccinations.

Merni Fitzgerald, Fairfax’s public affairs director, said officials were aiming to administer 12,000 doses of the vaccine to those most at risk for serious complications from the H1N1 virus, mainly pregnant women and children 6 to 36 months old.

Extra care

But that did not stop some other high-risk patients. “I lied and told the doctors I was pregnant,” said Theresa Caffey of Centreville, who has multiple sclerosis and was nursing her 11-week-old son, Joshua. “I’m religious. I don’t lie. But it’s not about me. It’s for my son. It’s safer for him if I have the antibodies.”
In a briefing on Friday, Dr Thomas Frieden, the CDC director, acknowledged problems with the vaccine production. “We share the frustration of people who have waited on line or called a number or checked a website and haven’t been able to find a place to get vaccinated,” he said.

Federal officials predicted last spring that as many as 120 million doses could be available by now, with nearly 200 million by year’s end. But production problems plagued some of the five companies contracted to make the vaccine. All use a technology involving growing the vaccine in fertilised chicken eggs; at most of them, the seed strain grew more slowly than expected.

The manufacturers are “working hard to get vaccine out as safely and rapidly as possible,” Frieden said. But since it is grown in eggs, “even if you yell at them, they don’t grow faster.”
Since last winter’s more isolated cases of swine flu, the expectation that the virus would return with a vengeance in this flu season had posed a test of the administration’s preparedness. Officials are mindful that the Bush administration’s failure to better prepare for and respond to Hurricane Katrina in 2005 dogged President George W Bush to the end of his term.

There is no overall shortage of seasonal flu vaccine — 85 million doses have shipped, and the season has not started. But there are temporary local shortages. The seasonal flu typically hospitalises 2,00,000 and kills 36,000 nationwide each year. But over 90 per cent of the deaths are among the elderly, while the swine flu mostly affects the young.