As many as 1.1 million Kansans may come down with the H1N1 flu over the next two years, local doctors and hospitals were warned today by the state’s health director.
Dr. Jason Eberhart-Phillips, director of health at the Kansas Department of Health and Environment, sent the letter to health care providers and local public health officials to provide “specific guidance” for dealing with the expected resurgence of the flu in the months ahead.
“While it is not possible to predict exactly what the pandemic virus will do next,” Eberhart-Phillips wrote, “recent experience in the southern hemisphere and elsewhere suggests that an escalation in cases will occur in the coming months.”
He predicted anywhere from 20 percent to 40 percent of Kansans might become infected but the letter did not predict how lethal the outbreak might be. Regular seasonal flus claim about 30,000 lives a year. Some have estimated that a more virulent H1N1 virus in the fall could kill as many as 200,000.
So, far H1N1 has been confirmed in 46 of 105 Kansas counties. An estimated 10,000 people in the state have been infected since the first case was confirmed 110 days ago, Eberhart-Phillips wrote.
The average age of persons confirmed as infected was 17 years-old with about 80 percent of cases found in people under age 35, he said.
Limited capacity
He also informed those receiving the letter that the state laboratory would no longer accept specimens for testing from patients who have not been hospitalized.
“Because the state public health laboratory’s capacity is limited,” he wrote, “specimens have not been accepted from ambulatory patients residing in counties already known to have widespread disease. This case-based system for surveillance is not sustainable in a full-blown pandemic and must now be replaced with an aggregated system focused on prompt local recognition and reporting of influenza-like illness by sentinel providers strategically located across the state.”
Eberthart-Phillips wrote that the resurgent flu might come in waves lasting several weeks each.
“These pandemic waves may put considerable stress on the state’s health care system,” he wrote.
Mike Heideman, a KDHE spokesman, said it remains unclear whether there will be enough resources to deal with a widespread outbreak.
“That’s been a point of concern as to whether the health care infrastructure will be adequate,” he said.
He said hospital officials have been planning to use “alternate care sites as well as in-home care,” should their own facilities become full. He said there also were plans to mobilize additional health workers, namely retired doctors and nurses.
Easy on the antivirals
Eberhart-Phillips advised in his letter that H1N1 remains “sensitive” to treatment with the drugs Tamiflu and Relenza and that so far pharmacies have adequate supplies without resorting to the state’s share of the Strategic National Stockpile.
But, “this could change with a rapid escalation of cases, at which point KDHE will issue instructions on dispensing of antivirals from the stockpile,” he wrote.
He said for now the drugs should be reserved only for patients with “severe” cases or underlying conditions that put them at risk of serious complications.
“Overuse of antivirals at this time is poor medical practice,” he wrote. “It depletes the supply of a potentially life-saving resource, it promotes the development of antiviral resistance, and it exposes the patients and their contacts to unnecessary costs and unwanted side effects.”
He also revised the guidelines pertaining to how long an infected person should remain home from work or school. An earlier guideline called for staying away for at least seven days after the onset of symptoms. The new guideline calls for absence from work or school until 24 hours after fever is gone except for people working in health care or with high-risk populations. They should continue to adhere to the earlier guideline.
Two doses
Providers who want to participate in the H1N1 vaccine campaign will be given an opportunity to register online, he wrote.
He predicted that most who are vaccinated will require two doses.
Priority groups are different from those for seasonal flu.
They are:
• All people ages six months to 24 years.
• People who care for children under age 6 months.
• All pregnant women.
• Health care and emergency medical workers.
• People ages 26 through 64 with potentially complicating health conditions.
He said vaccinations for the regular seasonal flu could be available by the end of the month and stressed that the focus on H1N1 “in no way diminished” the importance of those immunizations.
-Mike Shields is a staff writer for KHI News Service, which specializes in coverage of health issues facing Kansans. He can be reached at mshields@khi.org or at 785-233-5443, ext. 123.