By MARC M. BEUTTLER, MD
Every year at this time, you hear warnings that flu season has arrived. New data from the CDC indicates the season is far from over. So, you are urged by health authorities to get a flu shot. What you may not realize is how the flu can affect the hospitals you and your loved ones rely on for care.
In January, the large urban hospital where I am an intern faced the worst flu outbreak it has ever seen. Nearly 100 staff members tested positive for the flu. Residents assigned to back-up coverage were called to work daily to supplement the dwindling ranks of the sick. Every hospital visitor was required to wear a mask upon entry. At one point, every patient in the medical ICU had the flu and the whole unit had to be quarantined. Because of this, the hospital was put on diversion – no new patients could be admitted.
Why was this flu outbreak so bad? Doctors are still trying to understand all the causes, but one likely reason is that hospital staff with symptoms came to work and became a reservoir for the virus. A majority of visitors and patients don’t get their flu shots, making matters even worse.
Once administrators caught on to the mess this year’s flu was creating, they took some new and aggressive measures. In addition to the free vaccines provided to employees every year, they performed daily symptom check-ins, encouraged sick days, and held an influenza town hall. After discussion with the State Department of Health, medical residents were provided free Tamiflu and urged to take it as prophylaxis. Only 40% picked it up. Residency directors asked symptomatic house staff to stay home. A positive flu swab meant a mandated five days off work. One month later, we are still required to check in daily and confirm that we are symptom-free via a text messaging system or a checklist circulated to each hospital floor. These responses were effective, and the wave of flu appears to have passed. We must now plan ahead to prevent the next outbreak.
The tools we currently use work, but are not enough. Flu vaccines are up to 60% effective each year and rapid swabs take only 10-15 minutes to detect flu. Yet both vary in success depending on public cooperation and the type of viruses circulating each year.
Adults can spread the flu virus one day prior to the appearance of symptoms and five to seven days after symptoms begin. People are most contagious in the first three to four days when muscle aches, sore throat, cough, fatigue, and fever peak. While we can’t screen everyone entering a hospital for muscle aches and a sore throat, we can detect fever.
Thermal cameras were first used to screen for fever in Singaporean and Chinese airports during the SARS outbreak in 2002 and 2003. During the swine flu epidemic in 2009, airports around the world including Australia, Mexico, Hong Kong, Germany, and Canada adopted thermal imaging to screen passengers for high fevers. Many countries in West Africa used temperature monitoring in airports during the Ebola epidemic, while Taiwan continues to use this technology to detect dengue fever.
During flu season, everyone coming into a large hospital should be quickly screened for fever via thermal camera. Everyone entering a hospital must already check in as a visitor or present an ID badge; thermal scanning could easily become part of this process. A cheaper alternative to thermal imaging would be infrared thermometers which can read temperatures in seconds.
Any visitor found to have fever should be made to wear a mask. Employees with fever should be sent home to get a swab. Swabs should be readily and cheaply accessible in drug stores.
Flu vaccines remain essential. Every health care worker should be vaccinated. So should the public. But worsening flu burden, continuing public resistance to the vaccine, and effectivity that varies year-to-year means hospitals cannot continue to rely on shots alone. Screening everyone who enters a hospital for fever, swabbing the staff and masking infected visitors can help stop flu outbreaks before they happen. The flu should not be closing the ICU you rely on.
Marc M. Beuttler is a first-year resident in the Northeast with a Master’s degree in Bioethics from NYU. He thanks Dr. Arthur Caplan for his valuable time and input.
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I’ve thought that if, say, a highly lethal strain of flu was heading our way, e.g. H5N1, and that we did not have an immuno-specific vaccine for that strain, that it might still be wise to get vaccinated several times with the current poor vaccine and maybe with last year’s strain too. The reasoning is that there is research showing that neutralizing antibodies do increase a small percentage using any influenza A vaccine, no matter how poor is the the precise match with ongoing strain of the virus. I have never heard that there are bad side effects from following such a plan. Maybe others have? I don’t think this works with influenza B.
The influenza associated, larger issue is that we have no nationally sanctioned process to maintain a MASTER DISASTER PREPAREDNESS PLAN community by community. They would be “nested” within a County, State and Federal layering of connected Plans. Each community has certain variably predictable Disasters that would benefit from a locally structured and planned mitigation process. Influenza is an example. The most salient feature of an INFLUENZA Disaster Plan should assume the future occurrence of a world-wide Influenza pandemic. Practically, each community would need to embed a locally accepted means to manage scarce resources, such as the availability of ICU based machines for assisted respiration. In the midst of our nation’s healthcare crisis that is focused on cost and quality, the broader needs of our nation’s population HEALTH continue to be ignored. Shame on the APHA, AAMC, AMA and NASEM Health and Medicine for their combine lack of focus and resolve. The only industry with the capability to institute such a concept would be Agriculture, thanks to Congressional action in “1914”. Oh yes, the date is correct.