County health departments plan ahead for H1N1 epidemic
President Obama’s declaration of H1N1 flu as a national emergency on Oct. 23 came at a time when many counties were already ramping up efforts to combat the disease locally.
In LaPorte County, Ind., the county’s emergency management committee declared a local emergency and opened its Emergency Operations Center (EOC) a day before the presidential declaration.
John Jones, emergency management director for the county seat and a former LaPorte County councilman, said the EOC was opened in response to rising absenteeism in schools and number of people seeking medical attention. On Oct. 23, nearly 28 percent of students were absent from county schools and doctors offices reported five- and six-hour patient waits.
For counties already dealing with H1N1 flu, Obama’s emergency declaration suspends a variety of regulations to streamline mass treatment, Jones said.
“It gives us some waivers for setting up temporary clinics, we can do that pretty quickly with all reasonable precautions,” he said. For instance, rather than mandating individual dormitory-style exam rooms, medical center workers can create private spaces with curtains and screens to be more flexible to demand.
“We’re relieved of holding to bed limits, so we could put beds in hallways if we needed to,” he said.
The county’s emergency designation authorized two local hospitals to separate flu patients from injured patients in their emergency rooms.
“That takes the burden off of the volume the ERs see and stems the spread of the flu,” Jones said.
Before the H1N1 outbreak, county officials had been meeting met for three years to plan for pandemic threats.
“As much as the CDC (Centers for Disease Control and Prevention) and federal government know, when it comes locally, county government is where the buck stops,” said Paul Trost, LaPorte County Health Department administrator.
Nationwide, counties are taking varying approaches to fit their specific situations.
“Public health on the county level has been preparing for this for years,” said Carole Moehrle, North Central District Health Department director in rural Nez Pierce County, Idaho. “It can spread just as fast through rural counties as it can in urban areas. We have to be creative in making our resources stretch to the right people.”
In her case in northern Idaho, creativity meant partnering with organizations that weren’t part of the traditional public health infrastructure.
Her department has worked with schools, religious organizations and chambers of commerce to spread educational material about how to handle flu symptoms and encourage people who have them to stay home until they have recovered.
“They can reach a large portion of our population that we can as a single entity cannot,” Moehrle said. “In a rural county, we need those partners.”
Contra Costa Health Services in Contra Costa County, Calif. developed social media strategies. Setting up a Facebook page and Twitter account allowed county health services staff to disseminate information to people who expressed interest in public health alerts over those new media. These measures attracted 200 followers, including residents, teachers, parents, reporters, elected officials, community clinic reps, day care councils and county staff.
For many counties, having dealt with spring H1N1 outbreaks earlier this year gave them a chance to see how their preparations held up under stress and evaluate the results.
LaPorte County had opened its EOC earlier this year to deal with the H1N1 outbreak. The center closed when the spring outbreak ebbed in early May. Trost and the LaPorte organization did more networking, building a roster of volunteer off-duty and retired nurses and data entry volunteers to be ready when they needed help administering vaccines and trying to reach out to pregnant women and Hispanic groups.
Now as then, Trost and his counterparts will monitor their populations as the second outbreak bears down.
“We had a peak, we hope it doesn’t get worse, but we’ll find out over the next week,” he said. “If it seems to gear up for a rise, we have plans in place to deal with it.”
H1N1 National Emergency Declaration: What It Means
At the heart of President Obama’s H1N1 National Emergency Declaration Oct. 23 are the 1135 waivers. The “1135” refers to a section of the Social Security Act that allows the health and human services secretary to suspend certain healthcare facility regulations. These regulations in general affect restrictions imposed upon healthcare facilities by several federal programs or laws such as Medicare, Medicaid or HIPAA, according to the Centers for Disease Control.
When granted, the 1135 waivers allow hospitals or other health care facilities to establish alternate care sites, modify patient triage protocols or patient transfer procedures. For example, if an 1135 waiver has been granted, a hospital may set up an alternate screening location away from its main campus; skilled nursing facilities may increase the number of certified beds without prior approval, and patients may be more easily moved between hospital ERs and inpatient wards.
Also, some sanctions would be lifted for non-compliance with certain HIPAA Privacy Rule provisions.
Waivers only apply to hospitals that have instituted a disaster protocol in certain geographic regions for a limited amount of time.
They are not uncommon. Waivers like these were given in previous disasters such as Hurricanes Katrina (2005) Ike and Gustav in 2008 to help healthcare facilities cope with larger than normal patient loads
In the meantime, it is also possible as the H1N1 virus spreads that the president could invoke the Stafford Act, which would set off a round of federal support for state and local governments via FEMA.
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