Lessons from H1N1 outbreak have Houston ready
A year later, a wary look at a killer
H1N1 outbreak taught lessons that left the area ready for future
Published 5:30 am, Monday, May 10, 2010
The H1N1 influenza threat that emerged a year ago killed thousands and sickened many more but didn't become the plague that some feared.
Dozens died in the Houston area, while an estimated hundreds of thousands fell ill. But people washed their hands more often and employed etiquette that cut the spread of germs. Hospitals learned how to keep the sick from infecting patients or medical providers.
A year later, what did we learn from our collective bout with H1N1?
Texas Children's Hospital became Houston's ground zero for an illness disproportionately striking youngsters. The institution made national headlines when a Mexican boy died there on April 27, 2009, becoming the first death on U.S. soil from complications of the new flu.
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Taking lessons from the surge of pediatric patients following Hurricane Katrina, Texas Children's handled the unexpected crush of sick kids beginning last May by establishing an open-air triage clinic outside the hospital's emergency center. The unit — open for a week — had its own doctors, nurses, pharmacy and supplies to treat patients quickly while not contaminating the main ER.
“You can completely immobilize a hospital or an entire region if the capacity (of hospitals) is overwhelmed,” said Dr. Paul Sirbaugh, the Texas Children's clinical chief of emergency medicine and an associate professor of pediatrics at Baylor College of Medicine.
Lesson learned: “Regionalization and collaboration” among a broad group of agencies and institutions — as during Katrina's aftermath — are necessary to respond to widespread medical emergencies.
“We had to give up control. That's the hard one,” Sirbaugh said.
“The tragedy was that there were a lot of young, healthy people who were erased by this virus. When you put it in the context of years of life lost, this pandemic was very severe,” he said.
The U.S. Centers for Disease Control and Prevention released estimates from April 2009 through mid-March showing that about 60 million Americans have been infected with H1N1, the virus that sent roughly 270,000 to the hospital and killed more than 12,000. The estimated deaths include 1,300 children.
A split with CDC
Glezen criticized early CDC recommendations that limited the use of Tamiflu, an antiviral drug that reduces the severity and duration of flu symptoms, and said initial efforts should have focused on children.
Lesson learned: “If they had followed the policy of containment of treating every patient who appeared, they would have decreased the morbidity (deaths).”
And it turns out that the so-called swine flu wasn't.
She credits surveillance systems with helping scientists catch a unique, new virus in circulation and exposing how quickly the flu can spread.
“Within a month, we had infections around the world. We learned how fast viruses like this can emerge and infect people,” Nichols said. “Last year's H1N1 experience proved that science and education can slow the spread of the virus when it emerges.”
Educational campaigns helped limit infections until doses of vaccine began trickling into Houston-area communities last October.
Today, hand sanitizers and hand-washing posters are part of daily life.
“You see everyone now — even the little bitty ones in kindergarten — coughing into their shirt or elbow,” said Jan Jones, director of health services for the Cypress-Fairbanks Independent School District.
She called shutting schoolhouse doors in H1N1's early days “an overreaction.”
Lesson learned:“We closed a school with just one confirmed case. … It causes more problems than it would if we kept the schools open and dealt with the kids who were ill.”
Dr. Luis Ostrosky, an infectious disease expert who teaches at the University of Texas Medical School at Houston, said the alarm sounded by public health officials was appropriate. Absenteeism and slow-to-arrive vaccines tested pandemic flu plans for both the UT medical school in Houston and Memorial Hermann-Texas Medical Center, where Ostrosky serves as medical director for epidemiology.
Lesson learned: “You want to have flexible leave policies because the last thing you want is somebody who is sick to come to work.”
Since October, nearly 8.5 million doses of H1N1 vaccine have been distributed in Texas.
By the end of January, about 25 percent of Texas children and 14 percent of the state's adults had received the H1N1 vaccine, according to a CDC survey. That's below a national average of 37 percent for kids and 20 percent for adults.
Pandemics usually have three peaks of illness, hospitalizations and deaths — reached last spring and in late fall — but the third wave of H1N1 hasn't shown up. The traditional flu season lasts from October to May. Scientists are watching what happens in the Southern Hemisphere during our summer (their winter), to see if H1N1 surges again.
And even a year later, the virus continues to change lives.
A personal story
The global pandemic hit Eva Vega right after Christmas , sending a grandmother in “fairly good health” into double pneumonia.
The 63-year-old former beautician spent three months at Ben Taub General Hospital and was released from a rehabilitation center on Thursday.
“They had already told my children that I would probably not make it. They even talked to them about hospice,” said Vega, who also had three strokes while she was in the hospital.
“I got sick — but I'm here, thank God.”