H1N1 Widespread in 46 States as Vaccines Lag about:reader?url=https://www.nytimes.com/2009/10/25/us/politics/25flu...

nytimes.com

By Jackie Calmes and Donald G. McNeil Jr.

6-8 minutes

WASHINGTON President Obama has declared the swine flu

outbreak a national emergency, allowing hospitals and local
governments to speedily set up alternate sites for treatment and
triage procedures if needed to handle any surge of patients, the
White House said on Saturday.

The declaration came as thousands of people lined up in cities

across the country to receive vaccinations, and as federal officials
acknowledged that their ambitious vaccination program has gotten
off to a slow start. Only 16 million doses of the vaccine were
available now, 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 now 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 has killed more than 1,000 Americans and hospitalized over

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20,000. The emergency declaration, which Mr. Obama signed

Friday night, has to do only with hospital treatment, not with the
vaccine. Government officials emphasized that Mr. Obama’s
declaration was largely an administrative move that did not signify
any unanticipated worsening of the outbreak of the H1N1 flu
nationwide. Nor, they said, did 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.”

Mr. 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.

The department first declared a public health emergency in April;

Ms. Sebelius renewed it on Tuesday. But the separate presidential
declaration was required 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 Program.

As a practical matter, officials said, the waiver could allow a hospital

to set up a make-shift satellite facility for swine flu patients in a local
armory 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.

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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 Centers 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.

Image

After waiting for several hours on Saturday, Laura Coffey, 23,

received a swine flu vaccination at Truman College in
Chicago.Credit...Sally Ryan for The New York Times

In Chicago on Saturday, health officials began 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,
immunizing more than 7,000 people, said Tim Hadac, spokesman

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for the Chicago Department of Public Health. All but two of the sites
ran out of the vaccine.

At Truman College on Chicago’s North Side, lines formed at 7 a.m.,

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, Va., 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.

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 nurses 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 C.D.C. 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 Web site 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

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end. But production problems plagued some of the five companies

contracted to make the vaccine. All use a technology involving
growing the vaccine in fertilized 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,” Dr. 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 Obama administration’s preparedness. Officials
are mindful that the previous administration’s failure to better
prepare for and respond to Hurricane Katrina in 2005 left doubts
that 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 hospitalizes
200,000 and kills 36,000 nationwide each year. But over 90 percent
of the deaths are among the elderly, while the swine flu mostly
affects the young.

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