Tennessee's response to the 2009 H1N1 influenza pandemic

¶ … Emergency

The 2009 H1N1 influenza pandemic posed enormous challenges for state health departments across the United States. This case focuses on Tennessee which endured an intense resurgence of the disease in 2009 and explores how state health officials, working with their partners from public and private sectors, mobilized in advance for the second wave of the disease. An array of preparedness efforts, such as the development of mechanisms for distributing vaccine, ultimately put the state in a strong position to deal with H1N1 come fall, but health officials still experienced considerable difficulty in several areas, including vaccine delivery, communicating with an anxious public, and managing a surge of patients seeking care. The case highlights methods for preparing for a significant public health emergency and explores the difficulties of coordinating a response involving multiple jurisdictions and a mix of actors from both the public and private sectors.

The federal government had approximated that 30,000 to 90,000 deaths would occur as a result of the influenza with children and young adults recording higher infection rates. In addition, it was speculated that it could pose high risks for people with certain pre-existing conditions, including pregnant women and patients with neurological disorders, respiratory impairment, diabetes, and possibly for certain populations, such as Native Americans (National Conference of State Legislatures, 2009). This made the search for the cure an imminent task given the complexity of the speculations surrounding the virus.

Within the first month of outbreak, H1N1 spread rapidly across the United States, with states such as Texas, New York, Utah, and California recording high number of infected individuals. On May 4, the CDC reported 286 cases of H1N1 and one death across 36 states and the virus was expected to eventually spread to all states. By May 5, 2009, the number had risen to 403 and a second death was reported in Texas thus increased public belief that the outbreak would be severe across all the states. The virus was spreading fast across the country and Tennessee could not be left helpless when the virus struck so, the state had to search for alternatives to help contain the spread of the influenza when it hit the country.

The proportion of U.S. deaths due to pneumonia and influenza increased steadily above the epidemic threshold in the 2008 winter season. This led to speculation that the flu was directly related to the pneumonia witnessed increasing the perception among medical experts and citizens that the outbreak would be severe. The virus also spreads easily from person to person. The temporal and geographical spread of cases involving no contact with pigs leaves researchers with few doubts that sustained human-to-human transmission is under way. The state had to find resources for dealing with the problem if it struck and was not to be left unprepared following the onset of the virus.

Resources for Dealing with the Problem

Antivirals

The CDC outlined that there were antiviral drugs available for treating influenza; adamantanes (amantadine and rimantadine) and neuraminidase inhibitors (Tamiflu and Relenza). The agency discourages the use of adamantanes in treating and prophylaxis of influence A due to traces of adverse effects they have. Though antivirals provide minimal benefit by shortening the duration of disease by a day and a half, the World Health Organization recommends Tamiflu for treatment of patients above the age of one. The use of antivirals is likely to be used by the state to curb the rising cases of the flu before vaccines are dispatched to the affected population. This would reduce the severity of the infection among the infected population before proper treatment is administered to them.

Vaccine Development and Distribution

Vaccination is the most effective method for preventing influenza and influenza-related complications. Since 2004, the state has liaised with the Department of Health and Human Services to ensure the affected individuals receive the vaccines in time and medical clinics receive drugs in large quantities that can be given to the entire population (Centers for Disease Control and Prevention, 2009). In addition, following the CDC's recommendation that U.S. population groups receive the initial H1N1 influenza vaccine in October, the state has implemented its vaccination program. The state outlines that the order of priority will be pregnant women, those living with infants under 6 months, health care and emergency-services workers, young people between six months and 24 years of age and adults under 65 with underlying conditions, such as diabetes and chronic lung disease. Those aged 65 years and above will have the lowest priority levels. If the state uses this methodology, it would be easier to monitor the flow of vaccines to the infected persons. This would also ensure the most vulnerable population is attended to without risking their chances of getting infected.

Federal Legislation

The President declared H1N1 a national emergency on October 24. This declaration will make it easier for medical facilities within the state to handle a surge in flu patients by allowing the waiver of some requirements of Medicare, Medicaid and other federal health insurance programs as needed. The state's healthcare facilities will be required to reimburse the administration fee for the 2009 H1N1 vaccine for individuals under the age of 21 as part of the Medicaid Early and Periodic Screening, Diagnostic and Treatment program. Adults in the Medicaid program will receive coverage of the vaccine when furnished by a participating provider under a mandatory Medicaid benefit. The state will ensure that Medicaid and other Federal funding sources are appropriately coordinated to prevent duplicate payments.

Activation of Emergency Operations Center

During the week of April 19, the CDC activated its Emergency Operations Center (EOC) to augment the ongoing investigation of human cases of swine influenza A (H1N1). As of May 4, 2009, the CDC reported that it had deployed 25% of the supplies and medicines in the Strategic National Stockpile to the various states. The state of Tennessee will also activate its statewide emergency operation centers to curb the influx of the influenza to its population (Tennessee Department of Health, 2009). As opposed to distributing medicine to major hospitals, the state government will supply major pharmacies and private facilities serving remote areas and the most vulnerable individuals; pregnant women, children under the age of 6 as well as school children. In addition, the emergency operations center will ensure the education of the public regarding the virus and is open for information regarding the virus to the public.

Swine Flu Test Kits

As of April 29, only the CDC could confirm U.S. swine flu cases. Besides, California and New York had diagnostic test kits, and that the kits would be sent to all states starting the following day. On May 6, the CDC announced that testing kits would be available for all states. This is expected to generate an increase in the number of confirmed cases as more states begin doing their own tests. The influx of testing kits in Tennessee will help the medical practitioners diagnose common flu and H1N1 flu and accord the affected patients the appropriate medication required. This in addition will help the medical practitioners differentiate for the public the symptoms of H1N1 and of other common influenzas.

Recommendations for Schools

Initially the state government had issued a recommendation that schools close for as long as two weeks if a student catches swine flu. Some school districts closed all schools if a single child was classified as probable. This decision was retracted stating that schools that were closed based on previous guidance related to this outbreak may reopen (Alapo & Kennedy, 2009 ). This followed the closure of more than 726 schools in the nation serving more than 480,000 students. The state government amended its advice citing, new information on disease severity and the limiting effectiveness of school closure as a control measure. The decisions about school closure should be at the discretion of local authorities based on local considerations, including public concern and the impact of school absenteeism and staffing shortages. In addition, the decision required schools to carry out education to their students to increase public awareness and reduce misconception as far as H1N1 is concerned.