Focus turns to lessons learned from H1N1 scare

As the influenza A(H1N1) outbreak sent chills around the world this spring, physicians struggled to keep up with developments while tending to scared patients.

Many worried patients called Arkansas internist and pediatrician Robert Hopkins, MD, about what they called the "flu that is killing people right and left." Aurora, Ill., family physician Carrie Nelson, MD, scrambled to read policy changes faxed to her by federal health officials.

"When you are running to care for patients, you can't also run over to the fax machine all the time," Dr. Nelson said.

The outbreak has caused commotion and concerns, but it also has provided lessons that Dr. Nelson and other physicians said would help them when the next flu strain strikes. That means preparations such as dusting off pandemic plans, educating office staff and patients, and ensuring surge capacity in hospitals.

"So far, I would say we did a good job. But there is always room for improvement," said Daniel Fagbuyi, MD, medical director of disaster preparedness and emergency management at Children's National Medical Center in Washington, D.C.

The facility set up an area outside the emergency department where nurses separated out patients suspected of having the flu. "We'll go over what we did right and what we did wrong at the end of this so we can prepare for the next pandemic," he said.

The Centers for Disease Control and Prevention and other agencies are casting a wary eye toward the fall flu season, with the thought that the H1N1 virus might continue to circulate and, perhaps, become more virulent. Plus, it will be accompanied by seasonal influenza, which causes some 36,000 deaths annually.

Physicians are analyzing their first go-round with the H1N1 virus for ways to improve their responses.

Better patient education is crucial, said Dr. Hopkins, associate professor of internal medicine and pediatrics at the University of Arkansas for Medical Sciences in Little Rock. He is developing newsletters for his patients. He recommends that other doctors use newsletters, Web sites or postings in waiting rooms to relate prevention messages such as patients' need to stay home if they are sick.

"We spent a lot of time talking [to patients] about what the flu is," he said.

Prompt communication

The need for speedy communication was one lesson learned as the virus swept through the nation. Guidance to physicians was updated as federal health officials learned more about the virus. The CDC used Twitter to provide updated reports.

In the future, receiving updates via Twitter would be better than being bombarded with faxes, Dr. Nelson said. Her fax machine was nearly as busy as she was during the height of the outbreak.

She had prepared for an increase in patients as word spread of the new flu strain. Many people she treats are from Mexico and have friends and relatives there, leading to frequent travel in both directions.

What she wasn't prepared for were the rapid-fire policy changes faxed to her. "New policies were coming down sometimes hours apart from one another," she said.

The outbreak also served as a reminder to some physicians that surge capacity in emergency departments needs to be increased.

"Most emergency departments report they are at 150% to 200% of capacity on a regular day," said Richard N. Bradley, MD, chief of the division of emergency medical services and disaster medicine at the University of Texas Medical School at Houston. "When you put on top of that the possibility of a severe pandemic, you are really throwing some challenges at the system."

Medication and supplies

Dr. Bradley also wants to see sufficient medication provided in advance to front-line health care professionals. For example, doctors and their staffs might need numerous 10-day courses of antivirals for themselves to continue treating patients for the duration of a pandemic without getting sick.

Another lesson learned was the need to ensure that an adequate supply of masks and other equipment can be delivered. "You have to make sure immediately that your supplier reserves some materials for you," said William Schaffner, MD, chair of the preventive medicine department at Vanderbilt University School of Medicine in Nashville, Tenn. "Hospitals today don't have large stockpiles."

Planning now can make all the difference later, doctors said.

"No matter what we think of the response now, imagine what would have happened had we not had any planning," said Thomas Inglesby, MD, deputy director and chief operating officer at the University of Pittsburgh Medical Center's Center for Biosecurity.