Unclear Expectations

The Hospitalist. 2009 October;2009(10):

October 1, 2009|The Hospitalist

As flu season descends on North America, hospitalists from Boston to the San Francisco Bay are concerned about what might happen when normal seasonal influenza hospital admissions are added to new cases of the novel influenza A (H1N1) virus.

Perhaps the most basic, still-unanswered question is how the addition of novel H1N1 virus affects the severity of the upcoming flu season. From April 15 to July 24 of this year, states reported 43,771 confirmed and probable cases of novel H1N1 infection. Of the cases reported, 5,011 people were hospitalized and 302 died. After July 24, the CDC stopped counting novel H1N1 as separate flu cases.

“We are expecting increased illness during the regular flu season, because we think both the novel H1N1 and seasonal flu strains will cause illness in the population,” says Artealia Gilliard, a spokesperson for the U.S. Centers for Disease Control and Prevention (CDC) in Atlanta. “The biggest problem we are having is that there is no set number we can give for planning purposes. We can’t say go out and prepare for X percent more illness, because there is no scientifically sound way to arrive at a number.”

Another concern is that little guidance is available on how severe the novel virus will be. Gilliard notes that the World Health Organization (WHO) gave novel H1N1 the pandemic designation because of its ease of transmission, not the severity of the disease. Although the CDC expects more illness, it is not yet clear how many people will be made sick enough to be cared for by a hospitalist.

“The epidemiology of this illness and prevention issues related to this newly emerging virus are still being studied, making it very difficult to anticipate the staffing needs for the upcoming flu season,” says Irina Schiopescu, MD, a hospitalist and infectious-disease specialist at Roane Medical Center in Harriman, Tenn. “Hospitalists will be among the many front-line healthcare workers who provide direct, bedside clinical care to patients with suspected or confirmed H1N1 influenza.”

Most of the nation’s hospitals spent the summer preparing for another pandemic. Hospitalists have assessed their needs, too, and HM programs are focusing on a diverse set of concerns: prevention education for hospital-based employees, patient management updates, and expected personnel shortages.

What If a Member of My Family Gets Sick?

One of the problems that will be addressed by hospitalists this flu season will hit close to home: What should you do if your spouse or child comes down with flu? At press time, the CDC had not released guidelines on this specific subject. However, there are general guidelines for taking care of a sick person in your home. Among the CDC’s suggestions:

Keep the sick person as far away from others as is practical. The ideal situation is a bedroom or other area with its own bathroom.
Remind the sick person to cover their mouth when they cough and clean their hands with soap and water or alcohol-based hand solutions often.
Remind others to clean their hands often, as above.
Use paper towels, or dedicate cloth towels to each person, maybe by color or placement in the closet.
To the extent practical, open windows and use other methods to increase cross-ventilation within common areas.
If possible, have only one adult take direct care of the sick person. Unless there are medical reasons, that person should not be a healthcare provider.
If you or your spouse are the primary caregiver, spend the least amount of time possible with the sick person and consider wearing a surgical mask or N95 respirator. Although the guidelines are silent on the issue, a gown and gloves might be considered for additional protection.
Throw away disposable items in the regular trash.
Diligently keep surfaces clean using a household disinfectant.
Linens, eating utensils, and dishes used by the sick person do not need to be cleaned separately. The CDC suggests using regular household detergents and a hot dryer setting for linens. Utensils can be washed by hand or in a dishwasher.
Consider the use of vaccinations and prophylactic antivirals as appropriate.

Source: Centers for Disease Control and Prevention