H1N1: Here for the Duration

As the flu season heats up and the weather cools down, the media are beginning to more frequently report deaths from H1N1 influenza. Although overall influenza-related deaths are still within the expected range for this time of year, there have been 60 pediatric deaths from H1N1 reported to the CDC since April, including 11 this week, and hospitalization rates are indeed higher than normal.

In the public health arena, many of us are wondering just how the public will react to these reports and the growing numbers of children who are ill or dead. While it's true that an average of 36,000 Americans die every year from the flu, the majority of these individuals are usually elderly or otherwise compromised, and if the number of children who die continues to climb, anxiety and fear will rise proportionately.

The government claims that the H1N1 vaccine is safe, and they are urging every pregnant woman and individual between the ages of 6 months and 24 years to be immunized, among others. I have heard projections that only 20% of eligible Americans may actually elect to receive the new vaccine, but I am not certain how accurate that estimate is. When the vaccine begins rolling out to local health departments, schools, medical providers and municipalities next week, it remains to be seen how the public will respond to well-publicized offers of mass vaccination against a novel disease.

Of course, at times like these, the public can react in many ways. A small percentage feel that the government has overreacted, blowing the risks of H1N1 out of proportion. While this could potentially be the case when the book is finally closed on H1N1, there would be even greater consternation if the government underreacted and millions needlessly died. Hurricane Katrina taught a mean lesson when it comes to government negligence, and it appears that the Obama Administration does not want to repeat such a disastrous mistake at a time when the stakes are so high.

Meanwhile, other segments of the population worry and fret over every sneeze and cough, while others simply wait to be told what to do. Most, I feel, are simply watching the headlines, testing the winds with a tentative finger, and biding their time as the situation develops and changes.

So, the reports of deaths continue to roll in, cases are diagnosed daily, and the entire infrastructure of the global community itself is potentially at risk. You can wager any amount of money that massive contingency plans have been made by most every government on earth, contingency plans that focus on how crucial infrastructures can continue to function in the face of widespread illness.

Plans for continuity of operations are now being drafted by hospitals, newspapers, factories, schools, and many companies and organizations that realize the potential for massive disruption if widespread illness should visit their particular organization. Just imagine if you run a high school. What would you do if 50% of your teachers were ill, or 75% of food workers, custodians or bus drivers called in sick? Woe to those who leave their plans undrafted.

The wave of H1N1 is indeed beginning to swell, and just how powerful and far-reaching that swell will become remains to be seen. To be sure, it will be a historic flu season in many ways. Whole economies may be impacted greatly by the disease, schools may be closed, factories may lay idle, and governmental and non-governmental organizations may be crippled by absenteeism and illness. And when it comes to the children, we can only hope that the number of deaths is kept to a bare minimum in the larger scheme of things.

Facing the Unknown

The health care debate seems to be full of unknowns these days. As the arguments over health care reform heat up to the boiling point, the notion of a government-run program raises the hackles of so many people across the spectrum, and cries of socialism are heard across the land. Will our care be rationed? Will grandma be left to die when a bureaucrat decides that she has reached her life expectancy and her surgery is not cost effective based on her age? Misrepresentation and misinformation abounds.

Meanwhile, H1N1 challenges the public health infrastructure, and the availability and distribution of the vaccine poses questions that still cannot be fully answered. And as the manufacturing of that new vaccine is ramped up, seasonal flu vaccine distribution has been slowed to a veritable trickle, confounding the plans of even the most earnest local health department.

Speaking of H1N1, studies now show that many pregnant women and others eligible for the H1N1 vaccine will refuse to receive it, leaving public health officials wondering just who will want it, anyway? In our local circles, many of us are asking the following question: "If we throw an H1N1 party, will anyone come?"

H1N1: Many Questions and Stormy Days Ahead

The questions about H1N1 are coming fast and furious now, and I often don't know what to say.

Seniors feel slighted because they're lowest on the priority list for the new H1N1 vaccine. Middle-aged people who are otherwise healthy who would like the vaccine notice that they do not meet the criteria for being in the first wave of recipients, if at all. There are the many health care workers who usually don't receive a flu vaccine and are reluctant to get the H1N1 vaccine, even if it means protecting their patients from illness. Meanwhile, pregnant women are afraid to receive this newly formulated vaccine, even though they are top priority for receiving it in order to protect their gestating children, and parents of school age children are also afraid. And then there's the conspiracy theorists who feel it's all a government ploy to poison, sicken, and subjugate us.

What's an earnest Public Health Nurse to do, anyway?

The concerns, the worries, the misgivings, the fears, the suspicions---they are all rising to the surface as the flu season kicks into gear. There is certainly confusing information out there, and some of it even seems contradictory. We can rest assured that many media outlets will undoubtedly get it wrong along the way, further adding to the confusion that so many people feel.

So I answer calls, assuage fears, refer people to the most reliable websites about H1N1, and I cross my fingers that we find a qualified replacement for me before I leave my position on October 15th. It's a wild influenza world out there, and something tells me the weather's about to get rougher.

Stirrings of Nursely Guilt

Well, in a mere 6 weeks I will be saying goodbye to my work as a Public Health Nurse and hitting the open road with my wife and dog (see our new blog for details).

So, what does it mean to eschew the trappings of the workaday world and leave the workforce, at least temporarily? What does it say about someone who works in public health and chooses to step out of that role just as H1N1 begins to rear its wintry head in our very direction? How selfish am I?

As I prepare to quit my job, leave the workaday world, pack up our cares and woes, gear up the RV and launch ourselves onto the highways and byways of America, I feel stirrings of nursely guilt that I am abandoning ship just as my country needs me the most.

Sure, we could have changed our plans. We could have chosen to spend yet another frosty winter in New England, slogging through the snow to save humanity. But my wife and I are making another choice. We are choosing to catapult our lives forward in a radical way, and doing something this radical has its price, and one price that I am currently paying is the feeling that I am breaking ranks when my services are most urgently needed.

Now, I am not one to think that no one else can do my job. There are plenty of capable nurses out there, and two of them are interviewing for my position in a week or so. Still, taking leave of my job at this historical time does indeed put extra stress on our local public health infrastructure, and I am concerned that my replacement will completely miss the frying pan as she or he falls directly into the fire of H1N1 and flu season. (Oh, the guilt.)

Still, I am thankful and appreciative that my boss is so evolved and has given me her (understandably reluctant) blessings to go on my merry way. And perhaps my worries are for nothing. Will H1N1 fall flat on its face? Will the massive vaccination campaign never materialize? Will this public health juggernaut never leave the launchpad? I actually feel that the H1N1 horse has already left the gate and we are rushing headlong into what will be a pretty intense flu season, made infinitely more complicated by twin vaccination campaigns (for seasonal flu and H1N1).

May my successor accept this challenge with grace and equanimity, and may I take leave of my position without guilt or remorse. The helper and healer within me cringes at ever shirking my nursely responsibilities, and leaving this job at this time in history is one of the hardest professional decisions I have ever made.

H1N1, Fear, and the Need for Calm Vigilance

As the public health infrastructure gears up for the coming flu season and the potential resurgence of H1N1 from its summer lassitude, those of us on the front lines of that infrastructure are left with many questions.

First, as we await the first shipments of seasonal flu vaccine (which should begin arriving soon), we are faced with questions from the public about whether they are eligible for the seasonal flu vaccine, whether or not they will be able to receive the H1N1 vaccine, and how they might protect themselves against these strains of flu that threaten to sicken and perhaps kill thousands of people. We are also faced with the public relations nightmare of explaining the different criteria for the two vaccines, based on the fact that younger people are more susceptible to H1N1 infection, whereas the elderly more often succumb to seasonal flu. While there is some overlap between groups susceptible to both illnesses, a great deal of education will need to be done in order to allay fears and identify who will receive vaccinations.

Next, there are fears that schools, municipal offices, police and fire departments, hospitals and other critical services may be seriously curtailed or shut down if large numbers of employees become sickened with a virulent form of the flu. Just the other day, I attended a meeting with a number of local school officials, and weighty issues of great import were discussed at length as the group wrestled with contingency plans that may or may not come to fruition.

It is the fear of the unknown that drives the anxiety surrounding H1N1, and the potential for widespread illness and death does indeed stoke the fires of the media machine and the conspiracy theorists alike. For me, on the front lines of local public health, my job is to allay citizens' fears, prepare for a double-pronged mass vaccination campaign (for seasonal flu and H1N1), and meet with local officials and others in order to answer questions and suggest ways for citizens to be healthy and maintain a calm but alert vigilance.

This will be an interesting flu season, without a doubt, and it will only be hindsight that will inform us whether our preparations were thoughtful, wasteful, alarmist, or simply prudent.