Hospitals brace for flu outbreak

Flu season has struck California unusually early this year, which means the state’s emergency rooms could be overflowing during the Christmas and New Year’s holidays.

There’s still time to get a flu shot and avoid the prospect of a feverish, achy Christmas. Because it takes a couple of weeks to get maximum immunity after receiving the shot, it’s important to be vaccinated by the second week in December, if not sooner.

California is among 40 states where flu cases have been reported. So far, hospitals and doctors report that the flu is hitting children the hardest. Confirmed flu cases have increased in the last couple of weeks, particularly in Central California, and prescriptions for antiviral medications are up in Northern and Central California, according to the state Department of Health Services.

State and local health officials are concerned that the start of the 2003-04 season is reminiscent of 1997-98, when emergency rooms throughout the state were overwhelmed during Christmas and New Year’s.

Officials are studying how the more than 300 hospitals that handle emergency and acute-care patients would handle an onslaught of influenza patients, said Dr. Howard Backer, acting chief of the state health department’s immunization branch. Hospital administrators, he said, face difficult staffing issues because many workers already have planned to be off on vacation.

Even before the flu season peaks, hospital emergency departments throughout California are diverting ambulances daily to cope with severe overcrowding.

Getting more people vaccinated would limit transmission and “could make the difference between the whole system collapsing or not,” said Dr. Russell Kino, director of the emergency department at Saint John’s Health Center in Santa Monica.

Dr. Brian Johnston, an emergency room doctor at White Memorial Medical Center in East Los Angeles, said he was worried about unvaccinated emergency department workers becoming infected and transmitting flu to frail, hospitalized patients. Another concern: Flu season usually coincides with increased rates of respiratory syncytial virus, a major cause of respiratory illnesses in children, which could further complicate the crunch.

So far, the predominant flu strain reported around the country is Type-A Fujian, which is slightly different from Type-A Panama, one of three strains that this year’s vaccine was designed to prevent. The national Centers for Disease Control and Prevention said this year’s flu shots and nasal vaccine formulations should prevent most cases of the new strain, although some vaccinated people probably would become infected. For those who get the flu, the vaccine should lessen its severity.

Among healthy adults, the vaccine typically is 90% effective in preventing infections with anticipated flu strains; that figure falls with age and chronic illness, down to 30% to 40% among frail nursing home patients.

At the very least, this year’s vaccine should keep them alive and out of intensive care, doctors say.

“What we know is that if it doesn’t protect entirely, it will at least mitigate the illness,” Backer said.