- The Washington Times - Wednesday, January 9, 2013

Virginia hospital visitors were urged by health care advocates Wednesday to wear masks in an effort to protect against a widespread and severe outbreak of flu rapidly spreading across the country.

More than two dozen hospitals, medical facilities and urgent-care centers in the Hampton Roads area announced changes to their visitation policies that also include restrictions on visitors younger than 18 years old, since youth are more susceptible to the severe H1N1 flu strain.

“Our goal as health care providers is to use every available means to protect our patients from exposure to outside infections,” officials said. “This visitation change comes at a time when the pandemic H1N1 virus is already widespread and increasing well before seasonal flu typically hits our region.”

Officials said the changes would remain in effect through the flu season.

The Virginia move came as a Philadelphia hospital opened a triage tent to treat the large number of people reporting flu-like symptoms and several Chicago hospitals have closed their emergency rooms because they are over capacity. The response to the early and severe onset of the flu, which is rapidly moving across the country and is responsible for at least a dozen deaths, is raising questions about response capabilities both locally and nationally to a potential widespread outbreak.

The Lehigh Valley Hospital-Cedar Crest in Allentown, Pa., erected a “surge” tent on Monday, and the white canvas shelter opened for business Tuesday, said Terry Burger, the hospital’s director for infection control and prevention.

“We are seeing a large volume of patients coming in with flu-like illness. To say we are seeing a large number of patients in the emergency department is absolutely correct,” said Ms. Burger, a registered nurse. “This was our attempt to be proactive, to make sure we’re seeing traumas, heart attacks, strokes, to keep our doors open and try not to have people wrapped around the corner,”

Emergency rooms, urgent care centers and doctors offices all have reported an uptick in cases as the nation suffers the earliest flu season in a decade.

The Centers for Disease Control and Prevention late last month reported that the 2012-13 flu season was shaping up to be an early and severe year. Normally beginning to peak around Christmas or New Year’s Day, doctors reported treating patients with flu-like symptoms as early as Thanksgiving. This particular strain of flu is H2N3, the same type that prompted an early start during the 2003-04 season, CDC officials said, and tends to be more severe.

Melaney Arnold, a spokeswoman for the Illinois Department of Public Health, said that for the first week of January, Illinois had 24 hospitals on “bypass status,” compared to the seven hospitals reported last year. Tuesday alone, 11 hospitals reported being on bypass status.

Bypass status, Ms. Arnold explained, is when a hospital will refer incoming patients to another emergency room, provided their ailments are not critical. Most of the hospitals on bypass this past week are in the Chicago area, Ms. Arnold said.

The hospitals are working “very diligently,” she said, “but if you have a 10-pound bag of flour, only 10 pounds will fit in there.”

In October through December, 147 people with flu-like symptoms were admitted to Illinois intensive care units, Ms. Arnold said, compared to two people admitted during the same time last year.

“It shows there is a severe strain, which matches the rest of the country,” Ms. Arnold said.

The CDC in its most recent report stated that 31 states, including Virginia, were suffering from widespread illness and said 18 pediatric deaths — the only type of flu deaths the agency tracks — had been attributed to the flu.

Dr. Kathleen Parente of Pediatric Associates of Alexandria said her office has seen “a lot” of patients with symptoms.

“At least half are coming up positive, but a lot of kids have had the vaccine,” she said. “It’s a bit disconcerting.”

CDC officials said more than 120 million doses of the vaccine are available, and it prevents illness in about 70 percent of healthy people. Often people who have had the shot but contract the flu anyway have milder symptoms, officials said. But people can fall ill to a strain that the vaccine does not cover or could come into contact with the illness in the few weeks between the time they get the vaccine and the time it takes effect, officials said.

Dr. Parente said her office doesn’t normally see big flu numbers until late January or early February, but this year’s uptick has prompted doctors at the practice to host a flu clinic, where children can get a flu vaccine without an appointment.

Laurel Regional Hospital in Prince George’s County is holding its own flu clinic, and the Prince George’s Hospital Center also is planning a clinic to combat the increasing numbers of flu sufferers.

Erika Murray, a spokeswoman with Dimensions Healthcare System, which oversees three Prince George’s County hospitals, said the trio of health centers have all seen an increase in flu reports, though not to the extent that a triage tent is needed.

“We either bring in additional staff or hold over staff due to volume,” Ms. Murray said of the hospital’s contingency plan.

At George Washington University Hospital in the District, Dr. Tenagne Haile-Mariam, an emergency medicine specialist, said “we’re equipped for everything to happen.”

“We have a surge capacity plan to accommodate for any time when it looks like we’re going to need more resources for the number of patients that we’re going to be seeing,” she said. “Within the system we try to free up beds in the hospital, we try to free up beds in the emergency room. We have a system where we recruit other spaces and personnel with surges.”

The key to being ready, Dr. Haile-Mariam said, is to expect an annual uptick in influenza-like illnesses.

“We know this is a disease that spans a big part of the calendar,” she said. A sign at the entrance to the emergency room prompts patients to self-report if they have any symptoms associated with the flu, such as a high fever, body aches and headaches. If so, the person is asked to wear a mask.

Tony Raker, spokesman for the Inova Health System, said the hospitals and urgent care centers in Northern Virginia are all prepared for the deluge of flu patients.

“Everyone is seeing an uptick,” Mr. Raker said. “Triage at the emergency department is very important.”

Short of providing over-the-counter medicine, the hospitals and walk-in centers cannot do much more if a patient isn’t a young child, a pregnant woman, or a senior citizen — the three categories most susceptible to serious flu-related illness.

“We do case management within the hospitals themselves,” Mr. Raker said. “Those patients ready to go home free up beds that are necessary, but we always have certain areas to open up for additional patients.”

The five hospitals within the system were handling upticks very well, Mr. Raker said Tuesday, adding that “we anticipate the flu season all year round.

“This is very much like anything else we deal with. It’s like inclement weather — a sooner-or-later we’re gonna get it type thing.”