Doctors call flu season `potential catastrophe'
By Barbara Feder Ostrov
Mercury News
Emergency room doctors meeting in San Francisco warned Monday of patient deaths and packed emergency rooms if hospitals do not gear up fast for a winter marked by the worst flu vaccine shortage the country has ever seen.
On the same day, U.S. Health and Human Services Secretary Tommy Thompson told seniors to ``relax'' and stop waiting in long lines for flu shots. He assured them that the vaccine will be redirected to regions where it is most needed.
The conflicting messages came as seven states, including California, began reporting sporadic cases of influenza, according to the U.S. Centers for Disease Control.
Doctors at the American College of Emergency Physicians annual convention in San Francisco painted a bleak picture, calling this year's flu season ``a potential catastrophe'' even though it is unclear how serious it will be.
``I worry that they are trying to avoid panic rather than leveling with the American public,'' said Dr. Ellen Weber, referring to the federal government. The medical director of the emergency department at University of California-San Francisco Medical Center said emergency staffers have been asked to find flu shots on their own because the center only has enough flu vaccine to immunize its highest-risk patients.
The emergency doctors group called for hospitals to add emergency room doctors and nurses, make sure they receive flu shots, and even postpone elective admissions if they are inundated with flu patients, among other measures. They also called for more federal and state money for emergency room care, and urged federal health officials to hold a flu crisis summit to plan for the worst.
Federal officials said such a summit is not needed and lambasted the doctors group for frightening the public.
``Having a meeting isn't going to solve this problem,'' said Tony Jewell, Health and Human Services spokesman, noting that the department is working with public health agencies daily. Jewell said the government is calling for people to remain calm -- and ``that would include emergency room physicians.''
``Doctors are going to play a major role in meeting this public health challenge, and scaring people is not the way to do it,'' he said.
The United States will receive only about half its usual supply of flu vaccine because of widespread contamination of vaccine produced by one of the country's two major flu shot manufacturers, Emeryville-based Chiron.
Health experts worry that even those who need the vaccine most will not receive it, and seniors have confronted hours-long waits for their immunizations. About 36,000 Americans die every year from the flu, and 226,000 are hospitalized. The elderly and chronically ill are at highest risk for serious complications and death.
The vaccine shortage has become an issue in the presidential campaign, with Sen. John Kerry calling for, among other measures, a public buyback of surplus vaccine and creation of a national reserve of flu vaccine.
Some of the measures the emergency doctors called for will be particularly difficult in Santa Clara County, already coping with the loss of the emergency room at San Jose Medical Center. The hospital is expected to close Dec. 9, as flu cases in California begin to increase.
Bob Sillen, executive director of the county-run Santa Clara Valley Health and Hospital System, said the county's top priority is to absorb the 32,000 patients served each year by San Jose Medical Center, while still recognizing the effect of the vaccine shortage. ``It's about all we're going to be able to do,'' he said.
Dr. Elaine Nelson, medical director of the emergency departments at sister hospitals San Jose Medical Center and Regional Medical Center of San Jose, said Regional will add five beds to the 24 in its emergency room. Regional's ER staffing also will jump by 50 percent to 75 percent, with most of those new doctors and nurses transferring from San Jose Medical Center after it closes, she said.
While the measures were taken to respond to the closing of San Jose Medical Center, they will help Regional accommodate a potential crush of flu patients, Nelson said. Regional treats about 47,000 emergency room patients each year. Nelson said the hospital is ready to postpone elective admissions if necessary. Regional also plans to open a seven-bed urgent care clinic close to its emergency room.
But Regional and San Jose Medical Center may have trouble immunizing their emergency room workers because the hospitals ordered their vaccine from Chiron. The hospitals are expected to receive 70 to 90 doses each of FluMist, an adult nasal vaccine made by another manufacturer. But it may not be enough for all the emergency workers.
Kaiser Permanente ordered its flu vaccine from another manufacturer, Aventis, but received only half its supply. Immunizing emergency room staff and other hospital workers is a top priority, said Dr. Roger Baxter, who oversees Kaiser's flu vaccine program in Northern California.
Typically, patients with flu or flu-like illnesses account for 4 percent of Kaiser hospital admissions, rising to as much as 15 percent in a bad flu season, Baxter said.
Kaiser is prepared to bolster staffing and beds in its emergency rooms, he said, but officials want to see how bad the flu season is first.
Baxter said he supports the emergency physicians' efforts to improve hospital readiness but suggested taking the group's alarming predictions with a grain of salt -- at least until doctors can see how this year's flu season takes shape.
``Really bad things can happen -- that's the way emergency room doctors see the world,'' Baxter said. ``I'm just not sure that saying this to the public right now is so helpful. People are already worried.''