Preparing for a Pandemic, State Health Departments Struggle With Rationing Decisions

Saturday, October 24th, 2009 -- 10:38 pm

New York state health officials recently laid out this wrenching scenario for a small group of medical professionals from New York-Presbyterian Hospital:

A 32-year-old man with cystic fibrosis is rushed to the hospital with appendicitis in the midst of a worsening pandemic caused by the H1N1 flu virus, which has mutated into a more deadly form. The man is awaiting a lung transplant and brought with him the mechanical ventilator that helps him breathe.

New York’s governor has declared a state of emergency and hospitals are following the state’s pandemic ventilator allocation plan -- actual guidelines drafted in 2007 that are now being revisited. The plan aims to direct ventilators to those with the best chances of survival in a severe, 1918-like flu pandemic where tens of thousands develop life-threatening pneumonia.

Because the man’s end-stage lung disease caused by his cystic fibrosis is among a list of medical conditions associated with high mortality, the guidelines would bar the man from using a ventilator in a hospital, even though he is, unlike many with his illness, stable, in good condition, and not close to death. If the hospital admits him, the guidelines call for the machine that keeps him alive to be given to someone else.

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Frustration looms as H1N1 vaccines run out
Elizabeth Landau, CNN
October 24, 2009 -- Updated 1850 GMT (0250 HKT)

Yessica Maher of Los Angeles, California, feels let down. She had wanted to get the H1N1 vaccine for herself and her children, but that's proving to be difficult.Her doctor is out of the vaccine, and so is the pediatrician. Her two older sons were not eligible for the nasal spray version because of asthma, and she was told the shot would not become available until perhaps November. Her youngest son, 2, goes to a preschool where there was recently a diagnosis of H1N1.

"I feel that the government and health officials, they knew this was big when it first started, they know the size of our population before it started, and they didn't make leaps and bounds to make sure it was available to everyone when they would need it," she said. "It shouldn't be a supply-and-demand thing."

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Posted: 27 October 2009 1222 hrs

WASHINGTON: The United States will face a H1N1 flu vaccine shortfall of 45 to 55 million doses by the end of the year but half of the population could still be vaccinated, a senior US official said Monday.

"I don't think we will get to the original goal" of 195 million influenza A(H1N1) vaccine doses delivered during the US government's fall vaccination campaign, said Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases.

But he tempered that the government may obtain 140 to 150 million doses, "which quite frankly I think will likely be enough because we don't anticipate more than half of the people want to get vaccinated.

"If we get to 150 million, we will likely have as much as anybody needs," Fauci told AFP.

As of Friday, 16.1 million doses of H1N1 flu vaccine were ready for shipping, and over 11 million doses had been sent out to state health authorities.

Health Secretary Kathleen Sebelius has already warned that demand is outstripping supply of vaccine for the novel flu strain, as 46 of the 50 states now report widespread A(H1N1) activity at an unusually early time of the year.

"What we have seen in the US is a significant dichotomy or gap between the demand and the supply," warned Fauci.

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Officials Say Male Cat in Iowa is First to Catch H1N1
By LAUREN COX
ABC News Medical Unit
Nov. 5, 2009—

An unidentified male cat in Iowa is believed to be the first in the nation diagnosed with the H1N1 virus, sparking concerns that pets may transmit the swine flu or that frightened pet owners may abandon their cats in droves.

The 13-year-old, mixed-breed cat showed the symptoms of lethargy, sneezing and coughing typical to sick cats. He was brought last week to Lloyd Veterinary Medical Center at Iowa State University's College of Veterinary Medicine, where it was confirmed he had the H1N1 virus.

Veterinarians refused to release his identity and would not divulge the coat color or any other identifying characteristics to protect client-veterinarian privacy. One veterinarian who treated the cat, Brett Sponseller, said two people in the cat's Iowa home had flu-like symptoms before he became ill.

Officials at the Iowa Department of Public Health released the unnamed cat's diagnosis Wednesday.

"In this particular instance, the cat was treated for its dehydration with fluid therapy and also treated with antibiotics upon the results of testing," said Albert Jergens, professor of internal medicine at Iowa State University.

"The cat has been on therapy now for approximately seven days," he said. "I think the prognosis on this cat for a full recovery is excellent."

This is the first known transmission of influenza from a person to a cat, an expert at the Centers for Disease and Control told ABC News senior medical editor Dr. Richard Besser.

The expert, Dr. Carolyn Bridges, who is the associate director of Science in Influenza at the CDC in Atlanta, said flu viruses tend to stick to one species or another but the case of the Iowa cat shows the ability of the flu to cross species.

In light of the news, some veterinarians are worried about the well-being of other cats across the nation; whether the cats contract the H1N1 virus.

"This could be a thing that just fizzles out but it also has the potential for huge impact," said Tony Johnson, a clinical assistant professor at the Purdue University School of Veterinary Medicine. "We have these little fuzzy things living in our house that could be vectors for nasty diseases."

Johnson isn't so worried that cats will spread the flu to humans: "Most influenza viruses are not going to kill you," he said.

Rather, he worries cat owners might abandon their animals at the first sign of a sniffle.

"I think that's what's going to wig people out," Johnson said. "I don't want to see the shelters filled with cats and dogs tomorrow."

Veterinarians have long heard of the flu jumping from animals to humans, and some cases of pets to humans. But it's uncommon for a flu virus to jump from a human to a cat.

Has Human to Pet Transfer Happened With Other Flu Viruses?

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By Sebastian Smith (AFP) – 10 hours ago

NEW YORK — News that US swine flu vaccines, meant to be prioritized for the nation's most vulnerable, are being distributed to Wall Street firms such as Goldman Sachs, have sparked uproar.

The New York Department of Health said Citigroup, Goldman Sachs and Morgan Stanley have applied for supplies of the H1N1 vaccine and are eligible because they are large employers with in-house clinics.

With H1N1 vaccines often scarce and populist anger already raging at Wall Street for last year's financial meltdown, the news triggered furor.

Anna Burger, secretary-treasurer for the largest US healthcare union, the SEIU, said it was "obscene" that powerful and wealthy private organizations got vaccines when "at-risk Americans are either waiting in line for hours or getting turned away."

"Last time I checked, the Centers for Disease Control and Prevention have not prioritized Goldman Sachs CEO Lloyd Blankfein and other Wall Street executives over the rest of America," Burger said.

Democratic Senator Chris Dodd, from Connecticut, said he was "stunned."

"It is shocking to think that private firms would be prioritized ahead of hospitals when the vaccine supply cannot meet the demand," he wrote in a letter to US Secretary of Health Kathleen Sebelius.

New York City's health authorities said critics had got their facts wrong.

Banks, as well as two universities in New York, were allowed to make orders because they had their own health clinics and there was enough vaccine to go round, city health spokeswoman Jessica Scaperotti told AFP.

Vaccines won't be given to just any employee, but those falling into official at-risk categories, for example, pregnant women, health care workers, and people with chronic medical conditions, Scaperotti said.

"What they (critics) have to realize is that all providers who order H1N1 vaccine -- whether it be a hospital or an employee health service -- they have to agree that they'll only administer the vaccine to people in at-risk groups," she said.

So far, Citigroup has requested 2,200 vaccines and received 1,200, health department figures show. Goldman Sachs requested 5,400 vaccines and has received 200. Morgan Stanley, which requested 1,500, has not yet received any.

Giant media corporation Time Warner requested 2,000 and has received so far 100.

Scaperotti said 50 employee health clinics in the city had received vaccines. "As more becomes available we expanded that group to include providers that serve adults both in private practice and community settings."

Nevertheless, the row fueled anti-banker sentiment at a time when Americans are struggling with nearly 10 percent unemployment and tight credit -- even as Wall Street stock prices and employee bonuses surge back.

Melanie Sloan, executive director at the activists group Citizens for Responsibility and Ethics (CREW) in Washington scornfully questioned the logic of declaring bank staff at risk.

She said CREW had been "unable to uncover the demographic makeup" of the banks in question, but "it seems safe to assume the vast majority of their employees are not pregnant women, infants and children, young adults up to 24 years old, and healthcare workers."

Scaperotti said the anger was misplaced because vaccines were simply issued to those who asked as and when the supplies became available.

She said that large companies were ideal targets for preventing the spread of flu. "Employee health clinics are a great avenue for vaccines," she said.