Some events so impact us that they are etched in our memory with a time stamp of what we were doing at the time we heard the news. President Kennedy’s assassination, the Challenger disaster, Princess Diana’s death and the 9/11 terrorist attacks come to mind.
In April 2009, I was on vacation when my cell phone started ringing with alerts from the Department of Health. When I turned on the television, all the channels were abuzz with the new “swine flu” sweeping across Mexico.
As the lead agency in health emergencies, the Tacoma–Pierce County Health Department swung into action. The H1N1 pandemic response is an example of how we deal with immediate, ongoing and potential threats using assessment, policy development and assurance.
For years, we have planned and practiced for potential threats like a pandemic flu. We immediately began disease surveillance to assess the behavior and impact of this virus. We distributed timely and accurate information and began public education activities. We implemented necessary policies from our written plans and developed new ones as we learned more about the evolving threat.
Perhaps we do not always adequately communicate the logic behind our plans, but every intervention is based on science, national recommendations and local data and needs.
Why close schools early in an outbreak? Ask parents with young children, and they know what public health does: Children easily get sick with the flu and upper respiratory infections, quickly share it with others and spread it to adults. Especially with a new virus to which there is no immunity and no cure, it is important to reduce and delay infections.
Why keep repeating “Wash your hands, cover your cough and stay home when you are sick”? Because those steps are effective in reducing the spread of flu. Similarly, ensuring health care providers have masks and the antiviral drug Tamiflu help limit the sick from infecting others.
We continuously review information and fine-tune our approach. When surveillance found the H1N1 virus spread rapidly but was not as severe as the 1918 flu or the “bird flu” assumptions we planned for, we adjusted course. We stopped recommending school closures.
When we found that H1N1 was more severely striking the young, pregnant and those with chronic medical conditions while relatively sparing the elderly, we started planning how to deliver vaccine to those target groups.
Two weeks ago, faced with the reality that only 13 percent of our allocated vaccine doses had arrived and that we could not vaccinate the half million citizens of Pierce County in these target groups, I made the decision to focus on those at highest risk — the nationally recommended “subset of target groups.” As soon as the subset groups are adequately covered, we will return to vaccinating the larger target groups. Once they are adequately covered, we will make vaccine available to all who want it.
Public health agencies cannot do the job alone. Whether H1N1, flooding or other emergency, we are always working closely with the Department of Emergency Management and other governmental agencies. In the spring, schools were valuable partners in helping monitor illness in students, planning for the worst and getting educational messages to the community. Now, schools, hospitals, medical providers and pharmacies are getting vaccine to those who need it. The media have been key in delivering accurate and reassuring information.
I also want to thank the citizens of Pierce County for being wonderful partners. I am encouraged that many parents have embraced the message that vaccination, whether for seasonal or H1N1 flu, is the most effective way to protect their children and families. I appreciate everyone’s patience.
I know many are concerned about the slow availability of vaccine but are letting those who need it most be first in line. In addition, many – through the Medical Reserve Corps and other capacities – have volunteered to plan and run vaccination clinics.
We will continue to do our best to evaluate the situation and make sure whatever vaccine we have gets to those who need it. While many of you have already heard us, we will be repeating the same messages to “Wash your hands, cover your cough, and stay home when you are sick.” Of course, we will continue doing all the other things we do daily as part of our mission: “To protect and enhance the health of the communities of Pierce County.”
Anthony L-T Chen, M.D., is the director of the Tacoma–Pierce County Health Department.
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