What a difference a few days makes.
Last week, schools attended by children with probable H1N1 (swine) flu cases were shutting down in Chicago and in the surrounding suburbs. Hospital administrators were insisting on daily temperatures checks on all their employees, and sending home any employee who had an elevated temperature. Public officials were telling us to cover our mouths, wash our hands, and stay home if we felt sick. As new flu cases wane and the news cycle shifts from deadly viruses and pictures of masses of Mexican citizens wearing masks on the subway to Justice Souter's retirement announcement, it's natural to ask: was this response appropriate or over the top?
Personally, I think the response might be best described as a dry run for a potentially much deadlier infectious disease outbreak. And I think the city gets pretty high marks on that score.
I work as an internal medicine doctor at a community health center, and since last week, we have a reasonably good plan in place to respond to the H1N1 emergency. Our front-desk staff knows which questions to ask in patients in English or Spanish, and to alert our nurses to potential flu cases. They know that patients who come in looking ill or complaining of fevers must immediately put on a mask. Our medical assistants know that they must check vital signs and ask detailed histories, and our nurses know that patients with certain risk factors should be immediately placed in isolation, and referred to me or to the other practitioners. I know what steps I need to take to test potential flu and treat potential flu patients and their close contacts. The plans that local, state and federal officials have been developing for years seem to be working fairly well. If we ever face a pandemic, we should be able to save a lot of lives.
I have been following the stepped up federal disaster planning that started after the anthrax attacks in 2001. Both the 9-11 attacks and the bioterrorism that followed turned disaster planning on its head and demonstrated to the federal government and to the American public that our country really needed to be prepared for biological warfare. Dr. Julie Gerberding, the former Director of the Centers for Disease Control (CDC), developed a plan to prepare the nation for just about any outbreak, whether brought on by terrorists or spontaneous, as in the case of a flu epidemic. The CDC has worked hard to stockpile medication, IV fluids and other essential treatment items that can be mobilized and flown to any city in the country in the case of, say, a smallpox outbreak. Cities, including Chicago and its 'Dark Winter' exercise of a few years ago, held mock disaster drills. Municipal health departments like the one for which I work engaged in massive planning exercises to prepare for outbreaks and germ warfare. Medical journals and organizations such as the CDC disseminated information to the medical public and the general public in print and online on how to prepare for outbreaks and germ warfare. With the exception of the Katrina disaster, I think we have done a commendable job becoming prepared to face almost any public health emergency.
That might be why the flu is fading from the news. It may get worse again this week, but hopefully closing schools kept more kids from getting sick, hand washing and wearing masks stopped the flu in its tracks, and stepped-up hospital scrutiny of employees mostly reminded people that they should call in sick if they are.
And this flu got us ready to face the next public health disaster. Because the irony of good public health planning is that if it works, you might not know you needed it.