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Discussion: H1N1 Flu in Iowa

posted on October 22, 2009 at 5:42 PM

Prevention is a first step in the fight against H1N1.  But the best prevention techniques aren’t always enough to stop children from getting sick.  To discuss the many issues surrounding H1N1, we have three guests joining us at the Iowa Journal table. 

They are Rebecca Curtiss, Bureau Chief for the Center for Disaster Operations and Response at the Iowa Department of Public Health, Dione Somerville, Dean of Students at Iowa State University in Ames and Jami Haberl, Executive Director for Safeguard Iowa Partnership, a statewide disaster management coalition of businesses and government leaders.

Yeager: Ladies, thank you very much for coming in to discuss this issue. We have a lot to get to, so let's start with you, Rebecca. From the public health sense, let's talk about the schools -- the public schools first. Are schools very disrupted by H1N1, the flu, illnesses right now?

Curtiss: We continue to see increases in the number of absenteeisms. The schools are required to report more than a 10-percent absentee rate on a weekly basis to public health agencies. Three weeks ago we had about 100 schools. Last week 200 schools reporting over 10 percent, and this week that number continues to increase.

Yeager: And how many schools do we have? I guess I don't know. Is that 400? Are we halfway there?

Curtiss: There are over 300 schools in --

Yeager: So we're more than halfway there that have 10-percent absenteeism rate.

Curtiss: Yes.

Yeager: So you're very well aware of that. You were telling me there's a conference call that goes on. So how do you maintain a follow up on what's going on in schools?

Curtiss: We have the surveillance. We have the sentinel surveillance and then the schools are required to report more than the 10-percent absenteeism. So we keep a pretty close view on where those schools are. And then we can look very closely at what that disease -- at what those outbreaks are in that part of the state.

Yeager: And you can find out -- kind of map it, I'm guessing.

Curtiss: Absolutely.

Yeager: All right, go from there. All right, Jami, you deal a lot with business. And we go from the schools to the businesses and we've got -- I know co-workers of mine are out. Co-workers of everybody's are out right now. What are some of those -- what's the large -- is there a large work force absenteeism going on right now?

Haberl: You know, we don't really know if there's a large work force absenteeism because we don't do the sentinel type of surveillance like we do with the school districts and some of our hospitals, but we definitely are seeing some of the employers being impacted because children are out, whether it's through the day care or through the school system, and then themselves are getting sick as well. So we definitely are seeing some of an impact. We just don't have the numbers like we do through the school surveillance that we're -- you know, that the Iowa Department of Public Health is conducting.

Yeager: Now, this is something that we went through in March and April, kind of like a dry run of sorts. What has changed in plans -- contingency plans for businesses since this last outbreak to the current outbreak we have?

Haberl: We recently had a lot of opportunities to learn from the disease -- or the outbreak that we had earlier this year. A lot of people were able to test their plan, and there were of a lot of assumptions in those plans that actually were inaccurate, you know. so a lot of the companies that have been spending the summertime gearing up for what may happen over the upcoming fall and winter months as it relates to the influenza and looking at their hr policies, what can they do to ensure that their employees can stay home when they are sick or if they have ill family members they need to care for and then even making sure that they have supplies available for their employees as it relates to having hand sanitizers available, making sure that they're cleaning their facilities frequently, and also making sure that their plans are just updated and communicated with their employees.

Yeager: So it's just like it would be if it was a school but it's a workplace.

Haberl: Correct.

Yeager: Well, let's go back to another school. Dione, let's talk about campuses. I know Luther had an issue. They were one of the first schools to have the report, a smaller school. But on a large school, how is Iowa State faring?

Somerville: We're doing well. We actually had an opportunity to do exactly some of what Jami mentioned where when we had a confirmed case back when we were talking about confirmed suspected, we had an opportunity to test our plan and to look at the assumptions and revise those over the summer. So now that we are in the school year, we are seeing a rise in H1N1 cases. We don't have the ability to say this is exactly how many students or exactly how many employees are ill on our campus; however, we do use a variety of indicators. With us having a full-service health center on campus, our health center does participate in the surveillance project. And also in addition to that, they track flu-like illness. So we've had as many as one student a week report flu-like illness to 98. And so it just varies.

Yeager: Wow.

Somerville: But when you consider we're a campus of almost 28,000 students, you know, we can say wow and I can tell you that when we had 98 it was 12.5 percent of the students who went to the health center that week. But again, 98 out of 28,000 that we know of, we're looking at something that's on the rise that we want to continue to watch but that isn't yet at a level where it's of alarm to us.

Yeager: What were some of the things that you changed from last spring to this fall?

Somerville: Well, some of the assumptions in our plan were very much based on avian influenza, so we wanted to make sure that we were adjusting for more of a recuperate, more of a what do we do to prevent, things of that nature rather than this is absolutely catastrophic and we would have to look at more drastic measures. So a lot of effort has gone into prevention, into communicating with students and employees, what to do if you're ill, what to do if you notice a student in your class who is ill, what you some measures that you can take in terms of contingency planning. And especially with our students, with so many of them being in that vulnerable age group not only for H1N1 but where many of them really believe that they're invincible, how do we get a message across to them to where they understand.

Yeager: A college kid feeling invincible, that's never changed, has it. Let's talk about -- we're talking about information, severity. How severe is this right now? Do we know this is a more severe outbreak? Is this the most severe we've had in Iowa?

Curtiss: Well, there's not a lot of comparison between seasonal influenza and H1N1. So as far as an h1 severity of illness, this is the most we've ever seen, you know, compared to the last six months or the outbreak that we had in the spring. So the differences are not -- there really isn't a lot of comparison between seasonal and H1N1. The differences are that this is a novel virus, so it is acting atypically from seasonal influenza where the younger population are getting ill. And then it's also happening in October where seasonal influenza doesn't usually hit Iowa till December and peak until February. So we do expect that it will continue through the whole -- the winter months.

Yeager: Well, you just went in. So we are thinking this is not going to be one and done but this might be a cycle?

Curtiss: It might be. It very well could be. And H1N1 probably won't go away, but what will happen is next year the seasonal influenza vaccine will contain the H1N1 virus.

Yeager: And what is in exactly the vaccine, though, that's coming right now? We saw at the fairgrounds, at least in central Iowa, there was a long line. There's been other lines at other health departments. What is in that vaccine that people are getting right now?

Curtiss: H1 --

Yeager: Well, I know there's two.

Curtiss: I'm not sure --

Yeager: Well, there are two but let's explain what the two are.

Curtiss: Okay. There's the seasonal influenza vaccine, which is available at your doctors office, your pharmacies, commercially available. The H1N1 vaccine is only available through local public health agencies and health care providers that the local public health agencies have designated.

Yeager: And that's something that who should get?

Curtiss: There's a list of five priority groups right now. Since we do have very limited vaccine at this point: pregnant women, children six months to four years of age, caretakers of children under six months of age, health care workers with direct contact with people that are at risk of having the H1N1, and those individuals that are -- of any other age that are immuno-compromised or have other chronic illness.

Yeager: What about -- there's always a concern about some vaccines. Are you hearing discussions of I'm not getting the vaccine because of -- for whatever reason? Are you hearing concerns about people not wanting to get the vaccine?

Curtiss: At this point we are hearing that we're getting the vaccine out as quick as we can, and there's not enough to go around. People are continuing to wait in line for it. The vaccine itself is manufactured in the same way that the seasonal influenza is manufactured every year. Made by the same companies in the same formulation. It is safe and it is effective.

Yeager: On campus have there been lines as well or people saying, no, I don't want one either? I mean what's the makeup at Iowa State?

Somerville: The seasonal flu clinics have gotten a good response, both for employees and for students. Our first H1N1 clinic is this Saturday.

Yeager: Okay, okay. And are you expecting a big crowd?

Somerville: We're hoping to have a good crowd.

Yeager: That's a good sign, right, for what you're saying?

Somerville: Mm-hmm.

Yeager: Let's talk a little bit more about work. Jami, you did kind of briefly touch on it. Are we having discussions about employers that if they do need -- if employees need to be out that may be part time or don't have sick leave -- I think the number is somewhere around -- according to the labor department, 34 percent of U.S. workers do not have paid sick leave. Is that similar numbers in Iowa?

Haberl: Yeah. You know, that is a concern obviously because we want to make sure that we're following the public health recommendations that people do stay home when they're ill. One of the things that we've been doing is working with businesses to make sure that they are looking at their policies, that they are trying to accommodate and follow the public health recommendations. It is a challenge for part-time workers or even full-time workers that have limited sick leave or even the hourly employees. So I think making sure that you have talked with your employer and you understand what their policies are is going to be critical. And I think you'll be surprised. A lot of those employers, they don't want you to come to work either because they don't want the rest of their staff to get ill. So I think we're very fortunate that people are being flexible and making sure that we are following the public health recommendations. It's just most important to talk to your employer, find out what the policy is there, and I think you'll be quite surprised that they will be quite flexible.

Yeager: Has an illness like this helped your organization have dialogue with business leaders because of the severity of what's happening? Are you able to get in and say we need to have these discussions because -- are you getting in the door to talk to employers?

Haberl: Yes. You know, last summer's floods was probably another great example of another type of disaster to really bring to light the situation that we do need to be prepared for any type of disaster. A public health emergency is a little bit different than dealing with a flood or a tornado, so this has definitely brought some different assumptions up. There's also been different discussions with different people that we don't typically talk with when we're dealing with, you know, tornadoes or other types of natural disasters. So unfortunately, yes, these type of events are helping our organization make sure we're meeting our mission, because a lot of times we don't want to think about disasters and we don't want to think about impacts on our employment but, unfortunately, they do happen, as we've seen in the last two years.

Yeager: Seeing the way that goes. Rebecca, I want to ask you something. This is a viewer interaction we had through our Twitter feed that someone had asked. They wanted to know exactly -- and we'll get into myth busting later, about some of your favorite myths. But someone just wants to know basic, how is H1N1 spread?

Curtiss: Just like seasonal influenza. If someone coughs on you, and that virus is spread then through that droplet method. It also can be spread by touching surfaces such as doorknobs and then touching your nose, your eyes, or your mouth.

Yeager: So there's no difference really in the two. It's the same. It's not if I touch it with two hands -- you know, that's one of those myths that you can knock out of the park right now. Is there prevention that we can do beside the three C's? What are the three C's first, and are there prevention things we can do besides those?


Curtiss: The three C's are cover your cough; contain yourself, if you're sick, stay at home; and the third C is to clean your hands. Those are the most basic prevention methods for any influenza, whether it be seasonal or H1N1. And then finally get vaccinated when it's appropriate. When that -- if you fall into that priority group or when we get in that vaccine to vaccinate the general public, get the vaccine.

Yeager: Okay. Jami, I want to ask you a little bit more on a -- I don't know if emergency is the proper term, but are you prepared in dealing with the public health department -- I mean you're a former health department employee so you know kind of how some of what their discussions are. But when you're discussing emergency disaster plans, are you thinking this is going to get more widespread and it's going to impact more businesses and we're not through the woods yet on this?

Haberl: Well, I definitely don't think we're through the woods yet because, as Rebecca said, our peak season isn't until February, so we're early in the seasonal and the H1N1, I think, season. So it will have an impact on employment and our employers in the state of Iowa as well as across the United States. So gearing up and preparing for it now is very important so that as we do see an increase in more people getting sick that they actually are prepared to handle -- and making sure that they can function as an organization and that it doesn't cause them any type of delay whether they're a manufacturing company, a florist to, you know, a large insurance company. We want to make sure that they can continue to operate, just like we do during any type of disaster. Businesses are very important to our community and our economy, and we want to make sure that they can continue to operate.

Yeager: We need people working and doing services. We also need people going to class because they're paying so much to go to school, but we don't have professors at the door with a checklist. The professor doesn't care if you make it or not. But how -- you talked about some of the monitoring processes, but you also have students that aren't coming to class. What are you telling them if they think they are sick? Do they stay in their room? Do they go back to their parents' home? What are you telling them?

Somerville: We tell them both. A lot of our students are close enough to where if they do get sick, they can go home and recuperate, and that's a great option for them. And nothing beats mom's chicken soup every now and again. But for those students who for whatever reason can't go, then dining service has great chicken soup as well. So we ask them to stay in their rooms, recuperate. We'll even deliver meals to them if they're ill. Their roommate can get meals to them. Even our Greek community has set up similar systems to where they can have someone in a room in isolation and have meals delivered to them.

Yeager: Now, some of that protocol, how did you develop that? I know we talked about that you had a run back in the spring, but is that something you're talking with the university of Iowa dean of students or the university of Minnesota or smaller schools? Who are you talking with in helping set up some of these things?

Somerville: Most of it has been through either Iowa Department of Public Health or CDC or just all of those protocols that are in place for us through the national wisdom that's here. And we've set them up so that we can follow the three C's so that we can contain them, even giving them recommendations on, okay, this is when you really need to seek medical care, and be that coming to the health center or a family doctor, whatever it is, so that we can -- we don't have the ability to absolutely have our finger on our entire campus community, and so we rely a lot on communicating with them so that they can advocate for themselves, take care of themselves. Our house directors in the Greek community, our hall directors and community advisors in the residence halls, our faculty and staff, there are enough people throughout the institution that if all of us become well versed on what it is we're supposed to do to prevent being sick and what to do if we do get sick, then we're better able to help our students.

Yeager: I'm going to come back to you in a moment, but I want to bring in Rebecca. I want to ask you, we're getting to a travel season -- holiday season. Everybody likes to get together for thanksgiving or the holidays. Should we travel?

Curtiss: If you're not sick.

Yeager: If you're sick?

Curtiss: If you're sick, you need to stay home. Don't travel. If you become ill while you're traveling, then you need to wash your hands frequently. You need to make sure and cover your cough, and then get to somewhere until you're well. Mass transportation is great. We just need to make sure that people are washing their hands.

Yeager: What if I've had the shot and I've been exposed to it, maybe had it once? Should I travel then?

Curtiss: Absolutely. The vaccine is very effective. CDC believes without a doubt that it's going to be just as effective as a seasonal influenza shot.

Yeager: Well, I guess I should follow up. But if I've already had it, could I give -- if I've already been passed -- if I've already passed the illness, could I pass it to my aunt or uncle that I'm seeing at Thanksgiving if they haven't been infected?

Curtiss: Right. The science is telling us that if you've already been ill, you've had H1N1, and you have been fever free for 24 hours, then it's not likely that you'll pass it on.

Yeager: Okay, good. I just want to do clarify. Sorry. I wanted to make sure I got that down. Thank you, Rebecca.

Yeager: What about students' concerns about traveling? You've got lots of international students, but you have 28,000 students traveling. What's the recommendation there?

Somerville: We give the exact same recommendations. And for our international students, we'll follow state department guidelines. We have lots of students who study abroad. We have trips that leave for breaks in particular. We have students that just go on vacation. So we encourage everyone to follow the state department guidelines.

Yeager: All right. We're in our final about 60 seconds here. You get to break a myth. Jami, I'll start with you. What's the favorite myth that you need to bust about H1N1 when it comes to businesses?

Haberl: I'd say that the H1N1 vaccine is not effective or that it's harmful, because it is effective. Like Rebecca said, it's done just the same way as our seasonal influenza shot. So if you're getting your seasonal influenza shot, you should have no fear of getting the H1N1 vaccine.

Yeager: Rebecca, same question. Bust a myth for us.

Curtiss: She took it.

Yeager: You've got to come up with another one, so I need to tap dance for a moment. No, what else?

Curtiss: That washing your hands, staying home when you're sick, and covering your cough really are going to reduce the spread of this disease. It's not just what mom told you since you were a little kid. It really is important to follow all of those.

Yeager: All right. Fifteen seconds for you.

Somerville: I want folks to pay attention to all the messages that are there to help them prevent getting sick and to get well if they do get sick.

Yeager: That's Dione Somerville from Iowa State University. Appreciate you coming in. Rebecca Curtiss with the Iowa Department of Public Health. And Jami Haberl with Safeguard Iowa Partnership. Thank you so much for coming in tonight to discuss this and hopefully busting a few myths and other things.

Tags: flu H1N1 health health care Iowa