October 25, 2009

H1N1 Declared A National Emergency

President Obama has declared the swine flu outbreak a national emergency, allowing hospitals and local governments to speedily set up alternate sites for treatment and triage procedures if needed to handle any surge of patients.

The declaration came as thousands of people lined up in cities across the country to receive vaccinations, and as federal officials acknowledged that their ambitious vaccination program has gotten off to a slow start.

Only 16 million doses of the vaccine are available now, and about 30 million are expected by the end of the month. Some states have requested 10 times the amount they have been allotted.

Flu activity "” virtually all of it the swine flu "” is now widespread in 46 states, a level that federal officials say equals the peak of a typical winter flu season. Millions of people in the United States have had swine flu, known as H1N1, either in the first wave in the spring or the current wave.

Although there has been no exact count, officials said the H1N1 virus has killed more than 1,000 Americans and hospitalized over 20,000.

The emergency declaration, which Mr. Obama signed Friday night, has to do only with hospital treatment, not with the vaccine. Government officials emphasized that Mr. Obama's declaration was largely an administrative move that did not signify any unanticipated worsening of the outbreak of the H1N1 flu nationwide. Nor, they said, did it have anything to do with the reports of vaccine shortages.

"This is not a response to any new developments," said Reid Cherlin, a White House spokesman. "It's an important tool in our kit going forward."

Mr. Obama's declaration was necessary to empower Kathleen Sebelius, the secretary of Health and Human Services, to issue waivers that allow hospitals in danger of being overwhelmed with swine flu patients to execute disaster operation plans that include transferring patients off-site to satellite facilities or other hospitals.

The department first declared a public health emergency in April; Ms. Sebelius renewed it on Tuesday. But the separate presidential declaration was required to waive federal laws put in place to protect patients' privacy and to ensure that they are not discriminated against based on their source of payment for care, including Medicare, Medicaid and the states' Children's Health Insurance Program.

As a practical matter, officials said, the waiver could allow a hospital to set up a make-shift satellite facility for swine flu patients in a local armory or other suitably spacious location, or at another hospital, to segregate such cases for treatment. Under federal law, if the patients are sent off site without a waiver, the hospital could be refused reimbursement for care as a sanction.

A few hospitals, including some in Texas and Tennessee, have set up triage tents in their parking lots to screen patients with fever or other flu symptoms. A Health and Human Services official said no hospitals had requested a waiver. David Daigle of the Centers for Disease Control and Prevention said he had not heard of any hospital that has faced a surge of patients so large that it had to set up a triage area or a treatment unit off site.

In Chicago on Saturday, health officials began giving free vaccinations at six City College locations, and within hours hundreds of people were turned away because supplies had been exhausted. The city distributed 1,200 vaccines to each site, immunizing more than 7,000 people, said Tim Hadac, spokesman for the Chicago Department of Public Health. All but two of the sites ran out of the vaccine.

At Truman College on Chicago's North Side, lines formed at 7 a.m., two hours before the doors opened. Mary Kate Merna, 28, a teacher who is nine months pregnant, arrived too late to get a vaccination. "I thought I'd be a priority being nine months pregnant," she said. "You hear it's a national emergency and it scares you."

In Fairfax County, Va., officials had planned to have swine flu clinics at 10 different locations on Saturday. But the county did not receive the number of doses it requested, and was forced to offer the vaccinations only at the government building. People began lining up with camping gear the night before to get vaccinations.

Merni Fitzgerald, Fairfax's public affairs director, said officials were aiming to administer 12,000 doses of the vaccine to those most at risk for serious complications from the H1N1 virus, mainly pregnant women and children 6 to 36 months.


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