Obama Declares Swine Flu a National Emergency

Schools should have waited

Until the vaccines were ready to give, and only opened after most were vaccinated.

I feel for the parents of the kids that have died because they started school too soon.

---

by: mountainlady @ Sat Oct 24, 2009 at 20:53:10 PM UTC

the other shoe...

Economic Cost and Health Care Workforce Effects of School Closures in the U.S.

http://www.brookings.edu/paper...

---

by: DemFromCT @ Sun Oct 25, 2009 at 15:55:14 PM UTC

[ Parent ]

Reports

History has shown that dollars trump lives.

It is better to look ahead and prepare than to look back and regret.

---

by: Grace RN @ Sun Oct 25, 2009 at 16:55:13 PM UTC

[ Parent ]

Should we be blaming the weather?

Let me throw this out for discussion. Schools have been in session for almost two months and we are only getting this new surge with the change to cold, dry but not freezing temperatures. (For the surge see http://www.cdc.gov/flu/weekly/... ) The information on the effect of temperature and humidity on the influenza virus is in this diary - http://www.newfluwiki2.com/sho...  

UV light is also decreasing in the northern hemisphere and I think this means that UV is less likely to damage these airborne droplet nuclei on cloudy days or in the early morning. So this increased viral survival combined with lots of people still out (unlike when it is freezing cold outside) means that people are more likely to come in contact with viable airborne droplet nuclei outside than during the summer.  

In summary, in my opinion, we (in the northern US states) are now intermittently having the kind of weather where virus can survive outdoors airborne for extended periods (hours).  During these short optimal periods of viral survival, we should see an increase in the number of people infected from a single case.  This leads to spikes of new cases.

This could explain the increase in cases.  I hope we won't see an increase in the severity of cases although unfortunately even if only a tiny percentage cases are severe, this will result in increased deaths. (Please anyone sick or caring for someone sick should at a minimum read this for potentially life saving information - http://www.cdc.gov/h1n1flu/sic... )  I am hopeful that this pandemic H1N1 won't  become more virulent because it is genetically different from  the 1918  H1N1 see  http://www.sciencedirect.com/s...  and because in the southern hemisphere where they had these weather conditions earlier (cold, and little UV), their mortality did not approach 1918. (See http://www.flu.gov/professiona... )

---

by: Public_Health_Networker @ Mon Oct 26, 2009 at 02:27:36 AM UTC

[ Parent ]

Weather

Have you ever set a brush pile on fire which was spread out and loose.  It burns, but not very intensely.  On the other hand, when you make the pile fairly compact it burns quicker and hotter.  I see cold weather as the mechanism which packs the influenza fuel closer.

During the summer the flu was a fire without much fuel easily available.  It crept along.  When school started, this slow moving fire contacted piles of fuel which increased the spread and intensity.  Now the fire is coming in contact with closely packed and volatile fuel.  It will blaze that much higher and more intense within a shorter period of time.  All we have for water to fight it is limited quantities of antivirals.  What we need is a fire break: vaccine.

I use this analogy because for years pandemics have been compared to wildfires.  Please, no offense intended by using this analogy.  I use it because it is effective.

---

by: Okieman @ Mon Oct 26, 2009 at 23:53:31 PM UTC

[ Parent ]

Well...

I've given myself some time to ponder this.  First of all, I want to say that I think it is a good thing.  Sounds like it facilitates a more efficient and expeditious response when and where needed.  That may be needed in some locations of the country as this plays out over the next few months.

But...you knew there'd be a but...I have to wonder what has precipitated this action.  Maybe it is just as it appears.  But, what if something new has developed.  I could take their word for it that no new development has occurred and they are simply playing it safe. Ok...  Or, I could consider past information they have provided and how accurate it has been shown to be.  When I do that I have a strong urge to go newshounding for something new developing.  That said, I've not found anything I could put my finger on yet.  An odd mystery viral fever in India...a county declaration of emergency in southern Oregon...news of very rapid increases of flu in parts of California and Massachusetts...etc...the list goes on.  But all of this may simply be the current version of pandemic H1N1 spreading and causing pandemic conditions.  I have nothing that I can point at and say, Hmmmmm...  So, I accept the declaration of an nation emergency at face value...for now.

I wish they'd let Vice President Biden speak on this for a little while.  Not long...just a little bit would do ;-)

---

by: Okieman @ Sun Oct 25, 2009 at 02:18:32 AM UTC

in this case

I think your first para has it. Hospitals need this now.

---

by: DemFromCT @ Sun Oct 25, 2009 at 15:56:36 PM UTC

[ Parent ]

It is unclear to me exactly what this does to help hospitals, etc.

When it says :

The White House on Saturday said Obama signed a proclamation that would allow medical officials to bypass certain federal requirements.

 I cringe a little, wondering if that means in regards to vaccine testing and production protocols. Dem, you being the public health expert, can you give a quick rundown of exactly what this does and doesn't do?

Always have a plan B.

---

by: maryinhawaii @ Sun Oct 25, 2009 at 18:19:25 PM UTC

[ Parent ]

Well

It means federal insurance patients (Medicare and Medicaid) can be triaged and sent to an alternate care clinic from the ER without getting fined. It has nothing to do with cutting corners on vaccine safety.

It means little else.  

---

by: DemFromCT @ Mon Oct 26, 2009 at 00:34:28 AM UTC

[ Parent ]

See

http://www.emtala.com/

---

by: DemFromCT @ Mon Oct 26, 2009 at 00:36:43 AM UTC

[ Parent ]

The official legal declaration language...

The legal declaration by Kathleen Sebelius on October 28
http://www.flu.gov/professiona...

1. Pursuant to Section 1135(b) of the Social Security Act (the Act) (42 U.S.C. § 1320b-5), I hereby waive or modify the following requirements of titles XVIII, XIX, or XXI of the Act or regulations thereunder, and the following requirements of Title XI of the Act, and regulations thereunder, insofar as they relate to Titles XVIII, XIX, or XXI of the Act, but in each case, only to the extent necessary, as determined by the Centers for Medicare & Medicaid Services, to ensure that sufficient health care items and services are available to meet the needs of individuals enrolled in the Medicare, Medicaid and CHIP programs and to ensure that health care providers that furnish such items and services in good faith, but are unable to comply with one or more of these requirements as a result of the 2009-H1N1 influenza pandemic, may be reimbursed for such items and services and exempted from sanctions for such noncompliance, absent any determination of fraud or abuse:
        1. Certain conditions of participation, certification requirements, program participation or similar requirements for individual health care providers or types of health care providers, including as applicable, a hospital or other provider of services,  a physician or other health care practitioner or professional, a health care facility, or a supplier of health care items or services, and pre-approval requirements.
        2. Requirements that physicians or other health care professionals hold licenses in the State in which they provide services, if they have an equivalent license from another State (and are not affirmatively barred from practice in that State or any State a part of which is included in the emergency area).
        3. Actions under section 1867 of the Act (the Emergency Medical Treatment and Labor Act, or EMTALA) for the direction or relocation of an individual to another location to receive medical screening pursuant to an appropriate state emergency preparedness plan or a state pandemic preparedness plan or for the transfer of an individual who has not been stabilized if the transfer is necessitated by the circumstances of the declared public health emergency for the 2009-H1N1 influenza pandemic.
        4. Sanctions under section 1877(g) (relating to limitations on physician referral) under such conditions and in such circumstances as the Centers for Medicare & Medicaid Services determines appropriate.
        5. Limitations on payments under section 1851(i) of the Act for health care items and services furnished to individuals enrolled in a Medicare Advantage plan by health care professionals or facilities not included in the plan's network.
  2. Pursuant to Section 1135(b)(7) of the Act, I hereby waive sanctions and penalties arising from noncompliance with the following provisions of the HIPAA privacy regulations:  (a) the requirements to obtain a patient's agreement to speak with family members or friends or to honor a patient's request to opt out of the facility directory (as set forth in 45 C.F.R. § 164.510); (b) the requirement to distribute a notice of privacy practices (as set forth in 45 C.F.R. § 164.520); and (c) the patient's right to request privacy restrictions or confidential communications (as set forth in 45 C.F.R. § 164.522); but in each case, only with respect to hospitals in the designated geographic area that have hospital disaster protocols in operation during the time the waiver is in effect.
  3. Pursuant to Section 1135(b)(5), I also hereby modify deadlines and timetables and for the performance of required activities, but only to the extent necessary, as determined by the Centers for Medicare & Medicaid Services, to ensure that sufficient health care items and services are available to meet the needs of individuals enrolled in the Medicare, Medicaid and CHIP programs and to ensure that health care providers that furnish such items and services in good faith, but are unable to comply with one or more of these requirements as a result of the 2009-H1N1 influenza pandemic, may be reimbursed for such items and services and exempted from sanctions for such noncompliance, absent any determination of fraud or abuse.

These waivers and modifications will become effective at 5:00 P.M. Eastern Standard Time on October 29, 2009, but will have retroactive effect to October 23, 2009, nationwide, and continue through the period described in Section 1135(e).  Notwithstanding the foregoing, the waivers described in paragraph 2 above are in effect for a period of time not to exceed 72 hours from implementation of a hospital disaster protocol but not beyond the period described in Section 1135(e).  The waivers described in paragraphs 1(c) and 2 above are not effective with respect to any action taken thereunder that discriminates among individuals on the basis of their source of payment or their ability to pay.

The waivers and modifications described herein apply in the geographic area covered by the President's proclamation, pursuant to the National Emergencies Act, on October 23, 2009, that the 2009-H1N1 influenza pandemic constitutes a national emergency; and former Acting Secretary Charles E. Johnson's April 26, 2009, determination, pursuant to section 319 of the Public Health Service Act, that a public health emergency exists nationwide involving Swine Influenza A (now called 2009 - H1N1 flu), renewed by me on July 24, 2009 and October 1, 2009.

---

by: ReginaPhelps @ Thu Oct 29, 2009 at 10:35:59 AM UTC

[ Parent ]

Politicians respond to public pressure.

And I believe that the recent hearings put pressure on the White House to do more.  They probably already had this move in the planning stages and put it into action when they experienced very strong questions and concern at the hearings.

"I am opposed to any form of tyranny over the mind of man."  Thomas Jefferson

---

by: History Lover @ Mon Oct 26, 2009 at 00:52:43 AM UTC

[ Parent ]

Comment to Public Health

I wasn't sure where to put my comment so I'll put it here. Public health officials really need to state the obvious. I was watching reports regarding the first H1N1 vaccine clinics in my area (only FluMist available)and noticed everyone crammed in together, waiting for their vax. Hundreds of people. The problem? Several people had come to the clinics already sick - fever and coughing. How many people did they infect at the vax clinic? Now you know some are going to now say "I got vaxed and it give me swine flu." You need to explicitly state that if you are sick, don't come! It's too late to get vaxed. You also need to let people know that it takes upwards of eight days to develop immunity to H1N1 after receiving the vax. Then people would understand that it was not the vax that made them sick. Also, it would let people know that they shouldn't let down their guard too soon. They need to keep washing hands, staying away from sick people, etc. I'm guessing that quite a few people think that the vax gives them near instant immunity.

---

by: banshee @ Sun Oct 25, 2009 at 17:36:09 PM UTC

Should Have Fax'd the Hospitals

I think if the purpose of the "National Emergency" declaration was to waive rules and ease red tape for the hospitals the gov't should've sent the hospitals a fax, email or letter stating that. Instead by going public with this declaration in a big way they have created concern and demand for vaccination that can't be met at the present time. It will be weeks, if not months, before there is enough vaccine supply for everyone that wants it now, in the meantime some people will be quite upset.

To me a true national health emergency would be one that required closing schools and limiting large public gatherings, such as at stadiums, etc. along with some travel restrictions. I'm not saying the current H1N1 situation is at that level, just stating what I think most people would call a national emergency.  

---

by: Nevadan @ Mon Oct 26, 2009 at 22:11:10 PM UTC

transparency means being criticized

and not going public would have opened ctiticism for hiding it.

---

by: DemFromCT @ Tue Oct 27, 2009 at 15:19:31 PM UTC

[ Parent ]

In my thinking...

Declaring H1N1 a National Health Emergency not only allows the rules to be relaxed, but also makes the public more aware of what we're facing.
It's gotten all the talk shows buzzing, whether for or against, but at least now they're talking about it...

---

by: Bronco Bill @ Tue Oct 27, 2009 at 15:27:40 PM UTC

[ Parent ]

Why is Las Vegas hoarding H1N1 shots instead of giving them?

Clark Co. Heath Dept. admits that they have 6,000 H1N1 injections as well as an ample supply of Flu Mist spray but are only dispensing the spray. They said, in a sidebar to the news story below, that they want to wait another week or 10 days until they get more doses before holding another clinic. Does this make sense when it takes time for the vaccine to become effective after you receive it, they are prolonging the exposure period.
http://www.lvrj.com/news/staff...

---

by: Nevadan @ Tue Oct 27, 2009 at 16:08:29 PM UTC

it's a logistics decision

we give out whatveer we have as soon as we get it. But we are not doing in in mass dispensing clinics.

---

by: DemFromCT @ Tue Oct 27, 2009 at 22:28:12 PM UTC

[ Parent ]