Important H1N1 Influenza A (swine flu) Information for Physicians

To my colleagues:

Please consider the following information as we work through the current flu situation.

It is not the intent of either the federal or state response to the current H1N1 influenza outbreak to diagnose and/or treat all individuals with relatively mild disease.

At this time, this flu is characterized as a relatively mild strain in the U.S., and our health care response should align with this. Unless there is evidence that the severity of the disease is changing, otherwise well patients with influenza-like-illness should stay home and use typical over-the-counter symptomatic treatment. 94% of current confirmed U.S. cases have or are recovering with home care.

Patients with severe symptoms, such as difficulty breathing, as well as your pregnant patients and those with chronic conditions that put them at increased risk for complications of the flu, should be evaluated for testing and antiviral treatment. Prophylaxis is also warranted for pregnant women and those with chronic conditions, if they are close family contacts of confirmed cases.

We are asking Colorado physicians to assist us in managing the limited testing resources available to our state, and to understand if we turn away test requests that do not align with national guidance and our state response. In addition, we want to stress that the federal stockpile of antivirals is intended for use in patients meeting priority guidelines as outlined by CDC, namely, hospitalized patients and those ambulatory patients as above, who cannot otherwise be treated with the commercially-available supply of medications. While you may be experiencing local shortages in the commercial supply, information from the CDC indicates this is a temporary problem and that there will be plenty of supply available almost immediately.

This email is a simplified version of the treatment guidelines available on our web site, www.cdphe.state.co.us, which I hope you will take the opportunity to review. We will be sending out a revision to our testing and treatment guidance early next week. My purpose in sending this message out now is to stress that our health care response need to align with the impact of the disease in the community, and at this point, we do not intend to diagnose and treat all otherwise well patients with relatively mild H1N1 influenza. If this approach changes over time, we will notify you. Please recognize that this situation is changing rapidly, and we will need to adjust our guidance accordingly.

Thanks,

Ned Calonge, M.D.
Chief Medical Officer
Colorado Department of Public Health and Environment

GENERAL INFORMATION
We have activated the Incident Command Structure in order to plan and manage the continually evolving information flow from the state and the CDC regarding H1N1 (formerly known as swine flu).

There are two confirmed cases in the state; none in El Paso County.

General information about the flu will be sent out by Infection Prevention in All Users batch e-mails at 10 a.m. and 2 p.m. each day. Please check the All Users e-mail notifications to stay updated on the status and inform your staff.

Our local public health department web site:

http://www.elpasocountyhealth.org/pages/Swine_flu.aspx

Other information regarding how we're handling this within the health system will be distributed via the public information officer.

ACCESS
Flu-related safety guideline signs are being posted at entrances and will be updated if/when a change occurs.

All entrances remain open as usual at this time. However, we are encouraging the following guidelines to keep our patients, visitors and staff safe:

To remain consistent with community standards and avoid unnecessary risk, we encourage the following people to avoid visiting the hospitals:

• people who have weak immune systems
• women who are pregnant
• children 12 years old and under

In addition, we advise that visiting friends and family be kept to a minimum.

PROTECTION
Staff exposed to someone with the following symptoms - elevated temp, 37.8 degrees Celsius and respiratory symptoms to include coughing, sneezing, sore throat, runny nose - need to wear personal protection equipment, which includes:

• Mask (N95) (Note: Surgical masks are sufficient to use until N95 masks are available.)
• Eye protection
• Gown
• Gloves
• Handwashing

No exceptions, for any reason.

ISOLATION
To ensure safe, patient-centered care, it is an expectation that all employees, physicians and visitors comply with isolation guidelines.

EXPOSURE
Any employee who has unprotected exposure to a confirmed H1N1-infected patient will be contacted by Employee Health through normal exposure procedures. Upon notification, the employee will report to Employee Health for mandatory screening. These are the only employees who need to report to Employee Health.

Unprotected exposure means the exposed staff was not wearing PPE … no mask, eye protection, gown, or gloves.

OTHER
Plans are in place for emergency departments and urgent care clinics related to early recognition, triage and treatment of patients who may be infected.

We will monitor the situation and provide updates. Please share them with your teams.

DOWNLOAD DOCUMENTS
These documents have more detailed information from the CDC and Colorado State Department of Public Health and Environment.

» H1N1 Influenza Update - 051909 (.pdf/8K)

Download, print, and post in your office:

» Caution Poster: Visiting When Ill in English (.pdf/53K)
» Caution Poster: Visiting When Ill in Spanish (.pdf/66K)
» Swine Flu & You in English (.pdf/39K)
» Swine Flu & You in Spanish (.pdf/54K)

CDC Guidance for Physicians:

» CDC: Interim Guidance Update for Pregnant Women with H1N1 Influenza (.pdf/64K)
» CDC: Interim Guidance for Pregnant Women with H1N1 Influenza (.pdf/24K)
» CDC: Interim Guidance for Home Care for H1N1 Influenza (.pdf/54K)
» CDC: Interim Guidance Update for Children with H1N1 Influenza (.pdf/128K)
» CDC: Interim Guidance for non-Pharmaceutical Community Mitigation (.pdf/42K)
» CDC: Interim Guidance for Anti-viral Recommendations for Confirmed or Suspected H1N1 Influenza Patients (.pdf/32K)
» CDC: Interim Guidance for Cardiovascular Disease Patients with H1N1 Influenza (.pdf/72K)
» CDC: Interim Guidance for Rapid Diagnostic Influenza Tests (.pdf/68K)
» CDC: Interim Novel Guidance?for Cruise Ship Passengers with H1N1 Influenza?(.pdf/116K)

» World Health Organization (WHO): Pandemic Phases (.pdf/27K)

» State of Colorado: Health Update, May 7, 2009 - Updated Reporting & Testing Guidelines for H1N1 Influenza (.pdf/63K)
» State of Colorado: Antiviral Update (.pdf/68K)

» Newsweek Article: The Path of a Pandemic?(.pdf/116K)