H1N1: HHS, CDC, Health Departments all screw it up

The BBQ Pit
1

Kids will die this year that did not need to. It sucks but it is true.

Nevermind the overpromising about vaccine supply that Sebelius made. No passing blame down over how long it has taken to produce a vaccine.

Just the dealing (or not dealing as the case may be) with a reality that H1N1 is here, that the vaccine isn’t, and that some people need it a lot more than others.

Original hopes had been for 150 million doses by mid-October to then be followed by 10-20 million doses a week until the full 250 million order was filled. It soon became clear that such was not to be, but we were assured of 40 million by early to mid-October and the same doses per week after. No worries sayeth Sebelius. But some us worried: the race was on - would we get enough vaccine on board before the epidemic hit and be able to prevent the bulk of the infections, or would the epidemic hit first.

Alright the epidemic has hit first and preventing it is now no longer possible. At most 30 million doses will be delivered by the beginning of November and then, we are told, they’ll get up to the 10-20 million doses per week. We’ll get up the hoped for by October doses maybe by mid December and full supply in late January.

But I’m not ranting over that. The bug chose not to grow in the chick eggs well; the producers did their best. Someday we’ll have better technology, but not yet.

But we are faced with a critical shortage and some individuals are at much greater risk than others. Buried in the CDC’s site is this guidance:

(Bolding mine.)

We are clearly in the latter category. 30 million total doses available, and for high risk kids you won’t get significant protection until a week or so after the second dose. Even if everyone followed the “Limited Vaccine Availability” guidelines we wouldn’t have enough to get a fist dose in everybody of that group and some are at greater risk than others: pregnant women are at a 4-6x greater risk of hospitalization and death than most; so far more kids have died of H1N1 than in the vast majority of complete flu seasons and the early months of H1N1 showed that 2/3s of those deaths were in kids with a high risk factor, most of all the broad category of neurodevelopmental disorders. Ideally those should go first.

Yet the neither the CDC nor the HHS dept has emphasized that we are in a “limited availability” mode. And the idiots who run many Health Departments, are not prioritizing who gets it accordingly.

They are going to try to cover 159 million people (the initial target group), many of whom will need two doses, with a supply of under 30 million doses!

Goddamn idiots. Even if half of the population is too stupid to want this vaccine that is still 2-3x more people clamoring for a vaccine than there is vaccine available. So what happens? Some pregnant women, some kids with neurodevelopmental disorders, some kids with bad asthma, etc - a bunch of people who are at greatest risk of dieing from this bug, who want the vaccine, will be unable to get it. And even if they got it NOW they’ll be unprotected for a large portion of the epidemic. Goddamn Chicago Dept of Health (And they are not alone) is vaccinating healthy 23 year olds with no risk factors at relatively low risk for serious complications while I don’t have a single dose to give to an 18 month child with bronchopulmonary dysplasia!

And while sure, whoever is in charge there is an idiot to be doing that, but dammit, the CDC could make a statement that calls attention to the fact that we are in a critical limited supply circumstance and remind people of the guideline buried in their webpages. And so could Sebelius.

Sheeyut. Nature has given us something bad. Stupidity is making it worse.

2

“Buried in the CDC’s site”???

I’ve heard nothing but this information for roughly a month now. Mind you, I work for the NIH, so I get their updates in my inbox pretty much every other day, but I’ve seen the same information in newspapers and heard it in casual conversation with non-biomedical people in public. I can’t speak for what various Health Departments are doing, but the CDC has very much gotten the information out there.

That said, I’m really sorry you don’t have vaccine to give your high-risk toddler. That must be very scary for you, and I don’t blame you for venting. If I had any, I’d send it your way.

3

My wife is in the high risk category, and we haven’t been able to get it either.

I post on another board that is mostly libertarian cranks who think the swine flu vaccine is a goverment plot to kill the citizenry. Apparently chemtrails were taking too long.

4

Go to the CDC’s site. Find the box for H1N1. Easy 'nuff. Click updates. No, nothing about the current critical vaccine shortage and the need to go into “limited availability” mode or that there is such a thing there. Backtrack. Click vaccination. Okay. Click information for clinicians. Fine. No info yet but four choices under the heading of Recommendations. Click the first one. Nope. Hmm a recent one, Oct 9th. No mention about “limited availability” guidelines or mention that we in that circumstance there. Okay try the 8/20 update. Ah there it is. If you read the whole thing.

Yes, I’ve known it is there, read it before, and yet trying to find it to link to to convince my own large medical group to not follow the area health departments stupidity took me a while, exactly those eight clicks and reading other links through to find that it was not there. Many good docs do not know that that guideline says that. Only a few really appreciate that we are even beyond that “limited availability” point. And again, the regional health departments are handing it out to the entire first target population and calling that “high risk” - either they do not know what the limited availability guidelines are or they do not appreciate how limited the current availability is and will be for the next several months. And neither the CDC nor HHS is doing much to change either of those.

Today’s press conference - mentioned that there isn’t enough vaccine currently. Did they mention that there is a specific set of recommendations for who should get it when there isn’t enough? Nope. The ball is being dropped badly and again, kids will die as a result.

5

Except I live in the middle of nowhere and that information is being put out. From our local online paper:

So maybe you folks in the big cities are missing it, but out here in the boonies, we’re paying attention. :smiley:

6

Clarify please, because I’ll happily admit to being ignorant but I don’t think I’m stupid.
My understanding was that healthy adults with non-compromised immune systems are in general, not at any serious risk from this flu and that while the vaccine helps herd immunity, that it isn’t necessary in the individual sense.

Am I missing something? I’ll admit after bird flu and SARS and killer bees and god knows what else, I tend to tune out doomsaying. Have I missed something this time?

7

DSeid is talking about the distinction between the “target group”, which is the high-risk group you describe, and the “limiting availability target group” which is a much smaller subset of super high-risk populations:

If Dseid’s information is correct, local health departments are giving vaccine to the anyone in the “high-risk” category and therefore doesn’t have enough for the “super high-risk” category".

I agree, a toddler with bronchial problems is obviously at higher risk than healthy college kids and should be preferentially vaccinated. However, if the Health Departments have spent the past two months getting the word out that this disease is dangerous to all young people, even healthy ones, then it becomes difficult to turn down the people who are actually responding to your message and coming in for vaccination.

Me, I’m a reasonably healthy mid-thirties woman, but I’m well overweight and I tend to get very sick when hit with respiratory infections. I’m not in any of the high-risk groups, but I’m very eagerly awaiting vaccine availability.

8

It is precisely the fact Lok that the Boards of Health and others are hitting on those people, the original “Initial Target Group”, decided upon when it was believed that we’d have over 140 million doses by early October and 10-20 million coming each week after that, and thinking that they are going for the High Risk Group subset that should be targeted during limited vaccine availability, that pisses me off. So far we’ve got a tenth of the doses out there that we were supposed to have by now, and about a third of the much more modest correction of those numbers made later.

We do not have enough to hit that “initial target group”; Hell, we don’t have enough to cover the much higher risk subgroup if we used it all on them and these idiots are not just using it on them.

Finn, those over 60 have a good chance at not catching this bug at all on their own and they are at the greatest risk of dieing with any flu. So the group that usually casues the most deaths is being spared and so total deaths compared to a normal seasonal flu are down. But the mantra that this means this is not so bad, still being made by many who should know better, is false. Check out FluView and scroll down to look at Influenza assocoated hospitalizations. A poor graphic but what it shows is that the number of people hospitalized for influenza this year aged 18 to 49 is already about as many there are hospitalized by the end of most years flu seasons. Even the 50 to 64’s have it as bad already as most years. The experience in Australia and New Zealand showed that this flu caused 15X as many ICU admits as most flus. This bug is not a mild bug. Those who get in the ICU stay longer and get a treatment resistant shock and multiorgan disease that doesn’t hit people with normal influenza. It is a bad bug. Per person who gets it, matched for age, it is much more deadly than the usual year’s influenza. It’s so called mildness is a mere artifact that the elderly do not catch this one.

Still, with only 30 million to be had by early November we have to make sure we protect those at greatest risk of ending up in the hospital, or the ICU (and I have long been very fearful that this bug will overwhelm Peds ICU surge capacity), or dieing. And those are that “Limited Vaccine Availability” subset, and even more a subset of them for when it is this limited.

9

Looking at the county site, they do have a link to the CDC information, but it doesn’t look like they have made that connection about limited dosage. OTOH, it really doesn’t matter at this point. Their press release from the 22nd, about the start of the weekly clinic on Monday, they don’t have any vaccine for infants aged 6-35 months. :frowning:

10

The health department in my county appears to be limited the vaccine to pregnant women. I only know this because a coworker of mine is pregnant and has been following the availability.

11

I really want the vaccine. I am testing specimens for the flu. Yes, I work behind a splash shield and I’m careful but if half of us in the lab get sick, the hospital is screwed. They’re so far only giving the shot to the emergency room personnel, which makes perfect sense to me because they’re exposed to sick folks before they’ve been evaluated and put on droplet precautions (masks). But the swab they stuff up their noses is pretty full of flu germs, and that’s what I get to play with.

I’ve asked the employee health department, and they still say they don’t know how much they’ll have and who they can give it to. My supervisor is pushing them hard to get us on the short list, but who knows.

12

http://jac.oxfordjournals.org/cgi/content/full/dkp313v1 Swine flu is being over diagnosed. It may well be not as scary as many are led to believe.

13

That link is for a discussion of the possible over-prescription of antibiotics when treating pneumonia and other flu-related respiratory illnesses. I see no place in it that says anything about H1N1 being over diagnosed.

14

Found it, just after the time limit to edit. :stuck_out_tongue:

But the author doesn’t include any actual statistical analysis or records to support the statement, just:

IOW, this is what that guy and I think is happening. He may be correct, but there is nothing backing it up.

15

Thank you, gonzo, for another sterling contribution of knowledge and prescient commentary to a thread on a topic for you don’t have a single scintilla of knowledge nor have absolutely anything of value to add.

16

This is interesting. My employer, a hospital, is offering its H1N1 supply to all employees, whether they are nurses or janitors, or secretaries who never see a patient. It is not offering ANY of it, yet, to anyone in the general public. We’re referring all callers to their primary care physicians. I haven’t heard what they’re doing with inpatients.

Seasonal flu vaccine is even more restricted – only available to staff that comes into direct physical contact with patients. Everyone else, staff and public, will have to wait until they see what’s left and what will be coming in the pipeline.

17

Well, due to vaccine scarcity, so far our prison system has restricted doses to that ultra-high risk group. Medical staff who actually care for patients have been vaccinated, as have inmates under 18 who have high risk due to other disease, and pregnant women.

We had just enough vaccine to cover all those folks.

18

DSeid asks, the President responds:
just announced.

Will you ask him for a pony for me next? :slight_smile:

19

I am happy to ask for your pony but I still want the clear statement that Boards of Health and other providers should be distributing according to the specific “Limited Vaccine Availability” guideline, and even then may need to further prioritize, not using the “Initial Target Group” guideline. I want a CDC pres conference stating that and Sebelius (or Obama even) announcing “Right now, vaccines need to be distributed only to those who need them most. That means that for now only pregnant women, children under age five, children up to age 18 with certain chronic health problems, household contacts of those under 6 months, and healthcare workers with direct patient contact. If you do not fit one of those categories we will need to have you wait while we focus on protecting those at greatest risk. We hope to expand to other groups again soon but these higher risk individuals must be able to get to the front of the line.” Until then Boards of Health will continue to be stupid. Spell it out for them.

20

That would be a step forward indeed.

Preach it!