AMA President Dr. Nancy Nielsen on H1N1 Flu (Swine Flu): A Message to Physicians
April 30, 2009
A National Response To An International Outbreak
By Nancy Nielsen, MD
President, American Medical Association
It’s been only two weeks since I wrote a column about the importance of focusing on public health. Now we are confronted with a real-life opportunity to test our partnership with our public health colleagues.
I’m talking, of course, about the swine flu outbreak in Mexico, the United States and abroad. While right now the appropriate stance is “alert” rather than “alarm,” let’s examine the role of practicing physicians, and our AMA, in this circumstance of a new influenza virus that seems more virulent in young adults and against which we don’t have immunity.
Each of us needs to be vigilant when seeing patients with acute respiratory symptoms. Although the clinical illness caused by this swine flu virus has been mild in the U.S., it has not been mild in Mexico, as you know from news reports. In case you are confronted with a patient with possible influenza (recognizing that the “usual” seasonal influenza season is over), here are some important considerations.
Take a travel history from anyone with significant acute respiratory illness. Take appropriate precautions yourself, wearing an N95 respirator or a surgical mask/gown/gloves. Do a nasopharyngeal swab, put it in viral transport media and send to the appropriate clinical lab at your hospital. Dispose of gown, gloves and goggles in a biohazard bag. Pay strict attention to hand washing with soap/water or hand sanitizer.
Note that public health budgets are stretched, so don’t do swabs for viral isolation on folks who seem to have the common cold!
The lab will do a real-time RT-PCR assay for influenza A. If the sample is A but is H1 and H3 negative, this will be considered “probably” H1N1 swine influenza and will be handled by a reference laboratory with biosafety precautions.
This is a new H1N1 swine influenza virus that has been identified. People who received flu vaccine this year are not protected. Antivirals zanamivir or oseltamivir are effective against this virus, but should not be used prophylactically except in very narrow, specific instances (see the Centers for Disease Control and Prevention Web site for details of treatment).
Each of us has an important role to play: educator, vigilant clinician and responsible public health partner. There is no need for alarm, just be cautious and remember to take the travel history. Stay tuned, as the situation is evolving daily. And if you’re on your way to Mexico for a vacation, check out the State Department Web site before you go.
On an organizational level, the AMA’s Science, Medicine and Public Health staff has monitored the swine flu developments since late last week. We have communicated with the CDC throughout the week and weekend; the AMA formally offered assistance to the Obama administration and to CDC Acting Director Richard Besser, MD. As of this time, conversations with the CDC indicated that the most supportive course of action would be for us to disseminate accurate and timely outbreak information to our membership and the general public.
In response to this request, we have developed a page on the AMA’s Web site devoted to swine flu and the most recent developments. Included on the page are detailed CDC guidelines for clinicians on infection control, case identification, use of respirators and antiviral medications. The page will be updated with the most recent swine flu information, including outbreak case numbers and infection control information. The page can be accessed from the AMA’s home page by clicking on “Swine Flu Resources for Physicians” under “Important Messages” in the bottom right-hand corner.
The AMA’s Center for Public Health Preparedness and Disaster Response (CPHPDR) convened the Health Emergency Response Team to consider various strategies and options for the AMA’s response to the H1N1 swine flu outbreak. A key assumption is that the response to the outbreak will require a marathon approach, since this virus has “pandemic” potential, with the possibility of producing ongoing waves of infection.
Our role now is to be a source of timely and credible health information and clinical guidance on swine flu from the CDC. Links to other authoritative Web sites and tools will be added to the page. AMA members will be notified through e-mail about the availability of the Web page. CPHPDR staff have also contacted domestic and international agencies, including the CDC, the Office of the Assistant Secretary for Preparedness and Response, the World Health Organization and the North Atlantic Treaty Organization, and will continue to work with the AMA Federation and other federal and private sector partners to prepare for, and respond to, this public health challenge.
The AMA’s strategies on disaster medicine and public health preparedness education are implemented through its National Disaster Life Support (NDLS) Program and peer-reviewed publication, Disaster Medicine and Public Health Preparedness. Through the Disaster Medicine and Public Health Preparedness journal, the AMA will release all pandemic influenza related articles for open access, to provide resources for medical and public health responders. Relevant articles in the journal pipeline also will be published ahead of print to ensure timely dissemination.
The May 4 meeting of the NDLS Educational Consortium was to have introduced a facilitated exercise on pandemic influenza, an educational session that was presented at the 2007 Interim Meeting of the AMA House of Delegates. However, the consortium meeting has been postponed because of the outbreak, as many of the attendees are a critical part of our nation's response.
As part of a new AMA CitizenReady program, the CPHPDR received a grant from the Department of Homeland Security to develop a two-hour, facilitator-led exercise and a 90-minute interactive Web-based module on pandemic influenza. This training program targets all citizens and is scheduled for release this fall.
So that’s what your organization is doing. Let’s hope the swine flu infections abate soon. Meanwhile, each of us can exercise clinical vigilance and recommend hand washing and common sense measures like staying home when ill.
