Local officials preparing for swine flu

In a flurry of activity, local health officials spent much of the weekend preparing for the expected arrival of a disease that no one knows much about.

"Probably it won't be very long before the map gets filled in with cases in Pennsylvania and elsewhere in the country," said Stephen Ostroff, the state's acting physician general and director of the Pennsylvania Department of Health's Bureau of Epidemiology.

With more questions about swine flu than answers - why, for example, have nearly all of the 20 confirmed cases in the United States been mild while people in Mexico have been dying? - state and local health departments have largely been limited to shoring up their ability to spot infections quickly.

The Pennsylvania Department of Health has put the state's public health lab in Lionville, Chester County, on alert to be able to handle laboratory specimens round the clock. The Philadelphia Department of Public Health will analyze daily data summaries from hospital ERs to find case reports that mention both symptoms of a "flulike illness" and travel to Mexico. New Jersey has enhanced its normal disease-surveillance practices.

The U.S. Centers for Disease Control and Prevention determined yesterday that "yellow cards" with information about swine flu would be given out soon to passengers returning to Philadelphia and other airports from Mexico. The city and all states will also receive stashes of antiviral drugs, masks, gowns, and other medical equipment from a national stockpile.

So much is still unknown, however, that it is not clear exactly how health officials would use the equipment if an outbreak is confirmed.

"What do we need to do to limit transmission?" said Caroline Johnson, director of the city Health Department's Division of Disease Control.

There is not yet a consensus among public health experts, Johnson said, about what the appropriate response should be to a confirmed case. Should officials focus on preventing its spread to close contacts through intensive measures? Or should they instead assume that many people have been exposed and thus target the broader community with precautionary measures?

In fact, the response will probably differ from place to place depending on local conditions.

Health officials were already worrying yesterday that people with little reason to be at risk might flood emergency rooms.

"People tend to take inappropriate actions when they don't have access to information," said Ostroff, adding that a primary focus of the state's efforts so far has been to keep health-care providers informed. They have been asked to send to the state lab samples from throat swabs of every patient who appears to have the flu.

Neither recent travel to Mexico nor flulike symptoms alone are cause for concern, doctors said. In combination, however, they could be.

Because swine flu is related to seasonal influenza, states and major cities have long had in place mechanisms that can be used to detect it, although without the speed and certainty that they would like.

Both hospital and independent laboratories automatically report tests that are positive for any kind of influenza, a practice that normally allows local public health authorities to get a handle on the spread of various types of seasonal flu.

The labs also forward the samples to the state public health laboratories - Lionville in Pennsylvania and Trenton in New Jersey - that are capable of more sophisticated subtyping. If the state laboratories are unable to determine a known subtype - an unusual event, health officials said, and one that could suggest swine flu - then the samples are forwarded to the CDC in Atlanta for additional analysis.

Officials in Pennsylvania and New Jersey said no untypable samples had been sent recently from their state labs to the CDC.

Both states also said that their labs are currently able to complete tests on samples within hours of receiving them by courier. They said that a sample could be subtyped from start to finish - from the swab in a doctor's office to the most sophisticated tests at the CDC lab - in one to three days.

Other methods of tracking influenza include reports from "sentinel doctors" around the state and analysis of hospital emergency room data by the Philadelphia health department.

Johnson, the city disease-control director, said health department workers receive 24 hours' worth of ER data from hospitals every morning and are able to sort them into categories and scan for keywords, such as Mexico that a nurse might have flagged.

Despite all the preparations, Johnson last night said that from what she knows so far, swine flu ranks only among the "top 10" public health crises she has faced, up there with SARS in 2003, which never arrived in Philadelphia.

Her advice at the moment: Wash your hands.

Based on what is known so far, officials urge people mainly to stay informed and practice good hygiene:

If you have flu symptoms, stay home from work or school to avoid spreading the disease. Do not return until two days after your symptoms are gone.

Wash your hands often and cover your nose and mouth when you cough or sneeze.

Go to the hospital if you have severe symptoms such as difficulty breathing. But if your symptoms are mild, stay home to avoid exposing others.

Masks may be recommended for health-care workers and others who come in close contact with swine-flu patients, but there is no need for the general public.

It is safe to eat properly handled pork. Cook it to at least 160 degrees Fahrenheit.

Think ahead about how to respond to possible disruptions, such as school closures.

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