Horizon, Host: Ted Simons

May 5, 2009

Host: Ted Simons

Swine Flu Update

  • Will Humble - Acting Director,Arizona Department of Health Services
  • Dr. Bob England - Director, Maricopa County's Department of Public Health
Category: Medical/Health

View Transcript
Ted Simons:
Good evening, and welcome to "Horizon," I'm Ted Simons. State lawmakers took some official first steps today toward balancing a projected $3 billion budget deficit in 2010. The House Appropriations Committee heard a series of budget-related bills, and endorsed the main money bill on an 8-5 party line vote. The bill cuts state spending by about $630 million. It takes nearly $400 million from a variety of dedicated funds, and relies on nearly $1 billion in federal stimulus funding. It raises more than $500 million in non-tax revenues. Three valley schools forced to close because of the swine flu were allowed to reopen today, earlier than expected. Maricopa County health officials believe the H1N1 flu or swine flu is no more dangerous now than the seasonal flu. The county's public health director is recommending that schools in Maricopa County no longer be closed due to a confirmed case of the virus. Here with the latest on swine flu is Will Humble, acting director of the Arizona Department of Health Services. And Dr. Bob England, Director of Maricopa County's Department of Public Health. Thank you both for joining us on "Horizon."

Bob England:

Ted Simons:
Bob, let's start real quickly. Where are we right now, what's going on?

Bob England:
We are keeping our guard up, watching this very closely. We had enough information by the weekend to make the decision that yes, indeed, this flu is behaving just like regular seasonal flu, so we could begin to treat it just like regular seasonal flu, but we've got to keep our eye on it. Brand-new strains that can become a pandemic do evolve and come back in waves over time. And either in this first wave or in future waves it might become a virus that makes people sicker than it is at this point. We're watching it like a hawk.

Ted Simons:
How did the state and county, all public health officials around the state, how did y'all handle this thing?

Will Humble:
I think we did really well. There's two aspects to this that I think went really well. Number one, the logistics of it. We got the national supplies in, got them out to the county health departments. And those supplies were available should this have been worse than it was. The logistics were good. The epidemiology was good. I think our surveillance worked well with hospitals and clinicians. We got samples in quickly. Our laboratory scientists worked well to get good answers quickly. The key is really this putting all that together, the epi-data, putting it together to make good decisions. That's really ultimately what made this thing go well, is that we made good decisions as we went. And as Bob just mentioned, one of the key decisions over the weekend was, you know, it was really clear from the surveillance data, from the severity data on this virus, that it didn't make sense to keep closing schools. So that was a key decision, because it demonstrated that we were able to synthesize all of this information. Actually we were ahead of the curve. C.D.C. was not calling -- they were still calling for school recommendations over the weekend. They changed that today. We were ahead of the curve on that. I think that also demonstrates the fact that the surveillance system worked and we were independent enough to make the call early so that we didn't send a bunch of kids out of school again.

Bob England:
And state and local working together to make that determination, it's been a very good working relationship in the middle of a crisis, which was a very good decision.

Ted Simons:
How is that determination made? How do you decide it's time to close a school, and how do you decide its okay to reopen them?

Bob England:
Everybody in the world was very cautious at the beginning. This has been less than two weeks that we even knew this existed. Brand-new virus and we knew that past pandemics could be very bad. It behooved us to treat this very cautiously and do what we could to slow down the spread until we had enough data to be sure that we were more comfortable, that at least so far it's behaving like the regular flu. That was what we were able to do. Also, we were able to determine really quickly that this is very widespread. It wasn't limited to just a few schools, it made no sense to close schools that just happened to be ones where children had been tested and you could tell that it was there. If we were going to continue the same kind of control, we would have had to have closed all the 5 schools and this virus just didn't merit that.

Ted Simons:
Some might say there was a bit of an overreaction. Do you agree?

Bob England:
I don't think so. We made the right decisions at the right time. The C.D.C. guidance was appropriate at the very initial phase when we didn't yet know what we were facing. That's a tool in our toolbox that we will pull back out and use if we need to. If this virus looks like its getting worse, we will do whatever we need to do to protect this community, that and more, if it's really bad.

Ted Simons:
Do you think there was an overreaction?

Will Humble:

I really don't think there was an overreaction. If you roll back the screen to a week ago, there was a handful of cases in the whole country. We didn't really know how severe it was. And we had this information from Mexico that made it seem like, holy smokes, this is the real thing. That's really what it looked like last Tuesday a week ago. Look at how much information that we have between then and now, and it's not a ton of information. But we really drilled down to the issue of severity and looked at hospitalizations, looked at deaths, making sure that we were capturing all of what we call unexplained deaths, so we were making sure that we were making a good call based on severity. Using that information, we backed off, and we backed off quicker than the rest of the country.

Bob England:
When we say this is no more severe than the regular flu, regular flu can be really bad. People die from the regular flu. Hundreds of people die every year because they got the regular flu. 36,000 in an average year in the United States die from complications of the flu. So just like that, people will get very sick and some people will die from this, too, and we have to be ready to expect that.

Ted Simons:
That being said, when it came out of Mexico, the first reports seemed so severe, lots of deaths, lots of serious illness, it didn't seem to translate here. Or was that just a regular flu season in Mexico?

Bob England:
It may well have been. We still don't have the data that we would like. It will be quite a while before we have a clear picture of what happened. But Mexico City is enormous, there are 20 million who live there. Thousands die in Mexico City in a regular flu season. It could be that it had been there long enough to become very widespread, and the fraction of people who get tested, just as here, the fraction tested are the people who are the most sick. In fact, that's the only people we want tested at this point. We've got plenty of tests to show that it's widespread. Because people who are sick in the hospital, near death, may be the ones who are tested, that's what it would look like at first when you're very first test results come rolling out.

Ted Simons:
Interesting. Are you concerned now about a possible flu rebound come the fall?

Will Humble:
Well, we're always concerned about a flu rebound in the fall. Guess what, it happens every single year. Every year, either from usually sometime between November 1st and January 15th or so, we see a big spike in influenza here in Arizona. It could come earlier or later, but it always comes. And so, really, the focus here is to get folks to think about -- especially that time of year -- making sure they get their regular vaccine, and do that basic personal hygiene, hand-washing kinds of things, making sure they don't go out when they are sick and so forth.

Bob England:
Whether it continues to spread is out of our hands. It's more in the hands of the community to follow those simple things that we just mentioned. The good news about this, if it comes back in another wave in the fall, hopefully we may have had time to produce a vaccine. If we do have a vaccine available, though, I think it's doubtful that we'll have enough for everyone who wants it or should have it. So the next issue we may have to face is who gets that vaccine first, how do we lay that out. And we need to learn from what we're seeing in this right now. We've got a lot of children with this; clearly children transmit the flu great, to people who are more susceptible of complications. Maybe we need to take the information and think hard about taking our limited vaccine and targeting it to our kids first, to help prevent spread in the community.

Ted Simons:
Wish we could go a little longer on this. Sounds like things are pretty safe in hand for now.

Bob England:
Yep, we're watching it like a hawk.

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