What is the CDC doing in response to the Swine Flu Outbreak?

What is CDC doing in response to the outbreak? April 29, 2009, 10:55 PM ET

CDC has implemented its emergency response. The agency’s goals are to reduce transmission and illness severity, and provide information to help health care providers, public health officials and the public address the challenges posed by the new virus. CDC continues to issue new interim guidance for clinicians and public health professionals. In addition, CDC’s Division of the Strategic National Stockpile (SNS) continues to send antiviral drugs, personal protective equipment, and respiratory protection devices to all 50 states and U.S. territories to help them respond to the outbreak.

H1N1 Flu (Swine Flu) and You

April 29, 2009, 10:55 PM ET

What is swine flu?
Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza viruses that causes regular outbreaks in pigs. People do not normally get swine flu, but human infections can and do happen. Swine flu viruses have been reported to spread from person-to-person, but in the past, this transmission was limited and not sustained beyond three people.

Are there human infections with swine flu in the U.S.?In late March and early April 2009, cases of human infection with swine influenza A (H1N1) viruses were first reported in Southern California and near Guadalupe County, Texas. Other U.S. states have reported cases of swine flu infection in humans and cases have been reported internationally as well. An updated case count of confirmed swine flu infections in the United
States is kept at http://www.cdc.gov/h1n1flu/investigation.htm CDC and local and state health agencies are working together to investigate this situation.

Is this swine flu virus contagious?CDC has determined that this swine influenza A (H1N1) virus is contagious and is spreading from human to human. However, at this time, it is not known how easily the virus spreads between people.

What are the signs and symptoms of swine flu in people?The symptoms of swine flu in people are similar to the symptoms of regular human flu and include fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and vomiting associated with swine flu. In the past, severe illness (pneumonia and respiratory failure) and deaths have been reported with swine flu infection in people. Like seasonal flu, swine flu may cause a worsening of underlying chronic medical conditions.

How does swine flu spread?Spread of this swine influenza A (H1N1) virus is thought to be happening in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing of people with influenza. Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose.

Can I get swine influenza from eating or preparing pork?No. Swine influenza viruses are not spread by food. You cannot get swine influenza from eating pork or pork products. Eating properly handled and cooked pork products is safe.

How can someone with the flu infect someone else?Infected people may be able to infect others beginning 1 day before symptoms develop and up to 7 or more days after becoming sick. That means that you may be able to pass on the flu to someone else before you know you are sick, as well as while you are sick.

What should I do to keep from getting the flu?First and most important: wash your hands. Try to stay in good general health. Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food. Try not touch surfaces that may be contaminated with the flu virus. Avoid close contact with people who are sick.

Are there medicines to treat swine flu?Yes. CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with these swine influenza viruses. Antiviral drugs are prescription medicines (pills, liquid or an inhaler) that fight against the flu by keeping flu viruses from reproducing in your body. If you get sick, antiviral drugs can make your illness milder and make you feel better faster. They may also prevent serious flu complications. For treatment, antiviral drugs work best if started soon after getting sick (within 2 days of symptoms).

How long can an infected person spread swine flu to others?People with swine influenza virus infection should be considered potentially contagious as long as they are symptomatic and possible for up to 7 days following illness onset. Children, especially younger children, might potentially be contagious for longer periods.

What surfaces are most likely to be sources of contamination?Germs can be spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth. Droplets from a cough or sneeze of an infected person move through the air. Germs can be spread when a person touches respiratory droplets from another person on a surface like a desk and then touches their own eyes, mouth or nose before washing their hands.

How long can viruses live outside the body?We know that some viruses and bacteria can live 2 hours or longer on surfaces like cafeteria tables, doorknobs, and desks. Frequent handwashing will help you reduce the chance of getting contamination from these common surfaces.

What can I do to protect myself from getting sick?There is no vaccine available right now to protect against swine flu. There are everyday actions that can help prevent the spread of germs that cause respiratory illnesses like influenza. Take these everyday steps to protect your health:

- Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
- Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.
- Avoid touching your eyes, nose or mouth. Germs spread this way.
- Try to avoid close contact with sick people.
- If you get sick with influenza, CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.

What is the best way to keep from spreading the virus through coughing or sneezing?- If you are sick, limit your contact with other people as much as possible.
- Do not go to work or school if ill. Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick. Put your used tissue in the waste basket. Cover your cough or sneeze if you do not have a tissue. Then, clean your hands, and do so every time you cough or sneeze.

What is the best technique for washing my hands to avoid getting the flu?Washing your hands often will help protect you from germs. Wash with soap and water or clean with alcohol-based hand cleaner. We recommend that when you wash your hands -- with soap and warm water -- that you wash for 15 to 20 seconds. When soap and water are not available, alcohol-based disposable hand wipes or gel sanitizers may be used. You can find them in most
supermarkets and drugstores. If using gel, rub your hands until the gel is dry. The gel doesn't need water to work; the alcohol in it kills the germs on your hands.

What should I do if I get sick?If you live in areas where swine influenza cases have been identified and become ill with influenza-like symptoms, including fever, body aches, runny nose, sore throat, nausea, or vomiting or diarrhea, you may want to contact their health care provider, particularly if you are worried about your symptoms. Your health care provider will determine whether influenza testing or treatment is needed.

If you are sick, you should stay home and avoid contact with other people as much as possible to keep from spreading your illness to others.

If you become ill and experience any of the following warning signs, seek emergency medical care.

In children emergency warning signs that need urgent medical attention include:
Fast breathing or trouble breathing
Bluish skin color
Not drinking enough fluids
Not waking up or not interacting
Being so irritable that the child does not want to be held
Flu-like symptoms improve but then return with fever and worse cough
Fever with a rash
In adults, emergency warning signs that need urgent medical attention include:
Difficulty breathing or shortness of breath
Pain or pressure in the chest or abdomen
Sudden dizziness
Confusion
Severe or persistent vomiting

How serious is swine flu infection?Like seasonal flu, swine flu in humans can vary in severity from mild to severe. Between 2005 until January 2009, 12 human cases of swine flu were detected in the U.S. with no deaths occurring. However, swine flu infection can be serious. In September 1988, a previously healthy 32-year-old pregnant woman in Wisconsin was hospitalized for pneumonia after being infected with swine flu and died 8 days later. A swine flu outbreak in Fort Dix, New
Jersey occurred in 1976 that caused more than 200 cases with serious illness
in several people and one death.

WSJ Article - By AVERY JOHNSON and KELLY EVANS

Employment in health care, the only major industry outside the federal government still adding jobs, is succumbing to the recession.

In the latest sign, the president of New York City Health & Hospitals Corp. wrote Friday to community organizations as well as employees and unions at its 11 hospitals and four nursing homes, saying the agency will lay off more workers even after slashing 400 jobs last month.
[health]

"We now project that HHC's deficits will worsen, even if we are spared further state cuts," Alan Aviles wrote to the staff of 39,000. "The challenges will deepen." He blamed the job losses on state cuts in Medicaid payments to the public-health system.

Across the country, hospitals are taking financial hits. They are seeing losses in the portfolios that they rely on for investment income. The number of uninsured patients is rising. Elective procedures -- which reap big profits -- are down at a third of hospitals nationwide. Nursing homes are trimming payrolls. And with state governments continuing to cut budgets and talk of health-care reform from Washington, industry executives are preparing for even leaner times.

More than 16 million people -- one in eight workers on U.S. payrolls -- work in health care today, up from just 1% of the work force 50 years ago. Employment in health care and social assistance -- which includes hospitals, doctors offices, nursing homes and social services such as day care -- has grown by half a million jobs since the recession began in December 2007, while the rest of the economy has shed 5.1 million jobs.

But the pace of job growth in health services has slowed sharply this year. The sector added an average of 17,000 jobs per month in the first three months of the year, less than half last year's pace. Health care usually weathers downturns better than many other industries because consumers tend to cut spending on cars or clothes before they forgo trips to the emergency room or pharmacy. But this recession is the deepest in a generation.

"To the extent that health care might have been recession-proof, it is no longer," said Paul Levy, chief executive of Beth Israel Deaconess Medical Center in Boston, a teaching hospital for Harvard University. The hospital last month announced 140 job cuts, salary freezes, and reductions in vacation allowances and retirement-fund contributions to make up a $20 million budget shortfall.

Mr. Levy began to get worried in October, when Massachusetts cut Medicaid payments to his hospital by $7 million. In November, he noticed researchers weren't applying for grants as actively as usual, anticipating less government funding; that cost another $7 million in revenue for the hospital, which gets some of the grant money to cover overhead. Then in January, patient volume slowed. During the first three months of this year, hospital discharges -- a standard measure of patients treated -- dropped to 112 a day from a targeted 122, which translates into $20 million less in yearly revenue.

Big hospitals such as the University of Pittsburgh Medical Center and Akron General Health System in Ohio have announced layoffs recently. In February, the number of mass layoffs for hospitals was double what it was a year ago, according to government data.

In Tarboro, N.C., Kim King, a 49-year-old contract worker in the hospital laboratory at Heritage Hospital, received a letter from her manager last Monday cutting her contract short by three weeks and asking staff to voluntarily reduce hours. The letter cited the economic pressures facing the hospital. Ms. King isn't sure what she is going to do when her job analyzing blood and other fluids in the hospital lab ends in June. She is looking for work and considering going on unemployment.

She and her ex-husband, a corrections officer, "used to joke that we had the most secure jobs out there, because people always need health care and prisons. It's not true anymore," she says. "I've never seen it so bad. It's the one thing you would think wouldn't be affected by the recession."

Wick Baker, president of Heritage Hospital, says the hospital is being financially responsible by looking at all of its costs, including replacing contract employees with less expensive full-time staff.

The squeeze isn't limited to hospitals. Pharmaceutical firms and health insurers also are shedding jobs. On Thursday, health-care conglomerate Johnson & Johnson said it would lay off 900 workers.

Since the Labor Department began tracking monthly unemployment figures in 1958, there have been nine recessions, but employment in health services has declined only a handful of times. The only significant losses to date occurred in mid-1984, as the industry shed 41,000 jobs, based on slightly different historical data, following the double-dip recession of the early 1980s. Since then, no month has seen a drop of more than 4,000 jobs in health care, and there have been no back-to-back declines.

As manufacturing employment has declined, many cities have come to see health care as the employer of last resort. Rochester, Minn., home to the Mayo Clinic, is one illustration of the industry's power to turn around regional fortunes and revitalize downtowns. Forty years ago, Mayo employed 4,000 workers; today, the international destination for top-tier health care employs some 35,000, more than a third of the city's total work force.

But Mayo, like the rest of the industry, is now struggling to meet it its capital and payroll obligations. Last month, the ratings agency Standard & Poor's downgraded Mayo's debt, citing the hospital system's large unfunded pension liability and break-even operating margins.

Mayo is freezing salaries for doctors and senior administrators, reducing travel and overtime expenses, and cutting capital spending this year by $150 million, says Chief Financial Officer Jeff Bolton. There have been no layoffs, though temporary staff are being pared back and only essential positions are being filled. Mayo is delaying occupying one floor of a new outpatient exam building on the Rochester campus, since finishing the interior of each floor costs $12 million.

The decline, while unusual, is still likely to be a temporary break in the industry pattern. Growth in health-care spending, and thus employment in the sector, is likely to rebound when the recession ends, a function of the enormous advances in medical technology and Americans' strong appetite for health care. President Barack Obama has also named the sector one of his three pillars of the future U.S. economy, alongside energy and education. Health expenditures as a share of gross domestic product have more than tripled in the past 50 years to about 16% today, and the government's Centers for Medicare and Medicaid Services say that figure is likely to hit 20% within a decade.

"It's a long-term shift reflecting changes in technology and what consumers want," says Robert Fogel, a Nobel laureate and professor at the University of Chicago's Booth School of Business. "Health care is the growth industry of the 21st century."

NC Senate budget proposal hits schools, Medicaid By GARY D. ROBERTSON Associated Press Writer

RALEIGH, N.C. — The Senate's version of the North Carolina state government budget cleared key committees Tuesday despite significant cuts to health and public education programs and confusion among lawmakers and lobbyists as to how they would be carried out.

The Senate Appropriations Committee approved the plan that narrows a $3.4 billion budget gap for next year in part through spending reductions, federal stimulus money and $500 million in tax increases. It passed the chamber's finance and pension committees later Tuesday.

Budget writers said the plan would seek to get the unemployed back to work by providing funds to train students in still-growing health care sectors and inject funds into small towns seeking help with economic development projects.

"We believe with this budget, we're attacking the (bad) economy in North Carolina," said Sen. Linda Garrou, D-Forsyth, co-chairwoman of the Senate Appropriations Committee. She made her remarks at the beginning of more than three hours of debate.

But the tax details won't be added to the budget before it's heard on the Senate floor as early as Wednesday. Senate Democrats who control the budget process said the details - which are likely to include higher cigarette and alcohol taxes and possible taxes on some services for the first time - are still being worked out, frustrating Republicans.

"There's a half-a-billion per year ... tax increase in there and nobody know what taxes they're talking about," said Senate Minority Leader Phil Berger, R-Rockingham. "For members of the Senate to vote for a budget proposal that has that kind of provision just strikes me as being irresponsible."

The $20.05 billion spending plan for the coming year, coming three weeks after Gov. Beverly Perdue offered her own two-year proposal, would save money by laying off 712 state workers and keep another 910 positions vacant for the fiscal year starting July 1.

Perdue and the North Carolina Association of Educators oppose a Senate provision that would increase the average size of public school classrooms by two students through the 2010-11 school year, at a savings of $322 million annually.

But child care advocates are worried about a provision that would essentially phase out the More at Four program, which provides free, high-quality preschool to 32,000 at-risk 4-year-olds, and merge it with an initiative that sets ratings for child care programs.

"We're trying to look at some efficiencies there but we also believe strongly it's important to prepare our children to go to school," Garrou said Monday. "We decided that this was a good year to look at combining some of these areas and try to make it more efficient."

More at Four, which receives $85 million from state lottery profits, would lose $40 million but take in $37 million in stimulus funds.

Roz Savitt, a lobbyist with the North Carolina Childcare Coalition, said the provisions were confusing but appear to erode the value of More at Four.

"In the end, it's less money and lower standards," Savitt said. "No. 1, it's going to hurt children."

The budget also left providers of personal care services for Medicaid patients living at home scrambling to block a $55 million cut in state funding.

Combined with federal matching dollars for Medicaid, the proposal would reduce the $361 million program for next year by 60 percent, according to legislative staff.

Workers assist patients with bathing and other tasks. The reimbursement cost of about $15 per hour is much less than the cost for Medicaid if that patient must be sent to a nursing home, lobbyists for service providers said.

"It defies logic," said Tim Rogers, chief executive officer of the Association for Home & Hospice Care of North Carolina. "We cannot balance the budget of the state of North Carolina on the backs of 84-year-old grandmothers."

A recent audit of the personal care services program found that more than 40 percent of the cases reviewed shouldn't have qualified for the service, said Sen. Bill Purcell, D-Scotland, co-chairman of the health budget subcommittee.

Rogers said those findings were misleading and that doctors and registered nurses must sign off on such personal care treatment.

Purcell said it's not surprising that the industry is unhappy with such a cut given the state's bad fiscal situation.

"Who's not upset right now?" Purcell said.