Local Public Health Departments Tackle Flu

Jan 28, 2013, 1:12 PM

Paul Etkind, NACCHO Paul Etkind, NACCHO

The most recent update on flu activity in the U.S. from the Centers for Disease Control and Prevention finds 47 states showing widespread activity, down from 48 states the week before. “Widespread” means that more than half of the counties in a state are reporting flu activity. While the Western part of the country will likely see more cases, flu seems to be slowing some in the South, Southeast, New England and the Midwest—though still packing a punch in terms of illness, deaths, emergency room visits and hospital admissions.

NewPublicHealth spoke with Paul Etkind, MPH, DrPH, MPH, DrPH, Senior Director of Infectious Diseases at the National Association of County and City Health Officials about the role local health departments play in educating communities about flu prevention and helping to facilitate treatment.

NewPublicHealth: What, if anything, is different about the flu this year?

Paul Etkind: The flu severity that’s being experienced, which we haven’t seen for several years now, has gotten the public’s attention and they’re really heeding the public health urgings, communication and education that’s been going on all along saying hey, get your flu shots, protect yourself. So now, within a relatively short period of time, there’s a very large demand for flu shots.

CDC Flu Map Weekly Flu Surveillance Map, CDC

During the H1N1 outbreak of a few years ago, there was much greater funding for what the health departments were doing. I saw some magic happening then. They had the funds to hold clinics in very unusual places, such as local baseball stadiums and airports. They went to places where people are most comfortable.

But those are not the circumstances that we’re in right now. So, I think we’re not hearing so much about innovation because we don’t have that kind of staffing in local health departments. Health departments are absolutely doing what they’re relied on for, but it’s being done in a more traditional fashion.

NPH: At least one city, Boston, and one state, New York, have declared public health emergencies because of the flu, and that has certainly raised awareness. What prompted those actions?

Paul Etkind: The departments have statistics to back up those actions. In Boston, they had over 800 documented flu cases. They had reports from the hospitals that they were short on beds; they had reports that physicians’ offices were being swamped with people with upper respiratory infections that look like flu, and so they had all of these metrics indicating that they had very severe problems. Declaring the emergency resulted in a large turnout for influenza shots in the many locations offered by physicians and the health department.

[Editor’s Note: Each municipality has the authority to take different actions when declaring a public health emergency. Boston provided shots free of charge during the public health emergency period. New York State granted authority to pharmacists to give flu shots to people between six months and 18 years. Authority to vaccinate older people was already permitted.]

NPH: How else are local health department cuts impacting this flu season?

Paul Etkind: We have lost about 20 percent or more of our workforce and effectively managing flu season requires experienced people to run the clinics, manage vaccine distribution, and collect and analyze data. That data includes how many flu cases there are in a region, absentee rates at school, and upper respiratory infections or influenza-like illnesses at doctor’s offices and emergency rooms. It takes a lot of time, it takes a lot of effort, and when you have cuts your workforce you may not be able to collect the data you need in order to be able to say ‘this is what’s happening in our town,’ which is a very important function. People want to know that at the very least you understand what’s going on. If it looks like the health department or the government is unable to really grasp the extent of a problem, people started losing confidence, and that’s a very dangerous situation. So, the budget cuts have hurt, without a doubt. We have fewer nurses, we have fewer epidemiologists and fewer experienced people who can manage logistics of the large scale clinics and can manage the logistics of vaccine distribution and the other many things that a local health department does.

A lot of what a local health department does is not readily visible, and yet, it’s sort of like the image of the duck—it’s really working furiously hard under water to keep moving and to move ahead. The work is important—especially since the health department is very frequently seen as a neutral party; it’s not looking for turf, it’s just trying to make sure that the services that are expected by the public are received by the public. That’s not an easy task to do, but that’s what they do every day.

This commentary originally appeared on the RWJF New Public Health blog.