It was the worst of times and the worst timing.
“The uptick in flu cases in mid-December spiked around Christmas and New Year’s Eve, around the holidays, a lot of traveling and socializing with family and friends,” said Dr. Wendy Coling, a Kaiser Permanente primary care physician in Orange County. She said it didn’t help that this year’s H3N2 influenza virus is a “more virulent flu strain.”
H3N2 is the most dangerous of the four seasonal flu strains because it “mutates so quickly,” said Dr. Alistair Aaronson, medical director of utilization management at St. Jude Medical Center.
Local healthcare providers said their hospitals have built-in programs to respond to unexpected events, but this year’s flu did present challenges because of the earlier onset and high number of hospitalizations.
The flu season is far from over—typically lasting until late May—but experts said there are important takeaways from this season to better coordinate care and allocate care-provider resources.
Workforce
“Flu this year was definitely earlier than the previous season with a much earlier, high peak of cases,” said Dr. Jasit Singh, a pediatric infectious disease subspecialist at Children’s Hospital Orange County. She also serves as assistant director of the division for CHOC Children’s specialists.
There have been approximately 600 influenza cases, inpatient and outpatient cases combined, according to Singh.
Dr. Marc Taub, medical director of emergency services at MemorialCare Saddleback Medical Center, and Dr. Philip Robinson, medical director of infection prevention and hospital epidemiology at Hoag Memorial Presbyterian, also confirmed a high level of activity at their emergency departments and urgent care facilities during the last two weeks of December and into the first week of January.
Singh said given the timing of the surge—“with staff on vacation or themselves being sick and having to miss work—we certainly don’t allow them to work if they are sick”—it was a challenge making sure enough staff were available.
The Centers for Disease Control and Prevention estimates that the country’s about halfway through the season in a flu update report released on Jan. 26. “For the past three weeks the entire country has been experiencing a lot of flu, all at the same time,” according to the report.
“Nationally it looks like it’s trending up, but I think in Southern California we’ve already spiked,” Coling of Kaiser said.
Every flu season is different, with some years worse than others.
Singh said while the influx over the holidays isn’t a predictor for what will happen next season, CHOC plans to factor that into planning for backup staff.
Resource Allocation
Efficiency involves not only what St. Jude’s Aaronson said, “making sure patients coming to emergency departments with the flu can get the right care they need as soon as possible,” but also connecting people to seek care at the most appropriate care site.
“If you aren’t in a high-risk category for complications but still require immediate attention, choosing an urgent care can save you time and money, as well as keeping the emergency room free to handle more serious situations,” Hoag’s Robinson said.
Those at high risk are children younger than 2, adults over 65, women, pregnant women, and anyone with underlying chronic conditions, such as heart failure, diabetes or lung problems.
Line of Defense
Prevention is also key.
“Vaccination, vaccination, vaccination,” stressed every care provider the Business Journal interviewed. They said even if the vaccine is only about 30% effective, that remains “your best line of defense … if you haven’t had a flu shot, it’s not too late to get it now.”
Hospitals told the Business Journal that they allocated resources to educate patients about the importance of vaccination, as well as set up dedicated teams to administer those shots.
“We were very aggressive with our vaccination strategy this year,” Coling said. She said the health system started reaching out to members to get vaccinated as early as August.
Its vaccination rate is 45.9% for Southern California, up from 43% last year. About 46% of OC members are vaccinated.
High Alert
Seniors are at increased risk of developing complications from the flu, including pneumonia, dehydration and infections.
Taub said MemorialCare emergency physicians and staff watch for subtle signs of severe illnesses in the elderly, as well as “signs for other conditions which can both worsen and masquerade as the flu, such as heart attack, bacterial bloodstream infections and strokes.”
Taking care of more severe cases could take, literally, all hands on deck.
Coling said the team at OC Kaiser implemented a telecom update program where “leaders at our hospitals—emergency room, primary care, urgent care, gynecology, inpatient pediatric [and] radiology, video conferenced daily to talk about what numbers we’re seeing, challenges we’re having … to [better] coordinate our care.”
The group had about 30 leaders.
