By John Palmer
If you think that the flu season is going to go easier on us this year, think again. A new study says that this winter’s flu season may last longer in large cities, while smaller cities will experience a shorter but more explosive bout with the virus.
That news follows a CDC revelation that an estimated 80,000 Americans died of flu and its complications last winter, which would make that season the highest death toll the country has seen from the flu in at least four decades.
The study, published in the October issue of the journal Science, presents evidence that flu incidence tends to fluctuate depending on environmental moisture levels, population density, and activity levels of the general population. By that logic, it would seem reasonable that cities near the humid coastlines or with larger populations that spend more time together inside during flu season will be subject to a longer, “more diffuse” infection season.
By contrast, the study claims that cities in drier climates with less population and more outdoor activity would see fewer cases of the flu overall with shorter lifespans and more intense periods of infections, because as humidity drops the viability of flu germs grows.
“Cities can differ from each other in several ways that could potentially influence influenza transmission, including variation in the timing and coverage of public health interventions and variation in population health and socioeconomic conditions,” the authors wrote. “Cities also differ fundamentally in population size, spatial structure, and connectivity, in ways that may affect infectious contact patterns. These have the potential to substantially alter epidemic dynamics, including responses to climate forcing, and the impacts of public health interventions.”
The findings suggest that a one-size-fits-all approach to flu season preparedness no longer works—and in the healthcare world where patient care and infection control protocols rule the roost, individual organizations may need to tailor their preparations based on their location.
“We thus propose that elevated base transmission potential in the presence of climate forcing leads to divergent epidemics among cities,” the authors wrote. “Increased base transmission potential in urban centers enhances influenza spread outside of peak season, which elevates herd immunity to currently circulating strains, and subsequently attenuates explosive spread when climatic conditions are most favorable for transmission. This leads to the counterintuitive outcome that larger cities, with higher base transmission potentials, have more diffuse influenza epidemics. Base transmission potential may be elevated in large cities as a consequence of increased spatial organization, including aggregation of residences and workplaces, and the prevalence of high-density mass transit, among other factors.”
What does this mean for hospitals? By the study’s logic, small hospitals should bolster their surge capacity—their ability to handle a lot of sick people over a short period of time until they get reinforcements—while larger ones should find ways to reduce flu transmission among their patients and employees while becoming more prepared to deal with larger numbers of longer-term infectious patients.
According to OSHA, many scientists believe that it is only a matter of time before another pandemic occurs. However, it is difficult to predict when the next influenza pandemic will occur or how severe it will be. In recent years, flu-related deaths have ranged from about 12,000 to 56,000, according to the CDC. Last year’s surprisingly intense season should serve as warning that hospitals need to ramp up their preparations now.
The specifics of each year’s influenza strain are famously unpredictable, but for the most part, outbreaks themselves can be predicted because surges tend to occur within the same period each year. For instance, in the Northern Hemisphere, that period typically falls from late autumn through late winter or early spring.
“The scale of influenza epidemics can sometimes mirror that of pandemics—for example, the recent influenza seasonal outbreak in winter 2017–2018 had a similar epidemic size and peak intensity as that of the 2009 pandemic in the United States,” the authors wrote. “More research is needed to understand and predict the scale and intensity of influenza outbreaks, as a function of population susceptibility and spatial organization, and the potential trade-offs between these epidemic parameters. Our work indicates potential trade-offs between scale and intensity of epidemics that raise important questions for future work on the optimization of health systems against endemic and pandemic threats.”
What does this mean for hospitals? Well, the study’s findings aren’t likely to make it easier to predict the likelihood of a major flu epidemic, but they can give some insight about how hospitals should plan for one.Infection control experts say there are many improvements to be made in the way hospitals and workers prepare to protect patients and staff from the flu. Here are some suggestions:
Buy more PPE than you think you’ll ever need and find someplace for it. What if you don’t have enough respirators available for your entire team? You don’t want to come to that realization in the middle of a pandemic. By now, you should have purchased at least the minimum amount of PPE your staff will need to wear when dealing with very infectious organisms. Many hospitals also have begun stocking the equipment in easy-to-access cabinets outside patient safety rooms.
Get your triage protocols in order. Many infection control experts say in the event of a major outbreak, one of the best ways to control the spread of the illness is to keep infectious patients out of your facility in the first place.
Institute a policy that requires appointments to be made over the phone. By doing this, patients stay at home, where they are most comfortable, and keep themselves from exposing themselves to cold and the stress of a clinic visit in the first place. This policy also keeps your staff and other patients from being exposed to potentially dangerous germs. While such a strategy might sound impersonal, it gives you a chance to better care for those who might need quicker attention.
This isn’t necessarily possible in a hospital ER, for instance, but even in this setting you could set up a triage area separate from the general population. By asking the right questions and knowing what is incoming, your staff can avoid exposing a busy waiting room to illness.
Some hospitals have created “SWAT” teams consisting of physicians, critical care nurses, respiratory therapy assistants, and radiological staff that are ready to swing into action with their specialized skills during an infectious outbreak. Response plans have been mapped out that involve blocking off certain areas of the hospital, designating certain rooms as off-limits, and setting up pre-stocked carts that can be wheeled into place at a moment’s notice.
All hail gloves. At this point, we shouldn’t have to tell you how important it is to wear gloves when working with patients. Not only does the practice help to keep your germs off patients, and theirs off you, but wearing a glove can also help prevent needlesticks and blood getting into an open cut or sore, which can lead to hepatitis and other illnesses.
Once contaminated, gloves can spread infectious materials to other healthcare workers and environmental surfaces. Change gloves when heavily soiled, and never wash or reuse disposable gloves. Some experts are now recommending that hospitals maintain enough PPE inventory to allow double-gloving protocols when dealing with patients who have the flu or other highly infectious diseases.
It’s your responsibility as an employer to foster a culture of safety, so make sure employees know that gloves are a job requirement, and check your inventory for latex and powdered gloves—the FDA has banned them to prevent allergic reactions from sensitive individuals.
Tell your sick workers to stay home. A report published in the November 2017 issue of the American Journal of Infection Control found that as many as four out of 10 healthcare professionals show up at work even when they are sick with flu-like illnesses. The study asserts that illness transmission by healthcare employees represents a grave public health hazard.
Lead researcher Sophia Chiu, MD, MPH, called the findings “alarming” and cited an earlier study that showed patients exposed to a sick medical worker are five times more likely to get a healthcare-associated infection. “We recommend all healthcare facilities take steps to support and encourage their staff to not work while they are sick,” she added.
The survey of nearly 2,000 health workers during the 2014–2015 flu season interviewed doctors, nurses, nurse practitioners, physician assistants, aides, and others who self-reported flu-like symptoms at work such as fever and cough or sore throat.
“Health care personnel (HCP) working while experiencing influenza-like illness (ILI) contribute to influenza transmission in health care settings,” the report’s authors wrote. “Influenza infections are associated with thousands of deaths in the United States each year. Transmission in health care settings, where there is a higher concentration of elderly persons and individuals with immunosuppression or severe chronic disease, is a major concern.”
Consider making the flu shot mandatory. The CDC recommends healthcare workers get vaccinated annually. But in many states, they are not required by law to do so. Some healthcare facilities have instituted a mandatory flu shot policy for employees, if they don’t have a health condition that could be compromised by the vaccine or a religious objection to being vaccinated.
Education of your employees is key to compliance. While The Joint Commission does not mandate that facilities require flu shots, standard IC.02.04.01 requires that a facility offer the vaccine to its practitioners and staff if the facility provides treatment or services on-site, as well as education about the flu and why the vaccine is recommended.
John Palmer is a freelance writer who has covered healthcare safety for numerous publications. Palmer can be reached at firstname.lastname@example.org.