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U.S. Preparing for Resurgence of H1N1 Flu

August 25, 2009 at 12:00 AM EDT
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Amid predictions of a new H1N1 swine flu outbreak, health officials warn that children going back to school are especially at risk. Gwen Ifill talks to Dr. Anne Schuchat, the director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention.
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GWEN IFILL: And still to come on the NewsHour tonight: fighting malaria in Cambodia; and weighing in on the economy and more.

But first, as millions of school children head back to class this week, their backpacks will be stuffed with notebooks, pencils, and hand sanitizer. While the nation braces for a new outbreak of the H1N1 virus, known as swine flu, students and adults are learning all over again how to wash their hands.

The President’s Council of Advisors on Science and Technology reports children and young people are at special risk for infections, expected to peak in mid-October. Its scenario: up to half the U.S. population could be infected; 1.8 million Americans might require hospitalization, 300,000 of them in intensive care; and for 30,000 to 90,000 people, the disease could be fatal.

Only 36,000, most of them elderly, die from the conventional flu each year.

For more, I’m joined by Dr. Anne Schuchat, the director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention.

Welcome.

DR. ANNE SCHUCHAT: Thank you.

GWEN IFILL: Do those numbers sound right to you, 60 million to 120 million infections, 30,000 to 90,000 of them fatal?

DR. ANNE SCHUCHAT: You know, the PCAST advisers offered a planning scenario that was really meant to be used to take this seriously so that states and local health departments, the private sector, the public would be aware that things could be quite challenging.

But we really can’t predict exactly how much disease there’s going to be this fall and winter. I can say we’re working hard to be prepared and ready to respond.

Preparing the hospital system

Dr. Anne Schuchat
Centers for Disease Control
The government has released funds to strengthen hospital preparedness, as well as state and local health preparedness.

GWEN IFILL: So you're saying, to be clear, that this is a plausible scenario, were the words they used, but not necessarily a prediction?

DR. ANNE SCHUCHAT: They used the words a planning scenario, right.

GWEN IFILL: How about -- even if there's a possibility of, they say, 1.8 million hospitalizations, say it's only a million hospitalizations. It sounds like a lot. Is the U.S. hospital system prepared for that rate of admission?

DR. ANNE SCHUCHAT: You know, we're working closely across government to strengthen the preparedness of the hospital system and the medical community in general. The government has released funds to strengthen hospital preparedness, as well as state and local health preparedness.

And we're carrying out a number of outreach activities this summer to work closely with the medical community and the public health community, as well as communicators, to really be as prepared as possible. Things could be quite challenging, but we're all in this together, and I do think we have some time to get -- to really strengthen further our preparedness efforts.

GWEN IFILL: There are different kinds of preparedness, of prevention. One, as you mentioned, are the things we've heard so much about, washing hands, taking care to stay away from work and places like that, if you think you may be sick. But there's also this question of a vaccine. How available will that vaccine be in time to try to head off some of these numbers?

Developing a vaccine

Dr. Anne Schuchat
Centers for Disease Control
Well, it's important for people to know that disease hasn't gone away. We continue to see transmission this summer, and we're currently at higher levels of influenza disease than would be expected for this time of year.

DR. ANNE SCHUCHAT: Well, it's important for people to know that disease hasn't gone away. We continue to see transmission this summer, and we're currently at higher levels of influenza disease than would be expected for this time of year.

We do think that over the next several weeks, as school kids return to classes, we'll see increases. And we know that we won't have a vaccine before school kids are back in school. They're already back in school.

So we have a number of weeks to months where we'll be needing to use other interventions. But we are working carefully on vaccine development, testing, and planning to implement a vaccination program. At this point, we're expecting to be launching a voluntary vaccination program in the middle of October.

And so it's very important before then for people to remember those important steps they can take: washing their hands, staying home when they're sick, staying informed about what's going on.

The vaccination program, though, we are working hard to be ready for. We're expecting doses to be online and available by mid-October and that additional doses will be coming out every week. And we're working closely with the public health system, as well as private providers, to find ways to reach people who are recommended to receive vaccines.

GWEN IFILL: But if mid-October is the time we're probably going to see most of this vaccine online, and that is the peak time, won't that be a little late for a vaccine, especially if you're one of the groups, like pregnant women or very young people, who are most at risk?

H1N1 to emerge before seasonal flu

Dr. Anne Schuchat
Centers for Disease Control
We like to remind people is that, even when things peak, that means 50 percent of the cases that are going to occur haven't happened yet.

DR. ANNE SCHUCHAT: Influenza is very unpredictable, and none of us really know when disease will peak in any given community. There's, of course, the seasonal influenza that we do expect to occur this year. Often, that occurs between December and May every year. We think the H1N1 influenza virus that emerged this year is likely to start to increase in occurrence before the seasonal strains come into prevalence.

But we don't know in any given community when peak will occur. And what we like to remind people is that, even when things peak, that means 50 percent of the cases that are going to occur haven't happened yet. So we think there's a lot we can do before vaccine is available and when vaccine becomes available to protect people and help them protect their families and the community.

GWEN IFILL: We saw a lot of school closings, a lot of quarantines, especially in other countries, that happened at the earlier outbreak. Can we expect to see that again this fall?

DR. ANNE SCHUCHAT: You know, we studied hard the spring situation, as well as the situation in the southern hemisphere, and have been able to update our guidance to schools and to higher education universities to try to find a balance between interventions that will help and interventions that might be more difficult on the population.

For the current level of severity of what we're seeing with the H1N1 virus, we aren't expecting that school closures are going to be the general way to intervene. There are likely to be some school closures, but in general there are other ways that we expect the disease to be handled.

The principal one, of course, is staying home when you're sick. Another key measure is washing your hands, covering your cough and sneeze, and staying informed. So we know that schools are taking steps to be ready if they do need to dismiss students, but we think that there's a lot of things that can happen without that being necessary.

Covering the cost of disruption

Dr. Anne Schuchat
Centers for Disease Control
Everyone is vulnerable to get influenza or its complications, and every sector is affected.

GWEN IFILL: Who covers the cost for the disruption, whether it's closing schools or, in the private sector, individuals staying home who may not have enough accumulated sick leave and lose pay?

DR. ANNE SCHUCHAT: You know, that's a really important question. One of the very difficult things about influenza is it crosses all sectors. Everyone is vulnerable to get influenza or its complications, and every sector is affected. It's not something that only the health sector has to worry about. The business community, the education sector, and so forth are all engaged.

And I can say that across government we're working hard to address some of the policy issues that really make it challenging for people to stay home from work when they're sick or to keep their children home out of school. And I know that the Education Department is working hard on ways to help schools manage this challenge.

Sometimes schools are paid based on the number of kids that are present on a certain day, and that might cause disincentives for kids to stay home when they're sick. So there's a lot of work going on behind the scenes to try to take care of some of those challenges that are really economic in nature.

GWEN IFILL: Dr. Anne Schuchat of the CDC, thank you very much for your thoughts.

DR. ANNE SCHUCHAT: My pleasure.