In some areas of New Jersey the flu has already reached crisis proportions, and many fear the worst is yet to come. Monday's meeting of the Assembly's Health and Senior Services Committee focused on ways the state can help relieve overextended and overwhelmed hospitals and doctors.
Physicians and legislators also discussed steps everyone can take to lessen the severity of this year's flu season.
Dr. Shelley Greenman, an emergency medicine physician at Cooper University Hospital in Camden, struck the appropriate note when she said she has never seen anything like the number and range of flu cases that she has encountered this year.
Her colleague, Dr. Rick Hong, Cooper’s head of emergency medical services and disaster medicine, offered an even blunter assessment.
“It scares me a little bit as to what we’re seeing now,” Hong said of the increased admissions for flu.
He added that the hospital is considering activating the plans it made after the H1N1 pandemic in 2009. That could include using areas outside of the emergency department, possibly including conference rooms, to treat patients.
Hong said that while these steps may seem drastic, “if we have to do it that way, we have to do it that way.”
“We are trying to get a global picture in the state as to what is happening,” said Diane Anderson, the New Jersey Hospital Associations’ emergency preparedness director, noting that some emergency departments still have open beds.
The association, Anderson said, is working closely with state Department of Health officials, letting primary care doctors know that patients shouldn’t be sent to emergency rooms unless they have acute symptoms.
Assemblyman Herb Conaway Jr. (D-Burlington) addressed the problem of overcrowded hospitals from another perspective, discussing the tension between running an efficient statewide hospital system in which beds are filled and having enough beds available for a flu outbreak.
“We’re being impacted by having a number of hospitals drop out of the system,” Conaway said of closures in recent years. Hong agreed, stating that while hospitals are doing what they can to provide beds, “we can’t just make hospitals happen.”
Greenman concurred. “The unprecedented influx of patients is taxing an already overwhelmed system,” she said, leaving nowhere for flu patients to go.
“We may well have yet to see the worst of this year’s outbreak,” she said.
Further complicating the issue is the fact that the flu outbreak has also overburdened many primary care doctors, making it difficult for them to relieve the pressure on hospital emergency departments.
According to Anderson, some hospitals are exploring the possibility of requesting waivers for licensing requirements and have been in daily contact with state officials about the situation.
Healthcare waivers --which were approved in February 2012 -- make it possible for medical facilities to exceed bed capacity and boost patient-staff ratios above what is normally allowed.
A hospital can contact the state Department of Health’s Certificate of Need and Licensure program if it has a waiver request, department spokeswoman Donna Leusner said.
If government officials declare a public health emergency, however, waivers would be automatically triggered across the entire state.
The state Department of Health joined U.S. Centers for Disease Control in urging residents to take three actions to prevent the flu from spreading: getting flu shots; covering their noses and mouths when they sneeze or cough; and avoiding contact with sick people.
Equally important: taking antiviral medication if a doctor prescribes it.
The state also follows the CDC vaccination guideline, which says that everyone over six months old should be vaccinated annually. Residents under 18, however, can't get their shots at a pharmacy, since the state Board of Pharmacy bars druggists from giving shots to minors.
Conaway said it is particularly urgent that hospital employees get flu shots, adding that he would support a state mandate requiring this.
“When you’re in healthcare, in my view you have a responsibility beyond someone who is not in healthcare,” said Conaway, adding that this season’s flu vaccine has been highly effective. “It will protect you, it will protect your child, it will protect your grandmother.”
Leusner said the state works with healthcare provider groups to strongly encourage workers to protect themselves, their families, and their patients by getting a flu shot. She noted that hospitals across the state have policies making it easy for them to do so.
“They also offer [shots] on multiple shifts, multiple days, so if you are only working the overnight shift, the flu vaccine is available on the night shift,” Leusner wrote in an email.
Hospitals are also using other tactics to minimize the spread of the virus. These include screening visitors for flu symptoms and providing them with masks.
According to Hong, more residents should be informed that different flu symptoms require different levels of care. Anyone experiencing chest pain or having difficulty breathing should probably go to the hospital. Patients should visit a doctor if they develop symptoms like coughing, congestion or fever that won’t go away or if they can't keep food or fluids down.
Greenman cautioned that patients have a misconception that doctors can provide a “quick fix and that an antibiotic will make them better,” noting that neither is true. As a virus, the flu is not affected by antibiotics.
Greenman also said that while many flu patients are not in need of hospital care, the experience of the virus is so painful “you feel like you’re going to die.”
Assemblyman Erik Peterson (R-Hunterdon, Somerset and Warren) said his children’s pediatrician has given his family a checklist of flu symptoms that require a trip to the doctor. “I think it would be effective for adults as well,” he said.
Conaway said it might be appropriate for the state’s 211 phone help line to provide flu information. “Unless you have more severe symptoms, then you really ought to treat yourself,” he said.