Flu pandemic precautions include isolation, readiness and social change

A Hubbard County flu readiness plan could include inoculations at schools and churches, setting up flu centers and educating people on "social distancing" to minimize the spread of the H1N1 flu strain that is sweeping the world. Three Minnesotans have died.

Healthcare and good health dominated discussions Wednesday at the Hubbard County Board of Commissioners regular meeting. Commissioners have requested regular monthly meetings with Public Health Director Chris Broeker to stay on top of flu preparations because the landscape keeps shifting and the unknowns are ever-present.

"We've been very busy in what direction we want to go with the H1N1 planning," Broeker told the board. "We also have to think about the regular flu and will start vaccines soon."

Seasonal flu vaccines will be given through November and December, she said.

Vaccines for the H1N1 virus may become available about mid-October, she added, and would be given on a priority basis.

The number of vaccinations available has fluctuated wildly, she said, giving health officials little guidance on availability.

Pregnant women would be the top priority to get the two-dose swine flu vaccines, with children and adolescents ages six months to 24 in the next priority group.

"The median age of those hospitalized in Minnesota is 12," she said. "Kids seem to get much sicker than adults seem to. People 50 and over aren't getting as sick because they have a long history of exposure" to various flu strains.

Schools and churches could be used as inoculation centers, Broeker said a consortium of health officials has discussed. Flu centers could be set up if doctors notice a large influx of patients. Health officials don't want flu-stricken patients sitting in waiting rooms.

"We don't want to intermingle them" with healthy patients, Broeker said.

And that may be the most important aspect to containing the flu. Broeker said the public should be educated about social distancing if flu symptoms arise.

Last spring, many schools throughout the nation and in Minnesota with flu outbreaks closed, leading potentially sick students to congregate at malls. Now schools - and workplaces - have the option of closing or not.

"If people have symptoms don't come to work," she said. Office "troopers" should stay home even if they feel the need to work.

She said the H1N1 virus may necessitate a 7-day quarantine period, which could be hard on workplaces. Generally, people can return to public places 24 hours after symptoms have subsided.

The workplace, as her office found through a culture test experiment, can be a dangerous place. Copying machines, telephones, keyboards and public access computers should be regularly cleaned because they can easily be contaminated.

"Are we building up our own immunity if you have access to all those germs?" wondered commissioner Cal Johannsen.

Yes and no. Middle aged people do seem to have more immunities, Broeker said, but if the H1N1 strain mutates or changes, it is unknown which segment of the population might be immune.

"Although it doesn't appear as virulent, it's quite a moving target," she said.

And the mortality rate from H1N1 is a bit elusive, she said. Almost 400 deaths are attributed to the H1N1 flu, but regular flu kills 36,000 people annually. It's hard to differentiate the two and also possible the deaths from the newer flu strain have not been identified, Broeker said.

But flu wasn't the only health-related topic on commissioners' minds. A discussion of healthcare options arose spontaneously during a discussion with Hubbard County Social Service Director Daryl Bessler about state plans that insure low-income people.

"When I look at all these programs I can't see why anybody wouldn't want to be insured," said commissioner Dick Devine.

"It reaches the point where people choose not to be covered," Bessler replied. And sometimes people don't qualify for some of the plans if they make too much income or have too many assets, even though they would not be considered wealthy.

People with pre-existing conditions "can't get insurance without paying horrendous premiums," Bessler said.

And there's the choice factor.

"You're choosing to pay the premiums of Minnesota Care versus going to Valley Fair or buying that pack of cigarettes," he explained. "People will always make those choices."

He said especially younger adults may forego monthly premiums of $300-$400 and do other things with the money.

"You're assuming competency and that doesn't always exist," said commissioner Don Carlson, a retired dentist.

But board chair Lyle Robinson questioned why the state takes so long to determine eligibility for its various health plans.

"If I plunk money down at Blue Cross Blue Shield how long does it take me to get insured?" he questioned.

Bessler said unlike private insurers the state plans are income-driven, so determining eligibility is more complicated than simply giving a patient a physical and having an underwriter review that patient's medical history.

"There are checks and balances to make sure employers don't drop lesser income employees to get them in MNCare," he said.

And, he admitted there's backlogs to completing the processing for state plans.

That's why Hubbard County Social Services entered into another yearlong contract to process MnCare applications, even though it adds dramatically to his staff's workload.

"Eligibility through the state can take three to five months," he said. "We would be remiss in not doing them" because locally staff can cut down that waiting period.

"They must pay the premium meanwhile," he said of MNCare applicants. If the state delays determinations of eligibility, "they can be in a world of hurt" financially, Bessler said.

Bessler said part of the nationwide healthcare debate to insure the 47 million uninsured is centered around the notion that all kids need coverage.

"Kids should not be sacrificed for lack of good decision-making by the parents," he said.

And with a flu season bearing down on that young demographic, prevention steps, while crucial, may be for naught if uninsured kids wind up in the hospital.