New treatment boosts H1N1 survival locally

K.C. Meadows

Nov. 22, 2009 (McClatchy-Tribune Regional News delivered by Newstex) -- County to hold first H1N1 vaccination clinic

Acknowledging concerns at the number of people who don't have their own doctor and can't afford to see one, the Mendocino County health department will hold an H1N1 flu vaccine clinic in Willits this week to provide 700 shots to high risk people like pregnant women, children between 3 and 12 and medical and emergency providers; 200 more doses will be given directly to the county's obstetricians.

Previously, the county had opted to forego giving flu shots and passing its H1N1 flu vaccine doses to local doctors and hospitals.

Meanwhile, at Ukiah Valley Medical Center, new somewhat experimental equipment has proven successful in helping relieve dangerous H1N1 flu complications and given local physicians a fighting chance to save people in most serious cases.

Thus far, the county has received about 10,500 doses of its allotted 13,700 doses of H1N1 flu vaccine, an allotment calculated by the state of California and given out in unpredictable spurts.

County Health Officer Dr. Marvin Trotter said the county never knows when a shipment is coming until the FedEx (NYSE:FDX) truck arrives at the door. He noted that one shipment was almost missed because it arrived on a Friday when county offices are closed.

While citizens across the nation struggle with the decision on whether to get the vaccine and how, confusion still seems to reign on where the doses come from and where they go.

Trotter explained that of the county's 13,700

allotted doses of H1N1 flu vaccine, the health department itself has gotten only about 2,000. The rest -- about 8,500 so far, are distributed directly to other providers, such as clinics, physician offices and pharmacies (although he said he believes commercial pharmacies are somewhat down the list. Public Health Nurse Gloria Gutfeld said the commercial pharmacies get the vaccine through their own channels).

Trotter would have preferred to have had control at the heath department of all the county's doses, which he would have used for inoculating more school children, a method he believes would have greatly helped control the spread of the disease.

And while the county is probably not going to get the 40,000 H1N1 flu doses he thinks are necessary to inoculate everyone he believes should be, Trotter said that a new treatment is giving him the only peace of mind he has at the moment.

It came to the county via a $25,000 ventilator paid for by Ukiah Valley Medical Center, a ventilator especially aimed at pediatric cases.

Ventilators have become a big part of treating H1N1 flu as the dangerous cases inevitably trend toward a type of pneumonia -- known as ARDS or adult respiratory distress syndrome -- where the patient's lungs fill up with fluid and the patient can literally drown because no oxygen is getting from the lungs into the bloodstream.

Ventilators force oxygen into the lungs through a tube -- known as an endotracheal tube. The patient is paralyzed or semi-conscious, and the ventilator is essentially breathing for the patient. The county recently increased its stock of them, from 12 to 20 ventilators, when CALSTAR found eight in storage that could be refurbished.

And while ventilators are essential, they are also one-trick ponies in that they force air in and out but cannot control the reaction of the air sacs in the patient's lungs. Too much air in, the air sacs can pop, collapsing the lungs. Too much air out and the air sacs collapse, only to be reopened on the next intake of oxygen. That expand-collapse syndrome will damage the air sacs over time and can lead to severe lung damage and inadequate oxygenation.

When UVMC's new Galileo Ventilator arrived, it came with an extra module called a "3Duo-Pap.2." The hospital's respiratory technician team studied it and figured out that it could breathe for patients in a different way, allowing patients to actually be conscious enough during ventilation to continue breathing on their own, while receiving breaths from the machine at the same time. This allowed the patient to aid the ventilator by keeping the air sacs open all the time, instead of just when the machine forced air through. With this method, the patient's air sacs dried out faster and the lungs' air sacs did not suffer from the expand-collapse syndrome.

Trotter said the first person they used the new machine on was a 39-year-old woman with ARDS who was successfully treated this week on a ventilator with this new module at UVMC. Trotter feels she may otherwise have died.

He is clearly impressed with the results, but warns it will not be a cure-all for future cases.

"I don't want to scare people, but this is not a regular seasonal flu season. In 20 years I've never seen the regular flu knock off 30- to 50-year-old people," he said. "I'm more comfortable taking care of the serious consequences of this disease than I was three weeks ago, because of this new way to ventilate. Having said that, more people may die."

The federal Communicable Disease Center estimates that Mendocino County will see 50,000 cases of H1N1 flu. Most will not be serious or even ever diagnosed. Trotter said that is no reason to be complacent. He says that already he has seen hospitals in larger cities turning down transfers from our area for lack of bed space. Conversely, Fresno recently airlifted a case to UVMC because of lack of bed space in that major metropolitan area.

Sooner or later, Trotter said, each area will simply have to be prepared to care for its own patients and not expect to be able to ship them elsewhere.

Right now, he said, he is encouraged that at the moment the county is not seeing more people who need to be placed on breathing machines.

He said he is anxious about the upcoming Thanksgiving holiday when families and children spend lots of time together in small spaces and pass the virus around.

Newstex ID: KRTB-1045-39922209