A healthy discussion on bird flu

Potential flu pandemic among several topics at ‘mini-health summit’

By Jason King
Information and Communications Specialist

If a flu pandemic struck the United States in 2007, would your county be prepared to deal with its share of the 1.4 million Tar Heel residents who seek hospital treatment? How about a 25 percent reduction in workforce for a six- to eight-week period?

Dr. John Graham, deputy director of the N.C. Institute of Public Health, addresses steering committee meeting attendees. (Photos by Jason King)

As the number of confirmed cases worldwide of a deadly subtype of avian influenza (bird flu) rises each year, federal and state governments have taken steps to ensure any outbreak of the flu causes minimal disruption. During the NCACC Human Resources Steering Committee’s July 21 “mini-health summit,” state health officials addressed preparations for a potential flu pandemic.

According to Medical Epidemiologist Dr. Megan Davies of the N.C. Division of Public Health’s General Communicable Disease Control Branch, the subtype of avian flu that has killed at least 135 people worldwide since 2003 hasn’t displayed sustained human-to-human transmission but has still caused enough alarm for the World Health Organization (WHO) to reach Phase 3 of its six-phase influenza pandemic scale.

“I get worried when we hit Phase 4,” Davies said.

While influenza mildly mutates every year, leading to seasonal outbreaks due to the lack of a vaccine, large mutations occur every 20 to 40 years. Almost 40 years have passed since the Hong Kong pandemic of 1968-69. Of the 20th century’s three flu pandemics, it killed the fewest number of U.S. citizens – approximately 30,000. The state’s Pandemic Influenza Plan, updated in January 2006, estimates between 4,000 and 11,000 North Carolinians will die during the next outbreak. There’s no guarantee that number won’t be higher, however.

“We won’t know what the mortality rate will be during the next pandemic,” Davies said. “We won’t know until we start counting sick people and bodies.”

A pandemic flu could come in three waves, three to nine months apart, and local health departments should be prepared to be without a vaccine for the first wave of the outbreak, she cautioned. The loss to local economies can be staggering, with up to 40 percent of the workforce staying home for up to several weeks at a time.

Davies added that the Department of Public Health did not have a formal recommendation for local departments looking to stockpile masks, but a possible mix of surgical masks and N95 masks – which, if fitted properly, can block tuberculosis, anthrax and spores as small as 1.0 micron – would be good to have on hand, as resources and storage allow.

A workshop at the NCACC’s Annual Conference will focus on intergovernmental planning and response activities in light of the current pandemic flu threat.

Cabarrus Health Alliance: Not just surviving, but thriving

In 1997, Cabarrus County and its health department took a bold step – away from each other.

Phred Pilkington said the transition from a typical county public health department to the Cabarrus Health Alliance has not been without bumps, but has been successful, thanks in part to support from the county commissioners.

Faced with a number of obstacles – including inadequate resources, equipment, technology and facilities, and declining revenues and public perception of the department – the health department decided to recreate itself, with the blessing of the county board of commissioners. Nine years later, the move is paying handsome dividends in the form of new services for the community.

Phred Pilkington, director of the Cabarrus Health Alliance (CHA), briefed meeting attendees on the reasons behind the move.

“We didn’t want to just survive – we wanted to be successful,” Pilkington said.

CHA is many things. Under G.S. 134-E, which has since been changed, the county created a public authority to oversee health services. The Alliance also became a corporation (Public Health Authority of Cabarrus County, Inc.) and a not-for-profit (Public Health Interest of Cabarrus County) in order to qualify for a multitude of grants.

“We want to be whatever we need to get that money,” said Pilkington, whose $16 million budget is roughly 50 percent dependent on grants.

The Board of Commissioners, which has one seat on CHA’s seven-member governing board, has seen its annual contribution hold steady at around $3 million, even as CHA has grown and added services.

With the help of a variety of community partnerships, CHA has added one full-time nurse to each public school and two registered nurses to visit day care facilities in the county. In addition to serving as primary care centers, its three facilities provide asthma, ADHD and diabetes education, and – along with a mobile unit – dental services via ultra-modern equipment.

“The private dental practitioners say they want to work with us,” Pilkington said. “It’s that nice.”

With its new business-oriented approach, CHA has also stepped up its operating hours to the tune of 450 additional service hours per year. According to Pilkington, the Alliance loses $33,000 in revenues every day it keeps its doors closed.

20 local health departments now accredited

While Cabarrus has achieved the respect of the public and its private peers, public health departments representing more than a quarter of the state’s 100 counties have taken pride in successfully completing the state accreditation process.

In 2005, North Carolina became the first state in the nation to mandate that local health departments achieve accreditation, and since then 20 departments representing 28 counties have been awarded the designation. Four county commissioners – Moses Carey (Orange), Bobby Greer (New Hanover), Mary Ann Enloe (Haywood) and David Plyler (Forsyth) – are members of the N.C. Local Health Department Accreditation Board, which has lined up 20 more county health departments to undergo the process over the next two years. The state makes $25,000 available to each county that undertakes the process.

Joy Reed, head of the Division of Public Health’s Local Technical Assistance and Training Branch, said one of the benefits of accreditation is that it allows the agency to recognize and celebrate what it’s doing right.

The process, which establishes 41 benchmarks for a local health department to meet as part of a self-assessment, also encourages team building, consistency in expectations between facilities, and succession planning by providing department personnel an opportunity to take a step back and look at the big picture of its role in the community.

“It’s the beginning of a long-term, systematic improvement,” said Craig Michalak, accreditation administrator for the N.C. Institute for Public Health.

Incubator Collaboratives hatching solutions

Improvement is the driving force behind N.C. Public Health Incubator Collaboratives (NC-PHICs), a regional initiative that is making use of state funding to reach public health project goals. According to Program Coordinator Heather Gates, more than 75 counties are participating in the voluntary program through six regional partnerships.

The Legislature has committed $1 million in recurring funds to the project, but regional partnerships have pulled together to find additional funding.

Gates described a number of projects funded through the NC-PHICs, including the purchase of handheld computers in the Western North Carolina Partnership for Public Health. In Swain County, health educators used the handhelds to record height and weight measurements of students at four schools in order to track obesity rates and trends among students.

Technicians were able to download the information from the handhelds directly into a database – saving a bundle of time from the old system of collecting information on paper and entering it into the database at a later time.

Each partnership lists a number of projects for 2005-07. The partnerships also collaborated on a shared project through the N.C. Alliance of Public Health Agencies to provide additional temporary environmental health professionals to help reduce the backlog of on-site wastewater site visits.

Other presentations from the committee meeting: