Region concerned about spread of H1N1 virus

BRISTOL, Va. – In recent months throughout Southwest Virginia and Northeast Tennessee, one of the most frightening words isn’t a word at all. It’s actually one with two letters and two numbers: H1N1.
More accurately, it’s what is known as the novel H1N1 flu virus.
More commonly, it’s what is referred to as swine flu—an illness that, through sneezing, coughing and touching infected surfaces, has struck numerous people of varying ages around the world.
It is an illness that, in most cases, leaves people weak, sick and feverish for days with various flu-like symptoms. In more extreme cases, it has led to death, though there have been none documented in Southwest Virginia or East Tennessee.
“The human species, by and large, has not been exposed to a virus like this before,” said John Dreyzehner, director of the Cumberland Plateau Health District in Lebanon, Va.
But Dreyzehner and a host of other doctors, medical personnel and local officials also quickly point out two other realities about the novel H1N1 flu virus:
n It remains an illness that can be aggressively fought with medicine: A vaccine can be administered by a nasal mist (for now) or an injection (in future days and weeks).
n It remains an illness that can be aggressively fought with knowledge: People constantly remaining aware that THEY can limit the spread of the virus and reduce hysteria over its presence.
So, as the fight continues against the virus in this region, here are the five major facts one should know about the novel H1N1 flu virus:

1. No geographic area is immune.
“There’s nowhere in this area where there isn’t H1N1,” said Stephen May, medical director of the Sullivan County Regional Health Department in Blountville, Tenn. “That’s the reality of how widespread it is. If you have something that looks like the flu, acts like the flu and tests positive for the flu, it most likely is the novel H1N1 virus.”
May’s blunt assessment was shared by D. Craig Smith, medical director for the Mount Rogers Health District in Virginia’s Washington County.
“It’s pretty clear that the only major flu strain circulating around here, right now, is novel H1N1,” Smith said.
The virus played a huge role in causing 20 percent of the 500 pupils at Virginia Middle School in Bristol to be absent from classes recently, a large number of them suffering flu-like symptoms.
“We’ve definitely had a period of high flu cases. And we’ve had to deal with it,” said Mike Amstein, assistant superintendent of schools in Bristol.
The virus also had a clear impact at Vance Middle School in Bristol, Tenn., where during one recent day some 18 percent of students were absent, with many battling high temperatures and flu-like symptoms.
And the virus likely had some effect (while not at Vance’s dramatic level) in Bristol Tennessee’s remaining six schools.
Rebecca Craddock, school health coordinator for those schools, said there were 66 percent more visits to the district’s seven nursing clinics in September than there were in September 2008.
“We can’t say all of that increase is due to [novel H1N1 flu],” Craddock said. “But it’s a pretty dramatic statistic on the impact of the sickness.”
Finally, the H1N1 flu virus hasn’t even spared local celebrities, hitting 11 Connects television newscaster Josh Smith several weeks ago – and hard, too.
“It knocks you on your fanny,” Smith said during a September H1N1 town hall meeting in Johnson City. “It makes you just want to lie down and sleep for a week.”
In short, whether you’re walking on a street in Abingdon, Va., or strolling a Bays Mountain Park trail in Kingsport, Tenn., the novel H1N1 flu virus is probably around you, too.

2. The vaccine is here, but not so many doses so soon.
Sullivan County’s Regional Health Department has received the first 600 of the 40,000 total vaccine doses it hopes to have eventually. While department Director Gary Mayes said the 600 initial doses “aren’t nearly enough for what we’d like to do right now in terms of vaccination,” Sullivan County can at least start building momentum in its battle to protect residents against novel H1N1 flu.
“We’re very pleased to finally begin getting some shipments,” Mayes said.
The county plans to use most of its first 600 doses – all in nasal-mist form – to vaccinate children from ages 2 and up and young adults from 18 to 24. Both are considered among the groups highest at-risk for getting novel H1N1 flu.
“Hopefully, in a few weeks, we’ll get to the point we want – where we have as much supply of the vaccine as the demand for it,” Mayes said.
His optimism was shared by May, Sullivan County’s medical director. “There will be plenty of vaccine to go around as the [weeks] go by,” May said.
The nasal mist vaccine also has begun to circulate in Southwest Virginia, but unlike the situation in Sullivan County, Virginia Department of Health officials have been extremely tight-lipped about the number of doses available.
Robert Parker, a health department spokesman based in Southwest Virginia, would not openly explain the agency’s reluctance to provide details.
“We cannot provide exact information as to the schedules and quantities for receipt of the H1N1 vaccine, as the vaccine orders are being filled and delivered over a period of days,” Parker wrote.
“What we do know is that vaccine availability will be increasing rapidly over the next few weeks,” Parker said. “[The Virginia Department of Health] will announce when it is available to the public.”
Virginia Health Commissioner Karen Remley recently said the state would receive 43,500 vaccine doses at first, with more to come in upcoming weeks.
“By mid-November, every Virginian should have the opportunity to be vaccinated,” Remley said.

3. If you’re not in a high-risk category, be prepared to wait.
Area medical officials and others generally agree that the following groups are most at risk for becoming ill with novel H1N1 flu:
n Infants and children, ages 6 months and older
n Young adults, up to age 24
n Pregnant women
n Health care workers, emergency medical staffers and others who provide care to those who are ill
n People with existing medical conditions that affect their immune systems.
Local medical officials also agree that, in its early stages, the novel H1N1 vaccination process must be aggressively focused on protecting those high-risk groups. Only afterwards, they said – as more vaccine arrives – can the work to protect everyone else ramp up.
Dreyzehner, head of Cumberland Plateau’s health department, said people shouldn’t underestimate the immediate need to administer the vaccine to health care workers and other medical personnel.
“They’re going to be the ones critically needed to give the vaccine to everyone else,” Dreyzehner said. “So we clearly have to vaccinate the vaccinators, as early as we can.”
Mayes, meanwhile, said Sullivan County’s immediate decision to use most of its early vaccine doses on infants and children was obvious – given the clear presence of H1N1 flu among those groups.
“We feel strongly that children need to take the vaccine as soon as possible,” Mayes said.
Pregnant women, meanwhile, will become an extremely high priority for vaccination in upcoming weeks, as shipments of the injectable vaccine begin to be sent out along with the nasal mist that’s now available. The mist contains a small, weakened version of the actual H1N1 flu virus, which makes it unsuitable for use on pregnant women.
Remley said Virginia will aggressively work to vaccinate that state’s pregnant women, which she estimated to be 70,000 to 80,000 at any one time. And May said Sullivan County would “absolutely” begin a major vaccination effort for pregnant women as the injectable vaccine arrives.
“After that, we can protect them and others in the high-risk categories,” May said. “We will start working our way right down the list with everyone else.”

4. Schools and colleges are taking the threat seriously.
Bristol Tennessee Director of Schools Gary Lilly said his district has been “extremely vigilant” in addressing novel H1N1 flu for weeks, but its recent experience at Vance Middle School showed that the effort requires constant, intense monitoring.
“You definitely have to be constantly active in addressing and watching it, that’s for sure,” Lilly said. “We’ve done that, as well as staying in contact and communicating with health officials and everyone else we can.”
In Bristol, Va., Amstein said the district responded to its encounter with novel H1N1 flu at Virginia Middle School by stepping up cleaning and sterilizing work, and its efforts to keep parents quickly informed.
“We done a lot of different things already,” Amstein said. “And we have to keep doing a lot of different things. That’s the key.”
Meanwhile, area universities and colleges, from Virginia Intermont College in Bristol, Va., to Northeast State Community College in Blountville, Tenn., have asked to be vaccination sites, which would make the vaccine more accessible to students who are among the at-risk groups.
“We’re monitoring it as heavily as we can,” said Greg Nayor, Virginia Intermont’s dean of student development.

5. The best medicine is simple: Wash your hands – often.
The reaction among some area individuals, organizations and others to the threat of novel H1N1 has ranged from dramatic (some churches have discouraged hand-shaking during services) to some things a bit over-the-top. In September, Johnson City launched a campaign that included distributing placards with the screaming headline, “SMILE DON’T SHAKE - PREVENT FLU” – complete with artwork of people with exaggerated grins.
But medical officials including Dreyzehner said there’s a far more effective – and much less alarmist – way to slow the flu’s spread:
n Just wash your hands
n And clean them frequently with soap and warm water or with hand-sanitizers that have an alcohol base of 60 percent and higher.
It’s that simple.
“If we were in a different culture like Japan, where people traditionally greet each other by bowing, you could get away with banning handshakes,” Dreyzehner said. “But in this country, that’s hard. It’s not realistic. Shaking hands is part of the business world and everyday life, in general, in this nation.”
The key then, Dreyzehner said, is “just keeping your hands clean. That, and just other common-sense things, like staying home if you feel feverish or ill.”
Dreyzehner’s advice was actively backed by Felix Sarubbi, a Johnson City doctor who specializes in infectious diseases and is a professor at East Tennessee State University’s Quillen College of Medicine.
“It’s not possible to over-emphasize how important personal hygiene helps in fighting [novel H1N1 flu],” Sarubbi said.
“It’s washing your hands. It’s sneezing into tissues. It’s covering your mouth when you cough,” he said. “It’s not dramatic stuff. But it really helps in addressing what we’re facing.”

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