By Erin Roberts, MPH, Program Analyst, Environmental Health and Global Health Security, NACCHO and Christina Baum, Program Analyst, Infectious Disease, NACCHO
Influenza viruses cause illness year round, but ‘flu’ season begins now, in early October and runs through May, marking the time of year when infections are most common. ‘Flu’ is colloquially thought of as “a cold” or being “under the weather,” but while influenza can be mild, it can also cause severe disease and even death. A flu vaccine is the best way to protect against the flu.
Despite the critical protection the flu vaccine provides, there were over 17,000 laboratory-confirmed influenza-associated hospitalizations last flu season, according to the May 17-23, 2015 Weekly FluView Report published by the Centers for Disease Control and Prevention (CDC). Further, the hospitalization rate of people 65 years and older was the highest on record since data collection of lab-confirmed influenza hospitalizations began in 2005. The proportion of deaths attributed to pneumonia and influenza was 6.4%. Once this proportion crosses 6.6%, an influenza outbreak is deemed an epidemic.
Pandemic influenza poses an even greater public health threat. The last flu pandemic – H1N1 in 2009 – although not particularly virulent, resulted in an estimated 60.8 million cases in the United States alone, with 274,304 laboratory-confirmed hospitalizations, and 12,469 deaths. A pandemic like the one in 1918, during which communities experienced morbidities of 25-40%, would result in much higher mortality.
A severe pandemic would trigger surge on emergency departments, medical facilities, and providers’ offices. The healthcare system could buckle under such demand. Because it would take months to create a new vaccine for a novel influenza strain, antiviral medications would be the first line of defense. But because antivirals require a prescription, demand for antivirals would compound this surge on medical facilities.
It is important to increase healthcare system capacity, but it is also important to reduce unnecessary demand for services. This can be done by appropriately triaging people and “right-sizing” care. To achieve this, the CDC, in partnership with NACCHO and other public health partners, is creating new tools to offset surge and to increase access to antiviral medications. One of these tools is Flu on Call™.
A Tool to Reduce Surge while Increasing Access to Antivirals
Flu on Call™ is a new pandemic influenza capability that has been in development since 2011. Flu on Call™ establishes a national network of telephone triage lines that are designed to integrate with local preparedness plans. The goals of Flu on Call™ are three-fold: reduce surge on medical facilities, reduce the need for face-to-face encounters, and increase access to antiviral medications. State poison centers and 2-1-1 call centers make up the network; the American Association of Poison Control Centers and United Way 2-1-1 are core project partners.
How Flu on Call™ works: In a severe pandemic, people who call Flu on Call™ and need information are guided to appropriate information by information specialists. If the caller is sick, or caring for someone who is sick, they are transferred to a medical professional who gives them medical advice. The clinicians staffing Flu on Call™ strictly adhere to a protocol developed by CDC and public health departments in order to ensure patient safety.
In some locations, Flu on Call™ clinicians may prescribe antivirals over the phone. Because Flu on Call™ is designed for a severe pandemic, Flu on Call™ clinicians will generally only prescribe medications in the event of a state- or federally-declared emergency.
Testing Flu on Call™
After many years of refining the system, Flu on Call™ has moved into the testing and demonstration phase. On September 9, CDC held a Flu on Call™ Simulation Exercise (SIMEX). During the exercise, the call network was activated using an “exercise only” line. Sixteen poison centers and fifteen UWW 2-1-1 call centers participated. Sixty-five actors from CDC and partner organizations, including NACCHO, followed scripts and placed calls to participating Flu on Call™ sites around the United States. “Sick” callers were transferred to poison centers, where clinicians triaged the caller and dispensed the appropriate level of care.
Using an online, interactive dashboard developed especially for Flu on Call™, poison center clinicians were able to access the protocol, calculate antiviral dosage, and locate a pharmacy near the caller (using a mock ZIP code or address). Prescriptions were called, faxed, or emailed to designated numbers and in-boxes. The Exercise Simulation Cell served as a virtual pharmacy.
The goals of the SIMEX were to a) not disrupt real-world 2-1-1 or poison center calls; b) test the Flu on Call™ telephony infrastructure; c) evaluate the effectiveness of call transfers; d) collect call data; and e) measure the system’s ability to provide access to antivirals. CDC is currently reviewing the data collected from the exercise, which will be available at the end of October.
Although Flu on Call™ is designed for use in a severe pandemic, the 2016 seasonal influenza response offers an opportunity to live test Flu on Call™. In August, a call for applications went out to select health departments that were interested in hosting a Flu on Call™ Demonstration Project. Applicants were required to prove buy-in from a diverse group of partners, including their state poison center, participating 2-1-1 center, and healthcare providers. Sites were selected in September and will be announced in late October.
The Flu on Call™ Demonstration Project will take place in two jurisdictions over the peak of influenza season. Lines will be open to the public and Flu on Call™ information specialists and clinicians will offer advice and triage callers. Callers may be directed to their regular providers, given information about home care and prevention, or be directed to emergency or urgent care, as needed. Antiviral medications will not be made available through the spring 2016 project.
NACCHO will provide updates as the project unfolds, so stay tuned for more!
How is your health department handling increased demand for care during flu season? Tell us in the comments section below.