Lessons learned from H1N1

It started over a weekend during spring break 2009 and now, a year after the H1N1 virus was declared a global pandemic, county health officials are reflecting on their response and how the incident can help them prepare for an even bigger health crisis.

The first report of H1N1 came on a Friday morning at the end of April, Clallam County Public Health Officer Tom Locke said. By Friday afternoon, an alert was sent to local health care providers.

"At that point, no one really knew how serious this was going to be," he said.

The virus, a mix between human, swine and bird flu, was taking Mexico City by storm with a remarkably high death rate, Locke said.

On May 28, 2009, the first case of H1N1 was confirmed in Clallam County, said Public Health Program Manager Christina Dettra.

Immediately public health officials looked at if they should go into incident command mode, she said.

In incident command mode, pre-established assigned duties put all responders on the same communications system with a common goal. It is commonly used during natural disasters, major power outages or other emergencies, Locke said.

Dettra said the biggest challenge was finding a way to disseminate information as quickly, accurately and simply as possible.

"Information changed so rapidly that getting information back down the chain of command was extremely challenging," she said.

The pandemic, an infectious disease spreading rapidly across a large region, hit Level 4 out of 6 in the U.S. in May 2009 and a federal stockpile of antivirals was released.

"It was the first time we'd ever received that," Dettra said. "It was so fast and easy to get it to people. It gave us the ability to get it in peoples' hands as soon as they started showing symptoms."

A global pandemic

On June 11, 2009, the World Health Organization declared H1N1 a global Level 6 pandemic, the first since the 1968 Hong Kong flu pandemic. Level 6 is the highest level a pandemic can reach, classified as when increased and sustained human-to-human transmission is seen across the general population, according to the WHO.

Locke said that in 2005 the county began making contingency plans of what to do in the event of a pandemic.

"We have plans as far as closing schools, banning public events and limiting the number of people in grocery stores," Locke said.

Fortunately summer arrived and the spread of the virus was slowed, he said.

But that didn't mean public health officials got to rest easy.

"We knew it was going to come back," Locke said.

A volunteer medical reserve corps led a campaign to distribute educational material on H1N1 and how to stop the spread of flu to more than 100 local businesses, Dettra said.

Meetings were held with school officials, who were told they would have to exclude sick children from school and emphasize the importance of covering coughs, sanitizing and proper hand washing to prevent the spread of the virus, Locke said.

The virus was especially dangerous for children, which is opposite of the regular seasonal flu, he said.

By September, H1N1 returned, earlier than expected.

"We were hoping we'd have another month or two," Locke said.

Vaccines come in nasal sprays, injections

Vaccines weren't made available until close to the peak of the pandemic, which hit in late October, he said.

The nasal spray vaccine was delivered to Clallam County in mid-October and was available only for healthy children and health care workers, he said.

Several weeks later the injectable virus was received but the amount was far less than expected, Dettra said.

"We had more demand than we had supply and that meant we were saying no to a lot of people," Locke said.

Since the vaccine was provided by the federal government, local health agencies had to maintain the federal priorities and administer the vaccine only to designated high-risk populations such as children and the chronically ill, Locke said.

It wasn't until Dec. 14 that the vaccine was made available for everyone and by then the virus was a month past its peak, he said.

Three people died from H1N1 in Clallam County during the outbreak, he said.

As 2009 turned to 2010, health officials were surprised to see the regular flu season was almost nonexistent, he said.

"It was a mystery," he said. "What happened to the regular flu?"

One theory is that the increased vaccinations for seasonal flu along with the improved health habits of the public, such as covering coughs and washing hands, helped keep it at bay, he said.

That explanation gives hope for the upcoming flu season, he said.

The vaccine to be distributed this fall will include three strains of the flu: two seasonal strains and H1N1.

Looking back, Locke gives the county an A-minus for its response but said more needs to be done to prepare for a pandemic like the 1918 Spanish Flu.

Locke said vaccine manufacturing needs to be modernized, communication systems need to be simplified and people need to be serious about preparing, because the stakes are so high.

"Pandemics have changed the course of human history," he said.

Amanda Winters can be reached at

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