When 200 lives are wiped out by a single cause, you usually think plane crash, earthquake or terrorist bombing.
But now you can start thinking about as many as 200 people in Colorado Springs dying from the H1N1 virus, according to Centura Health, Colorado's largest hospital and health care system, which runs Penrose-St. Francis Health Services locally.
Centura's worst-case fatality estimate was part of a meeting of Penrose-St. Francis medical staff Sept. 10, where an infection control expert from St. Paul, Minn., spoke to a couple hundred physicians and staff.
The purpose of Cori Ofstead's visit was to provide information about influenza's current status, to explain related issues and to increase professional awareness of H1N1 and the implications for patient care and safety. Reached by phone this week, Ofstead declined an interview but confirmed Centura's death estimate and its forecast that 90 percent of intensive care unit beds could be occupied by H1N1 patients.
The mutation factor
Dr. David Ross, a Penrose-St. Francis emergency room physician who also serves as medical director for American Medical Response in El Paso County, came away from Ofstead's presentation with an impression of how grave the virus might turn out to be, if it mutates in coming weeks.
"We don't want to freak people out, but worst case, it could be 200" deaths in the Springs, Ross says. "The mortality potential could be three times the seasonal flu."
Ross says although the virus hasn't claimed a large number of victims so far, the highly contagious illness could mutate quickly.
"Is it going to change over the next month or two and become more dangerous?" he asks. "The possibility is that it may."
Penrose-St. Francis spokeswoman Stacey Knott tried to dismiss the estimates in a statement provided in response to questions, writing: "Penrose-St. Francis does not make public predictions. No one knows exactly what will happen during this flu season."
She called the fatality and ICU information "an internal planning tool."
"Any numbers for the 2009 flu season do not account for vaccination rates and are not relevant to predict actual rates of infection," she wrote, noting in the statement that Penrose-St. Francis gleans information "from various sources based on assumptions to help in planning and purchasing equipment and supplies."
Seasonal flu historically kills about 36,000 people a year nationwide, but the Centers for Disease Control and the President's Council of Advisors on Science and Technology say the nation's H1N1 death toll could reach 90,000.
In Colorado, 636 people die annually, on average, from seasonal flu and pneumonia, a common complicating factor, according to state records. In El Paso County, the annual average is 62.
The President's Council also noted in its Aug. 7 "planning scenario" that the illness could strike up to 120 million people in this country, more than half of whom would seek medical attention, leading to 1.8 million hospital admissions. Of those, up to 300,000 patients could require ICU treatment. The council warned that the timing of the vaccine, which federal officials now say won't be ready even for high-risk patients until mid-October, "could significantly diminish the usefulness of vaccination for mitigating the epidemic and could place many at risk of serious disease."
According to the Centers for Disease Control, Colorado wasn't among the 21 states reporting widespread influenza activity through Sept. 12, the most recent report available, but surrounding states were, including Kansas, New Mexico and Oklahoma. But the virus seems to be gaining steam here, with the Cesar Chavez Academy in Colorado Springs closing its doors last week as a temporary precaution after some students and teachers experienced symptoms.
Ken Gershman with the Colorado Department of Public Health and Environment says he's skeptical of Centura's death-toll forecast, saying, "I'm not in the business of prediction and speculation."
As for how many new cases are popping up per day, Gershman says, "There's a fair amount of H1N1. I wouldn't venture putting a number on it."
The important figure to track, he says, is hospitalizations, which hit 171 statewide for all types of influenza as of Sept. 19, almost triple the number from the week before. The state began tracking flu hospitalizations Aug. 30. Of those 171 cases, 94 were H1N1. Only seven people were hospitalized with flu in El Paso County — three with H1N1, the state reports.
State health officials said in a press release this week that nearly all the current flu viruses being tested by the Public Health and Environment Department's laboratory are H1N1, but that could change if seasonal flu strains re-emerge.
Knott says Penrose-St. Francis has created an H1N1 task force, which has planned the health system's response, including vaccinations and information for employees and the public, preparation of "critical resources" including supplies and staffing, and response plans throughout the flu season.
The Penrose system has 39 ICU beds, 27 at Penrose Hospital and 12 at St. Francis Medical Center, with "other areas that can be used for critical care if needed," according to Knott.
Ross says the Penrose system has equipped emergency room workers with special masks, called N95s, which he termed "the most effective device in terms of reducing exposure," although they're uncomfortable and he worries health care workers won't wear them for an entire eight-hour shift. Staff also have been advised on other ways of minimizing contact.
No silver bullet
At city-owned Memorial Health System, spokesman Chris Valentine dismisses any death projection: "Nobody can say how big it's going to be or how bad it's going to be." But he adds that Memorial is "planning for the worst."
Cindy Corsaro, Memorial's emergency preparedness officer, isn't specific about Memorial's plans but says officials have agreements in place to share resources with other providers. She also says Memorial is reviewing potential needs for staffing, facilities, education and supplies, and that the local response to an outbreak that overwhelms resources would be coordinated by the city and county offices of emergency preparedness and the county Health Department.
Asked to provide specific plans for coping with more patients than Memorial's 66 ICU beds can handle, Corsaro declines, saying, "There's too many what-ifs to give details."
Valentine says Memorial's 41 adult and 16 pediatric ICU beds at Memorial Central and nine adult beds at the north facility "stay relatively full" under normal conditions.
Ted Sayer, with AMR's El Paso County operation, says the company has installed a software program called First Alert, which provides real-time awareness through data analysis of patient symptoms.
"We've got it set up to watch for flu right now," Sayer says, adding that the system will alert AMR managers and public health officials if it detects a propensity for symptoms associated with H1N1, such as respiratory problems and stomach ailments, in geographic regions. He also says paramedics are poised to assist the Health Department in administering vaccine when it becomes available next month.
Meanwhile, the work site of the only local death so far due to H1N1, U.S. Northern Command at Peterson Air Force Base, has put together a plan to keep the nation's homeland defense nerve center humming in case the virus sidelines a significant number of its staff, says NorthCom spokesman Mike Kucharek.
But NorthCom's priority wouldn't be playing Florence Nightingale; rather, it would be protecting its own forces, so there's no hiccup in the war on terror and support to civil authorities. Says Kucharek: "The military is not going to be the silver bullet in a pandemic."