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[Music Playing]
[Laughter of Children]
[Child Coughs]
Child: Mommy, I don't feel good.
Narrator: In the spring of 2009,
Florida's healthcare system was faced with protecting the public
from the world's first flu pandemic of the 21st Century.
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Narrator: The H1N1 virus was a new strain of influenza,
whose severity and virulence was unknown.
Dr. Richard Hopkins: The H1N1 virus is so different;
it's related to the viruses that circulated between 1918 and 1957,
but then it was gone completely from the world,
as far as we can tell, from 1957 until 2009.
So people that were born after about 1952 or so
don't have any previous exposure to this virus,
they've been exposed to other viruses but not to this H1N1 virus,
and so as far as they're concerned this is a brand new virus
that they have no immunity to.
Dr. Russell Eggert: So it was completely unknown as to
how severe this influenza would be and how easily transmitted it might be.
That caused a lot of concern amongst the medical community.
Initially, the reports coming out of Mexico,
where the virus was first presented and was reported, showed severe disease.
Ultimately, later we learned that that severe disease
was really kind of the tip of the iceberg,
that it was the most severe cases that were being identified and reported
and the milder cases were not being generally being identified
or seen and treated in hospitals.
So initially, it looked like it could be a very severe disease
and that's why we were very concerned in the United States
about how this disease would be transmitted,
how severe it would be, and how we could best protect our population
from this new strain of influenza.
Dr. Hopkins: On May 1st is when we got our first confirmation
that we had a known case in Florida.
The peak of our epidemic was probably in Mid-October
and it stayed at high levels for about six weeks,
from early-October through Mid-November.
Our message to doctors all through the summer,
and into September and October, was:
If it looks like influenza it probably is influenza
and if it is influenza it is certainly H1N1
because it is the only influenza that is circulating now.
Narrator: Florida officials quickly mobilized to provide the public
and medical professionals with the tools necessary to battle the virus.
State Surgeon General Dr. Ana Viamonte-Ros: We were able to base our response
in great part based on what had happened in other states,
as well as what our Federal partners were recommending that states do.
Doc Kokol: We had several channels of communication
for the public to receive information about H1N1.
One of our most popular was our call-in number;
we had operators who spoke in three different languages
and could provide basic information to individuals.
We also had a really close tie with the Florida Poison Control Centers
that took those calls that really needed medical questions answered.
Dr. Viamonte-Ros: The production of vaccines, initially for H1N1,
took a little bit longer then everyone expected,
that is why we had targeted groups that were identified.
Doc Kokol: Those groups turned out to be the very young and pregnant women,
as well as people who had chronic diseases.
Dr. Hopkins: Florida was one of the first places
to have significant activity starting in Mid-September.
So we were really well into the influenza activity
before the vaccine actually first appeared.
The vaccine was available in a quantity within 6 months
of when the virus was first discovered,
and this is an incredible accomplishment
to get hundreds of millions of doses of vaccine into the field
within 6 months of when the virus was first discovered.
So delays of a week or two or three,
in the context of this incredibly rapid production and distribution,
should not be very surprising.
Dr. Viamonte-Ros: But eventually we did have enough vaccine
for everyone that wanted the vaccine.
I think about 3 million Floridians
actually took advantage of the vaccination program.
Narrator: While officials encouraged the public to get vaccinated,
rumors circulated that the vaccine was not safe
and government mandated vaccinations may be on the horizon.
Dr. Viamonte-Ros: What's important to remember is that
our vaccine campaign was totally voluntary.
There are some individuals who are concerned about vaccinations
and the contents of those vaccines.
Dr. Hopkins: There has been a fair amount of alarmist information
put out there by people who really do not understand the science very well,
suggesting that vaccines are a lot more dangerous then they really are.
Dr. Eggert: The vaccine was developed through the same process
that the vaccines we have been using for 50 years were developed.
It was tested, and it was very safe and effective for H1N1.
Doc Kokol: We wanted to make sure that
everybody knew where vaccination clinics were available to them.
So we had a special webpage designed where people could put in their zip code
or go to their county and they would be able to see
what vaccination clinics were open at that particular time.
It was really important that we let the local county health departments
determine where the best sites were for these vaccination clinics to take place
because they know their county better then we did
so we really looked to them for that information,
they fed it up to us and we had
a 24 hour seven day-a-week vaccination clinic web screen.
In addition to that, if you were to call the Flu Information Line,
the operators there could give people information in three different languages
as to what clinics were available
and where they were available throughout Florida.
Dr. Viamonte-Ros: Our challenge is always being able to reach our residents,
to make sure that they understand that
vaccination is the most effective way to protect yourself
and to reassure them that this was very safe and that it was very effective.
Narrator: Because of the unknown severity of the H1N1 virus,
large quantities of antivirals were distributed to county health departments,
pharmacies, and hospitals to treat those that became ill.
Brandon Brantley: The Tamiflu and the Relenza,
both of which are antivirals used in the H1N1 campaign.
They were used primarily to shorten the duration of I.L.I.,
or influenza-like illnesses.
It shortened from a time-span of 10-14 days to about 3-5 days.
The antivirals were managed utilizing recommendations from the CDC and the FDA.
It was recommended that we send out information to the medical community,
consisting of hospitals, physician offices, nursing staffs,
the Florida Department of Health, county health departments
as well as pharmacies, as to how and when to utilize these antivirals.
Doc Kokol: 200+ people in Florida died from H1N1,
so it is a serious it is a serious situation it is
not something that we want to make light of.
But it was not the deaths that people were
initially anticipating with a 1918 type pandemic flu.
Dr. Hopkins: We did have hundreds of deaths,
directly attributable to this virus,
so it is not like it was just totally innocuous,
it was not an innocuous virus, it killed people at high risk
and it killed a certain number of perfectly health people.
But it was on average somewhat less severe then we had feared
based on the 1918 virus or even perhaps then the 1957 H2N2 Virus.
Narrator: To help manage the H1N1 event,
the Florida Department of Health turned to
a modified incident command structure
that is based on national incident management system principles.
Mike McHargue: The DOH was the lead agency for the H1N1 response in Florida.
The Department used the incident command structure and it worked very well.
There were a lot of moving parts,
of course ICS is based on management by objectives,
and we established a branch structure that
handled all the major throughput, the operations if you will,
getting the job done,
and then using the oversight and the coordination control structure,
as well as the support components for the organization,
the H1N1 ICS structure was quite effective.
One of the things we had to adjust in the ICS environment
was the planning cycles.
ICS is based upon operational periods,
and operational periods in typical field deployments are 12-hour shifts.
Obviously, we were not working 24 hours-a-day;
therefore our planning cycles had to be adjusted.
They ran anywhere from one-week to two-weeks throughout the life cycle,
and we were able to do that to produce our incident action plan
and set the pace and tempo for daily or weekly operations
over a one or two week period, which promoted manageability.
So that's one of the great features and flexibility with ICS,
we can tailor the structure and the operational periods
to meet the needs of the incident.
Rhonda White: You have to have the ability to stand up a response system
that covers the entire health and medical spectrum
that may be impacted by the event.
What we did with H1N1 is that we stood up that response system
at the state, at the local, at the national level,
and as the threat reduced and the vaccinations became available
we began to turn off, if you will, the response system
and put that back into normal business operations for the healthcare sector.
Dr. Hopkins: There is still concern about
what this virus might do in the future
and it could do several different things.
It could evolve in such a way that
it transmits from one person to the next more easily.
It could evolve towards greater clinical severity,
so that people on average get sicker.
It could evolve away from the vaccine,
that is it could change its outer coat over time,
so that the vaccine that we have prepared against it
is less effective then it otherwise would be.
It could evolve in the direction of being more resistant to antivirals.
None of those four things have been observed, anywhere in the world,
and the virus so far in the last 12 months has been remarkably stable,
it has changed very very little, over time.
That is no guarantee that it will stay that way in the future.
Doc Kokol: We do not know when the next pandemic is coming,
but we do know it is going to be here.
If you believe in history, about every 30 years or so we see a pandemic,
and H1N1 may be around with us for a while,
it may be a flu that we see circulating for a while.
Dr. Viamonte-Ros: We are not over this.
Whether it is the same type of H1N1 that we just saw in this past season,
or something a little bit different, we just do not know.
We need to be prepared, and we will be prepared,
our best experts in the world and in our country
are looking at forms of vaccines that will best protect us
and we will make sure that that is offered
in a very efficient manner, and safe manner, to our population.
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