Huron Valley Ambulance medic prepping a flu vaccination shot for administration as part of Saturday's immunization clinic. (Photo by the writer.)

Last Saturday morning, The Chronicle rolled south down State Street just past I-94, turned right at the Citgo gas station and headed for Huron Valley Ambulance headquarters on State Circle. At 9 a.m. HVA medics and staff had started delivering seasonal flu shots “pit crew style” to motorists who waited in their vehicles at one of four stations in two open garage bays.

The early rush already put two dozen cars ahead of us.

Around 15 minutes later, The Chronicle was immunized against the regular, seasonal flu – but not the H1N1 variant known as “swine flu.”

The drive-through clinic was scheduled to go through 3 p.m., but around 1 p.m. Joyce Williams, HVA’s public affairs manager, began explaining to motorists that the 400 doses they’d started with were gone.

Williams started giving directions to other locations where flu shots were available: Concentra (3131 S. State St. in Ann Arbor – 734.213.6285) as well as a series of clinics through St. Joseph Mercy that are staffed by Michigan Visiting Nurses Association nurses. [Link to .PDF]

For a list of additional seasonal flu shot clinics, the American Lung Association has created a flu shot clinic locator.  [Results of ALA locator for 48103 zipcode]

After the jump, more on the HVA clinic, as well as the local arrival of the vaccine against the current H1N1 variant of the flu, which was announced today. [Link to .PDF]

Huron Valley Ambulance Seasonal Flu Shots

This is the third year that HVA has helped distribute seasonal flu vaccine. It’s part of a partnership with Washtenaw County Public Health Department to distribute flu vaccines. But it’s also meant as a test of emergency preparedness: How fast can large numbers of residents be vaccinated in the event of a disaster?

This was the final checkpoint before vehicles could pull forward into one of four vaccinations stations in the two Huron Valley Ambulance garage bays. (Photo by the writer.)

Two years ago, HVA sent ambulances on-site to two different locations: the county offices on Zeeb Road, and St. Joseph Mercy Hospital. Last year was the first attempt at drive-through vaccination – 286 doses were distributed.

Last Saturday, the 400 doses distributed in 4 hours worked out to 1 vaccination every 36 seconds. That rate could conceivably be doubled by opening two additional garage bay doors at HVA headquarters.

The drive-through clinic was supported by volunteers from three different groups: (i) alums from the HVA’s Citizen Academy, (ii) the Athletic Trainers Student Organization at Eastern Michigan University, and (iii) Tau Kappa Epsilon fraternity, also from EMU.

The purchasing agency for the vaccine was the county’s public health department, and the $20 price covered the cost of the shots, plus the county’s administrative costs. HVA is an independent nonprofit, so where did the funding come from to pay the HVA medics who actually wielded the needles? Sponsors.

Gene Butman Ford and Wolverine Sports contributed cash to the effort, and multiple other organizations provided various in-kind donations. A gift bag handed out to people getting vaccines included a can of lemonade and a bag of potato chips, courtesy of Northern Vending and Coffee.

The drive-through concept is one that was also adopted by the University of Michigan Health System on Oct. 3 at the intersection of South Industrial and Eisenhower, in a clinic administered by the Michigan Visiting Nurses Association. According to UMHS spokesperson Shantell Kirkendoll, that clinic vaccinated 168 people. [A Stopped.Watched. record of that clinic: "S. Industrial & Eisenhower"]

Percentage of visits for influenza-like illness (ILI) reported by the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet). The chart shows a national summary for 2008-2009 and the previous two seasons. The previous two years are in blue and green. This year's season is in red. It's off to an early start. (Image links to higher resolution file.)

2008-2009 Flu and H1N1

According to the Centers for Disease Control’s weekly FluView update, the flu season is off to an early start, with 37 states already reporting “widespread” flu activity. Michigan is currently reporting “regional” activity, which is second-highest on a five-point scale anchored by “widespread” and “no activity” on its respective ends.

The CDC’s surveillance system for flu cases, based on “sentinel providers,” shows elevated flu activity nationwide since late April, compared to previous years, with a rapid rise above baseline levels in the last five weeks.

The vaccine distributed at the drive-through clinics the last two weekends in Ann Arbor and available at clinics listed on the American Lung Association Flu Shot Clinic Locator is for the “seasonal flu” only.

It does not offer protection against the current H1N1 variant, commonly known as the “swine flu.”

According to the Centers for Disease Control, as of Monday, Oct. 5, about 2.4 million doses of H1N1 vaccine were available nationwide for ordering, and nearly all of those doses had been ordered.

Arrival locally of some limited amount of H1N1 vaccine has begun, according to an Oct. 13 press release from the Washtenaw County Health Department.

Some of the H1N1 vaccine will be distributed first to the Washtenaw County Health Department, which will act as a clearinghouse for the vaccine to health care providers. Other supplies are being shipped directly to health care providers.

Spokespersons for UMHS as well as for St. Joseph Mercy Health System said that as the H1N1 vaccine becomes available, it will be distributed on a priority basis. From the UMHS “Flu Facts,” the first priority for vaccination against H1N1 flu are:

• Pregnant women
• People who live in the same household as, or care directly for, babies under the age of 6 months;
• Children aged 6 months through 4 years (up to the 5th birthday)
• Children and adolescents aged 5 to 18 years who have conditions that make them vulnerable to H1N1 complications: Cancer, blood disorders including sickle cell disease, chronic lung disease including asthma, diabetes, heart disease, kidney disorders, liver disorders, neurological disorders, neuromuscular disorders, and weakened immune systems due to disease or medical treatments they are receiving
• Health care workers who have direct patient contact

A shortage of H1N1 vaccine is not expected, but the availability of initial supplies will be limited, according to the Washtenaw County Public Health Department.

In the second priority for vaccination against the H1N1 variant are the following groups:

• Healthy children and young adults 5-24 years old.
• Adults aged 19 through 64 years who have conditions that make them vulnerable to H1N1 complications.

Depending on that availability, school-based mass vaccination clinics may begin the first week of November. The Washtenaw County Public Health is coordinating with public schools throughout the county to finalize clinic dates and details. Dates for public vaccination clinics will be announced at http://publichealth.ewashtenaw.org.

On Tuesday, county epidemiologist Laura Bauman told The Chronicle that there have been cases of the current H1N1 strain in Washtenaw County since April, but with a sharp increase in numbers beginning in September. They’re now seeing between 10-15 confirmed cases each week, she said. Officials assume there are many more cases that haven’t been recorded.

Residents who want more information or who have questions about the flu can call the county’s main public health number at 734.544.6700. Nurses and health educators will be answering the phone weekdays between 8 a.m. and 5 p.m.

Commissioners each received a Red Cross personal safety kit at Wednesday's meeting.

Washtenaw County Board of Commissioners (May 6, 2009): At Wednesday’s meeting, commissioners got an update on how the county is responding to the swine flu threat, plus a bonus: Every commissioner was presented with a Red Cross personal safety kit. The implicit message was  that the county is prepared for emergencies, be it virulent viruses or something else entirely. Dick Fleece, interim director of the county’s public health department, assured commissioners that funding for the kits came from the feds, not the county’s general fund budget.

Commissioners also discussed a federal grant aimed at helping track purchases of pseudoephedrine.

Meth Tracking System

The county is the fiduciary for a $218,000 federal grant that will help pay for a computer system that tracks the purchase of pseudophedrine from large drugstore chains as well as small pharmacies. It’s a Michigan State Police COPS-Meth grant for the Michigan High Intensity Drug Trafficking Area, known as HIDTA, which includes Washtenaw County but operates out of Detroit. Pseudophedrine is taken as a decongestant and contained in over-the-counter products like Sudafed, but it can also be used to make methamphetamine, an illegal drug.

Commissioner Jeff Irwin asked what information would be collected for this database, and how will that information be used by law enforcement. Kari Dorr, from the county prosecutor’s office, said that pharmacists currently are required to check the driver’s license for anyone who buys products like Sudafed, and that you have to sign for such purchases. If someone  who has a history of using meth buys the drug, the database will flag it, she said. Likewise if someone is buying large quantities, perhaps from different pharmacies. That kind of information would be shared with law enforcement officials statewide. Steve Hiller, deputy chief assistant prosecuting attorney, said the same information is already being collected – this system is just a conduit to get the information into a central database.

Irwin said he was skeptical about the accuracy of the front-end data. If he were a criminal, he said, he wouldn’t be using his own ID to buy drugs. He said it looks like the feds are spending a mountain of money nationwide that would be better used elsewhere. Hiller noted that state police troops are being cut in Michigan, and that this kind of data collection and information sharing is helpful as fewer resources will be available for law enforcement.

Commissioner Ken Schwartz asked Hiller if meth trafficking was a problem in Washtenaw County. Hiller said they do see meth on the streets quite often, but that Washtenaw County is a little less affected by it than neighboring counties.

Outcome: Commissioners approved the grant in their Ways & Means Committee meeting. It will be forwarded for action at the regular board meeting on May 20.

The Flu Formerly Known as Swine

Stating that “it’s been quite a week,” Diana Torres-Burgos, the county’s medical director, gave commissioners an update on the H1N1 flu virus. As of Wednesday, May 6, there were no confirmed cases in Washtenaw County, she said, and only four probable cases – two residents, and two nonresidents who attend school in the county. [As of May 9, there were nine confirmed cases in Washtenaw County. This report from the state is updated daily at 4:30 p.m.]

Torres-Burgos noted that this is something health care workers deal with every year – seasonal flu typically results in 30,000 to 40,000 deaths a year, nationwide. There was reason for concern because it was a new strain, which means there’s no immunity against it, she said, and it wasn’t clear whether it would be more virulent than seasonal flu. They’ll continue to monitor the situation to see if the virus mutates into something stronger, but at this point, normal precautions – like washing your hands regularly, not touching your mouth nose or eyes and staying home if you feel sick – are sufficient.

Cindra James, the county’s public health emergency preparedness coordinator, described the protocol for dealing with outbreaks like this. She said they have sufficient quantities of the antiviral drugs Tamiflu and Relenza, and that they would not open a central dispensing site unless demand escalated.

Torres-Burgos said that communications had been challenging, particularly in keeping up with demands of the media. The county was in daily contact with local hospitals, communicated regularly with schools and kept its website updated. She said that earlier guidelines had recommended schools be closed if they had probable cases – that’s what happened at Father Gabriel Richard High School, she said. The county contacted the school principal and recommended that the school be closed last week because two students had probable cases. The county also called for a community-wide meeting of schools, Torres-Burgos said, noting that it was a very fluid situation. Soon after, the Centers for Disease Control and state public health officials issued new guidelines saying that schools did not need to close, and so Gabriel Richard reopened on Wednesday with the caveat to be vigilant, she said.

As part of their presentation, Torres-Burgos and James gave each commissioner a Red Cross Deluxe Personal Safety Kit. Here’s a sampling of what it contains, according to its label: Gloves, mask, light stick, whistle, a 4.5 oz. pouch of drinking water, hand warmers, hand sanitizer, first aid supplies, poncho and emergency blanket.

Public Hearing

The board held a public hearing about the one-year action plan for the Washtenaw Urban County group, an entity chaired by commissioner Leah Gunn and consisting of representatives from 11 local jurisdictions: the cities of Ann Arbor and Ypsilanti, Ann Arbor Township, Bridgewater Township, Northfield Township, Pittsfield Township, Salem Township, Scio Township, Superior Township, York Township, and Ypsilanti Township. The group is a conduit for federal grants to fund affordable housing and community development projects.

Only one person – Thomas Partridge – spoke at the hearing. He said not enough is being done to provide affordable housing in Washtenaw County. He urged commissioners to establish an affordable housing commission and to provide more funding for affordable housing.

Recognitions

Mark Ouimet, board co-chair who was leading the meeting in the absence of the chair, Rolland Sizemore Jr., gave two presentations. He presented a proclamation to Washtenaw County Sheriff’s commander Dieter Heren declaring the week of May 10-16, 2009 as Police and Correction Officers Week, and designating May 15 as Peace Officers Memorial Day in Washtenaw County. The week is intended to honor those in law enforcement who have been injured or killed in the line of duty.

Ouimet also presented Rich Sheridan with a resolution congratulating Menlo Innovations, an Ann Arbor firm, for being named to the Worldblu List of most democratic workplaces. Sheridan is Menlo’s CEO. Ouimet, a Republican, said he felt like he’d been set up in making the presentation. Sheridan promised that next year they’d try to be named the most republican workplace.

Commissioner Barbara Levin Bergman presented a resolution honoring the Area Agency on Aging 1-B for its 35-year anniversary. Tina Abbate Marzolf, the group’s CEO, thanked the commission and showed them an original letter that the agency had written to the board in 1974 asking for funding. At that time, they received $348,000 – today, she said, the agency gets more than $5 million in state and federal funds to support services for seniors. In response to a question, Marzolf said that they were trying to work more collaboratively with veterans groups, and that she’d be happy to return to the commission with details about that project.

Public Comment

Two people spoke during the four public comment sessions Wednesday evening. Tom Partridge spoke at all four opportunities for public comment, calling for action to protect the county’s homeless and vulnerable populations. Roberta Asplund, a former public health nurse, said she was a member of the  Michigan Public Health Association and past chair of its nursing section. She said the group was trying to make legislators more aware of the importance of public health nurses, and urged commissioners to provide more funding for public health nurses at the local level. She said school nurses were important as well, and that coordinating between the schools and the county public health nursing staff was crucial.

The board ended its meeting by going into closed executive session to discuss labor relations.

Present: Barbara Levin Bergman, Leah Gunn, Jeff Irwin, Kristin Judge, Mark Ouimet, Jessica Ping, Wes Prater, Ken Schwartz, Conan Smith

Absent: Rolland Sizemore Jr., Ronnie Peterson

Next regular board meeting: Wednesday, May 20 at 6:30 p.m. at the County Administration Building, 220 N. Main St. The Ways & Means Committee meets first, followed immediately by the regular board meeting.  (Though the agenda states that the regular board meeting begins at 6:45 p.m., it usually starts much later – times vary depending on what’s on the agenda.) Public comment sessions are held at the beginning and end of each meeting. [confirm date]