Posted on Thu, Nov. 5, 2009
After several weeks of sharp increases in the spread of swine flu around the region, the first hints that the pandemic may be leveling off have begun to emerge.
Experts caution that it is too early to draw conclusions. It is likely to come back in the winter, and even the early trend is not uniform: Just as flu patterns vary around the country, the evidence here suggests that disease is continuing to spread quickly in New Jersey even as it might be leveling off in Philadelphia.
And public-health officials are adamant that people at risk of complications should keep trying to find vaccine against both the swine and seasonal flu.
But there are encouraging signs:
Children's Hospital of Philadelphia experienced a significant decline in emergency-room visits Monday, before the SEPTA strike. A dramatic increase in ER visits three Mondays ago, most for mild cases of flu, had forced the hospital to convert part of its atrium into an ER waiting room. Two Mondays ago, visits hit a record high.
The percentage of specimens testing positive for influenza at a sampling of laboratories in the extended Philadelphia region declined slightly for the week that ended Saturday. They had increased for seven weeks straight, including sharp jumps the last three weeks.
The rate of increase in patients visiting a sample of pediatric clinics in the city slowed last week for the first time in several weeks.
"I think we are all cautiously optimistic that we are past the peak of this pandemic wave," Richard Scarfone, medical director of emergency preparedness at Children's Hospital, said in an interview yesterday. "I don't think any of us believe that the pandemic is anywhere near over."
Indeed, the 389 ER visits Monday - down from the record 524 seven days earlier - was still more than 50 percent above normal for this time of year. (Visits declined even more sharply Tuesday, but officials said the SEPTA strike might have been a major factor.)
Alfred I. du Pont Hospital for Children in Wilmington reported a similar drop in ER visits Monday, which is normally the busiest day of the week.
"My gut feeling is that we are starting to see some leveling off," said Caroline Johnson, director of the Philadelphia Department of Health's Division of Disease Control. "But that doesn't automatically mean there is going to be a down slope just as quick."
And she, like others, cautioned not to draw conclusions from a one-week change.
"At this point, we are still seeing quite a significant amount of influenza in Philadelphia," said Laurel Edelman, vice president for clinical accounts at SDI Health L.L.C. in Plymouth Meeting, which collects and analyzes health-care data nationally for regions that are defined by their Nielsen TV ratings markets. The Philadelphia market extends from Reading east to Ocean City, N.J., north to Trenton, and south to Dover, Del.
"To see an ongoing trend," Edelman said, "we have to wait and see."
SDI's laboratory-surveillance data for last week also noted a national decline for the first time. But that is an average of multiple markets, some of which are trending up at any given time while others are trending down.
And while flu in other cities has generally increased for several weeks and then started to subside, Edelman said, in some cases it started to go up again, bucking the pattern of seasonal flu.
In New Jersey, several indicators - school absenteeism, laboratory positives, a sampling of physicians - point to continuing spread of disease, state officials said at a news conference yesterday, when they also reported the state's 20th fatality from swine flu, a 42-year-old man with multiple medical conditions who lived in Middlesex County.
Illness is spreading faster in the southern part of the state than in the north, they said. And Cooper University Hospital in Camden, unlike children's hospitals in Philadelphia and Delaware, is still experiencing increases in visits to its pediatric emergency room, a spokeswoman said.
More vaccine continued to arrive in small amounts around the region. The Philadelphia School District has immunized about 20,000 children through yesterday, a spokesman said, and many suburban districts were starting - and in some cases, finishing - flu vaccine clinics.
The city Health Department now has enough vaccine against novel H1N1 flu to offer immunizations at 28 walk-in clinics beginning Monday, Johnson said. The 12,500 doses will be available free on a first-come, first-served basis - and replenished weekly as shipments arrive - to city residents who are members of priority groups: health-care workers; pregnant women; people ages 6 months to 24 years; people 25 to 64 who have underlying medical conditions; and people who care for infants under 6 months of age.
They should get the vaccine, Johnson said: "Even if this wave declines, it is going to come back."
To find swine flu vaccine at public clinics, including 28 locations in Philadelphia, go to http://go.philly.com/swineflu
Contact staff writer Don Sapatkin at 215-854-2617 or dsapatkin@phillynews.com.
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