Concerned that the double-whammy of H1N1 flu and seasonal flu will overwhelm clinics and hospitals with anxious patients this winter, Minnesota health officials are set to launch a novel solution -- a statewide nurse hot line that will triage people needing health advice and prescribe medicine over the phone.
It will be the first time in Minnesota that state government has stepped in to provide a free public health service that parallels the nurse hot lines provided by large clinics and insurers. But Minnesota is not alone. Alarmed by the spectre of triage tents set up outside hospitals in Texas and California, many other states are setting up similar services to handle the growing volume of worried flu patients.
State officials say the hot line promises to both relieve hospitals and clinics of the enormous burden of screening thousands of flu patients, and, more important, provide the fastest access to antiviral medicine for people most at risk of developing life-threatening illness.
It also will provide help for the growing numbers of people without health insurance or who face large copays for doctor visits and medicine.
"It's a huge issue," said Dr. John Hick, an emergency room physician at Hennepin County Medical Center in Minneapolis. "If we have a hot line, it's a big piece of the puzzle."
Health officials said they are still planning the hot line and declined to provide details, including the date that it will be up and running.
The state plans to contract with a private vendor to provide the service, which will be financed with $5 million in federal emergency funds. The nurses would ask callers about their symptoms and underlying health conditions, and make recommendations on whether they should seek medical care. They could also prescribe medicine, particularly antivirals such as Tamiflu.
Aggie Leitheiser, head of emergency preparedness for the state Health Department, said the Centers for Disease Control and Prevention (CDC) has encouraged states to think of new ways to handle the demand for information and guidance on flu.
"We are trying to balance a lot of issues," she said. "How do we give people information and manage the medical surge?"
Delays in the arrival of vaccine for both types of flu make the need for a triage service even greater, said Michael Osterholm, an infectious disease specialist at the University of Minnesota. On Friday, the CDC said only 28 million to 30 million doses will be divided around the country by the end of this month, not the 40 million-plus that states had been expecting.
In Minnesota, vaccine shipments are just trickling in. Shots will not be widely available to the general public until after Thanksgiving, officials said last week. Meanwhile, supplies of seasonal flu shots remain spotty and unpredictable. Many providers say they won't get more until November -- if at all.
That means the only stop-gap treatment for vulnerable groups such as children and pregnant women who become infected are antiviral medicine that reduce the severity and duration of the infection.
To be most effective, however, those drugs must be taken within 48 hours of the onset of symptoms. If patients can't get through to their doctor or some other health care professional, they can't get the drugs.
On Friday, the CDC reported another increase in the number of flu deaths and hospitalizations among children and teenagers. So far, 86 children have died of swine flu in the United States since the outbreak began last spring -- half of them since September, said the CDC's Dr. Anne Schuchat. That compares to 40 to 50 deaths from seasonal flu in some past seasons.
Already, Minnesota's existing nurse lines are overburdened with calls from people worried about their symptoms or asking about the availability of vaccines for both H1N1 and seasonal flu.
For example, the call volume on the HealthPartners nurse line has doubled in the last two weeks, forcing it to hire temporary staff.
HealthPartners has added a flu symptom guide to its website that provides much of the same information its nurses provide.
Clinics have complained that inquiries about flu are making it difficult to serve patients who call for help with other problems or to make appointments or get test results.
"It's a very positive thing to take the pressure off the health care system," Osterholm said.
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