Despite a statewide drop in reported influenza cases, Los Angeles hospitals are preparing for this year's season to worsen in the coming weeks, fearful of the deadly H1N1 "swine flu" virus strain that is to blame for most of this year's flu deaths.
H1N1 killed thousands of people around the world in 2009. That has hospitals worried about the spread of the illness, especially since California's flu deaths this year have dramatically outpaced last year's at this time.
Dr. Rekha Murthy, epidemiologist at Cedars-Sinai Medical Center in Los Angeles, said that starting Monday the hospital will require that visitors wear masks — whether or not they're sick — and that patients see only two visitors at a time. The last time flu prevention measures were stepped up like this, she said, was during the 2009 pandemic.
"I think we learned at that time that we've got to act quickly," she said.
This year's flu is fast-moving. State health officials Friday reported 95 confirmed deaths from influenza among people under 65, with an additional 51 cases likely to be confirmed next week. That would put this year's flu fatalities at 146 so far.
At this time last year, nine deaths had been confirmed, and the season ended with a total of only 106.
In part, the higher number of deaths this year compared with this time last year is because the season began earlier, said state epidemiologist Dr. Gil Chavez in a conference call with reporters Friday. It's also because H1N1 — which accounts for 75 of the 95 confirmed deaths — tends to affect younger people more than the other strains of flu present this season.
He added that for the week ending Jan. 18 there was a decline in flu-related hospitalizations and outpatient visits in the state. It remains unclear whether that suggests a coming drop in flu cases, he said.
"It's too early to tell ... whether that's the beginning of a reversal or just a temporary change," he said.
Los Angeles County hasn't released data for the week ending Jan. 18, but area hospitals agreed that they haven't seen a drop in the number of flu-related hospitalizations or outpatient visits due to the flu. Murthy said Cedars-Sinai said has seen a steady increase in flu patients since mid-December.
At Children's Hospital Los Angeles, there were 54 inpatient and outpatient flu cases as of Jan. 13. As of Friday, the number had risen to 91.
Mary Virgallito, clinical administrator of infection prevention and control for the hospital, said she expects more weeks like this one and a peak in coming weeks.
Similarly, Dr. Paul Holtom, epidemiologist for USC Keck Hospital and Los Angeles County-USC Medical Center, said those facilities haven't seen any sign of a decrease and are still dealing with "a tremendous increase of numbers of people who are hospitalized, and a very significant increase of people who are severely ill from influenza."
In the midst of this bad flu season, hospitals are pushing for as many of their staff members as possible to get flu shots. Numbers are up, they say, in part because of a county mandate that required all health staff to either be vaccinated or to wear a mask at work and because people saw in the 2009 season how dangerous the flu can be.
At Olive View Medical Center, immunization rates among staff have increased from 50% to roughly 75%, said Dr. Suzanne Donovan, medical director of infection control. Several measures to prevent the spread of illness at that hospital have been in place since the 2009 pandemic, such as not allowing visitors under age 12 into the neonatal intensive care unit and the screening of all other visitors.
Dr. T. Warner Hudson, medical director of occupational and employee health at UCLA Medical Center, said officials there are encouraging everyone to get vaccinated. He added that UCLA hospitals ramped up their efforts to encourage sick people not to visit patients.
"We're seeing the kind of thing you expect to see when there's kind of an echo of the pandemic of 2009," he said.
Most Californians who died of the flu had underlying risk factors, including pregnancy, asthma or obesity, according to state epidemiologist James Watt.
In Los Angeles County, the 10 adults who had died as of Jan. 11 all had underlying medical conditions or a medical history that put them at risk. The top three co-morbidities in those patients were being overweight or obese, hypertension and heart disease.
"We're kind of at the liftoff of the season," Hudson said. "If you haven't gotten your flu vaccine, run and get it as quickly as you can."