Fifteen states could run out of available hospital beds during the peak of the swine flu outbreak, if 35 percent of Americans were to get sick from the H1N1 flu virus, according to a report released Oct. 1 by Trust for America’s Health (TFAH). Twelve additional states could reach or exceed 75 percent of their hospital bed capacity.

• The 15 states that would be at or exceed hospital bed capacity are Arizona (117%); California (125%); Connecticut (148%); Delaware (203%); Hawaii (143%); Maryland (143%); Massachusetts (110%); Nevada (137%); New Jersey (101%); New York (108%); Oregon (107%); Rhode Island (143%); Vermont (108%); Virginia (100%); and Washington (107%).
• The 12 states that would be at 75 to 99 percent of their hospital bed capacity are Colorado (88%); Florida (80%); Georgia (78%); Maine (83%); Michigan (79%); New Hampshire (84%); New Mexico (93%); North Carolina (95%); Pennsylvania (77%); South Carolina (93%); Utah (83%); and Wisconsin (75%).

According to the new report, “H1N1 Challenges Ahead,” the number of people hospitalized could range from a high of 168,025 in California to a low of 2,485 in Wyoming, and many states may face shortages of beds or may need to reduce the number of non-flu related discretionary hospitalizations due to limited hospital bed availability. The numbers of people who get sick could range from a high of 12.9 million in California to a low of 186,434 in Wyoming, if 35 percent of Americans were to get H1N1.

“Health departments and communities around the country are racing against the clock as the pandemic unfolds,” said Jeff Levi, PhD, Executive Director of TFAH. “The country’s much more prepared than we were a few short years ago for a pandemic, but there are some long-term underlying problems which complicate response efforts, like surge capacity and the need to modernize core public health areas like communications and surveillance capabilities.”

The report examines other H1N1 outbreak concerns the country faces this fall related to vaccines, antiviral medication, health care, and special needs of at-risk communities. Additional key findings from the report include:

• Last year, only 36.1 percent of adults were vaccinated against the seasonal flu, with rates ranging from a low of 30.8 percent in California to a high of 49.2 percent in South Dakota. This means that there will need to be a major upsurge in vaccinations in order to vaccinate the entire population for H1N1 compared to what states and communities have managed in the past.
• 69.5 percent of seniors (over the age of 65) are vaccinated for the flu annually, but only 24.1 percent of younger adults receive vaccinations (ages 18 to 49). Seasonal flu vaccination efforts have concentrated on immunizing seniors, but H1N1 is considered to be more dangerous for young adults and children, which means outreach for vaccinations must be very different.
• Budget cuts and layoffs in states and communities are hampering preparedness efforts. Local health departments eliminated 8,000 staff positions in the first half of 2009, which adds to the 7,000 local public health jobs lost in 2008. In addition, federal public health preparedness funding was cut by 25 percent from fiscal year 2005 to 2009.
• Nearly half of private sector workers do not have any paid sick leave benefits, which means millions of Americans will face losing their jobs if they are sick or going to work and contaminating others.
• While the federal government pays for the purchase and distribution of vaccines, payment for the administration of vaccines will be the responsibility of insurance providers, state and local health officials, or, in some cases, it could be an out-of-pocket cost for individuals.
• There are 47 million Americans without health coverage. If 35 percent of the public becomes infected with H1N1, some 15 million uninsured Americans could become sick and either go without care or seek care in already crowded emergency rooms.
• African-Americans and Hispanics are more likely to have severe cases of H1N1 because they suffer from more underlying chronic conditions, like asthma and diabetes, at the same time many significant gaps remain in systems for reaching minority communities. For instance, emergency preparedness information is often disseminated on the Internet, which many people do not have access to, and there is limited availability of non-English information.

The report includes short-term recommendations to address some immediate concerns for the upcoming H1N1 season and long-term recommendations for improving the nation’s overall capacity for preparing for health emergencies. Some of the short-term recommendations include:

• Refine plans for rapid distribution and administration of vaccines for the first mass vaccination effort to be conducted in such a short time in U.S. history;
• Risk communications must be a top priority. Special efforts must be made to reach out to young adults, minorities, and other at-risk groups to get vaccinated. This should include communications in many languages;
• Vaccination campaigns must continue past the fall to prepare for a potential third wave outbreak;
• An emergency health benefit should be established to care for the uninsured and under-insured during the H1N1 outbreak;
• An emergency sick leave benefit should be made available to Americans without sick leave benefits;
• The emergency supplemental funding for H1N1 preparedness has been very important, but it is one-time funding and is insufficient to fill chronic public health infrastructure gaps, including the need to modernize surveillance systems and upgrade other technologies;
• All public and private health insurers should waive co-payment requirements for H1N1 vaccines and out-of-network care for H1N1-related illness and allow providers to bulk bill for the administration of vaccines instead of requiring cumbersome paperwork for every individual;
• The U.S. Department of Labor should communicate with the private health benefit plans governed by the Employee Retirement Income Security Act (ERISA) to encourage them to waive co-pay requirements for vaccines and out-of-network restrictions and to provide information to state and local health departments to help with their vaccination campaigns in communities; and
• Health providers should follow the guidance from the U.S. Department of Health and Human Services and the Occupational Safety and Health Administration on the best way to protect health care personnel; and
• Health providers and health departments should develop and disseminate strong public messages about ways to practice good hygiene and understand symptoms and remedies.

The full report, including a chart with state-by-state information on illnesses, hospitalizations, and flu vaccination rates, is available on TFAH’s Web site www.healthyamericans.org. The report was supported by a grant from the Robert Wood Johnson Foundation.

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Excerpts from TFAH Oct. 1 press release

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