This article first appeared in the St. Louis Beacon, April 28, 2009 - Health officials said Tuesday that a case of swine flu had been confirmed in St. Charles County, making it the first known case in the St. Louis area.
No additional information was released about the person who has the flu. It was one of four new cases detected in Missouri on Tuesday, bringing the total number of confirmed and probable cases in the state to 12.
The new cases of the 2009 H1N1 virus were found in Platte and Jackson counties as well as in St. Charles County. They were discovered during testing of specimens sent to the state Public Health Laboratory by doctors whose patients reported flu-like symptoms.
The Missouri State Public Health Lab was able to confirm the presence of swine flu in the four new cases after receiving the chemical test for the virus developed by the Centers for Disease Control and Prevention.
Local area is prepared for epidemic, official says
Every disaster is different, whether it's a tornado, a terrorist attack or a swine flu pandemic, but if the St. Louis area's response to the big power outage in July 2006 is any measure, Nick Gragnani is confident we're prepared.
"It really stressed our system," said Gragnani, who is executive director of the St. Louis Area Regional Response System - - STARRS for short. He recalls that nursing homes had to move 4,800 patients into area hospitals and over a two-day period there were no beds available -- to the point that he was in touch with Kansas City, Chicago and Memphis, just in case.
Now, with swine flu showing up in the Midwest, though not locally as of Tuesday afternoon, Gragnani is confident that experience and the constant training and upgrades that his agency conducts have the region in good shape.
"Every type of disaster has its own unique needs," he said, "but there is a baseline you start with. You do an assessment of what you need in the region, what is at risk and what is vulnerable. You break it down from there."
STARRS began with a homeland security grant in 2003, in the wake of the terrorist attacks on 9/11. It operates under the umbrella of the East-West Gateway Council of Governments and covers the same area -- five counties in Missouri and three in Illinois.
It coordinates information among the eight local health departments and 55 hospitals in the region to make sure the resources that exist are available when and where they are needed. "What our organization does," Gragnani says, "is make sure that plans are coordinated on a regional basis, so Peter is not robbing from Paul."
He also makes sure that information is available quickly and distributed widely. As more and more swine flu cases have been reported, he said, frequent conference calls and online updates have been used to keep everyone up to date.
In a situation such as swine flu, Gragnani said, such monitoring is particularly important, because no one can know when -- or even if -- cases may show up.
"It can develop anywhere," he said. "It can develop in a school, it can develop with someone showing up at a doctor's office or an emergency room, it can even develop with an EMS call. We have to be on top of every situation.
"So we really force the issue of talking regionally, so we all are sharing. That way, when something does come up, we immediately know what we are doing."
In St. Louis County, the head of the health department, Dr. Dolores Gunn, said her staff has increased its regular surveillance of emergency rooms, doctors’ offices and pharmacies, so any local increase in flu-like symptoms can be identified as soon as possible. The health department is also in close contact with the Missouri Department of Health and Senior Services and other area health departments to learn of any other suspected cases of swine flu.
County physicians and hospital emergency rooms have also been contacted by the health department with the latest detailed information on swine flu and the appropriate testing procedures to use when swine flu is suspected.
County health department spokesman Craig LeFebvre noted that because precautions for swine flu are about the same as those for common flu, whose season just ended, schools, hospitals and other institutions should already have been prepared for the new disease. He also noted that symptoms of the two types of flu are similar, so they are often hard to tell apart, and many people who suffer from flu symptoms never see a doctor and simply stay at home and use time-honored remedies such as bed rest or chicken soup.
For businesses, the Department of Health and Human Services has a preparedness checklist on its Pandemic Flu website. It lists tips including identifying a pandemic team or doordinator and a plan for response; identify critical employees and resources needed to continue operations during a pandemic; and develop a scenario that calls for either an increase or a decrease in your business' goods or services if a pandemic should strike.
As the potential for a swine flu outbreak spreads into the public consciousness, health officials have to be ready to move quickly, Gragnani said.
"People are hearing about it in the press," he said, "so right away they may think, 'I have it,' and they go to the emergency room. That's OK, but then you have to check from there. Did they have contact with anyone who may have had the disease, or contact with anyone from Mexico.
"If it is somebody in a school, you immediately can figure out who they have been around -- family, classmates. If it is somebody who was at the Cardinals-Cubs game over the weekend, it's going to be a lot more difficult. Then health planners have to get out there and do an investigation, much like law enforcement authorities investigate a crime."
Building on the 2006 storm experience -- as well as his 20 years in emergency management, including the floods of 1993 -- Gragnani said he helps to keep track by using access to a secure website that tracks all beds at the region's hospitals, so if anything happens that prompts what he called a "medical surge," where the vacancies are would be readily apparent.
He said the system is also ready with "surge trailers" that have bedding and cots that could be dispatched to hospitals that may need them.
The response protocols have been refined since the summertime power outage three years ago, he added, though he did not want to go into detail. "We definitely had this situation occur already," he said, "so we know how to deal with it.
"The region definitely has it covered. It's going to be a testing event; it is not going to be a school picnic. But the region has resources readily available, and those it can reach out to, to handle the situation."
In the end, Gragnani said, preparedness is all. If all the training and advance work is done properly, execution under stress should go smoothly as well.
"We're like the football team manager," he said. "We don't wear the uniform. We're not on the field, we're not one of the players. We're up in the press area, watching the game and seeing where we need more help.
"It's kind of a cavalier statement, but if we've done our job right, we're at home watching the game on television and saying 'Go, team, go.'"
