Clearly, the 2009/2010 flu season was an unusual one.  The sudden appearance of H1N1, the lack of a vaccine, the decision to manufacture a vaccine and then its’ delayed arrival, all lead to a flu vaccination season like no other.  What’s on the horizon for the 2010/2011 flu vaccination season?  It may be early to say but we know the following:

1.  H1N1 is one of the three strains to be included in the seasonal flu vaccine.

2.  Vaccine prices have gone up.

3.  Nursing costs have also increased.

The WHO delivered the strains to the manufacturers on time but it is too soon to know how well the strains are growing.  We’ll get early reports from the manufacturers in about two weeks at the CDC/ AMA National Flu Vaccination Summit.

Last year, we saw the highest uptake of seasonal flu vaccine in history with nearly 40% of the US population getting their seasonal flu shots.  Let’s see if we can’t build on that this year.

Employees who participated in medical surveillance programs up until recently were overwhelmingly male.  That has changed in recent years and nearly every employer now has both male and female employees who are required to participate in annual medical surveillance requirements.  Yet, here has been no  medical surveillance program design, testing requirements or interpretation of findings based on gender.  Well, that may be changing very soon…

Recently, Corporate Wellness identified a pattern of abnormal laboratory findings in female employees who completed serum cholinesterase screens as baseline tests for a new environmental consulting client. They have more female employees than many others in the industry.  While the laboratory normal range for this test is 1900 to 3800 units per milliliter (U/mL), more than half of the female employees we tested this year had significantly lower results – some hovering around the 1000 U/mL mark even after retesting.  Normally,  we’d recommend limited potential for exposure and retest for 75% of normal and removal from all assignments that might include exposures for findings that are 60% of normal or below.

Together with Dr. Randy Young who heads clinical operations for LabCorp, we took a closer look.  We found that although there is currently only a single normal range for both males and females, normal findings for females, and especially females using estrogen based birth control, are more likely to be in the 1000 to 1800 units range – well below the published “normals” of 1800- to 3800 units.

LabCorp examined its own results, for our clients’ employees and their entire patient population and found that our observations appear to be correct.  And they will be publishing a new set of “normals” for both serum and rbc cholinesterase that are gender based.

For the moment, we are sending letters to all female employees whose laboratory results are below 1800 units, explaining where we are in the process of helping set new gender based normals but also offering retest if they’d like it.

We suspect that this may be the first of many things we learn as a result of the changing workforce.

Flu continues to receive a great deal of media coverage and sometimes it is hard to figure out why the media covers one story and glosses over others. Here are what we think were the most important flu stories of this past week and our comments on them:

1. A small study from Mexico showed that individuals who received seasonal flu shots and contracted H1N1 flu had a significantly lower mortality rate. In fact, none of the critically ill patients in the study who had received a seasonal flu shot died while 34% of those critically ill patients who had not received a seasonal flu shot did. We will have more and better US data, hopefully validating this study , within the next week or two.

This study’s findings were directly opposite from the findings from a small Canadian study several weeks ago.

2. The shortage of seasonal flu vaccine is widespread. Unlike other flu shot seasons, it will not resolve itself over time.

In past flu seasons when there were vaccine delays or shortages, the manufacturers would continue to make vaccine as long as necessary. This year, they have converted their production lines over to H1N1 production lines and are no longer manufacturing seasonal flu vaccine. There are always vaccine “losses” when vials are filled after their lots are approved by the FDA. This year, those fill losses are three times normal which adds to the shortage (that one has received nearly no media coverage).

As a result, most retail flu clinics (like those in Costcos and CVS pharmacies) will be ending weeks ahead of schedule as they run out of vaccine.

3. There appears to be a renewed shortage of hand sanitizer. Don’t wait until you are out before re-ordering because there are back orders.

4. Flu activity is now present in all 50 states with high activity reported in 37 states.

5. Flu “burnout” is our newest concern. Dr. Anne Schuchat from the CDC reports that we will likely see flu activity levels similar to this week’s for the next seven months (until the end of traditional flu season). Remaining vigilant for that long of a period of time will be challenging for most businesses. As we hear how different clients and employers are creatively addressing ways to prevent flu burnout, we’ll pass them along.

The other day a reporter called with questions about employees and H1N1 vaccination.  After explaining that we do not think that swine flu shots will be available on the open market and therefore not available for employees, he asked the question we’d be waiting for -  Would you take a swine flu shot?

The answer is:  Probably not.  I’ll explain.  First, I may have already had the swine flu.  About twelve weeks ago, while eating dinner one night, I became extremely tired – tired enough that I asked my husband to drive my car home.  By the following morning, I had a sore throat, bad cough, headache and generally overall achiness – but not fever.  At that point, the experts (my friends at the CDC and AMA) were telling everyone that H1N1 flu had a fever of 101.5 or higher.  As I slept away the weekend, I took my temperature frequently.  It never inched above 98.6.  By Sunday morning, my daughter (who is asthmatic) had similar symptoms and my pediatrician advised starting her on Tamiflu.  I recovered by Monday afternoon.  My daughter, on Tamiflu, was sick less than twenty four hours.

But back to the question, why am I not planning on taking a swine flu shot even though I am considered high priority to receive one (as a healthcare professional).  Well… there are quite a few reasons. 

REason #1:  the last time we gave Swine flu shots in the US (1976), the outcome wasn’t great.  Every single release and consent for a seasonal flu shot talks about Guillaume Barre Syndrome – that warning is directly related to the Swine flu vaccine given in 1976.

Reason #2: This vaccine is being rushed to market – without some of the kinds of testing that we have deemed necessary for safe vaccine production.

Reason #3:  At this point, H1N1 flu just isn’t that bad.  Nearly every one of our clients have had employees become ill with H1N1 flu.  Although recently there was one death, hundreds of employees got sick, were sick for about two days, took another day or two to bounce back and came back to work.  At this point (at least until if and when it mutates), it is a fairly mild flu. 

Is my advice that no one should take a swine flu shot?  No.  Speak to your pediatrician or personal physician.  Evaluate your risks (pregnant women appear to be at higher risk for complications and hospitalization).  Watch to see if this flu seems to become more severe.  And make your own informed decision. 

There is no doubt that we are in the midst of a pandemic.  It just seems to be, at this point, less than the worst case scenario.  Let’s hope it stays that way.

Word has is that President Obama wants a vote on his health care reform plan before Congress recesses for summer.  It is an aggressive timeline …

Our health care reform gold star of the week goes to Congressman John Hall who proposes that Congress itself participate in whatever health care plan is passed .  Congressman Hall subscribes to the theory – if it’s good enough for you., it’s good enough for us  Hat’s off to him for this proactive approach for staving off critics of the yet to be fully designed plan.

Our health care reform black mark of the week goes to Richard Scott; founder of Columbia/HC who has formed the group Conservatives for Patients Right and raised nearly $20 million to fight President Obama’s plan.  Keep in mind that Mr. Scott is the same man who was ousted from the company he founded after the FBI raided five Columbia Hospitals and three executives were indicted for systemic Medicare fraud.  Seems that he’s the wrong guy to be telling us we’re wrong in trying to fix this mess he helped create.

The bottom line is that fixing health care is key to righting the economy.  They are inextricably intertwined.  We cannot move forward without some kind of health care reform.  Obama’s plan may not be perfect, might not even be close, but at least it is a start.  And you have to start somewhere.

It seems that there is a new health care crisis looming -one we may not have seen coming.  The average monthly COBRA bill for a family is almost $1500.  And the newly unemployed simply can’t afford it.  Sometimes, the monthly unemployment insurance is less than that. Only a very small percentage of those affected by layoffs are accepting COBRA.  And that means that we have a whole new uninsured population.  

Doctors are reporting fewer office visits.  Dentists who never had available appointment slots do now.  Pharmacists are reporting an increase in unfilled prescriptions and refills not being  picked up.

At this point, this is fairly anectodal but the short and long term impact on the health care system is likely to be severe. We haven’t seen where this is going but it doesn’t look like it’s going anywhere good.

For years now, the CDC tracks the spread of influenza each year beginning in early October.  They receive reports from emergency rooms, hospitals and doctors nationally and publish that data on their website – generally about two weeks after the fact.

But here comes Google with Google Flu Trends and a totally new way to find out what is happening out there in real time.  Who is sick enough today to be googling flu remedies?  Who is wondering how long their ailing spouse is going to be home?

http://www.google.org/flutrends/

Google Flutrends tracks computer users web searches for words related to flu – influenza, flu, fever, flu remedies, etc.  And it appears that Google is accurately trending the spread of flu two weeks ahead of the CDC.  All we can say is Wow!

Of course, there are already naysayers.  Google insists it is tracking and using anonymous aggregated data to conduct its trending analysis.  The folks at EPIC , the Electronic Privacy Information Center,  filed a Freedom of Information Act request asking federal officials to disclose how much user search data the company has recently transmitted to the Centers for Disease Control and Prevention, or CDC, as part of Google Flu Trends.

But the implications for predicting a flu pandemic and being able to take precautionary action at an earlier point are signficant.  And its potential tracking other infectious diseases and other types of illness is incredibly exciting.

Google does it again…

It’s here and it’s 750 pages long.  It was originally published in February, 2008.  And on November 17th, the Department of Labor finally published its revised regulations to guide employers as we navigate FMLA.

Employers had identified many areas that required clarification  since the FMLA was enacted. And the new regulations do address many of them.  For instance, most of us see a potential of abuse of intermittent leave and  we also find gray areas that prevent asking medical questions regarding FMLA that are allowed under the ADA.

But, and it’s a big but, according to Frank Alvarez of Jackson Lewis, ” Many employers do not have the resources to master complex FMLA rules.  Most are cutting staff and slashing training budgets.  At the same time, they can’t afford to ignore this issue.  FMLA is a major compliance obligation, and in the midst of today’s economic uncertainty, attendance and productivity can be keys to a company’s survival.”

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Recently, we were asked ” Just what are the hidden costs of managing medical surveillance programs that you sometimes talk about?”  That may sound like a simple question but it really leads to a series of much more difficult questions.

 When was the last time that one of your new hires had his start date delayed because his medical clearance had not been received?

Did the delayed start cost you billable hours?

Did the delayed start cost you additional overtime or additional payments for contract personnel?

When was the last time one of your field personnel had to return to a clinic a second time or even a third time because some portion of the annual medical requirement had been omitted?

How many errors are there on the bills you review?

The cost of an asbestos exam isn’t simply what the clinic charges you for that exam.  Did they do the correct exam, with only the necessary components, in a single visit with minimal waiting time and report it  and bill it accurately in a timely fashion?