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Obama declares swine flu national emergency
Order could speed up treatments by waiving certain medical standards


msnbc.com news services
updated 3:06 p.m. ET Oct. 24, 2009

WASHINGTON - President Barack Obama has signed a proclamation declaring swine flu a national emergency, the White House said Saturday. The order gives his health chief the power to let hospitals move emergency rooms offsite to speed treatment and protect noninfected patients.

Administration officials said the declaration was a pre-emptive move designed to make decisions easier when they need to be made. Officials said the move was not in response to any single development.

Health and Human Services chief Kathleen Sebelius now has authority to bypass federal rules when opening alternative care sites, such as offsite hospital centers at schools or community centers if hospitals seek permission.

Some hospitals have opened drive-thrus and drive-up tent clinics to screen and treat swine flu patients. The idea is to keep infectious people out of regular emergency rooms and away from other sick patients.

Hospitals could modify patient rules — for example, requiring them to give less information during a hectic time — to quicken access to treatment, with government approval, under the declaration.

It also addresses a financial question for hospitals — reimbursement for treating people at sites not typically approved. For instance, federal rules do not allow hospitals to put up treatment tents more than 250 yards away from the doors; if the tents are 300 yards or more away, typically federal dollars won't go to pay for treatment.

Administration officials said those rules might not make sense while fighting the swine flu, especially if the best piece of pavement is in the middle of a parking lot and some medical centers already are putting in place parts of their emergency plans.

The national emergency declaration was the second of two steps needed to give Sebelius extraordinary powers during a crisis.

On April 26, the administration declared swine flu a public health emergency, allowing the shipment of roughly 12 million doses of flu-fighting medications from a federal stockpile to states in case they eventually needed them. At the time, there were 20 confirmed cases in the U.S. of people recovering easily. There was no vaccine against swine flu, but the CDC had taken the initial step necessary for producing one.

More widespread than ever
Swine flu is more widespread now than it's ever been, and has resulted in more than 1,000 U.S. deaths so far, officials said Friday.


Flu illnesses are as widespread now as they are at the winter peak of normal flu seasons, Thomas Frieden, director for the Centers for Disease Control and Prevention, told reporters. "To be basically in the peak of flu season in October is extremely unusual," he said.

"We expect that influenza will occur in waves and we can't predict how high, how far or how long the wave will go or when the next will come," he added.

"Many millions" of Americans have had swine flu so far, according to an estimate he gave at a Friday press conference. The government doesn't test everyone to confirm swine flu so it doesn't have an exact count.

Frieden updated some other estimates, too, saying there have been more than 20,000 hospitalizations.

Nearly 100 swine flu deaths in children have been reported, CDC officials also said.

Forty-six states now have widespread flu activity. The only states without widespread flu are Connecticut, Hawaii, New Jersey and South Carolina. There are at least two different types of flu causing illnesses; tests from about 5,000 patients suggest that nearly all the flu cases are swine flu.

'Frustrating' production delays
This year's seasonal flu vaccine won't protect against swine flu; a separate swine flu vaccine is needed. Vaccine production takes several months, and the work on seasonal vaccine was already well under way when swine flu was first identified in April. It was too late for the swine flu virus to be included in the seasonal doses.

Because of swine flu vaccine production delays, the government has backed off initial, optimistic estimates that as many as 120 million vaccine doses would be available by mid-October. As of Wednesday, only 11 million doses had been shipped to health departments, doctor's offices and other providers across the country, CDC officials said.

"It's frustrating to all of us. We wish there were more vaccine available," Frieden said.

The flu virus has to be grown in chicken eggs, and the yield hasn't been as high as was initially hoped, CDC officials explained. "Even if you yell at them, they don't grow faster," Frieden said.

He added that 5 million new doses became available in the past week, and vaccine should be more plentiful soon.

Much of the vaccine currently available is a nasal spray from AstraZeneca's unit MedImmune.

The Obama administration has ordered vaccine from five manufacturers: Sanofi-Aventis SA, CSL Ltd, Novartis AG, GlaxoSmithKline and AstraZeneca's MedImmune.

Also Friday, federal health officials said more Americans have been vaccinated against seasonal flu this fall than ever before by this time of year.

Sixty million people have gotten the winter flu vaccine — probably because they're paying more attention to flu warnings in general, thanks to swine flu. It's an unprecedented number of seasonal flu shots for October; most usually aren't given until later in the fall.

Part of it is due to supply: There are already 85 million doses of seasonal flu vaccine available, a much larger amount than usual for this early in the fall. Most years, roughly 100 million doses are used during the season.

But a big factor probably is that swine flu is drawing attention to public health warnings that seasonal flu is also a deadly illness that can be prevented through vaccinations, said Joe Quimby, a spokesman for the CDC.

"There's been a heightened awareness in the American public due to H1N1 this year," said Quimby.

Global figures
Also Friday, the World Health Organization reported more than 414,000 laboratory confirmed cases of H1N1 worldwide, with nearly 5,000 deaths.

But the Geneva-based health agency noted that the figures were only the tip of the iceberg.

"As many countries have stopped counting individual cases, particularly of milder illness, the case count is significantly lower than the actual number of cases that have occurred," WHO said.


http://www.msnbc.msn.com/id/33459423/ns/health-cold_and_flu/