Two children are given the swine flu vaccination in Miami, Florida.
It sounded worse that it was. Late Friday evening, with a stroke of his pen, President Barack Obama declared H1N1 a national emergency. The statement said that Obama does "hereby find and proclaim that, given the rapid increase in illness across the Nation may overburden health care resources and that the temporary waiver of certain standard Federal requirements may be warranted in order to enable U.S. health care facilities to implement emergency operations plans, the 2009 H1N1 influenza pandemic in the United States constitutes a national emergency."
Scary words. But White House officials were quick to assure that Obama's proclamation was more of a formality, and wasn't meant to indicate that the H1N1 virus had suddenly become more deadly or dangerous. Instead, by declaring a national emergency, the White House will allow hospitals and governments on the local level to more rapidly prepare triage sites and procedures to handle any future surge in sick patients. A hospital in danger of being overrun by H1N1 patients would be allowed to segregate them in a separate site for treatment, which might slow the spread of the disease. It's not unlike declaring an emergency before a hurricane hits landfall — the action removes legal barriers that might slow a rapid response.
But even though the emergency declaration doesn't mean the end of the world has arrived, H1N1 remains a serious threat — and the government's response, on all levels, has been spotty. On Friday the CDC reported that the H1N1 virus is now widespread in 46 U.S. states — a level of flu activity that is usually not seen until later in the winter. Since the virus began spreading, millions of Americans have been infected, at least 20,000 have been hospitalized and 1,000 have died — including nearly 100 children. "To be basically in the peak of the flu season in October is extremely unusual," said Centers for Disease Control (CDC) head Thomas Frieden. "The numbers continue to increase."
The best way to slow the growth of those numbers would be to rapidly manufacture and distribute the new H1N1 vaccine. But that's proven even more difficult than health officials anticipated when the virus first began spreading in the spring. Drug manufacturers have experienced setbacks growing the vaccine — instead of the 120 million doses the CDC had initially hoped to have by the end of October, the real number will likely be closer to 30 million. "Vaccine production is much less predictable than we wish," says Frieden. "We are nowhere near where we thought we'd be by now."
At the same time, actually getting the vaccine to the people who most need it — pregnant women, kids between the ages of six months and 24 years, health workers — hasn't been easy either. Complaints of vaccine shortages have emerged around the country, and local public health departments say they don't know when more vaccine will arrive. Worried parents say they don't know where to go to get the vaccine for their kids — their doctor's office, the school, a local hospital? Nor is it clear who should get the bulk of the complaints — while the federal government is in charge of actually procuring the vaccine and setting priorities, state and local governments are meant to take the lead on actually distributing the vaccine. It's a recipe for confusion and frustration. "We've got a new vaccine pipeline starting to flow, but at the end of it are a lot of rusty faucets," said Michael T. Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota, at a recent conference.
Fortunately, while H1N1 virus has made people a lot of people sick, it hasn't been as deadly as many scientists had initially feared. Even in hard-hit communities, hospitals haven't been overwhelmed. In some parts of the country, the virus may even be waning. States in the Southeast, which experienced spikes in infection when students went back to school in August, are now seeing declines. But pandemics often come in multiple waves of infection, and we may see another spike later in the year, during the colder months of winter — and it could be more severe, as has occurred in past pandemics. "I think this was a wakeup call in terms of preparing for something which would have [worse] characteristics," said Arnold Monto, an epidemiologist at the University of Michigan School of Public Health.
It might not look like it right now, as lines stretch around the block for limited supplies of the new vaccine and a national emergency has been declared, but we've been lucky so far. We may not be lucky again.