How will Oklahoma health officials handle the swine flu pandemic?

Andrew W. Griffin
Red Dirt Report
September 11, 2009

OKLAHOMA CITY – What lies in store for Oklahomans who are faced with a serious swine flu threat? Will the state require citizens to be quarantined if they are exposed to the disease? What if folks refuse the vaccine that is being strongly promoted by state health officials, as noted in a Red Dirt Report story this week?

This online newspaper is seeking answers as more and more questions are raised about the state and their real plans when faced with the harsh realities presented by this growing pandemic.

Thanks to the hard work of the folks over at We Are Change Oklahoma, a two-year-old public document they provided Red Dirt Report from the Oklahoma State Department of Health (OSDH) titled “2007 Oklahoma Pandemic Influenza Management Plan,” reveals plans to enforce “mandatory isolation or quarantine orders.”

In the PDF file, provided to Red Dirt Report, it begins with a letter from Dr. James Michael Crutcher, the state’s Secretary of Health and Commissioner of Health until his retirement earlier this year. In the letter, dated August 31, 2007, addressed to public health workers and their partners, Crutcher notes concerns about H5N1 “bird flu,” which was more of a problem at that time. He also notes the “numerous community-wide preparedness exercises, and implemented new strategies for medical surge capacity and continuity of operations.”

And in the planning for a flu pandemic, Crutcher hopes the state will be able to minimize “the infrastructure disruption that pandemic influenza may cause.”

Well, under a section called “Community Disease Control and Prevention,”  “The OSDH Office of the State Epidemiologist, Acute Disease Service, Office of General Counsel and county health departments will coordinate degree of enforcement with partners and stakeholders who may be involved in enforcing mandatory isolation or quarantine orders.”

On the following page, there is a subsection that notes the importance of “(d)irecting isolation of persons with suspected novel influenza virus infection. Depending on the characteristics and severity of illness, patients may be isolated at home or in hospital.”

• A d v e r t i s e m e n t

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In the next section the OSDH is more in-depth about what happens with those the state believes may be infected with a pandemic-level flu: “Defining guidelines for close contact management. Identifying and quarantining individuals or groups in contact with cases may be recommended. OSDH and county health departments will recommend contact tracing and management on a case-by-case basis. Decisions will be based on the likelihood that the suspected cases is infected with a  novel influenza strain, the likelihood that the virus is or may become transmitted from person-to-person, and the feasibility of contact tracing. Quarantine may be lifted as soon as the exposed contact had remained without symptoms for a complete incubation period.”

Subsequent subsections address the issue of isolating “persons with suspected novel influenza virus,” like bird flu or swine flu, “at home, a hospital or alternative facility.”

One wonders what “alternative facility” or facilities are scheduled to be set up if Oklahoma is hit hard by the swine flu this fall.

Red Dirt Report went looking for answers.

Larry Weatherford, with OSDH, did return a call from Red Dirt Report and stated that much of the 2007 plans were in advance of concerns over the bird flu. However, little or no revisions have been made and

Forced quarantines and isolation would be “unusual,” Weatherford said, adding, “That’s a rarely used last resort.”

To compare, Weatherford said the state might intervene if someone with hepatitis insisted on continuing to work as a cook in a restaurant, possibly infecting others.

Discussing the fact that the World Health Organization (WHO) has the H1N1 (swine flu) outbreak set as a Level 6 pandemic, Weatherford reminded your Red Dirt Reporter that “it doesn’t refer to virulence, it refers to the widespread nature of the disease.” He added that it’s much more of a geographic designation than anything.”

When asked about any “alternative facilities” the state might have available, as noted in the ’07 document, Weatherford wasn’t sure if there was such a specific facility or facilities designated by the state. He did say that if hospitals were overwhelmed, they would look at gymnasiums or even buildings like the old Lucent Technologies building in west Oklahoma City where refugees from Hurricane Gustav camped out a year ago last week.

“There is a finite number of hospital beds,” Weatherford said. “We might set up a separate facility.”

And this, he said, would happen if, say, someone couldn’t go home because a family member had some health condition and they had nowhere to go. With a hotel being a poor option, Weatherford said an alternative facility set up by the state would be considered.

“The plan is designed to be as flexible as possible,” Weatherford said.

Continuing, several pages down in the state flu file, it states: “The OSDH and ODMHSAS will ensure that other occupational groups that might participate in the response to pandemic influenza (including police, firefighters and community workers) receive training materials that will help them anticipate behavioral reactions to public health measures such as movement restrictions (e.g. quarantine, isolation, closure of national or regional borders), especially if such actions are compounded by an economic crisis or abrupt loss of essential supplies and services.”

When Weatherford was asked about "partners and stakeholders" who would assist in enforcing mandatory isolation or quarantine orders, as noted several paragraphs above, he seemed unsure who they would be other than "local law enforcement" and "hospitals with patients."

More is mentioned in the document appendix regarding quarantines. It is here where it is noted that “Alternate care sites for quarantine may be necessary in certain situations such as persons who do not have a home suitable for this purpose or those who require quarantine while away from their home (e.g. during travel).

The document does make any forced quarantine during a pandemic to be more voluntary than anything.

And a call to Paul Sund, spokesman at Oklahoma Gov. Brad Henry’s office, was not returned by the time the story was scheduled to be published.

This article was posted: Friday, September 11, 2009 at 10:14 am

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