To stop the flu, you need to stop germs. To stop germs, you need to wash your hands.
And to learn how to wash your hands, you need to talk to Marty Cooney.
Cooney performs his ablutions several hundred times a day. As the manager of infection prevention at Rex Hospital, he provides demonstrations to hospital staff on the art of proper hand-washing and applying sanitizer.
As part of his demo, Cooney uses invisible Glo Germ powder that mimics the unseen travel pathways of bacteria and viruses. Under ultra-violet light, hospital workers suddenly see the luminous powder smeared on their faces and all over their belongings. Then they get it: They are unwitting accomplices in spreading the flu.
“They’ll have it on their drinks, on their pen, on their books,” Cooney said. “Or sometimes on their mouth, where you get an itch.”
Cooney is an example of measures hospitals locally and nationwide are taking to prevent the spread of influenza in what has been, by some measures, the worst flu epidemic in a decade. The illness has caused 31 deaths in North Carolina since October, but it’s not expected to approach the 107 deaths in the 2009-2010 flu season, which was exacerbated by the H1N1 global pandemic.
Hospital emergency rooms are the proverbial canary in the coal mine, registering flu outbreaks long before state agencies and private businesses. The cities of Boston and New York recently declared public health emergencies, but in the Triangle and much of the nation the influenza outbreak has not been severe enough to trigger contingency plans that would require canceling meetings and sending non-essential workers home.
In the WakeMed and Duke University health systems, hospitals recently implemented visitation restrictions to keep minors away from patient areas and limit visits to two adults per patient room. Patients and visitors in waiting areas who have sniffles or coughs are strongly encouraged to wear face masks.
“Our decision was based on our emergency room volumes,” said Dominique Godfrey-Johnson, WakeMed’s public health epidemiologist. “These are things we put in place not for our benefit but to protect the patients.”
On Friday, WakeMed stepped up its defenses and announced a mandatory flu vaccination program for all 9,300 employees and volunteers. That policy was previously adopted by UNC Health Care and Rex Healthcare, whose 5,600 employees and volunteers received shots by Dec. 1.
Even though the flu outbreak peaked in late December and is now subsiding, these health systems plan to keep the restrictions in place through February or longer. Because the flu season typically peaks in January or February, WakeMed officials say they are prepared for the possibility of a rare, second wave of flu that could spike again next month.
Cameron Wolfe, an infectious disease specialist with Duke University Medical Center, said that even if the outbreak has flatlined, influenza remains at elevated levels.
WakeMed has been particularly hard hit by the outbreak, which surprised health officials not only because of its intensity but because it arrived two months ahead of schedule. The health system’s six emergency rooms in Wake County have logged more than 1,400 cases of influenza or flu-like symptoms, compared to just 59 for the same time last year.
State and federal officials measure flu incidence by cases logged at “sentinel” sites and lab tested for the influenza virus. One of the participants in the N.C. Influenza Sentinel Surveillance Program is SAS, the Cary software company that employs 4,925 in Cary, including 58 at its on-site health care center.
The sentinels take patient throat swabs and send them to the N.C. Department of Health and Human Services, which forwards the data to the federal Centers for Disease Control and Prevention.
SAS offers a snapshot of how the flu outbreak is playing out across the Triangle.
At the peak of the outbreak in late December, SAS logged a 3.7 percent incidence rate on account of 19 SAS employees who visited the company clinic with the flu or flu-like symptoms, such as fever or a hacking cough. In mid-January the incidence rate had dropped, but only marginally, to 3.5 percent, reflecting 18 employees with flu or its symptoms.
While such statistics don’t constitute an emergency, they do indicate an epidemic.
Last January, during SAS’s single worst flu week of 2012, the influenza incidence rate at the company was just 0.6 percent. That was three people with flu symptoms.
“It was practically non-existent last year, to be honest,” said Gale Adcock, the chief health officer at SAS. “It’s certainly worse this year. People are seeing colleagues sick on their hall, people sick in church, kids sick at school.”