News Room

As flu cases pick up, hospital officials using math to help predict surges
September 12, 2009

Health department asking day cares to voluntarily report absences as health officials seek new surveillance tools uncover flu.

Written by Mary Ann Roser, Austin-American Statesman


In the waning days of April — the month swine flu hit the U.S. — the emergency room at Dell Children's Medical Center was so overrun that the staff set up cots in a covered parking garage to handle the load.

They were too late. Patient volumes fell, and the cots went back into storage. Too bad the staff couldn't predict the future.

But the self-titled numbers geeks at the Seton Family of Hospitals — the owner of Dell Children's — say they are close to developing a mathematical model that could help them predict patient surges from day to day. That algorithm is one of the new tools local health officials are using to better prepare for a challenging flu season that will feature the novel H1N1 virus and regular flu, both causing fever, body aches and coldlike symptoms.

As area schools report more flu after wrapping up a third week of classes, Dell Children's has been inundated with so many patients that Dr. Pat Crocker, chief of emergency medicine, said he is beefing up staffing: six additional doctor hours a day, an extra physician during peak hours starting Oct. 1 and a request for 14 traveling nurses before everyone else in the country tries to nab them first.

"Getting more staff on short notice takes a lot out of your resource pool, and doing that in a state with a nurse shortage and a doctor shortage means making people work extra shifts," Crocker said. "We don't like to make people do that unless it's something you can't plan for."

Busy ERs at Central Texas hospitals and facilities across the country — a signal of a tough flu season — have led to other changes in surveillance to give officials a heads-up on a spreading illness.

The Austin/Travis County Health and Human Services Department sent letters to 370 licensed day care centers — including all those in Travis County, according to Dr. Philip Huang, the department's medical director — asking them to voluntarily report absences twice a week.

Huang said he's working with the Department of State Health Services on the project, which started getting its first reports this week. "We're (also) definitely monitoring school absentee data," he said.

Like day cares, schools are gold mines of community health information.

Thousands of Central Texans have contracted swine flu, which remains similar to seasonal flu in severity and is causing mild or moderate illness in most people. Since April, 18 people in Travis County have been hospitalized, and two have died, according to Austin/Travis County health department spokeswoman Carole Barasch. Forty people in Texas out of 593 nationally had died by Aug. 30; most of those were younger people. Those older than 50 are thought to have some immunity.

The most recent flu status for Texas was bumped up a notch to "regional," meaning that there are increases in laboratory-confirmed flu and flu-like illnesses in at least two regions but in less than half of the state's 11 regions. The two regions that include far South Texas and Central Texas, which includes Travis, Williamson and Hays counties, reported increased flu activity the last week of August compared with the preceding week.

Universities have been hit hard, but classes have generally not been disrupted. Hundreds of students in the Austin school district — mainly in elementary and middle schools — have gotten the flu, but most recovered quickly, and schools are functioning normally, said Tracy Lunoff, coordinator of student health services.

In Round Rock, elementary school absentee rates were two to three times higher than normal, but attendance is better than average at the other levels, spokeswoman JoyLynn Occhiuzzi said. In Hays County, absenteeism at Lehman High School and Barton Middle School this week was twice the normal rate, spokeswoman Julie Jerome said, but like elsewhere, there were no plans to close a school.

"Kids are usually two weeks ahead" of the rest of a community when it comes to a potential outbreak, said Ryan Leslie, special assistant to the chief operating officer of Seton and one of its data gurus.

Central Texas' two largest hospital systems, Seton and St. David's, are collaborating with the Austin/Travis County health department by sharing information about ER volumes and admissions of flu patients to help beef up surveillance, hospital officials said.

The state health department also is trying new approaches. It has a $35,000 contract with University of Texas biologist Lauren Ancel Meyers to analyze data from hospitals and an estimated 130 Texas doctors and other health providers, said Doug McBride of the state health department.

The goal is "to see if there is a way to produce a tool in predicting ... more accurately health care needs, hospitalizations and deaths," McBride said.

Seton officials also have been in touch with Meyers about helping them perfect their data once various approvals have been given. Seton is testing several predictive models now, said Dr. Thomas Erlinger, Seton's director of research administration and infection control.

Like Seton, St. David's hospitals saw an increase in patients complaining of flu this week, mostly in children, but none required hospitalization, said Dr. Steve Berkowitz, chief medical officer for St. David's. Many had gastrointestinal symptoms, a common feature of swine flu that is not nearly as common with regular flu.

"We're trying to find a way to automate the process" of collecting data, he said.

Doctors can make educated guesses, but there are some things that "are hard to see when you're surrounded by patients," Leslie said. The algorithm can plug in variables such as day of the week, which has an impact on ER flow, and allergens, which can affect respiratory illnesses, Leslie and Erlinger said.

Based on sheer volume, officials at Dell Children's seemed to have every reason in April to set up cots.

On April 25, more than 70 patients came in complaining of flu, nearly a third of the total ER patients that day. By April 30, that number had swelled to 174 of 366 patients, nearly double the normal load, Crocker said.

Beyond helping with staffing, supplies and medications, advance warning can alert public health authorities of spikes in hospitalization and death rates so they can monitor whether the virus is changing in severity, a concern with the H1N1, Erlinger said.

What happened in April, Leslie said, "was a perfect dry run. ... We are now interpreting our data almost as fast as it is coming in."

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