San Francisco Medical Society Blog

SFDPH Health Advisory: Human Infections with Avian Influenza A: H7N9

Tue, 07 May 2013 11:31:06 GMT

May 1, 2013 (Revised from April 12, 2013)

The U.S. Centers for Disease Control & Prevention (CDC) has updated its interim guidance:

Antiviral Treatment: Due to the potential severity of illness associated with Avian Influenza A:H7N9 virus infection, CDC now recommends that all confirmed, probable, and suspect cases of Avian Influenza A:H7N9, including outpatients with uncomplicated illness, be treated with neuraminidase inhibitors as early as possible, without waiting for laboratory confirmation of influenza before initiating treatment.

Infection Control Guidance has been updated; Droplet precautions are no longer recommended but Standard, Contact and Airborne precautions should be implemented by health care personnel; suggestions are provided for clinics unable to fully implement Airborne Precautions.

Case Definitions: A definition for Suspect cases (Cases Under investigation) has been added, defining Suspect as patients with influenza-like illness (ILI1) with:

Recent contact (within ≤ 10 days of illness onset) with a confirmed or probable case of infection with Avian Influenza A:H7N9 virus; or
Recent travel (within ≤ 10 days of illness onset) to a country where human cases of Avian Influenza A:H7N9 virus have been recently detected or where Avian Influenza A:H7N9 viruses are known to be circulating in animals. (As of 4/29/13, those countries are China and Taiwan).

Actions Requested of Clinicians

IMPLEMENT Standard, Contact and Airborne Precautions2, including eye protection and respirators, for health care personnel caring for patients meeting criteria for a Suspect case of Avian influenza A:H7N9. Place a surgical mask on the patient to reduce spread of respiratory secretions and have the patient avoid public settings (e.g., public transportation). Aerosol-generating procedures should be performed only if they are medically necessary and cannot be postponed.
REPORT suspected Avian influenza A:H7N9 in patients who meet the criteria described in the case definition for case under investigation (CUI). Call the SFDPH Communicable Disease Control Unit at (415) 554-2830; after hours, weekends and holidays press “1” and “1” again to page the on call physician.
COLLECT specimens for testing and, after obtaining approval from SFDPH Communicable Disease Control, send specimens to SFDPH Public Health Laboratory per instructions below.
TREAT empirically with neuraminidase influenza antiviral medications (oral oseltamivir or inhaled zanamivir) as soon as possible, without waiting for laboratory confirmation in all patients who meet the case definition for case under investigation, including outpatients with uncomplicated illness.
CONSULT an infectious disease specialist and/or the CDC webpage3 for updated information

Click here to view the SFDPH health advisory on Avian Influenza A: H7N9.

For more information about health alerts, advisories, and updates from the San Francisco Department of Public Health, please visit http://www.sfcdcp.org/healthalerts.html.

Boston Declares Health Emergency Amid U.S. Flu Outbreak; Resources for Health Care Providers

Thu, 10 Jan 2013 11:40:55 GMT

The country is in the grip of three emerging flu or flulike epidemics: an early start to the annual flu season with an unusually aggressive virus, a surge in a new type of norovirus, and the worst whooping cough outbreak in 60 years. And these are all developing amid the normal winter highs for the many viruses that cause symptoms on the “colds and flu” spectrum.

Google’s national flu trend maps, which track flu-related searches, are almost solid red (for “intense activity”) and the Centers for Disease Control and Prevention’s weekly FluView maps, which track confirmed cases, are nearly solid brown (for “widespread activity”).

With flu cases in this city up tenfold from last year, the mayor of Boston declared a public health emergency on Wednesday as authorities around the United States scrambled to cope with a rising number of patients.

Health authorities say a virulent strain this year has caused the number of flu cases to surge earlier than usual. Hospitals around the country have scrambled to find additional space to treat the ill, and some have had to turn people away.

The U.S. Centers for Disease Control and Prevention (CDC) reported that the proportion of people visiting their doctors for flu-like illnesses has doubled in the past four weeks.

Encouraging vaccinations is one of the most effective steps in combating what looks to be a serious strain of the flu, said Dr. William Hanage, an associate professor of epidemiology at the Harvard School of Public Health.

The flu season typically picks up in December, builds to a peak in January or February and fades away by late March or early April.

Flu Information for Health Care Providers

San Francisco Department of Public Health Health Officer order regarding mandatory influenza vaccination or masking for health care professionals during flu season
Flu information from the SFDPH Communicable Disease Control and Prevention, including vaccination guide and health alerts
American Public Health Association's report on early start of flu season, December 4, 2012.
CDC Report of 2012-2013 Influenza Season Week 52 Ending December 29, 2012.

Justin Morgan, MD: SFMS December 2012 Member of the Month

Tue, 04 Dec 2012 12:37:07 GMT

Justin Morgan, MD is a family physician with the San Francisco Department of Public Health’s outpatient clinics.

Dr. Morgan is a resident of the Fillmore neighborhood, President of San Francisco’s African American Medical Association, a clinical instructor at UCSF and UC Davis, a member of the African American Democratic club. He is a community activist with over 10 years of experience providing primary care for low income families as well as working in the community on issues of health advocacy and youth mentorship. To view Dr. Morgan’s practice information, please click here.

I am a SFMS member because I believe the SFMS is one of the best ways that we, as physicians, can stay informed and engaged with each other and active as a community resource on issues of health, wellness and better living.

Which SFMS member resource is most helpful to you?

The most helpful resource in the medical society is the membership. Whether it is learning from other members about how to meet the professional and personal challenges that physicians often face, or hearing from others about career directions that I never thought possible, I get more out of being a physician by being part of the organized physician community.

My greatest achievement outside of practicing medicine was helping a young person, who delayed becoming a physician in order to work and support his family, return to school and successfully apply to and graduate from medical school. After years of hard work, presenting him with his own doctoral hood was more satisfying than the day I was presented with my own.

What is the most important thing you learned in medical school or residency?

I was once advised that, in order to achieve personal balance, I should always pursue my life, outside of medicine, with the same intensity that I’ve pursued my medical career. Since finishing residency, I’ve gone back to school to study art and foreign language, ran for public office, maintained pre-med school friendships and started new ones with people who know me from the local community or the interest group, not the clinic. This has helped me avoid professional burn out and make medicine that fun thing I do, when I’m not working hard at enjoying the rest of my life.

What are some of the biggest opportunities or challenges you see in health care within the next five years?

Moving this country from a “health cost system” to a “health care system” will either be the biggest challenge to us, or the biggest opportunity for us. It will be difficult, but we must decide if health care in this country is going to be an economic privilege or a human right and how best to make the path we choose a viable and sustainable reality for everyone.

I love practicing Family Medicine because I love that my clinics are in the neighborhoods and communities where I live and am also active in. Most of my patients come from the local area around the clinics, so I get to know them and their families, not just as patients, but as neighbors, too. It’s like being a small town doctor…in a big city!

What is your favorite restaurant in San Francisco?

I admit, on special occasions, I treat myself to a Bacon Double Del Cheese Burger at the Del Taco fast food restaurant on Market Street. I think it’s the special sauce that makes it taste so good!

If I wasn't a physician, I would likely ended up a comic book or animation artist. It’s the other thing I’m good at.

Mandatory Influenza Vaccination or Masking of Health Care Workers During Flu Season

Fri, 21 Sep 2012 15:02:41 GMT

The San Francisco Department of Health has issued a Health Officer order mandating that all hospitals, skilled nursing, and other long term care facilities in the City and County of San Francisco require their health care workers (HCWs) to receive an annual influenza vaccination or, if they decline, to wear a mask in patient care areas during this flu season.

Influenza infection accounts for 36,000 excess deaths in the U.S. each year; 90% of which are people over the age of 65. HCWs are both at risk for influenza and can transmit the virus to their patients. The goal is to increase influenza vaccination rates of HCWs, reduce employee absenteeism during the flu season, and reduce HCW to patient transmission of influenza.

The influenza season is defined as December 15 to March 31.

Click here for more information and a copy of the Health Officer order.

Laguna Honda Partners with Chinese American Coalition for Compassionate Care

Mon, 04 Jun 2012 11:29:37 GMT

Laguna Honda will announce a community partnership with the Chinese American Coalition for Compassionate Care (CACCC) at a press conference on June 8 at the hospital. CACCC is dedicated to the advancement of palliative medicine and end-of-life care in the Chinese American community.

Laguna Honda and CACCC will be sponsoring two weekend-long training sessions in July for palliative care volunteers from the San Francisco Chinese community. The partnership furthers Laguna Honda’s implementation of the Health Commission’s 2002 standards for Culturally and Linguistically Appropriate Services (CLAS) and the hospital’s strategic goal of community partnership.

To download a copy of the Physician Orders for Life-Sustaining Treatment (POLST) form, click here.

HealthShare Bay Area Founding Members to Form Health Information Exchange

Tue, 10 Apr 2012 15:25:11 GMT

Eighteen Bay Area health care organizations will be founding members of the region’s first community health information exchange (HIE) program, HealthShare Bay Area (HSBA).

The founding 18:

Alameda-Contra Costa Medical Association
Alameda County Community Health Center Network
Alameda County Medical Center
Brown & Toland Physicians
California Pacific Medical Center
Glide Health Services
Haight Ashbury-Walden House
Hill Physicians Medical Group
John Muir Health
John Muir Physician Network
Lyon-Martin Health Services
Mission Neighborhood Health Center
North East Medical Services
St. Anthony Medical Clinic
San Francisco Department of Public Health
San Francisco Medical Society
South of Market Health Center
Women’s Community Clinic

The HealthShare Bay Area HIE will provide a secure, safe, and interoperable method for exchanging patient health information among providers of care and patients in the San Francisco Bay Area.

In the coming weeks, the founding members will form a governing board for the HIE. The board will then contract with a vendor that will provide the technical infrastructure for the exchange. The chosen technology will operate according to robust data privacy and security standards.

The governing board will also be tasked with securing additional funding for HSBA. The HIE’s four-year, $11 million startup and operating cost will come primarily from the founding members’ participation fees. Additional federal and private grants will be sought to supplement expenses as HSBA develops. New members joining the exchange in the coming months will provide additional revenue.

HealthShare Bay Area began as a grass-roots community initiative. In August of 2009, the California eHealth Collaborative brought together various San Francisco parties interested in creating a HIE within the city. This meeting was precipitated in large part by the passing of the American Reinvestment and Recovery Act (ARRA), which allocated $20 billion for the deployment of health information technology. The ARRA also calls for medical organizations to participate in HIEs.

In March of 2010, a governing committee was formed under the auspices of the San Francisco Medical Society Community Service Foundation. A similar movement was also underway in the East Bay – the Alameda-Contra Costa Health Information Organization, fostered by the Alameda-Contra Costa Medical Association. That fall, the San Francisco and East Bay groups joined forces. In April of 2011, the effort officially became HealthShare Bay Area.

Flu, Rabies, Meningococcal... Prevent Any Sort of Debacle!

Wed, 14 Sep 2011 15:52:18 GMT

In partnership with the San Francisco Department of Public Health, San Francisco Immunization Coalition is hosting its annual Influenza and Infectious Disease Forum on September 28.

Wednesday, September 28, 2011 9:00 am to 12:00 pm

101 Grove Street, Room 300

Participants will learn about the new ways vaccine-preventable diseases are affecting our community and engage in an interactive discussion to identify sustainable solutions. CEU credits are available. Click here to download the registration flyer.

Prescription Drug Shortages Forcing Physicians and Pharmacists To Scramble

Mon, 22 Aug 2011 09:53:10 GMT

Sunday's San Francisco Chronicle reported record shortages of prescription drugs in the United States are forcing pharmacists and doctors to scramble to find medications for their patients, suitable alternatives, or to delay potentially lifesaving treatments. Federal recalls, production problems and corporate decisions to discontinue certain medications for financial reasons are cited as the chief causes of the dwindling drug supplies. In 2006, 70 drugs were in short supply. By the end of last year, the number had jumped to 211, according to the University of Utah Drug Information Service, which tracks prescription drug shortages. Some 190 drugs are currently hard to come by. More than 90 percent of U.S. hospitals polled by the American Hospital Association in June reported experiencing a drug shortage in the past six months, and nearly 45 percent said they had experienced at least 21 shortages during that time. [caption id="attachment_1223" align="alignleft" width="500" caption="Source: California Society of Health-System Pharmacists. * Reasons given by manufacturers."][/caption] Read the full article at http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2011/08/21/MNJ71KMGDU.DTL.

San Francisco Cigarette Ban: Safeway Lawsuit Dismissed

Mon, 18 Jul 2011 10:55:17 GMT

The city of San Francisco’s pioneering ban on tobacco sales by pharmacies has survived its latest challenge, a constitutional lawsuit by the Safeway grocery store chain. U.S. District Judge Claudia Wilken of Oakland dismissed a lawsuit in which Pleasanton-based Safeway Inc. claimed the measure was an unconstitutional restriction on its right to conduct a lawful business. Click here to read the full story. SFMS is a long-time advocate of anti-tobacco legislation and San Francisco’s law banning the sale of tobacco in pharmacies. Most recently, the SFMS has supported the San Francisco Department of Public Health against the Safeway suit with an amicus brief.

SFMS Endorses Proposal to Regulate Electronic Cigarettes

Fri, 15 Jul 2011 13:52:39 GMT

The SFMS Board voted on Monday to endorse the San Francisco Department of Public Health's (SFDPH) proposal to regulate electronic cigarettes. SFMS supports SFDPH's recommendation to:

Prohibit the use of electronic cigarettes (and other nicotine delivery devices not approved by the FDA as smoking cessation aids) in those areas where smoking is prohibited by the San Francisco Health Code.
Require a tobacco permit for the sale or furnishing of electronic cigarettes and other nicotine delivery devices not approved by the FDA as smoking cessation aids.

Click here to view the full proposal, Resolution No. 7-11 submitted to the Health Commission of the City and County of San Francisco. Click here to learn more about FDA's plan to regulate e-cigarettes as tobacco products.

Healthy San Francisco Expands Care

Wed, 01 Jun 2011 10:37:51 GMT

The city's 4-year-old safety net initiative survived a legal challenge to become an urban test bed for improving care coordination under health reform. Healthy San Francisco, managed by the San Francisco Department of Public Health, is a program designed to make health care services accessible and affordable to uninsured San Francisco residents.

It’s not insurance, but a reinvention of the San Francisco health care safety net, that enables and encourages residents to access primary and preventive care. It provides a Medical Home and primary physician to each program participant, allowing a greater focus on preventive care, as well as specialty care, urgent and emergency care, laboratory, inpatient hospitalization, radiology, and pharmaceuticals. More than 80,000 residents have signed up for the program since July 2007.

The concept is having some success. Better coordination has reduced hospital admissions and duplicate care. Healthy San Francisco has encouraged the working poor and people who recently lost private health insurance to seek health care. The city reports that about two-thirds of the city's uninsured are in the program. Healthy San Francisco offers a glimpse at how the national health system reform law’s Medicaid expansion might stress larger cities’ health care safety nets. The program has allowed early access to care for many people who will qualify for Medicaid under the health reform law's eligibility expansion starting in 2014. About 60% of program enrollees are expected to qualify for Medicaid or subsidized private insurance in 2014.

For more information about Healthy San Francisco and how this can be a model for patient care provision, visit Healthy San Francisco’s website or click here for AMA’s extensive report on this innovative care coordination.

Source: http://www.ama-assn.org/amednews/2011/05/30/gvsa0530.htm

Radiation Health Advisory from SF Health Department

Thu, 17 Mar 2011 13:38:01 GMT

Japan's Radiation Situation

Currently there is no danger to San Francisco residents from Japan's nuclear emergency. The San Francisco Department of Public Health does not recommend taking potassium iodide. Potassium iodide can have serious side effects and should not be taken unless recommended. We are monitoring the situation closely and will alert the public if recommendations change.

For more information, please call the California Department of Public Health hotline number at (916) 341-3947.

CDPH Radiation FAQs: http://www.cdph.ca.gov/Pages/RadiationFAQS2011.aspx
CDC Health Effects and Treatment: http://www.bt.cdc.gov/radiation/healtheffects.asp
http://www.sfdph.org/dph/comupg/aboutdph/newsMedia/emergency_notice.asp