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

1. 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.
2. 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.
3. COLLECT specimens for testing and, after obtaining approval from SFDPH Communicable Disease Control, send specimens to SFDPH Public Health Laboratory per instructions below.
4. 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.
5. 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. 

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 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.

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 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.