The BlackBerrys started buzzing with emergency alerts. The U.S. Centers for Disease Control and Prevention told all public health officers to join a conference call on the rapidly spreading swine flu.
"Uh, oh," Dr. Marty Fenstersheib, Santa Clara County's health officer, said to his three deputies sitting across the table. "This may be worse than we thought."
In the weeks that followed, local public health officials swung into action, launching their new pandemic plan, the one designed to protect county residents during a major health crisis. Now, with the virus still spreading but never evolving into the global killer health officials first feared, they are catching their breath and looking back on the real-life test to ask: Did it work?
The answer: For the most part, yes. Schools were closed, fears assuaged, common-sense health tips dispensed and officials identified 24 people as of Friday who have, or likely have, swine flu. But they are also considering the shortcomings: Antiviral medications were hard to find, critical Web sites crashed, labs were so overwhelmed that hundreds of samples still remain untested. The lessons point to how the system must be strengthened before the next crisis, which could come as soon as this fall if a deadlier version of swine flu returns.
'Patient zero'
As Fenstersheib began activating his emergency plan April 24, a 16-year-old girl from Branham High School in San
By Tuesday, she was "patient zero," the first known case of swine flu in the county. And that night, county health officials shut down Branham for a week. Officials thought closing schools would limit the spread of the virus; ultimately, more than 700 schools across the nation would close.
While students stayed away, a problem emerged at patient zero's house. The antiviral Tamiflu, which would have eased the girl's symptoms and slowed the reproduction of the virus, proved elusive. The girl's parents and the doctor's office called several pharmacies before her father drove to East San Jose to pick up enough doses for the entire family.
Despite the county's own patient zero having trouble finding medication, Fenstersheib insisted that the people who needed it the most got it. The county acquired its share of California's stockpile five days after the CDC's alarm, and Fenstersheib said local hospitals and large clinics — where the sickest people would congregate — were well-stocked. He said the run on Tamiflu came mostly from people worried about getting swine flu, not those who had it — and he didn't want people needlessly depleting the limited drug supply.
Debra Bede of San Jose saw the decisions another way. "My daughter suffered needlessly," said Bede, who waited four days for a pharmacy to fill a Tamiflu prescription after a doctor told her 19-year-old she almost certainly had swine flu.
'Lack of supplies'
The state Department of Public Health said periodic supply breakdowns caused shortages not only of antiviral drugs, but also surgical masks, N95 respirators and chemicals and swabs needed for testing. "That has been a real surprise to everyone," said Dr. Bonnie Sorenson, the department's chief deputy director. "We have the energy and the knowledge, but we've been held back by the lack of supplies."
Sometimes, even the knowledge wasn't widely shared in the health care system. On Day One of the crisis, Zoey North of San Jose couldn't get her husband with severe flu symptoms tested after returning from a Mexican vacation. "Do you know anything about swine flu?'' North said she asked the Kaiser Permanente triage employee who answered the hot line. "She said, 'Yes, I just had it last week.' ''
North winced.
Rumors spread
Officials worked hard to get vital information out. Fenstersheib regularly stood before a phalanx of cameras, giving out the latest on new cases and school closures. But the day after Branham closed, as parents went online looking for more information, the county health Web site went dark for about 24 hours. Instead, students went to their Facebook and MySpace pages and spread false rumors about who was infected and which schools were closing next.
Even the county health department letter, which was posted on the high school's Web site, didn't answer some key questions. The letter highlighted the closing, but didn't specify that kids weren't supposed to congregate so they wouldn't spread any viruses among each other.
"The school said that's not our responsibility. They just went by the official notice: We'll see you in a week," said Branham parent Erik Levine. "You have families and students doing different things. Some are not doing outside activities. But others were going to movies and parks."
Rhonda Farber, superintendent of the Campbell Union High School District, did not return repeated phone calls from the Mercury News to discuss the problem. Other schools, like Ruskin Elementary in San Jose and Daves Avenue Elementary in Monte Sereno, kept families better informed, with daily updates.
Even state schools Superintendent Jack O'Connell had a hard time assessing the extent of the crisis: To his chagrin, he discovered there is no statewide tracking system detailing how many schools in the state were closed. Instead, his staff frequently had to call all 58 county education offices to get updated counts. "And even some of them didn't know," he said.
Joy Alexiou, who led the health department's communication efforts during the crisis, says the county needs to make better use of Web-based technology such as RSS feeds and Twitter. The department also has a project under way with Stanford University and Google that will allow its Web site to have virtually unlimited bandwidth.
Testing delays
As the number of people with fever, body aches and bad coughs filed into emergency rooms, Santa Clara County soon found it didn't have enough lab equipment to process the burgeoning number of samples. The delay often meant that people weren't getting their Tamiflu during the critical first 48 hours after symptoms appeared, when the drug is most effective. The delay also meant that officials couldn't quickly identify sick people and keep them out of school while still infectious.
So Fenstersheib's staff bought a second LightCycler machine to help process the tests. Still, as of Friday roughly 800 samples remained untested.
Health funding
The testing delays exposed a deeper problem — the lack of funding for public health.
In recent years, public health budgets and staffs have been trimmed. And about half of the baby boomers who went into public health decades ago are expected to soon retire, said Dr. Marc Schenker, a public health professor at the University of California-Davis School of Medicine.
"We chronically underfund our public health institutions," Schenker said. "Then suddenly something like this happens and everyone wants instant, effective lab testing."
Arthur Caplan, a bioethicist at the University of Pennsylvania, applauded the public health response overall but said the breakdown in getting medication quickly and the occasional communication failures underscore the need for better coordination among those executing the multitude of pandemic plans nationwide.
"They need to be in sync," he said. "And unfortunately the CDC doesn't have an ability to yank everyone on the same page."
No one is glad swine flu came, but Santa Clara County's Alexiou said it did let the local health department put its pandemic plan to the test: "The fact that it was a mild flu will give us time to make sure everything we want — well, most things that we want — are in place next time."
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