H1N1 Readiness: A Conversation with Dr. Reuben Varghese


The Washington Post reports that many cities and counties are unprepared for the onset of H1N1. In the Washington, DC, area, the Metropolitan Washington Council of Governments (COG) helps coordinate the responses of local governments in Maryland, Virginia, and the District of Columbia to issues of regional concern. We recently spoke with Dr. Reuben K. Varghese, public health officer of Arlington County, Virginia, and chairman of Metropolitan COG’s Health Officials Committee, about how his county and the region are preparing for H1N1.

Q: What did you learn from last spring’s H1N1 challenges?

A: H1N1 started in the spring and never left. The virus has been present in the US and our region ever since. We’ve continued to prepare [since the spring]. What we saw from H1N1 is that it may not be any more severe than the seasonal flu. But even seasonal flu can kill and send people to the hospital.

Health education is primary — wash your hands, cover your mouth, get a flu shot, stay home if you’re sick. We’re working on public-private partnerships, trying to get different businesses (such as industry, schools, health care providers, nursing homes, and hospitals) ready. We also want to make sure that hospitals and other facilities are ready for the surge that could occur. We want to make sure that people know when it’s appropriate for them to go to the hospital – “when should you call the doctor, when should you go to the emergency room?” We’re doing a lot of coordination, since we have three states and many more local jurisdictions coming together here.

Q: Are you using existing structures or creating new ones?

A: We’re trying not to create new structures but to make sure our existing structures are better integrated, strengthening existing relationships and building new linkages. A lot of what happens in emergency preparedness is about the people involved knowing their counterparts elsewhere and developing trust. We want to make sure people know each other and work through established processes. I’m continuing to try to further my relationships within the county, with health officers in northern Virginia, with health officers in Maryland and Virginia at the COG level. The outbreak of measles [this spring] across the National Capital Region was a prime opportunity to know what’s going on, share information, and make sure we all had one message when investigating and communicating about a communicable disease outbreak.

Q: What two or three things should state and local governments be thinking about?

A: There’s time to prepare even now. We need to encourage local and state officials to encourage the public to get vaccinated. There’s a tremendous cost benefit to the entire system because it will reduce the burden of having to respond after people get sick, and require fewer resources for the whole system. I would ask elected leaders and agency officials to think about their continuity of operations plans in case workers get sick and stay home. For public health to respond to a pandemic, your other government systems – police, fire, communications, human resources, etc. – also have to be up and running.

Q: If there were one or two things you could get funding for, what would they be?

A: First, trying to find additional nurses and nursing assistants who can help with vaccinations. Second, getting messages out through the media targeted to people in different sectors so we can get to people who don’t traditionally think about getting vaccinations. And not just by email, voicemail, or the computer – get to the churches, for instance, to get our message out. We’re working on translating our materials into different languages.

Q: Are certain communities harder to reach?

A: Getting to populations who don’t traditionally think about getting vaccinated is a priority.  What makes it so difficult now is that people have so many more concerns going on in their lives, how to get the activities of daily living done.  When people worry about their basic needs, they don’t always put health in that mix.  If you need to feed your family, getting vaccinated doesn’t rise to the top as a priority.  So the more that people have their basic needs met, the easier it is for them to focus on their health.

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