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By Rose Hoban

Dozens of North Carolina hospitals have placed restrictions on who gets to visit patients this winter, as flu cases in the state are ramping up after a slow start.

And Health and Human Services Sec. Mandy Cohen predicts the flu season is going to get worse.

That’s what Cohen told lawmakers at the General Assembly today during their monthly legislative oversight committee meeting in Raleigh.

“What we want folks to notice is that the worst is yet to come,” she said, showing graphs of the numbers of reported cases in the state so far this season (see illustration).

North Carolina influenza surveillance summary: Week ending Jan 6, 2018. The red line denotes the trend lines for this year’s flu season, with an influenza type A the predominant strain. This type of flu is more likely to cause severe illness in the very young and those over 65 years old.

“The peak of when we see the flu season dominating is generally in the February timeframe, or it certainly was last year,” she said.

“We think it will be a little earlier this year, just looking at some of the data,” she said.

But Cohen told legislators that there is “still time for folks to get their flu shot before we see that big wave of flu cases.”

That wave could be challenging for some hospitals that are short-staffed. Some basics such as intravenous fluids, which are manufactured in Puerto Rico,have been in short supply since Hurricanes Irma and Maria hit the island last fall.

Not too late for flu shot, Cohen says

North Carolina is getting hit with widespread flu later than other states in the U.S. and in the Southeast, according to statistics from the Centers for Disease Control and Prevention. And it’s still not as widespread as in neighboring states.

Map courtesy: Centers for Disease Control and Prevention

Every year, infectious disease experts try to predict what strains of flu will be circulating during the winter, using information gained from the flu season in the Southern hemisphere, along with infectious disease reports collected by the World Health Organization. Then they make recommendations about what strains to include in the annual flu shot.

“We’re actually seeing a very good match this year in terms of the types of flu that we are seeing,” Cohen said. But she noted that the strain of flu that’s making people sickest is an influenza “A” strain, which tends to be more virulent.

“We’re seeing folks get sick and sicker with every incidence of getting the flu as opposed to last year, where the [vaccine] match wasn’t quite as good,” she told lawmakers.

She reminded lawmakers that even if the flu shot isn’t a perfect match, getting the immunization will make an infection less severe.

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“It’s the best way to prevent flu illnesses and complications. It prevents millions of illnesses every year and it can significantly reduce a child’s risk of dying from the flu,” she said.

North Carolina has had two pediatric deaths from the flu so far this season, along with 24 other deaths.

That seems like just a few deaths, but infectious disease specialists estimate that hundreds, if not thousands, of people die annually from side-effects of getting the flu, such as pneumonia.

“Even if you’re like, ‘Well, I’m pretty healthy if I get the flu, fine, I’ll be out of work for a few days,’ but no, it’s really a matter of who are your contacts,” Cohen said. “Are you bringing [flu] to those who may be immunocompromised around you, those who are elderly and those who are under the age of five?”

A DHHS public service video encouraging everyone to get flu shots.

Plenty of beds, not as many nurses

During the committee meeting, Rep. Greg Murphy (R), a physician who practices at Vidant Hospital in his hometown of Greenville, said that hospital systems are being stressed by this year’s flu season.

“This past weekend I had to turn away people right and left from other hospitals because we have the beds, but we don’t have the nurses to staff them,” he said.

According to Julie Henry, from the North Carolina Healthcare Association, which represents hospitals, there are about 4,000 nursing vacancies across the state, including registered nurses and licensed practical nurses, who require fewer years of training.

“I think everyone is looking for the same nurse,” said David Kalbacker from the NC Board of Nursing (Note: NC BON is a NC Health News sponsor). “That would be a bachelor’s-prepared nurse with three to five years. of experience in specific areas the client wants.”

Kalbacker said that his organization has never had so many licensees as it does currently. Nonetheless, when he went to the North Carolina Association of Health Care Recruitment’s annual meeting last year, he said three-quarters of the people there said they were having a hard time filling vacancies.

Erin Fraher, who studies health care staffing at the Sheps Center for Health Policy Research at UNC Chapel Hill, also said she’s been hearing about regional nursing shortages. She also said she’s gearing up to study the issue.

Her coworker Katie Gaul reported that in 2016, there were 101,570 registered nurses actively practicing in the state for a rate of 100 RNs per 10,000 population for the state as a whole. But she noted that 83 counties had fewer than 100 RNs per 10,000 people. So, while some counties where large hospitals are may show enough nurses, there might too few in counties surrounding them to fully staff a number of hospitals.

Gaul said the community college System and at least one hospital chain has been asking for more data on nursing supply.

County level data shows the number of nurses per capita looks good, but in parts of the state, hospitals continue to struggle to fill vacancies. Map courtesy: Sheps Center for Health Policy Research

Hurricane shortages complicate treatment

Even as sick people stack up in emergency rooms and doctors’ offices, health care organizations have been scrambling to find enough IV fluids to help treat sick patients.

One hospital standard, a sterile salt water solution known as saline and used to help administer everything from blood transfusions to antibiotics, has been in short supply since Hurricane Maria hit Puerto Rico in September.

Already, the U.S. Department of Justice had been investigating Baxter, one of the main manufacturers of saline and other IV fluids when the company’s factory was forced offline by power outages and logistical problems post-storm.

“The tight supply of saline products has been exacerbated by an increased demand for saline we’re seeing as a result of the worse-than-typical flu season,” wrote Food and Drug Administration head Scott Gottlieb in a statement Tuesday.

He noted that some facilities only have a few days’ worth of IV fluids on hand.

And in turn, those IV fluid shortages can exacerbate staffing shortages since it can take longer to give medications. That’s because nurses need to slowly “push” medications into an IV line by hand instead of the faster method of mixing them in a small saline bag and hanging it up to infuse into a patient.

Gottlieb said that he anticipates the situation will improve in the coming weeks and months. But in the meantime, the shortages will make patient care more challenging.

“We recognize that these challenges have created hardships and, in some cases, have had an impact on patients,” Gottlieb wrote. “We’re deeply concerned by this situation. Resolving it remains one of my highest priorities.”

This story has been updated with more information about nursing staffing.

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Rose Hoban

Rose Hoban is the founder and editor of NC Health News, as well as being the state government reporter. Hoban has been a registered nurse since 1992, but transitioned to journalism after earning degrees...