American Indians at higher risk of H1N1 death, designated a priority group

A letter issued by Centers for Disease Control and Prevention director Thomas Frieden M.D. has advised the states that American Indians and Alaska Natives may be more vulnerable to severe illness from H1N1 influenza and should receive vaccine on a priority basis.

Frieden writes that indigenous populations from Australia, Canada, and New Zealand have a three to eight times higher rate of H1N1-related hospitalization and death, and that two states in particular, Arizona and New Mexico, observed a disproportionate number of H1N1 deaths in American Indians.

His letter urges state health officers to redouble their efforts with minority providers to increase H1N1 vaccinations among underserved populations.

A CDC report issued Dec. 11 indicates from April 15 to November 13, American Indians including Alaska Natives in 12 states died from H1N1 at a rate four times higher than other races or ethnicities.

The American Indian H1N1-related death rate was 3.7 per 100,000 compared with 0.9 per 100,000 for all other racial/ethnic populations. It said reasons for the disparity are unknown, but might include a high prevalence of chronic health conditions such as diabetes and asthma, and delayed access to health care. Many of the deaths occurred before a vaccine was available.

“We’ve been worried from the very beginning,” said Indian Health Service epidemiologist and report co-author John Redd M.D. “We knew from previous outbreaks that there was severe disease happening in AI/AN and other indigenous populations.”

Redd noted the report’s recommendation that there be an expansion of efforts to promote vaccination in American Indian populations, and said the IHS has an excellent vaccine delivery system.

The IHS suffered delays in vaccine distribution to the same degree the rest of the country did, and while current distribution varies state by state, “We know it’s widely available now, and we’re asking people to contact their health facilities and get vaccinated.”

Individuals can be vaccinated against both the seasonal flu and H1N1 influenza vaccine at the same time, and should ask their clinic for the pneumonia vaccine if they haven’t received that.

The report is recommending stronger efforts to increase awareness among American Indians and their health-care providers of the potential severity of influenza, and the current recommendations regarding timely use of antiviral medications. That is currently a problem for patients with health care providers unfamiliar with the report or IHS policies.

A large urban IHS-funded medical clinic told a patient stricken with the flu on Dec. 17 that they were not treating patients with antivirals unless they were in the hospital. The clinic said they were following the policy of the CDC but, “That’s not consistent with our policy,” Redd said.

While clinicians have latitude with their patients, the IHS policy is that antivirals are appropriate for people in risk groups both as outpatients and as inpatients, he said.

In addition to American Indians and Alaska Natives, those at highest risk of H1N1 complications are pregnant women and those with chronic conditions such as diabetes, heart disease, asthma or other conditions that reduce immunity to influenza. Other groups at higher risk of infection or who can spread the virus to vulnerable populations are health care workers, people between the ages of 6 months and 24 years and caregivers of children ages 6 months and younger.

Influenza is widespread in all 50 states, and 99 percent of it is the H1N1 strain. Nearly all cases respond well to the antiviral drugs oseltamivir and zanamivir if treated within the first 72 hours after symptoms appear.

Naturopathic medical advice for staying well this flu season

By Terri Hansen
Environment, Science & Health Writer
As seen in Indian Country Today

Portland, Ore.—When naturopathic physician Dr. Orna Izakson looks at a plant she sees more than its stem, leaves or vibrant flower – she sees medicine. And naturally, she takes a natural approach to flu prevention and hastening a healthy recovery.

“Our bodies are trying to bring us toward health,” she says. “The responses we experience to outside stressors are our body’s intelligent response to that stressor. A fever is an intelligent response: It makes the body more responsive to invaders… and it makes us feel lousy so we slow down and go to bed so that our bodies can heal.”

So what can you do to stay well this flu season? “Keep things moving,” says Dr. O, as her patients call her. That means drinking clear fluids — especially water — and eating foods that are close to nature. You can get most of the pieces you need in your diet for good health from colorful vegetables, including fiber.

Avoid simple sugars they best as you can; they stun the immune system. “Each handful of berries you give your children is one less Twinkie, it’s a positive step.”

Cigarette smoking depletes vitamins and decreases natural immunity. “You need to cut back, smoke less and what you do smoke should be natural, or if packaged smoke American Spirits,” Dr. O says. “Make up for the extra cost by smoking less.”

Vitamin D, produced naturally in the skin by sun exposure, is critical to your immune system. Deficiencies are epidemic and darker-skinned people are more likely to have low levels. Depending on her patient’s lab assessments of their blood levels, she generally recommends 2,000 to 4,000 iu daily of D-3.

Probiotics support healthy gut bacteria, a barrier between you and the outside world. One 2009 study found regular use of probiotics reduced children’s cold and flu symptoms. Another found probiotics helped elders get more immunity from flu vaccines. Buy probiotics as supplements – acidophilus is one, and find them in traditionally fermented foods such as yogurt, sauerkraut, kimchee and uncooked miso.

Herbal steams are an old and effective tradition for any respiratory infection: Mix herbs with boiling water in a bowl and cover for a minute with a towel. Drape the towel over your head and the bowl, close your eyes and breathe the steam through nose and mouth into your nasal passages, throat and lungs to loosen mucous, strengthens mucus membranes, and disinfects your passages. Repeat as needed.

“You can use thyme, pine needles, cedars, eucalyptus, and chaparral. Orange peels can be effective too, but wash them well before using,” Dr. O says. “Talk to the Elders, they often know what’s best to use in your location. It could be herbs from the place your grandparents called home, or you may have a grandma in your head; listen to whose voice is louder.”

Lomatium and osha root are best taken as tea, tincture or by chewing on the root directly. “When you take it internally, you’re taking in the volatile oils. They want to volatize, spread out. They go into the bloodstream, their aromatics bubble out into and through your lungs and mucus, disinfecting.” Think of the flu as leaving junk stuck in your lungs, a perfect spot for breeding bacteria. Herbs move it out, disinfecting from underneath.

Garlic helps to fight many bugs that can make you sick, making it one of Dr. O’s favorites. Raw is best if your stomach tolerates it. Add a chopped clove or two, if you can, to any hot or cold food.
If you get sick in spite of these positive steps call your medical provider.

Home remedies Dr. O suggests for her patients include mustard plasters; to make your own grind yellow (or any) mustard seed and mix with water. Place a brown paper bag on your chest as a barrier, then smooth the mustard plaster on top. Use the plaster two to three times a day. How long you keep it on depends on your comfort level, but check frequently; if the skin starts turning red it’s time to take it off.

The next treatment, like the mustard plaster, moves blood and helps immune cells get to where they’re needed most. Wet a pair of cotton socks with cold water; wring them out thoroughly. Put on well-warmed feet, cover with a pair of dry wool socks and get into a warm bed for the night. You can also do this with a cotton t-shirt and wool sweater.

Bottom line, Dr. O says, is it’s the simplest things that help the most: Eat simply. Exercise moderately. Get plenty of rest. Drink water. Cover your cough. Wash your hands. Get outside and breathe clean air. And find some way to cultivate joy in your life every day. “This is traditional medicine, the best memory of the traditional medicine. It’s practical, it empowers people.”

2009-H1N1 (swine) flu vaccine on its way to IHS clinics, ETA October 7

By Terri Hansen

Environment, Science & Health Reporter

The vaccine for the 2009 H1N1 influenza A (swine flu) virus makes it arrival at Indian Health Service clinics and facilities October 7. The seasonal flu vaccine is at the clinics now.

“We want people to get their seasonal vaccination as quickly as they can, and once the H1N1 vaccine arrives, get that as quickly as they can,” said IHS epidemiologist John Redd M.D. Those unable to make separate appointments can get both vaccines at the same time, he said.

Testing of vaccines for H1N1 shows they work with a single dose and quickly take effect.

Influenza is increasing in all 50 states, and 98 percent of it is the H1N1 strain. Most cases are occurring in children and young adults, Dr. Anne Schuchat of the Centers for Disease Control and Prevention said at a briefing. The viruses remain similar to those chosen for the 2009 H1N1 vaccine, and nearly all cases respond well to the antiviral drugs oseltamivir and zanamivir.

Clinic patients should not delay in calling their clinic to learn what the vaccination plans are, said Redd. Many clinics plan mass vaccination days.

Last month President Obama’s science advisory council released a report that said Native American populations are considered at elevated risk of severe outcomes from 2009 H1N1 infection due to their populations being “historically at high risk for severe respiratory infections,” and, “A cluster of severe H1N1 disease among First Nation people in remote Manitoba, Canada suggests these groups may be at high risk. Cases of H1N1 virus infection in these clusters have had rapidly progressive, diffuse, lower airway disease … resulting in development of acute respiratory distress syndrome and prolonged ICU admission.”

“We don’t think that American Indian and Alaska Native people strictly by virtue of being AI/AN are individually at higher risk for H1N1 disease,” said Redd. “But risk factors such as diabetes and obesity are known to be more common in American Indians and Alaska Natives, so the population may be at higher risk because of the risk factors.”

The CDC says pregnant women, health care workers, people 6 months to 24 years of age, those who care for infants and those with chronic health conditions are priorities for the H1N1 vaccination.

The IHS has a proactive approach to pneumonia prevention, a severe respiratory infection that can be a serious and sometimes life threatening complication of influenza. “We take pneumonia in itself and as a complication of flu very seriously,” Redd said. “We definitely want to stay on top of that. In 2008 we vaccinated 82 percent of the American Indian and Alaska Native population against pneumonia.” He said the IHS offers the pneumococcal vaccine, and encourages those who haven’t received the vaccination to ask for that vaccination, too.

He said IHS efforts regarding H1N1 have been vigorous. “We started the first weekend of the outbreak,” he said. “We’ve issued guidance involving use of the Strategic National Stockpile. We’ve spent a lot of time communicating with states to consider those tribal populations within their borders. We’ve done a lot of outreach to providers including community health representatives and public health nurses on getting the system ready to receive the vaccine.”

The SNS is a large stockpile of medicines and supplies designed to support public health agencies during a public health emergency. It is deployed, according to guidance issued by the federal government, as a joint effort among state, local, territorial, tribal and federal officials if the health of a community is threatened.

As far as the antiviral medications, those intended for the general population are distributed through the SNS by the states, said Redd. “In the Arizona outbreaks, we received the antivirals we needed from the state.” The IHS has some internal distribution for their health professionals if they fall ill.

Redd said a big goal of the IHS is what they call mitigation – minimizing the impact of sick patients who might overwhelm a health facility. “A small hospital could deal pretty well with taking two intensive care patients for 10 days, whereas it might be very difficult for them to take 20 ICU patients in one day,” he said. “So one of our goals is to minimize spread and slow the flu down.

“The second portion in all this is every clinic having a local flu plan. That plan includes contingency planning – if the hospital intensive care unit or the local capacity is overwhelmed, in a worst-case scenario, we’d continue to see people as outpatients.

“We’ve got all these issues very much in mind.”

Native Americans at higher risk from H1N1 swine flu, report warns

President Obama’s advisory council led by the nations’ leading scientists and engineers released a report assessing preparations for H1N1 Influenza A. The report outlined steps to implement nationwide to curtail a serious H1N1 outbreak.

It said that while the precise impact of the resurgence of H1N1 infection is impossible to predict, a plausible scenario is that it could produce infection in 30 to 50 percent of the U.S. population this fall and winter.

And it said that certain populations including Native American groups are considered high risk, with elevated risks of severe outcomes.

The report said it is unlikely that the 2009-H1N1 pandemic will reach the same deadly proportions as happened in the 1918-1920 Spanish flu, also an H1N1 swine flu, but that the outbreak of 2009-H1N1 will be more dangerous than the 1976 swine flu outbreak.

The seriousness of H1N1 is not due to it’s severity but rather the fact that people have no immunity to the virus. The report indicates the possibility that overwhelming numbers of people could become infected, and that mortality could reach 30,000 to 90,000.

Dr. James Cheek, director of the Indian Health Service Division of Epidemiology and Disease Prevention said the IHS is doing much the same as are the Centers for Disease Control and Prevention, like identifying which people are at risk.

"We’ve been in the field the last month and a half, spending a lot of time with the over 200 hospitalized cases among Native Americans in Arizona," Cheek said. "They’re confirmed respiratory disease cases though not 100 percent confirmed H1N1 cases. We’re testing the blood of those who have recovered to see if it was H1N1. " He said the IHS hasn't received additional funding to fight H1N1.

Federal health officials recently announced $350 million in national grants to fight H1N1, but that money is going to states and hospitals, not to the federally recognized tribes, prompting the National Indian Health Board to cite this policy as making reservation communities increasingly vulnerable to epidemics.

An internal document produced by the CDC says a disadvantage of the Public Health Emergency Response grant is that it doesn’t allow enough time for local and tribal concurrence, but instead uses alternative strong language that asks that most or a significant amount of funding should go to local and tribal efforts.

This grant is a little different in that by using the states as a conduit the money is available very fast for communities to use, CDC spokesman Von Roebuck said. “We’re trying to work within the system, and we’re definitely running against the clock.”

Roebuck said the CDC has asked the state health departments to reach out to all local and tribal communities to provide them information about how this funding could be used, and asks that tribal governments provide the states information as to how they could use that funding and why they deserve the highest priority.

“As we learn more about the virus we’ll continue to reach out based on the science into where we feel that it is going to get the most information out to populations,” Roebuck said. “Protecting as many folks and as many locations is definitely our goal.”

Cheek said the IHS as a great record of providing vaccinations, and that their vaccination machine "is geared up to deliver the new H1N1 vaccine to all our populations the minute we get them."

Detailed guide to caring for flu stricken family without getting sick

A recent survey in a medical journal found that 76 percent of Americans worry about becoming ill if they have to stay home and take care of their sick during a severe flu pandemic.

Pandemic Flu Home Care: A Detailed Guide for Caring for the Ill at Home is a practical resource manual by health care professionals to caring for the ill at home in a public health emergency or pandemic. It’s free to download at http://www.pandemichomecare.com/.

The authors took on the project after citizens at local and regional pandemic planning meetings – including one with tribal representatives from the New Mexico area – asked for information about how to take care of themselves and their families during a severe pandemic.

In their review of existing resources, they found that most materials covered primarily mild symptom management and recommended that people contact physicians and hospitals when symptoms were more severe. But their historical review and current analyses of health care systems determined that people may have to manage severe symptoms and death at home if a virulent influenza outbreak is widespread.

“Existing resources lacked instructions on infection prevention, setting up a sick room, how to monitor a sick child or adult by taking a temperature with a thermometer, preventing dehydration, keeping the person comfortable and knowing when to contact a health care provider if one is available,” said co-author Sandra L. Schwanberg, Ph.D., R.N.

The authors decided that the more detailed information people had the better their coping would be in a changing situation. They also wanted to cover the key public health information people were likely to see in the news; infectious disease transmission, severity, reasons for vaccination, isolation of the sick and possible quarantine of those exposed to the disease.

“We took the same care in writing the book for the public that we would take in preparing information for a professional audience,” Schwanberg said. “We felt that if people had thorough information, they could cope effectively with a difficult situation and make good decisions for themselves and their families.”

The book took Schwanberg and co-authors Maurine Renville, L.I.S.W., M.Ed, and Lesley J. Mortimer, M.S.N., M.P.H., F.N.P., nine months to write, review and edit. Lay people and health care professionals reviewed the work throughout the process. There was a charge for the book until April 2009, when the U.S. declared a public health emergency.

Their goal now is to locate fiscal sponsors to increase the book’s distribution, provide more illustrations and include coloring books for kids, DVDs and games. They’ve translated the entire book into Spanish, and illustrations are complete for one chapter.

It’s distribution includes acute care facilities, public health centers, churches, businesses, tribal nations and other groups. It is also a resource for doctors, nurses, paramedics and community health workers.

“We wanted people to have information that hopefully they will never have the need to use,” Schwanberg said.

If you have a problem downloading the eBook contact info@pandemichomecare.com for assistance, or ask that they send you the pdf file to copy and print.

CDC Advisors Make Recommendations for Use of Vaccine Against Novel H1N1

The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices met today to make recommendations for use of vaccine against novel influenza A (H1N1).

The committee met to develop recommendations on who should receive vaccine against novel influenza A (H1N1) when it becomes available, and to determine which groups of the population should be prioritized if the vaccine is initially available in extremely limited quantities.

The committee recommended the vaccination efforts focus on five key populations. Vaccination efforts are designed to help reduce the impact and spread of novel H1N1. The key populations include those who are at higher risk of disease or complications, those who are likely to come in contact with novel H1N1, and those who could infect young infants.

When vaccine is first available, the committee recommended that programs and providers try to vaccinate: pregnant women, people who live with or care for children younger than 6 months of age, health care and emergency services personnel, persons between the ages of 6 months hrough 24 years of age, and people from ages 25 through 64 years who are at higher risk for novel H1N1 because of chronic health disorders or compromised immune systems.

The groups listed above total approximately 159 million people in the United States. The committee does not expect that there will be a shortage of novel H1N1 vaccine, but availability and demand can be unpredictable. There is some possibility that initially the vaccine will be available in limited quantities. In this setting, the committee recommended that the following groups receive the vaccine before others: pregnant women, people who live with or care for children younger than 6 months of age, health care and emergency services personnel with direct patient contact, children 6 months through 4 years of age, and children 5 through 18 years of age who have chronic medical conditions.

The committee recognized the need to assess supply and demand issues at the local level. The committee further recommended that once the demand for vaccine for these prioritized groups has been met at the local level, programs and providers should begin vaccinating everyone from ages 25 through 64 years. Current studies indicate the risk for infection among persons age 65 or older is less than the risk for younger age groups. Therefore, as vaccine supply and demand for vaccine among younger age groups is being met, programs and providers should offer vaccination to people over the age of 65.

The committee also stressed that people over the age of 65 receive the seasonal vaccine as soon as it is available. Even if novel H1N1 vaccine is initially only available in limited quantities, supply and availability will continue, so the committee stressed that programs and providers continue to vaccinate unimmunized patients and not keep vaccine in reserve for later administration of the second dose.

The novel H1N1 vaccine is not intended to replace the seasonal flu vaccine. It is intended to be used alongside seasonal flu vaccine to protect people. Seasonal flu and novel H1N1 vaccines may be administered on the same day.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

White House preparing Nation for upcoming flu season

Secretary of Health and Human Services Kathleen Sebelius, Secretary of Homeland Security Janet Napolitano, and Secretary of Education Arne Duncan leading the efforts to prepare the Nation for coming flu season.

Fellow Americans: This spring we were confronted with an outbreak of a troubling flu virus called 2009-H1N1. As the fall flu season approaches, it is critical that we reinvigorate our preparedness efforts across the country in order to mitigate the effects of this virus on our communities.

Today, we are holding an H1N1 Influenza Preparedness Summit in conjunction with the White House to discuss our Nation's preparedness. We are working together to monitor the spread of 2009-H1N1 and to prepare to initiate a voluntary fall vaccination program against the 2009-H1N1 flu virus, assuming we have a safe vaccine and do not see changes in the virus that would render the vaccine ineffective.

But the most critical steps to mitigating the effects of 2009-H1N1 won't take place in Washington — they will take place in your homes, schools and community businesses.

Taking precautions for this fall's flu season is a responsibility we all share. Visit Flu.gov to make sure you are ready and learn how you can help promote public awareness.

We are making every effort to have a safe and effective vaccine available for distribution as soon as possible, but our current estimate is that it won't be ready before mid-October. This makes individual prevention even more critical. Wash your hands regularly. Take the necessary precautions to stay healthy and if you do get sick, stay home from work or school.

We are doing everything possible to prepare for the fall flu season and encourage all Americans to do the same — this is a shared responsibility and now is the time to prepare. Please visit Flu.gov to learn what steps you can take to prepare and do your part to mitigate the effects of H1N1.

Take Care,
Kathleen, Janet and Arne

H1N1 swine flu in 52 states and territories, Indian Country cases emerge

by Terri Hansen
Environment and Science Reporter

Update June 5: The H1N1 flu has reached 52 states and territories, claiming 27 lives. IHS epidemiologist Dr. John Redd reported 35 confirmed and 13 probable cases across Indian Country May 25. Arizona Pima County Health Dept confirmed one death in Pinal County. Adults over age 60 may have immunity due to previous exposure or vaccination against a similar strain, and those born before 1957 may carry some pre-existing immunity.

May 6: The much talked about Influenza A/H1N1 virus, a never-before-seen, rapidly spreading swine flu strain has so far spared most of Indian Country. The Tohono O’odham Nation in the Arizona Sonora Desert reported four cases, all children, and all are recovering.

There are eight more probable cases in Pima County, Ariz., and 20 suspected cases elsewhere. A suspected case that closed a tribal campus at the Confederated Tribes of the Grand Ronde in Oregon was not the H1N1 strain.

The Havasupai Tribe, whose village in the Grand Canyon flooded last August, put off reopening to June 1, disappointing hundreds of would-be visitors. “We’re a small isolated community,” said vice-chairman Matthew Putesoy. “People come from all over the world to visit and even though we’ve lost our economy, we couldn’t take the risk.”

The U.S. has declared a state of emergency, and health officials say flu cases are likely to grow in coming days. The World Health Organization alert level remains at Phase 5, a strong indication that a pandemic is imminent and the time to implement planned mitigation measures is short. The WHO is warning against over-confidence, although most cases of the flu have been mild. A pandemic means world wide, and is not an indication of the severity of illness.

Dr. John Redd, branch chief of the IHS Division of Epidemiology, said the IHS is responding aggressively. “I’ve been on the job for 11 or 12 days,” he said. “We activated our emergency coordination center early on, and all of the tribes have put their emergency response plans into action. We feel the response has gone very well.”

Non-IHS medical providers are coordinating with state and local governments to provide services, Dr. Julia Wong, a physician with the Portland, Ore., Native American Rehabilitation Association said.

Its impact on non-federally recognized Indian nations could be harder. “We are on our own,” said Jennifer Lagergren of the Chinook Nation, a non-federally recognized tribe in Washington State. She worries if the flu virus does reach them, it will spread fast. “We live more close together with each other, with our children, our elders.”

Chief Albert Naquin of the non-recognized Isle de Jean Charles Band in Louisiana said tribal leaders attended a state funded class last year to learn what actions to take in a pandemic flu. But without grant monies the tribe cannot implement those procedures. “I pray this is just a scare to us, and that no life is lost because of this flu,” Naquin said.

Flu experts are struggling to predict how dangerous this new strain will be. During the swine flu threat of 1976, government programs rushed to vaccinate nearly 25 percent of the population. Only 200 came down with the flu but 500 people developed Guillian-Barre syndrome, a rare neurological disorder that causes temporary paralysis; 25 died. It cost the government their credibility, and millions of dollars in damages.

But memories of the 1918 Spanish flu – that affected Native Americans and Alaskan Natives especially hard – is a harrowing reminder that novel strains of human-to-human transmissible swine flu can turn into human plagues. This new swine flu strain lacks the genes that made the 1918 pandemic so deadly, the CDC has said.

Nor is this flu particularly virulent. CDC spokesperson Karen Hunter said, “It’s just that it’s a new strain and the human population hasn’t built up a resistance.” She said 36,000 deaths a year are flu-caused and the CDC is not expecting this flu to exceed that. There are concerns this strain could mutate and return in a more virulent strain the fall.

Mexican authorities noticed higher than usual number of respiratory illnesses in mid-March. In early April the CDC was investigating cases in California and Texas. They made their official announcement April 24. As of this report, the flu had spread to 38 states, and 21 countries. The U.S. has had two deaths, in Texas.

Newsweek is reporting that in 2005 a Wisconsin teenager who butchered pigs came down with an H1N1 swine flu virus, the first part of an evolutionary tree that has led to this current strain, which has evolved in a quadruple strain of human, bird and two types of swine virus. But even though this is pig virus, eating pork won’t give it to you.

Flu is caused by airborne spread of droplets, and everyday actions, such as avoiding contact with someone who is sick can keep you from getting it. The symptoms of this flu are usually fever, cough, sore throat, headaches or muscle aches, fatigue, and occasionally vomiting and diarrhea. If you or someone in your family has symptoms, call your medical provider for additional instructions. Young children may not have typical symptoms, but may show signs of low activity and have difficulty breathing.

The CDC and IHS is asking that those with any respiratory illness stay home from work or school to avoid spreading infection to others. Smart actions can protect you and your family: washing hands thoroughly and frequently with soap or using an alcohol-based hand sanitizer, practicing social distancing – keeping a distance between you and those who are sick, and using disposable tissues or sneezing into your elbow to keep from sending germs airborne.

Two anti-viral medications, Tamiflu and Relenza, are effective treatments for those with serious illness if used early. Most cases of this flu are mild, and do not need medical attention. Some clinics and emergency rooms cannot handle the number of patients seeking diagnosis and treatment, and say it’s putting heart attack and trauma patients at risk. They ask that you assess your situation, and make wise choices.

The IHS maintains their own stockpile of the anti-viral drugs, Redd said. If those supplies deplete then medical facilities will receive anti-viral drugs from the Strategic National Stockpile.

The U.S. Education Department said school closures have affected well over 500,000 children. Health officials are changing their school closure policy, keeping schools open but keeping sick kids home so schools don’t become infected. Messages have gone out to employers by different organizations, asking them to understand when parents have to stay home.