New America Media

In April 2009, a 10-year-old boy in San Diego became the first known case of H1N1 (“swine flu”) in the United States. Eight months later, as the second wave of the flu appears to be dying down, San Diego health officials said they expect to see more fatalities.

“We can’t predict whether we’ll see another wave or multiple waves or if it will go away. Every pandemic is different,” said Dr. Ben Sun of the California Department of Public Health’s pandemic influenza response team. “More illnesses and fatalities are expected.”

Since April, 834 people have been hospitalized with the H1N1 flu in San Diego. Fifty-seven people have died here—higher than the mortality rate of any seasonal flu in the past 10 years, according to County Public Health Officer Dr. Wilma Wooten.

“It hits close to home,” said Susan Delos Santos, marketing director of the Filipino Press in National City. On Tuesday night, she attended a bowling tournament to help fundraise for the family of one of the victims – a 35-year-old mother who recently died of H1N1, leaving behind five children.

The next day, at an ethnic media press briefing on H1N1 sponsored by The California Endowment and organized by New America Media, Delos Santos was the only member of the press who had gotten the H1N1 vaccine. “I got vaccinated,” she said, “because I have asthma and I’m always in public contact.”

This could be an opportune time to reach a tipping point in the spread of the virus, health officials said. As the number of cases decreases, and the vaccine supply increases, this could be a “prime window of opportunity to fight the pandemic,” said Sun. California has received about 1 million doses each week in the last few weeks, bringing its total up to about 10 million, nearly half its allotment from the CDC.

“If we can get enough people vaccinated, we can better our chances of fighting H1N1,” he said.

As of Dec. 11, about 833,000 doses have come into San Diego, which has a population of about 3.1 million. Another 89,000 doses were ordered on Monday.

Now in week 50 of the H1N1 pandemic, San Diego has vaccinated more than 9,000 students and almost 70,000 individuals. “By the end of the year, we probably will have vaccinated one-third of our population,” Dr. Wooten estimates.

“We’ve got more work to do,” said Ken August, spokesman for the California Department of Public Health, noting that many people are still reluctant to get the vaccine. An October survey by the Harvard School of Public Health found that only 40 percent of U.S. adults said they would get the H1N1 vaccine, and 41 percent said they would not get it.

“We do rely on the media to help get messages out to the public,” Wooten said.

San Diego health officials have released ads targeting different ethnic groups, including Latinos, Filipinos and African Americans.

They are working with community groups to provide information to homeless people and migrant workers. Dr. Dean Sidelinger, deputy public health officer for the county, is reaching out to Mexican day laborers and agricultural communities by providing community clinics, local organizations and the Mexican Consulate with Spanish-language information cards about H1N1. The CDPH also operates a statewide hotline six days a week in 10 different languages.

“San Diego was the epicenter for the first case of H1N1 reported in early April,” said Wooten. “Within 48 hours, we got San Diego proclaimed a local emergency early on in the outbreak.” San Diego health officials sent specimens to the CDC and the state, a process aided by the fact that the company that makes the testing equipment is located in San Diego.

“We really were overwhelmed when this outbreak initially occurred,” said Wooten. “We were able to respond to that by securing equipment, but it was a challenge.”

Wooten says the county still needs to improve in several areas, including tracking the vaccine, training more disaster workers, disseminating information, and increasing its lab capacity and IT to track the day-to-day operations of case reporting.

But many of their local and statewide efforts have paid off.

A report released Dec. 16 by the Trust for America’s Health and the Robert Wood Johnson Foundation gave California a score of eight out of 10 on key indicators of public health emergency preparedness. Twenty states scored six or less.

The report, “Ready or Not? Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism,” found that states that had invested in public health greatly improved their readiness for the H1N1 outbreak. In 2006, California invested $214 million in pandemic flu preparedness, including 50 million masks for hospital employees, anti-viral medications, equipment to turn cots into hospital beds and three mobile field offices.

“At the time, it was [seen as] questionable,” said August, “but looking back, it was very wise, and now other states wish they’d done the same thing,”

Health officials are hopeful that in the New Year, as they receive more shipments, they will be able to provide the vaccine to anyone who wants it. Until then, vaccinations are encouraged for those who are most vulnerable to H1N1: pregnant women; caregivers of infants younger than 6 months; health care and emergency medical personnel; anyone between 6 months and 24 years of age; and anyone between 25 and 64 who has chronic illnesses, weakened immune systems, or asthma.

Sun said that because of delays, the CPHD has received fewer doses of the vaccine than it hoped to have by now. People waiting for the vaccine must be patient, he said. “In the meantime,” Sun said, “take precautions: cover your cough, stay home from school or work if you’re sick, and wash your hands.”

For more information about the H1N1 pandemic in California, visit www.cdph.ca.gov.