Editor's Note: Dr. Tim Jones, the state's epidemiologist, was kind enough in the midst of the H1N1 flu outbreak to take time to chat with Medical News about Tennessee's preparedness, how far we've come, and lesson's that are still being learned from this most recent scare.

Are we better prepared to deal with a major, widespread threat today than we were a decade ago?

 

"Oh man, absolutely!" was the unequivocal answer given by Tim Jones, MD, state epidemiologist for the Tennessee Department of Health. "Since 2001 and the dollars and attention that got focused on preparedness in general, that has helped tremendously... and not just with core capacities, but it also allowed us to develop all kinds of capability that we didn't have before," he continued. "It is just night and day between our capacities then and capacity now."

 

Jones, who also directs the department's Communicable and Environmental Disease Services section, said the state has implemented additional surveillance systems over the last few years. One system is hooked up to emergency rooms and pharmacies to see if there are any "bumps" in different medical syndromes. "We have a separate system," Jones continued, "which during an emergency allows us to get feedback from every hospital in the state." He added, "We have 20 or 30 exercises per year at the county, regional and state levels."

 

The state's preparedness plans were put to the test recently when the H1N1 outbreak spread to Tennessee... first cropping up in Nashville in late April with cases soon being reported both east and west. Although the flu mercifully was much less deadly than first anticipated, it gave officials across the nation... and the globe... an opportunity to test systems and search for weaknesses.

 

"As difficult as this whole situation has been, we're lucky it's been relatively mild with relatively few deaths. It's been a great way to exercise the plan," Jones said.

 

In hindsight, he continued, it's easy to question whether or not the public was needlessly frightened by all the media attention. However, Jones noted that early on the indications were this could be a very deadly strain.

 

"I think this has been a triumph of early recognition and reacting vigorously in the beginning," he said. Jones added that as the threat level became more clearly defined, recommendations were adjusted accordingly such as allowing schools with confirmed cases to remain open.

 

He added the local media was wonderful to get the message out to Tennesseans in an appropriate manner. Likewise, he called the information flow to health providers smooth.

 

"I think the medical community in Tennessee ought to be proud of how they have handled this," he said. "I think there's still room for improvement in communicating directly with community physicians, and we're already working on that."

 

There have been other lessons learned, as well.

 

"Most of our exercises in our planning were directed at huge disasters. I think it's the lower level, but much longer duration, situations that will need some extra work," he said.

 

"We have plans for vaccinating the entire state in three days," Jones noted, adding thousands of volunteers would be immediately deployed. However, he continued, "We need to think about how we get out vaccines or antivirals or protective gear over weeks without slowing down other procedures... while operating business as usual."

 

The recent H1N1 outbreak also brought attention to areas where community health providers need to focus some additional thought.

 

"The biggest thing is dealing with the worried well," said Jones. "In recent situations, that's what is tying up emergency rooms and physicians' offices."

 

He noted that providers should make plans ahead regarding how to allocate resources, screen patients and deal with the sickest while finding a way to calm and educate lower risk patients.

 

"A doctor can't spend his time working with the worried well when people are dying in the waiting room. It's really important that physicians think about how they are going to deal with phone calls and people coming in to be checked," Jones said. "There's just not that big of a safety net in Tennessee... so telling everyone to go to the emergency room or the local health department... that capacity is going to get maxed out pretty fast."

 

He added the recent flu threat should jump start some of these conversations among providers and staff. "It's basically just thinking about things ahead of time rather than when you are in the middle of a crisis."

 

When disaster does strike, Jones and his colleagues have tried to make information easily accessible on the homepage of the state's Web site (http://health.state.tn.us). Jones said during the height of the H1N1 outbreak, the healthcare provider section was updated daily. "So when things are really busy and the phone lines are tied up, that's probably the fastest way for providers to get information." Jones also said that the state was in regular communication with the various county health departments. "We would encourage that to be the first line of contact," he said.

 

While there are always tweaks to be made in response plans, Jones was pleased overall with the response, communication and spirit of cooperation.