Physicians Discuss H1N1 Lessons Learned

By Navy Lt. Jennifer Cragg
Special to American Forces Press Service

Nov. 6, 2009 - Senior medical officials who successfully slowed the spread of H1N1 flu virus at the U.S. Air Force Academy in Colorado Springs, Colo., published what they learned in an October article featured in the American Journal of Preventive Medicine. Air Force Lt. Col. (Dr.) Catherine Witkop, a preventive medicine physician from the 10th Medical Group, told participants in a "DoDLive" bloggers roundtable yesterday that medical officials at the academy acted quickly to set up a team to look at some of the virus's characteristics.

"I was really pleased that we were able to capitalize on the opportunity to actually learn more about the virus and provide that information to the Centers for Disease Control, to the military, [and] to the United States at large," she said.

Witkop and Air Force Col. (Dr.) Kenneth K. Knight, 10th Medical Group commander, discussed what other institutions may be able to do to manage H1N1's spread. Witkop noted that some of the lessons learned from the summer outbreak can apply at other training facilities, such as Lackland Air Force Base, Texas.

With a large population of trainees living in very close quarters, Witkop said, controlling the virus's spread at Lackland and limiting absenteeism from the six-week training period "is really crucial to completing that mission."

"So we've done our best to share as much information as possible, as quickly as possible," she said, "since this is such a timely issue."

During a four-week period in July, 11 percent of the Air Force Academy's basic cadet population became ill. "There are 134 confirmed cases of H1N1 and 33 suspect cases, meaning they had all the same symptoms, but were not tested," Witkop said.

Many challenges had to be considered quickly, Knight said, such as how to treat patients, how to limit interactions with others, when to hospitalize, and how to isolate the cadets.

"It was a medical issue that had a huge implication to what their job was about," he said. "We did lots of different approaches as we were scrambling with the line leadership as how to isolate, talking with CDC, [and] figuring out what the appropriate treatment is," Knight said.

"And it appears, then," he added, "with any epidemiologic conclusion, [that] what we did was effective."

Knight said the academy's medical group was careful to share lessons learned through the outbreak's many phases.

"When we were in the thick of things, we were daily sharing what our experience was with the public health department downtown, with all the other local military medical facilities, with the other academies, comparing notes as to what their experiences were with Lackland [and] with the line leadership," Knight said. "Our line leadership here was pushing information up to the chief of staff of the Air Force. So near-term, we were essentially getting out real-time information as to what was going on, to share that experience."

Witkop spearheaded the article submission to the American Journal of Preventive Medicine while sharing the lessons with the CDC.

"We've shared this information with the CDC well before it got published, so that they would have the information to adjust the guidelines that they were publishing," Knight explained.

Isolation has proven to be a key factor in controlling the outbreak at the academy, Witkop said.

"Our current approach is ... to isolate the cadets; however, they are self-isolating per the CDC's guidelines," she said. "So they would go back to their dorm rooms, continuing until they are seven days from onset of symptoms and 24 hours after being symptom-free."

Both said public health education reminders are the key ways academy officials are preventing another outbreak among cadets, and that messages to wash hands, use sanitizers and cover coughs are shared continuously.

Meanwhile, Witkop said, academy medical officials continue to monitor the situation closely and continue their public health efforts.

"We're continuing to follow very closely ... the numbers of cadets who are ill, to make sure that we're not approaching another outbreak situation," she said. "We have daily reports from all of our various clinics about the numbers of both cadets and those in the community."

To read more about the published article in the American Journal of Preventive Medicine, visit http://www.ajpm-online.net/content/advance.

(Navy Lt. Jennifer Cragg serves in the Defense Media Activity's emerging media directorate.)