David Harlow speaks about swine flu with Harvard Vanguard Medical Associates Director of Infection Control Dr. Ben Kruskal

I’ve been following a lot of updates on swine flu (or, as we’re now supposed to call it, H1N1), found everywhere from The Daily Kos to the swine flu feeds “blokcast” set up by Tom Stitt.

Update 5/4/09: There is also an excellent overview of pandemic preparedness and thoughts about the future on Health Affairs’ blog.

To get a handle on the situation, I spoke with Ben Kruskal, MD, PhD, Director of Infection Control for Harvard Vanguard Medical Associates, a Boston-area medical group with about 400,000 patients.  The audio file of our conversation runs about 6 minutes and is available for download/podcast.  I plan to check in with him periodically as this situation unfolds.

Update 5/5/09: Read the linked transcript or the copy below.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting

Interview of Ben Kruskal, MD, PhD, Director of Infection Control, Harvard Vanguard Medical Associates, May 3, 2009

David Harlow:  This is David Harlow on HealthBlawg and I have with me today Dr. Ben Kruskal who is the Director of Infection Control for Harvard Vanguard Medical Associates — that’s a large group practice in the Boston area with about 400,000 patients.  Thank you for being with us today.

Dr. Ben Kruskal:  It’s my pleasure, David.

David Harlow:  I am interested in your perspective on the H1N1 flu pandemic, and how that is affecting your patients, the patients of your group and the public at large.  What should we be concerned about at this stage?

Dr. Ben Kruskal:  Well, the good news is that the severity of illness seems to be very much on the low end of the spectrum as of now.  Unfortunately, I don’t think we can be entirely complacent because there certainly is potential, based on history, for things to become more severe over time.

David Harlow:  Is there some point in time where you think we’ll have a good sense whether this is a pandemic that’s going to blow over with a less severe illness or whether we’ll start to see a more severe illness?  Is there a point in time where that will be apparent?

Dr. Ben Kruskal:  I don’t think we’ll be able to say with great confidence until quite a while from now.  Again, by analogy with the previous outbreaks, sometimes a novel strain will appear very mild, will go underground for a period of some time, often months, and then reemerge in a more virulent form.

David Harlow:  Right.  Now, I’ve seen some graphs and depictions of the course of pandemic in the 1918 Spanish flu epidemic and the question that’s raised there is whether some stricter controls including, for example, closing schools might be beneficial.  I’m thinking in particular of a graph comparing the number of cases say in Philadelphia versus St. Louis where Philadelphia didn’t close any schools or other public areas and St. Louis didn’t, their experience was overall better.  Do you see a need at this point in time for sort of stricter approaches to closures of places like schools?

Dr. Ben Kruskal:  Well, no question that with a virulent strain and a strain with a very high attack rate, school closures and others so-called “social distancing measures” can be very helpful.  It’s not clear to me at this point how necessary, how stringent we need to be in terms of school closings.  Right now the CDC has taken a fairly conservative view and is recommending that schools consider closing with even one confirmed or likely case. Given how mild this disease is and the fact that spread doesn’t seem extremely high at this point that may not be quite necessary, but again, it’s early to say for sure.

David Harlow:  Okay.  So the way things look now, it doesn’t seem that that’s entirely necessary.  We’re talking about the CDC and some recommendations coming from there, and I understand that the Federal government had put a pandemic plan in place over the past year or so and that that’s being activated or put into play.  There’s a lot of discussion in recent weeks about the fact that a lot of top appointed positions in the administration have remained unfilled.  Do you see that that has been a problem in addressing the pandemic as it unfolds?

Dr. Ben Kruskal:  I don’t think so.  I think, again, fortunately, things have been relatively mild so far and the CDC’s response seems as if it’s been pretty well coordinated, no major issues or problems.

David Harlow:  There are these plans that are in place — whether it’s the Federal level or say the local levels — and I wonder if, as you’ve been saying, this seems so far to be a relatively mild pandemic or relatively mild strain of flu, is it entirely necessary to be activating these plans?

Dr. Ben Kruskal:  Well, I think everyone has been reasonably measured in the response so far, really with a strain as novel as this one.  The potential for rapid spread and for severe disease is there and I think both at the state and the Federal level it has been appropriately conservative initially and is being tempered over time based on what’s occurring, so I think things had been quite proportional.

David Harlow:  Okay.  Well, thank you very much.  Any thing else that you would like to add?

Dr. Ben Kruskal:  I’m not sure I would call this a pandemic at this point, pandemic generally refers to a large segment of the population being infected and we’re certainly not there yet.  I think there is still quite a lot of potential for spread although again I hope the severity of the illness will remain as mild as it is now.

David Harlow:  Okay.  Well, I certainly hope so too.  Thank you very much.  I’ve been speaking with Dr. Ben Kruskal, Director of Infection Control at Harvard Vanguard Medical Associates in the Boston, Massachusetts area.  This

is David Harlow in HealthBlawg.  Thanks once again for speaking with me and I hope we’ll have a chance to follow up on the swine flu situation again in the future.  Thank you.

Dr. Ben Kruskal:  Thank you David.