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Obama declares flu emergency to ease restrictions for hospitals
Officials prepare for a surge in H1N1 cases

By Michael D. Shear and Rob Stein
Sunday, October 25, 2009

President Obama has declared H1N1 swine flu a national emergency, clearing the way for his health chief to give hospitals wider leeway in how they handle a possible surge of new patients, administration officials said Saturday.

The president granted Health and Human Services Secretary Kathleen Sebelius the power to lift some federal regulations for medical providers, including allowing hospitals to set up off-site facilities to increase the number of available beds and protect patients who are not infected.

Obama said in the declaration that the "rapid increase in illness . . . may overburden health-care resources." White House officials played down the dramatic language, saying the president's action did not stem from a new assessment of the dangers the flu poses to the public.

Instead, officials said the action provides greater flexibility for hospitals that may face a surge of new patients as the virus sweeps through their communities. The declaration allows Sebelius to waive certain requirements under Medicaire and Medicaid, privacy rules and other regulations.

"The H1N1 is moving rapidly, as expected," White House spokesman Reid Cherlin said Saturday. "By the time regions or health-care systems recognize they are becoming overburdened, they need to implement disaster plans quickly."

The Centers for Disease Control and Prevention reported on Friday that the flu was spreading widely in at least 46 states and had already caused the hospitalization of at least 20,000 Americans. More than 1,000 deaths have been attributed to the virus and more than 2,400 additional deaths were probably associated with it, officials said.

Emergency rooms across the country are seeing increasing numbers of patients. At least one hospital in Tennessee and another in Texas recently set up tents in their parking lots to screen those suspected of having swine flu; those tents did not require waivers because they were used for screening, not treatment.

In an e-mail, James G. Hodge Jr., a professor of health law and ethics at Arizona State University, wrote that Obama's declaration is "much more than a formality."

"Broader powers of the federal government are now authorized to respond to the emerging outbreak," Hodge wrote. "In short, the stakes just got raised with this proclamation."

Cherlin said the waivers, which would free hospitals from some regulations that guide their behavior during normal operations, may be granted only to health-care facilities that request them. "Adding a potential delay while waiting for a National Emergency Declaration is not in the best interest of the public, particularly if this step can be done proactively as we are doing here," he said.

Public health experts praised the move, saying it was an important precautionary step that could help hospitals and other first responders care for large numbers of sick people as the outbreak continues.

"We know a number of hospitals are already experiencing high but manageable loads. It's not a stretch to imagine that hospitals could be strained," said Jennifer Nuzzo of the University of Pittsburgh's Center for Biosecurity. "It's a just a precautionary move, so if need be we can focus on the care of patients rather than focus on administrative hurdles. In disasters, you often don't have the time or luxury to keep the paperwork in order. You want hospitals focusing on patients."

Others agreed, likening the move to getting plows and salt supplies ready before a large snowstorm.

"You get ready -- make sure everything is battened down," said Arthur Caplan, a University of Pennsylvania bioethicist.

But Caplan said he was concerned that the dramatic language could create unnecessary anxiety, in the same way that the World Health Organization's progressive elevation of pandemic alerts last spring caused widespread concern.

Obama's declaration could sharply increase demand for the vaccine, which is becoming available much more slowly than originally expected.

"I've already gotten a couple of calls from people today asking, 'Where can I get the vaccine?' whereas yesterday it was, 'I don't want that vaccine,' " Caplan said. "I'm worried about people getting panicky and the vaccine being diverted away from those who need it most."

David P. Fidler, a professor of law at the University of Indiana, said that "the declaration has political implications in that it will intensify scrutiny of the federal government's preparedness and response for this kind of event."

"I also wonder whether the increasing impact of H1N1, coupled with the presidential declaration, will make the U.S. move more slowly in sharing the H1N1 vaccine it promised to donate to developing countries . . . especially in light of all the problems being experienced with access to the vaccine in the U.S. now and for the foreseeable future," Fidler wrote in an e-mail.

Health authorities are especially concerned about pregnant women, young adults and children. At least 95 children have already died from the virus, far more than usually die during an entire typical flu season.

Although officials had hoped at least 40 million doses of vaccine would be available by this time, production problems have delayed the federal government's ambitious inoculation campaign. Only about 16 million doses have become available.

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