Case Study in Community Based Response – H1N1 Outbreak in Homeless in Salt Lake City Kevin McCulley Emergency Preparedness Coordinator Association for Utah Community Health, Utahs Primary Care Association

Association Background Represent Federally Qualified Health Centers and other accessible providers of care in Utah The FQHC system in Utah provides a health care home to over 113,000 Utahns annually 60% in poverty, 59% uninsured Includes general population Community Health Centers, Migrant Health Care, and Homeless Health Care grantees Provide ~60-70% of Safety Net visits in UT 2

Wasatch Homeless Health Care Located in Downtown SLC Know as the Fourth Street Clinic Adjacent to other homeless services In ,371 patients 98.5% at 100% FPL or below 80% uninsured 56% living in shelters or on the street 52% Caucasian, 10% Hispanic 3

2009 H1N1 Outbreak High rates of suspected H1N1 in homeless High visitation rates impacted clinics regular primary care service delivery Compounding the problem was the question of where to send suspect patients Back to the shelter? Not good 4th Street provided motel rooms and food delivery to suspected cases, which further impacted service delivery 4

Finding Solutions Key assumptions Critical to minimize spread of H1N1 among homeless, to both ensure safety of sheltered population and public To minimize the spread, aggressive outreach, education, and vaccination was needed To minimize spread, a system must be designed to segregate suspected/confirmed cases from general shelter populations 5

Minimizing the spread High rates of chronic and untreated disease leave homeless population more vulnerable to poor outcomes Homeless populations cannot be directed to go home and stay in bed Homeless populations inhabit the same public spaces (library, stores, etc.) as general public It is our responsibility to take care of those who need it the most 6

Outreach and Vaccination ACIP recommendations did not include homeless populations in priority target groups for initial vaccination campaign Worked with SL Health Department to allow all homeless to be a priority for vaccination, regardless of age or other ACIP standards Massive vaccination campaign in soup kitchens, shelters, at clinic site, and housing units Successfully vaccinated 4,000 homeless (~63%) 7

Outcomes 4 th Street was second only to Health Department for number of vaccines administered High vaccination rate reduced suspected case presentation and minimized impact on normal clinic primary care operations Procedures now in place for the next big thing 8

Alternate Care Site Planning As the outbreak grew, and the impact on the clinic rose, the need for an ACS was clear In the absence of vaccination, clinic could not in good faith send suspect cases back to shelters Worked with SL Health Department and others to plan and design a respite facility for flu cases Three components Triage Center Respite Care Facility Service Infirmary at Road Home Shelter 9

Triage Center At the point of entry into the clinic, patients with symptoms or suspected cases will be directed to a separate screening and assessment area Serves to minimize disease transmission within the clinic and clinic waiting room Initial estimates were for 50 patients each day during high outbreak period 10

Flu Infirmary at Shelter Part of scaled response, use existing facility first by segregating a part of the shelter Would still require staffing, medical supplies, and other services Funding provided for planning activities and purchase of supplies through State Department of Health using ASPR funding 11

Respite Care Facility Services Temporary housing for up to 80 infected patients Combined effort of 4 th Street, Road Home Shelter, and EMS and nursing student volunteers from University of Utah Needed full coordination of medical care, food services, housekeeping, and other materials Site identified on 4 th Street campus Estimated operational time of 4-5 months 12

Thank You! Kevin McCulley Emergency Preparedness Coordinator Association for Utah Community Health 13