The teacher of a first grade class in a school in a New York City suburb yesterday fell ill with chills, high temperature and muscle aches. The class is made up primarily by children of immigrant families, including ten from Mexico. Three of the children in the class had been out for a few days because of a disease characterized by a sore throat. The teacher was seen at a local Emergency Department (ED) and, after a rapid flu test, was told that she "did not have the swine flu".
What is wrong with this scenario?: (1) the null rule-out value of the rapid antigen test for the swine flu was not recognized, and (2) the patient epidemiological circumstances did not seem to have been addressed by the health care facility (even though they were aware of the risk to health care workers and held the patient in isolation while waiting for the test results).
The school nurses were well aware of the need to quickly rule out an outbreak, but had no idea whom to call for advice. I tried to help by calling the NY State's Swine Flu Hotline, but they referred me to a New York City physician resource, even though the school is outside the city limits. There was no information or contact links prominently listed on the CDC, State or County Health Department web sites for institutions to obtain rapid advice in situations where an outbreak is suspected.
Hopefully, this particular teacher's illness will end up being caused by something else, and the event will just be one of the numerous false alarms that will be triggered by the public concern about the disease. But the epidemic needs just one such institutional exposure incident to continue expanding in our midst. Institutions need instant clear guidance from local authorities in order to determine the need for timely and appropriate containment measures. Right now, this guidance is not easy to find.
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