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Posted on: November 22, 2022

Respiratory Virus Activity Increasing; Shortage of Medications Compounding Strain on Healthcare

 Health Advisory: Respiratory Virus Activity Increasing; Shortage of Medications Compounding Strain on Healthcare

November 22, 2022

Action Requested 

  • Be aware of continued increase in respiratory virus activity, including a rapid increase in influenza activity in recent weeks.
    • Respiratory syncytial virus (RSV) also has continued to circulate at high rates, and we anticipate increases in COVID-19 activity this fall and winter, as well.
  • Plan for medicine shortages, including but not limited to: Tamiflu oral powder for suspension, amoxicillin oral powder for suspension, over-the-counter cough medicine such as Robitussin and Delsym, and children’s Tylenol or ibuprofen. Clinicians may need to assist patients in identifying an alternative, particularly for pediatric patients.
  • Proactively encourage vaccination to prevent severe illness from influenza or SARS-Cov-2. Continue to emphasize preventive measures with all patients, including prompt vaccination for all patients 6 months and older who are not up-to-date on their vaccinations and booster doses.
  • Encourage patients to avoid non-essential urgent or emergency care visits. Share information with them about nurse lines available through their insurance provider(s) or nurse line/telehealth options available through your healthcare organization. 
    • Patients can check their insurance card for a listed nurse line. Attached materials also include phone numbers for multiple insurance plans and may be a helpful reference.
  • Treat high-risk patients with appropriate antiviral treatment or other interventions designed to reduce hospitalization. Administer antiviral medications for influenza or COVID-19 as early as possible after symptom onset. 
  • Prepare for continued, prolonged stress on the healthcare system from increased hospitalizations related to respiratory infections, exacerbated by the limited number of pediatric beds in Snohomish County.

Background 

Significant stress on the healthcare system is a continuing issue locally and regionally, particularly for pediatric care. The flu season is ramping up quickly. Initial indicators are that positivity rate for influenza testing in Snohomish County has gone from under 15% in early November to potentially 45% or higher in the last week. The Snohomish County Influenza Surveillance Report for the week ending November 12 is available here. Data for the most recent week is not yet final. 

We expect to see COVID-19 incidence increase in the near future, as well. 

Multiple medications have been reported to be in short supply during this surge in illnesses. The Snohomish Health District has received reports of shortages in the following, though this is likely not an exhaustive list of medications that may be hard to find at this time:

  • Tamiflu, in particular oral powder for suspension
  • Amoxicillin oral powder for suspension
  • Over-the-counter cough medicine such as Robitussin and Delsym
  • Children’s Tylenol or ibuprofen.

Though some medications are not readily available, please note that there is no shortage of vaccine. It is important for all eligible individuals to receive influenza and COVID vaccinations as soon as possible for their own safety, the safety of the community, and to mitigate the impact on the healthcare system.

As noted in the attached advisory from the Washington State Department of Health, the Washington State Childhood Vaccine Program (CVP) has plenty of pediatric flu vaccine available to order. Flu vaccine can be ordered at any time throughout the season and as frequently as needed. Please place your flu order in the IIS as you need it and ensure you have enough stock on hand by ordering again before you run out of supply. It can take up to a week to receive vaccine; order early if your supplies are running low. 

Additional resources attached to this advisory:

  • A packet of bronchitis information prepared by Seattle Children’s Hospital that providers can share with families to better prepare them to treat bronchitis at home. 
  • A template letter providers may use to send to their patients about the pediatric RSV surge and key prevention measures.
  • Nurse line numbers for multiple insurance plans, including plans under Apple Health/Medicaid. 

Full packet with attachments

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