All collectors are eleigible for buyouts - 35 thousand dollars for full timers, and five, ten or fifteen thousand for part-timers depending on how long they’ve been employed.  Distel hopes to reduce the workforce by the equivalent of thirty to forty full time collectors.

Distel:  “Our intentions are obvious.  We do not want to have any layoffs, so we are trying to come up with a way to reduce our toll collector workforce without creating any unemployment.”

Toll collectors make more than 20 dollars and hour - which for a full time employee is about 70 thousand dollars a year when combined with benefits.  They’re represented by the Teamsters Union.  Their current contract expires in January of 2011. 

The state health department has ordered 1.4 million doses since the vaccine became available in early October.  The department’s Kristpher Weiss says the most recent order of 435 thousand doses is just now being distributed to counties based on population size.

Weiss:  “The last several weeks we’ve been ordering exclusively for local health departments and hospitals because the supply has been limited, and we hope to be able to expand that as more vaccine becomes available and as providers are able to reach the high risk patients that they serve.”

Those high risk groups include women, children and young adults 6 months through 24 years old, and caregivers for children younger than 6 months of age.  Also health care professionals and chronically ill adults.

Cuyahoga County is offering 5000 doses in each of three locations this weekend.  Most counties have vaccine information available on their web sites or through swine flu hotlines.

ADA AVERYHART: And that bothers me.

Longtime resident Ada Averyhart says it’s just one of a number of longstanding disconnects between the community and city government.  She maintains there’s a distinct impression of indifference to neighborhood needs --- in everything from policing to housing inspections.  She sees that symbolized by the presence of an abandoned elementary school that takes up an entire block, just a few houses down from here --- a potential magnet for criminal activity.

ADA AVERYHART: That should not just be standing there. This wouldn’t happen in Beachwood or west side Lakewood.

Looking to spur more action from City Hall to some community concerns, a small group of protestors staged a demonstration downtown, yesterday afternoon.  Kathy Wray Coleman said it’s going to take more than candlelight vigils to ease the anger.

KATHY WRAY COLEMAN: We’re calling on Cleveland mayor Frank Jackson and City Council to adopt ordinances that address what’s going on in terms of missing persons.  We want an ordinance where they respond within a certain time, we want education and training for the police force to be more sensitive to these issues.

Area social service agencies have sprung into action to deal with other tensions and fears that may be bubbling below the surface.  At a community meeting at the Mt. Pleasant Library last night, the Cleveland Rape Crisis Center announced that a fulltime counselor will be stationed at the nearby Murtis Taylor Social Center to help area residents directly or indirectly impacted by the Anthony Sowell case.  In addition, a Shaker Heights-based family counseling group is setting up shop tomorrow in a Mt. Pleasant church. 

Cosgrove:  “I do not see anything in this that will keep the total cost for health care - not necessarily the government’s bill for health care, but the total bill for the country for health care, I don’t see anything in this that’s going to keep that from escalating.”

That’s in line with what some health care analysts, as well as some members of Congress, are saying as the full Senate prepares to take up the debate.  Also Denis Cortise, Cosgrove’s counterpart at the Mayo Clinic in Minnesota, which - along with Cleveland Clinic - has been cited by the Obama administration as a pioneer in setting new efficiency standards.  Both men call for a widespread shift away from the predominant fee-for-service system to a more outcomes-based approach as the best way to contain costs.  Cortise has said the House and Senate bills take only baby steps in that direction, and Cosgrove agrees. 

Cosgrove:  “I think that costs are going to keep going up, and in order to deal with it they’ll have to come back with more legislation, and have to identify and address some of the things that are driving costs.  And I think it’s going to be multiple.”

Cosgrove said he believes whatever system evolves will be uniquely American.  He doesn’t think Americans would stand for a system such as Britain’s or Canada’s, where patients have to wait for certain tests and treatments.

Bill Rice, 90.3. 

Allen says, “people think you can get sick from the vaccine, people think because the vaccine was developed quickly that somehow it’s less safe, we know for instance that those two are completely untrue.”

Dr. Philip Totzis of University Hospitals reinforced the effort to squash the misinformation that’s out there. He says everyone, particularly pregnant women and children should get inoculated as soon as possible.

Toltzis says, “all of the current data support that the novel H1N1 vaccine is as safe as seasonal flu.”

Nonetheless, federal agencies like the FDA, HHS, and CDC are stepping up efforts to monitor H1N1 vaccines as they are rolled out. They’ve also set up a group of independent experts, in case the feds miss anything. Officials say this isn’t because of concerns about safety, it’s just to keep tabs, and to allay any public concerns.

Dr. Jennifer Hanrahan is Chairman of the Infectious Health Control Commission at MetroHealth Medical Center. She says the situation is extremely serious, that cases are growing exponentially, and that the flu is threatening to overwhelm medical professionals who are treating the sick.

DR. JENNIFER HANRAHAN: “We’ve had somewhere between 50 and 60 people each day, over the past week. It’s not overwhelming yet. I think as the numbers continue to increase, there is certainly potential for that to happen”

As of Friday morning, 55 of the people treated at MetroHealth have been admitted. Five of them are in the Intensive Care Unit. Additionally, some hospital staffers have become infected, and are home recuperating.

The numbers are just as daunting at the Cleveland Clinic, which reported between 40 and 45 people a day are walking into its’ Emergency Room with flu symptoms. A dozen adults and children are currently being treated in the I-C-U there.

At University Hospitals’ main campus,` 851 people were treated between October 18th and 25th. 263 were admitted for either overnight observation or longer term care.

During that same period, Rainbow Babies and Children’s Hospital admitted 100 children, out of nearly 900 who went to the Emergency Room.

Dr. Hanrahan says while the growth in cases is alarming, a larger concern is that some at-risk people still aren’t trusting that the vaccines are effective.

DR. HANRAHAN: “The H1N1 vaccine is completely safe. People who are at high risk really need to go and get this, because we are seeing pregnant women who are sick, and that’s a terrible thing to see.”

However, supplies of the vaccine remain limited, as only about 16% of what was anticipated to be used - has actually been produced.

Dr. Jackson Wright, who heads the Clinical Hypertension Program at University Hospitals Case Medical Center, says the medical school will be one of five U.S. institutions taking a leadership role in what’s called the Systolic Blood Pressure Intervention Trial - dubbed SPRINT. 

Several other Health Systems will also participate, including Cleveland Clinic, Metrohealth Medical Center, St. Vincent Charity Hospital, and The Ohio State University Medical Center. 

Wright:  “The fact that Cleveland, Northeast Ohio and Central Ohio has a very diverse population makes this an outstanding location to conduct a study such as SPRINT.”

The study will take place over 9 years, and will involve 75 hundred patients.

Wright says it will measure the benefits of reducing systolic blood pressure against risks posed by increased medication and other factors in treatment of hypertension. 

Allen says what little injectable vaccine HAS come in has been used to immunize EMTs and paramedics, along with SOME pregnant women. 

When there’s more vaccine to dispense, it will be taken into daycares, school-based clinics, and some large community clinics.  But the Centers for Disease Control has adjusted down their vaccine production estimates from the producers for October and November, and Allen says that makes planning difficult. 

He says the county is asking people to be patient.

Cases of flu have been on the rise and they’re generally believed to be H1N1, although that’s not confirmed because most people who become ill aren’t tested for that particular virus.  Most cases are no more severe than a typical bout of the flu. 

Tri-Pointe is the first new “from the ground up” hospital to be built in Northeast Ohio in 28 years. 

It will have fewer beds than Lake East, but all rooms will be private, which means that it will actually be able to accommodate more patients, says spokesman Gary Robinson.  And it will have all the latest medical and information technology, something Lake East could not accommodate. 

Robinson:  “In terms of the kind of technology that’s available today, you’re just not able to retrofit that into older buildings.  So with Tri-Pointe Medical center we were able to put the latest digital technology into the facility.”

Painesville had struggled to convince the Lake Health System to build the new facility in Painesville, but it was decided the more natural and spacious Concord site was a better choice.  LakeEast Hospital will be demolished, with plans on the drawing board to fill the space with new homes and businesses. 

Weiss:  “The estimates for availability has been reduced by about 3 percent to about 114 to 115 million doses.  That’s still 4 to 5 million doses than were distributed last year and about half of that vaccine has been shipped.”

Shipments of the seasonal flu vaccine have been delayed around the country, according to numerous news reports, plus demand is way up this year - probably fueled by outbreak of H1N1 or swine flu.  So as in some past years, people still seeking the seasonal vaccine may have to wait and should keep checking back with their health care providers, as well as pharmacies and clinics that may offer it. 

The seasonal vaccine - which actually protects against 3 garden variety flu viruses - does not include protection against swine flu.  It could have, had swine flu arrived on the scene earlier, but by the time it became a well-established threat production of the seasonal vaccine was well underway.  Manufacturers had to identify and produce a separate vaccine, which is still several weeks away from widespread availability, says Dr. Steven Gordon of the Cleveland Clinic. 

Gordon:  “We have initiated at least getting the vaccine into, as we say, kind of a tiered approach in terms of our health care workers and first responders.  But of course we don’t even have enough vaccine to cover even those groups at this time, our hope is - and it changes every day - that we get more vaccine and more vaccine, and in a few weeks there will be plenty of vaccine for everybody.”

After health care workers and first-responders, pregnant women and people who care for infants are the next priority for swine flu vaccine.  After that it’s all people age 6 months to 24 years and people with chronic heart and lung conditions, then the rest of the population. 

CUDA:  These days you can order pretty much anything on the internet.  Even a copy of your genome – well parts of it anyway.  Anne Wojcicki is co-founder of 23andMe, a 2-year old company headquartered in Mountain View California that aims to make genetics as popular as facebook.

WOJCICKI: You go online you order a kit – it costs 399 dollars --you get a little vial, you spit in the vial, you send it back through the mail and then 2-4 weeks later you actually get an email saying “your genome has arrived.”

CUDA: After logging into the secure website – voila – your very own genome. But what on earth are you going to do with that? Wojcicki says a lot – for example the company will tell you your risk for more than 100 different diseases and conditions like heart attacks, arthritis and cancers, or if you’re a carrier for things like cystic fibrosis.  In addition to providing information about yourself – 23 and me wants to know something about you too --Wojcicki says that clients are asked to fill out a number of surveys that ask all sorts of questions —things like …

WOJCICKI : … when you take Benadryl do you get sleepy , do you get hyper –--things like when you see bright sunlight do you sneeze – and actually there is about 20 to30 percent of the population that when they see bright sunlight they sneeze

CUDA: Wojcicki says they’re looking for a genetic basis to questions like why some people sneeze in bright sunlight, or think cilantro is delicious and others think it tastes like soap. . The hook is that it’s fun she says; people are inherently curious about themselves and how they compare to others - but Wojcicki also believes this information gathering can lead to discoveries about serious conditions like Alzheimer’s or Parkinson’s disease. 

23andMe isn’t the only commercial genetics company on the block.  A company called Navigenics, also in California, is doing virtually the same thing.  Dietrich Stephan is co-founder.  He says when his company got started a couple of years ago it charged 25 hundred dollars for its services.  Today they’re starting package is 400 dollars.  Stephan’s selling point is prevention - by allowing people to have an assessment of their risk for various diseases, they can take action to be healthier

STEPHAN: For example, I’m at extremely high risk for prostate cancer, I’m in the top 5th percentile of risk based on my genes for prostate cancer – and now I know that I should go in for earlier screening, perhaps earlier than the classically recommended age of 50, that I should watch my PSA levels .

CUDA: And Stephan says that if everybody did that –in time – it might change the way medicine is practiced.  In fact, it might even have the power to change the whole health care system

STEPHAN: We actually believe Navigenics is the lynch pin to flipping the whole health care system from reactive and generalized to personalized and proactive.

CUDA:  The sort of personalized medicine Stephan is referring to is what many scientists hold up as the wave of the future – drugs and treatments tailored to an individual because of his or her genes.  Much of today’s medicine is based on studies of outcomes of large numbers of people; treatment that to a degree is a kind of generalized conclusion Edward McCabe is president of the American society for human genetics and a professor at UCLA school of Medicine – he believes the ability to be far more precise in knowing what works for a particular individual is right around the corner.

MCCABE: We’re now to the point where we’ll be able to say, is there 2% of the population that should not take this drug.  But it’s and outstanding drug for the other 98%.  And we won’t just know that there are 2 percent --we will know who those 2% are. 

CUDA: Still some scientists suggest caution is in order. Dr. Rudolph Tanzi studies the genetics of Alzheimer’s disease at Harvard.  He says that selling genetic services directly to consumers does have some merits –but he worries that the science isn’t quite there yet. 

TANZI:  I think it’s dangerous to eat a meal when it’s not cooked.
CUDA: So are you comparing this to an uncooked meal?
TANZI: Absolutely.  This is raw meat. 

CUDA: Tanzi argues that the science behind assigning a definitive information to individuals about their particular health risks is still imprecise and prone to misinterpretation. Many leading scientists agree with him.  This week a paper in the journal Nature compared the results of Navigenics and 23andMe for five individuals.  They found that for seven different diseases they agreed less than half the time.  Evidence to Tanzi and others that companies in the business of selling this information to consumers need to be very circumspect in the way they present the facts.

TANZI: You have to do this in a medically responsible way. You need to be very, very honest with incredible caveats and limitations – and the information should be delivered in such a way that doesn’t indicate hard science or numbers – because we’re not there yet. 

CUDA:  Another caveat is privacy. Recent federal legislation prevents your genetic information from being used to deny an individual health insurance or a job but it doesn’t protect discrimination by life insurance companies or long term care – and the new protections haven’t been tested in the courts yet.  If you share it with your doctor –as both companies selling genome sequencing suggest you should – it’s likely to become part of your medical record – and then insurance companies automatically have access to it. Harvard’s Rudolph Tanzi says that’s too big a risk for him – and he’s in the field.

TANZI : Until the amendment “cannot discriminate according to race color and creed” changes to “cannot discriminate according to race, color, creed and DNA sequence,” I wouldn’t want to have my DNA sequenced anywhere. 

CUDA: But 23 and me is betting that today’s Facebook generation isn’t concerned with privacy at all.  Their service includes a social networking component for those who ready to share and compare…not just with their doctor but on the internet.  And one final footnote to this story - The future may be written right here in Northeast Ohio.  Both 23 and me and Navigenics are discussing a research partnership with the Cleveland Clinic. Gretchen Cuda, 90.3

Elmwood Elementary School in Garfield Heights was closed on Tuesday but reopened Wednesday.  And Avon Lake in Lorain County has upwards of 200 high school students out sick, but Superintendent Robert Scott says there are no plans at this time to close the school. 

Allen says districts are encouraged to stay open, but they make those decisions at their discretion.  He says parents of schoolchildren should plan ahead for their child possibly becoming ill. 

Allen:  “Certainly they should be making contingency plans, and we’re also hoping that employers understand that there may be a need for parents to be there for their children, and to be part of the solution in trying to prevent transmission from expanding in the community by allowing them to stay home when they’re ill or when their kids are ill.”

Allen says flu viruses are unpredictable, but there’s one thing that’s known for sure:  this flu season is going to be far longer than usual. 

Bill Rice, 90.3.