By Karen Ocamb

Getting the flu is nothing to sneeze at, especially for people with compromised immune systems. Nor is it wise to dip a toe into the ocean at your favorite beach if, like Will Rogers Beach, it is closed by the health department because of raw sewage spills.

As of Feb. 16, Will Rogers Beach remained closed due to “persisting levels of elevated bacteria,” according to an alert on the Los Angeles County Department of Public Health Web site (www.lapublichealth.org), resulting from a sewage discharge on Feb. 6.

“Due to this sewage discharge, Los Angeles County residents and visitors to the area should avoid contact with the ocean water near the point of discharge until these portions of the beach have been deemed safe,” said Dr. Jonathan E. Fielding, public health director and county health officer. Call the Ocean Water Quality Hotline at (800) 525-5662 for updates.

Fielding is also concerned about reducing the risk for a flu pandemic. Indeed, six days before his interview with IN magazine on the health department’s new Clean Hands campaign, the Centers for Disease Control and Prevention held a "war game” in Atlanta to prepare for an inevitable global outbreak of a new, highly transmissible strain of influenza, according to the Washington Post.

There were three such pandemics last century, in 1918-19, 1957 and 1968, and another is expected but unpredictable. The Post reported that, “the H5N1 strain of avian influenza, or bird flu, has killed millions of birds and 164 people, mostly in Asia, since 2003. It does not pass from person to person efficiently. But it is highly lethal and still evolving; many experts believe it has the potential to cause a pandemic.” Fielding agrees. “The likelihood is close to 100 percent,” he told IN. “Whether it’s this year or next year, nobody knows.”

Meanwhile, seasonal influenza, which affects 5 to 20 percent of the U.S. population, can be easily prevented. “On average, 36,000 Americans die each year from the complications of seasonal flu,” Fielding said. “Staying healthy this flu season can be as simple as washing your hands, covering your cough and sneezes, not touching your hands to your face, nose or mouth, and getting a seasonal flu shot. This is particularly important for people with compromised immune systems who are at greater risk.”

Fielding was not aware of a new Williams Institute study that found rampant discrimination against people with HIV/AIDS by skilled nursing facilities, obstetricians and cosmetic surgeons. “This is very disturbing,” Fielding told IN after looking briefly at a report summary. “I didn’t have a chance to look at the methodology, but certainly this is very disturbing information.”

The public health department does not have jurisdiction over the practice of medicine, Fielding said, but “we do license skilled nursing facilities, and we can look at it from that standpoint.” Part of the issue, he said, “may be an educational issue with physicians.”

Asked about the progress the public health department is making in developing strategies to combat the epidemic of methamphetamine, Fielding said, “it’s coming along. It’s a process.”

On Dec. 12, 2006, Fielding submitted a progress report to the Board of Supervisors after the Board’s Sept. 19 directive to the directors of the departments of Public Health (DPH), Alcohol and Drug Program Administration, Office of AIDS Programs and Policy and Mental Health to come up with a “comprehensive strategy for methamphetamine use, prevention and intervention,” incorporating information from other departments as well. The report, developed by the DPH Methamphetamine Work Group with help from University of California at Los Angeles' Integrated Substance Abuse Programs, was prompted by a petition from the Act Now Against Meth Coalition.

The report said that preliminary data indicates that Latinas and men-who-have-sex-with-men (MSM) “have experienced a dramatic increase in admissions to County-funded treatment programs—Latinas increased from 46 percent in 2001 to 77 percent in 2005. Meth is also considered a “serious problem among MSM” and the LGBT population “because it reduces inhibitions and increases the likelihood of high-risk sexual activities.”

“This is a problem that, while not new, has become of increasing concern from a public-health standpoint,” Fielding said. “With respect to the transmission of HIV and other STDs, I think the combination of meth use, coupled with Viagra and Cialis, and the other male potency drugs, is really a perfect storm. There is no question in my mind that this is a significant barrier towards reducing the rate of STDs, including HIV.

“It is a big problem,” Fielding continued. “Nowhere have I seen that people have a single solution or a clear solution. So we’re therefore working on a bunch of different fronts, which are summarized in the report that we sent in September. But we are working on a further report and obviously one of the things is educating our provider groups about the specific ways that you try and treat meth addiction—and let me tell you, the results are not always heartening.

“Most of these drugs change the brain function in some way,” Fielding said. “But this removes inhibitions and it’s hyper-stimulation and that combination is really very, very serious in terms of public health significance. Our own survey found that 1.6 percent of all adult males and 1.2 percent of all adult females report using meth—and of course, I’m sure there’s under-reporting. People don’t necessarily want to talk about their use of illicit drugs. This is a problem. It’s a big problem, particularly among the MSM population, in terms of the transmission of HIV and that nexus, where the MSM population is at particular risk of both spreading it and acquiring it.”

The L.A. Health newsletter accompanying the progress report noted that, “the prevalence of meth use was higher among those 18 to 29 years of age (3.1 percent) compared to those 30 and older (0.9 percent). The prevalence was also higher among men who identified as gay or bisexual (4 percent) compared to those who identified as heterosexual (1.3 percent).”

“It’s three times as high in gay or bisexual men, compared to those who identify as heterosexual,” Fielding said. “And that’s consistent with the other studies.”

Given the higher prevalence in the MSM population, and the implication of HIV infection, where is the urgency? “We know that this is a problem,” Fielding said. “We know that it’s been a problem. The issue is—what specific things can we do to reduce the problem? One of the things that we’ve done is to try and educate the providers that we have for drug treatment to be sensitive to how to treat people with meth addiction. But if you look at the report—it’s not like anybody has a magic bullet for getting high cure rates that are sustained. We are doing more testing for STDs, for syphilis, for HIV, for other STDs, gonorrhea and Chlamydia, and those certainly are all increased by meth.

“But I have to tell you,” Fielding said, “I don’t know of any effective prevention program—at least in terms of the peer review literature—that shows clear effectiveness. So it’s not that we don’t treat it with urgency, but it can’t be ready, fire, aim. It has to be understanding what the best evidence shows us as the way to address this.

“Right now we’re very upset that there is a quarter of people with HIV/AIDS and don’t know it,” Fielding said. “And therefore, we’re trying to increase testing. We know what to do in those situations. We know how to try to get to more people. We’re trying to make testing more universal. We’ve provided significant funding for it, and we know that early treatment is good. With meth—we don’t have the same level of knowledge is the problem. And it’s a terrible addiction. It has major impacts on the brain. It has a high degree of recidivism. It causes a lot of serious problems in terms of function. It’s not like heroin where we have, for example, methadone.”

Fielding said he’s familiar with Prometa, a combination of drugs already approved by the Food and Drug Administration that has had some degree of success in interrupting the craving for meth so other behavioral changes can be employed. “I don’t have enough information,” he said about Prometa. “It’s a proprietary mixture. I have folks looking at that now and the studies that they claim have increased effectiveness.

“But I don’t want you to think we don’t have a sense of urgency,” Fielding said. “I wouldn’t have created this task force if I didn’t think there was a big, urgent problem. I can’t recommend a specific approach that is different from what the best advice, evidence and practice suggests, and there hasn’t been a huge amount of that so far.”

The final County meth-strategy report is due this March.