The Marina is San Francisco's Upper East Side, and the Safeway its singles bar -- a place that combines food with furtive-glancing yuppies in high heels, fancy suits or T-shirts moist from workouts at one of the two fitness clubs across the street. But along with broccoli and a potential date, hundreds this month have also picked up a flu shot.
The shot 'n' shop mix is not new -- in California, the Visiting Nurse Association has offered it since the early '90s -- but with this fall's round of vaccinations, nurses throughout the nation have moved beyond local pharmacies and grocery stores. In Fort Edward, N.Y., and at Target stores in Oakland, Calif., drive-through clinics were set up; in Colorado, nurses poked people at football games, and in four Atlantic City, N.J., casinos, people also received shots.
So far, the response to these campaigns has been overwhelming. The casino project brought in 1,400 people; in San Francisco, demand at many sites has jumped to three times what it was last year, said Mary Steiner, head of immunization outreach for the Visiting Nurses Association of Northern California. "People are catching on to preventive medicine," said Steiner, whose 500-person agency that distributed 108,000 shots in 1998.
Shopper Larry Darcy agreed. "In our busy times," he said, just before rolling up his sleeve for a shot at Safeway, "the more convenient you make health care, the better it is."
But in an unrelated (but unfortunate) development, that boom in interest is being joined by a national shortage, or at least delay, of supply. As of last week, the nation's four vaccine suppliers had filled only about 80 percent of their orders, causing health care providers to remain on edge. "We usually get it way in advance of our clinics," said Tom Oas, Health Services director for Arlington Heights, Ill., which had to borrow and buy doses from a local hospital and a Des Plaines pharmacist. "It's been a problem."
Making matters worse, some experts say flu season, which runs from November to April, is threatening to start early. Because the shot doesn't takes effect for a week or two after injection, the recommended time for shots is right now.
Steiner said San Francisco has plenty of vaccine, and public health officers in other cities and towns have yet to report major problems. But several cities -- San Antonio and Chicago, for example -- have been forced to scale back vaccination efforts, with potentially grave consequences. It's easy to dismiss the flu as simply an excuse for a day off from work, but each year 20,000 people in the United States die from it, while more than 200,000 are hospitalized, costing the health care system about $12 billion, according to the Mayo Clinic in Minnesota.
All that from a little virus that migrates like a bird each year from Alaska, bringing with it the high fevers and headaches that differentiate it from the common cold. In 1918, influenza killed 500,000, including some young-and-healthies, but now people over 50 and those with long-term illnesses such as diabetes suffer the greatest risk.
Still, the Centers for Disease Control and Prevention recommends that everyone get a shot. Currently, three different influenza strains circulate worldwide, creating the same miserable symptoms but mutating yearly. The vaccine contains viruses representing each strain. Efficacy rates, however, vary. For those in the high-risk group, a flu shot decreases the chance of getting sick by 30 to 50 percent. Healthy people win a 90 percent reduction of risk.
Shelley Arnold, who handles the San Francisco Department of Health's immunization program, questioned whether the VNA outreach was getting to people who really needed the shot: "You're not going to see people with liver disease in buying groceries," she said. But Steiner stressed that because the virus is spread through contact, reducing the number of total cases helps even the most vulnerable. Plus, she said, the public's response shows a shift toward prevention, one that may not have been possible if health care providers hadn't moved out of their offices and hospitals.
"Bringing it to the streets is probably one of the best developments going on in health care," she said, noting that cholesterol screenings could be the next thing available at the Marina Safeway and elsewhere.
But Tracy McArdle, the health officer of Atlantic County, N.J., said making your grocery store -- or casino -- a makeshift hospital would not be a good idea.
"These promotions also need to encourage people to maintain a relationship with their doctor," she said. "A flu shot is something we do to support the efforts of the private sector, not to replace it."
Still, a creative Marina Safeway shopper might prefer to have a nurse in the store, if only as an excuse for conversation. In Atlantic City, people have said they would work off the shot's soreness with a few pulls of the slot machine. Gretchen Dryden, a teacher who usually shops elsewhere, said the Marina Safeway crowd could probably come up with an exercise of their own.
"Depending on the clientele ... I'm sure they'd come up with something," she said.