Beware the Flu, Part Three

Flu season is in full, deadly swing in the U.S., with terrible stories popping up; like this 6-year-old child who died soon after paramedics told her parents that trouble breathing was a common symptom of the flu and to keep her hydrated. Her parents also want people to know that their daughter did not receive a flu vaccine and they are encouraging children to be vaccinated. While this year’s flu vaccine is not a perfect match, it can still reduce the severity of the symptoms.

The flu is so rampant it led to a misdiagnosis for this woman, who actually has necrotizing fasciitis, a flesh eating bacterial infection. The woman is expected to survive, but doctors had to remove 30% of the skin on the left side of her body.

Hospitals in California have had to set up giant medical tents intended for major disasters to handle the influx of patients.

“It’s like trying to surf a tsunami,” said Dr. Brian Johnston, an emergency medicine doctor at White Memorial Medical Center in Boyle Heights. “Maybe the wave has crested, one hopes.”

Another complication to this year’s flu is that many of the IV saline bags used to treat flu patients are made in Puerto Rico, which is still recovering from Hurricane Maria. Hospitals have resorted to two other methods: the “IV push” in which a nurse directly injects the drugs into an IV line (time consuming), and using “an old-fashioned system known as a buretrol device”, also time consuming because many younger nurses need to be trained in this outdated method.

There are only a handful of manufacturers in the US, and one of them – Baxter International – has all of its mini-bag factories in Puerto Rico…Though the federal government has worked with Baxter to get the plants back online, and to allow it to import IV fluids from abroad, serious shortages persist.

Earlier:
Beware the Flu
Beware the Flu, Part Two

Beware the Flu, Part Two

The flu this year is so bad the CDC is postponing their much anticipated How to Prepare for Nuclear War training. I suppose it’s comforting the CDC considers the flu a more pressing threat than the potential for nuclear war. On the other hand, the NY Times reports that “Even in the absence of a pandemic, a severe flu year kills nearly 650,000 people worldwide, while a mild one kills just under 300,000…In recent years, the C.D.C. estimates, flu has killed about 12,000 Americans in mild years and 56,000 in moderately severe ones.” Sure, those numbers don’t compare to those predicted to be killed in a nuclear attack, but that’s a different article.

Emergency rooms all over the country have struggled to keep up with incoming patients, some of them even having to turn patients away. Though the flu shot this year is estimated to be about 30% effective, it’s still very much worth getting:

It’s not too late to get a flu vaccine, the CDC said, and there should still be plenty of vaccine supply. Sometimes there are second and even third waves of flu, so a state that’s been hit hard by H3N2 might see a fresh wave of H1N1 flu later and then influenza B may pass through even later.

In addition to the flu shot and perhaps somewhat compulsive hand-washing, I’d like to offer my other personal recommendations of more citrus, and more fresh air.

 

Kids Dying of Swine Flu at Alarming Rate

Sobering news indeed.

The Boston Globe reports that “of the 86 children who have died since the new swine flu arose last spring, 43 deaths have been reported in September and early October alone, the Centers for Disease Control and Prevention reported. That’s a startling number because in some past winters, the CDC has counted 40 or 50 child deaths for the entire flu season — and no one knows how long this swine flu outbreak will last.”

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Severe Respiratory Failure

I had a mild heart-stopping moment just now when I was reviewing the WHO’s update on H1N1, published today on their web site, which hints at the real possibility of impending doom:

Severe respiratory failure

Perhaps most significantly, clinicians from around the world are reporting a very severe form of disease, also in young and otherwise healthy people, which is rarely seen during seasonal influenza infections. In these patients, the virus directly infects the lung, causing severe respiratory failure. Saving these lives depends on highly specialized and demanding care in intensive care units, usually with long and costly stays.

During the winter season in the southern hemisphere, several countries have viewed the need for intensive care as the greatest burden on health services. Some cities in these countries report that nearly 15 percent of hospitalized cases have required intensive care.

Preparedness measures need to anticipate this increased demand on intensive care units, which could be overwhelmed by a sudden surge in the number of severe cases.

Vulnerable groups

An increased risk during pregnancy is now consistently well-documented across countries. This risk takes on added significance for a virus, like this one, that preferentially infects younger people.

Data continue to show that certain medical conditions increase the risk of severe and fatal illness. These include respiratory disease, notably asthma, cardiovascular disease, diabetes and immunosuppression.

When anticipating the impact of the pandemic as more people become infected, health officials need to be aware that many of these predisposing conditions have become much more widespread in recent decades, thus increasing the pool of vulnerable people.

Obesity, which is frequently present in severe and fatal cases, is now a global epidemic. WHO estimates that, worldwide, more than 230 million people suffer from asthma, and more than 220 million people have diabetes.

Moreover, conditions such as asthma and diabetes are not usually considered killer diseases, especially in children and young adults. Young deaths from such conditions, precipitated by infection with the H1N1 virus, can be another dimension of the pandemic’s impact.

Higher risk of hospitalization and death

Several early studies show a higher risk of hospitalization and death among certain subgroups, including minority groups and indigenous populations. In some studies, the risk in these groups is four to five times higher than in the general population.

Although the reasons are not fully understood, possible explanations include lower standards of living and poor overall health status, including a high prevalence of conditions such as asthma, diabetes and hypertension.

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Looming Swine

A new round of the swine flu, which has been exploding in the Southern Hemisphere, could be making its way to the Northern Hemisphere in a matter of weeks.  There will be deaths,  but there are always deaths as a result of the flu.  As Marc Lipsitch, a professor of epidemiology at the Harvard School of Public Health who has been helping the CDC project the severity of the upcoming wave noted, “It’s fair to say there will be tens of millions of illnesses and hundreds of thousands of hospitalizations, and tens of thousands of deaths. That’s not atypical. It just depends on how many tens of thousands.”

The Washington Post provides a good summary, noting that:

Perhaps more important, in every country where the virus has spread, it has continued to affect children and young adults much more commonly than typical flu viruses.

“In a pandemic where a greater fraction of illness and deaths occur in kids and young adults, that will be clearly noticeable to the public. There will be a sense that this is a greater severity of illness even if fewer people die overall,” the CDC’s Bresee said.

Most of those who have developed serious illness and died have had other health problems. But those include many common conditions, such as diabetes, asthma and obesity. Pregnant women appear to be especially at risk. And the virus can cause severe illness and death in otherwise healthy people in perhaps a third of cases.

In the Southern Hemisphere, the virus has been more intense in some places, including those with few resources.  Countries with fragile health care like India and South Africa could be quickly overwhelmed if the swine flu starts infected a large number of people.

I guess we will have to wait and see.  Preferably with suspenseful music in the background.

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