It’s a flu season like none that most Americans have ever seen. The Hasbro Children’s Hospital emergency department and pediatric practice have been swamped, with record-breaking numbers of patients – 305 in the ED on Nov. 1, for example, vs. the typical 150 to 170.
The H1N1 virus, which the U.S. Centers for Disease Control & Prevention recently estimated has killed 3,900 people across the country so far, is of particular concern, and a national campaign to vaccinate children and other vulnerable populations is under way.
Dr. Nicole Alexander, an adult and pediatric infectious disease specialist at Lifespan, answered questions about H1N1, public confusion about the flu and what parents and providers can do to protect children’s health and prevent dangerous complications.
PBN: It seems like this flu season is particularly bad, and not just from H1N1. Is there a lot more severe illness going around, and how much of it is swine flu?
ALEXANDER: There are definitely an increased number of influenza-like illnesses, and a significant proportion of them are H1N1-related, but there are also other very common viruses contributing to it, so it’s a combination of both. And I think overall, influenza-like illness has increased.
PBN: How seriously are people getting sick? Are a lot going to require hospital care, or will primary-care doctors be able to handle most cases?
ALEXANDER: Actually, the majority won’t need either one of those. They’ll feel ill, have some fever and some body aches, but by maintaining hydration and staying at home, will recover fine. So the ones we see in the emergency room and get admitted to the hospital are really the tip of the iceberg in terms of what’s going on – just as in other seasons.
The ones who are coming to the emergency room, whom we are encouraging, are ones who have some type of underlying illness and have more severe symptoms, such as difficulty breathing, decreased fluid intake, or maybe some other problems that are more severe.
Nothing is always cut and dried, but the CDC Web site has excellent recommendations and guidelines that we all like to refer to and use in terms of when the next step should be taken. … But for parents, not much different from other winter seasons, it’s mostly what their gut feeling is, and what they sense is the appropriate response. If they notice their child isn’t eating, is having difficulty breathing, is having other more severe responses than usual, then those are situations when they should reach out to their physician and make decisions as to whether an emergency-room visit is appropriate.
PBN: The H1N1 virus has made this into a public-health issue, and a lot of people and institutions are being very cautious. Should people be more reluctant this year to go to work if they feel sick, or send their child to school if he has the sniffles?
ALEXANDER: The reason why this is different on a public-health level … is because it’s a new strain, and one that the majority of the population, especially children, have not been exposed to before. That’s essentially the only difference – that more people are at risk because they haven’t developed any immunity to it. Other than that, it’s basically the same, so the decision process should not be that different.
[People should] continue to follow the guidelines, that if you have a fever along with a cough or sore throat, those are the influenza-like symptoms that should require someone to stay home. Once a person is without a fever for 24 hours, and feeling better enough to return to school or to work, and they’re not requiring any fever-reducing medications, then it’s acceptable to return. Using sniffles alone, or cough alone, would not help, because that’s so naturally widespread throughout the community.
PBN: Lifespan sent out an alert recently explaining the difference between Tamiflu, the antiviral medication, and Theraflu, the cold remedy. Is there a lot of confusion among parents about medications?
ALEXANDER: I think naturally, among parents, hearing the terms Theraflu and Tamiflu led to a misunderstanding about what each of them does. I think some parents thought they were interchangeable, so we wanted to make some clarification – that Theraflu is an over-the-counter medication that does nothing to eliminate the influenza virus, but is designed to address the fever and body aches and other symptoms. … Tamiflu is a specific prescription medication that helps get rid of the virus itself. In most situations, particularly in otherwise healthy children or adults, Tamiflu is not needed, because oftentimes the virus will just take its course and go away. But it was important, particularly in populations where Tamiflu would make a difference, to clarify the difference.
PBN: How important is the H1N1 vaccine, and how else can the medical community help protect the public from this virus and especially from serious illnesses linked to it?
ALEXANDER: The vaccine is extremely important … because most people have never seen this virus before, and the vaccine is able to provide some immunity and either decrease the severity of the symptoms, or prevent the flu from occurring altogether. So even if someone has had influenza-like symptoms this year, if it has not been tested and confirmed to be swine flu – which most cases have not – they should still get the vaccine, because if they had another virus, they are still at risk of developing swine flu later this season.
[In terms of the medical community], the most important thing is what we’ve been doing already, which is to work together and really try to serve the patients and the community, decrease the fears and anxieties, and just educate people about how to best protect themselves and prevent the spread of the virus.
