Opinion: Putting the Swine Flu in Perspective

by Dr. Frank James, San Juan County Health Official

Three or four times each century a new flu bug shows up in the human population and spreads quickly from person to person worldwide. Sometimes these are mild diseases but sometimes they are severe. Over time, people develop resistance to the severity of infection and these new bugs that spread worldwide become the new seasonal flu. The current ‘seasonal’ flu strains each started out as a ‘pandemic’ strain.  Every year in the winter the ‘seasonal’ flu goes from community to community and while most are simply ill for a week or so the very old, very young and those with compromised health can become seriously ill, even die. The seasonal flu hospitalizes about 200,000 people in the US and kills about 35,000 each winter.

The flu that appears to have started in Mexico is one of the new strains that will travel around the globe and perhaps establish itself as one of the seasonal strains. But for this year it is the new kid on the block that humans have no immunity to, so it will spread quickly. We do not yet know for sure how severe it will be but early indications are that it is significantly less severe than the pandemic strains of 1918, 1957 and 1968.  But it is still too early to really know for sure. Typically the second wave of disease, that could happen this summer in the southern hemisphere and next fall and winter in the US, is more severe than the first wave, often many more people get the infections in the second wave and sometimes it mixes with other flu strains and can be more severe, or less severe than it was in the past.

We do know some things about this bug. It infects young people more than older adults. 65% of cases in the US are in people less than 18 years old. The data from Mexico show the highest number of cases in those below 10 and fewer cases in each age group, as they get older with few cases over 50 years old. This would lead us to believe that there is some resistance in those over 30 or 40 due to either having been exposed to a similar bug in the past or perhaps even some of the vaccines that they have received. In the US there have not been many hospitalizations out of about 900 cases there have been about 40 hospitalizations mostly for moderate disease and again mostly in young people.

What can we expect in the future?

There will be significant changes in both testing for the disease and treatment that will be a challenge for the public to understand. In the very near future the state and federal authorities will recommend that we not test for the disease at the state and federal level unless it is in a high risk person for complications or for someone very ill, ill enough to be hospitalized. The testing that can now be done in a doctors office, the ‘quick’ test will tell only that the person has flu, some time if it is type ‘A’ or type ‘B” but there is no locally available test  in the community to detect this particular type of influenza. Physicians will be asked to use the quick test if they have it and to base there care on what they believe the patient has without the confirming tests that have been used up until now. The good news is that we have very good clinicians who are most often able to do just that with reasonable accuracy. The reason they will stop testing, for the most part, is that the capacity of the state lab to run these test is about 30 a day, 70 if they work people on two shifts. These are complex tests that require specially trained staff and there simply is not enough capacity to continue with testing of all suspect cases.

The other change will be that treatment will be reserved for those who are at increased risk of death from the flu ( the very young, elders and those who already have medical situations that hamper their immune response.  Others may become ill and will be told simply to stay home and get rest, stay well hydrated and only go to the doctor if you have difficulty breathing or are worsening over time. This kind of advice is always a double-edged sword. We do need to keep those who have minimal illness away from others and out of the doctor’s offices (they are the last people we need sick). But knowing when you are so sick that you have to go to the doctor is sometimes a tough call.

Here is the best advice we have:

In children emergency warning signs that need urgent medical attention include:

– Fast breathing or trouble breathing
— Bluish or gray skin color
— Not drinking enough fluids
— Severe or persistent vomiting
— Not waking up or not interacting
— Being so irritable that the child does not want to be held
— Flu-like symptoms improve but then return with fever and worse cough

In adults, emergency warning signs that need urgent medical attention include:

— Difficulty breathing or shortness of breath
— Pain or pressure in the chest or abdomen
— Sudden dizziness
— Confusion
— Severe or persistent vomiting
— Flu-like symptoms improve but then return with fever and worse cough

My final advice is still the same as when this started. Cover your cough, wash your hands and stay home if you are sick. If you do go to the doctor, call first.