From the Trenches: When Should We Worry?

\”I need to talk to you\” was the greeting I was met with this morning as I walked into the office.  There were \”a large number of flu cases in a local school\” and we need to prepare for it.  These are supposedly \”documented\” H1N1 influenza.

My nurse and I sat down and we batted around scenarios that would possibly come up.  Our expectation is that the phones will be ringing constantly today, as word of this alleged outbreak spreads through the community.  Prepare for the worst and hope for the best.

  • When do we make people come in?
  • When do we call in medication?
  • When do we call in prophylactic medication?
  • What do we do about our staff who is seeing patients?

Here are the decisions we have made thus far (based on CDC recommendations):

  • Any child under 5 and high-risk people with symptoms must come in.
  • Symptoms of \”flu-like illness\” are defined as fever (over 100.5) with sore throat and/or cough.
  • For our lower-risk patients with symptoms who has had direct contact with a confirmed case of flu, we will call in antiviral medications as long as symptoms have been there less than 48 hours.
  • For high-risk people without symptoms who have direct contact with a confirmed case of flu, we will call in prophylactic antiviral medication.
  • We will refuse medication outside of these guidelines.
  • Patients with fever and cough in the office will be asked to wear a mask we provide

Even if today\’s initial news turns out to be negative, we have been seeing a good amount of confirmed influenza cases.  This is far outside the norm for this time of year, so it is likely the H1N1 variety.  The good news is that it has been relatively mild.  The bad news is that very few people have antibodies against this and nobody has been immunized.

Panic?  No, but we do need to prepare for whatever onslaught of phone calls we face.  Our nurses bear the brunt of community fears, and we need to cover most every contingency.

We haven\’t seen any sick pigs yet.

30 thoughts on “From the Trenches: When Should We Worry?”

  1. We’ve had five cases in three working days in our office… And I’m pregnant on top of that. And all five of the kids sneezed and/or coughed on me. So far, no symptoms… Maybe it’s my super-mommy-pregnancy immune system! 😉
    But, we’re doing the similar guidelines as well…

  2. We’ve had five cases in three working days in our office… And I’m pregnant on top of that. And all five of the kids sneezed and/or coughed on me. So far, no symptoms… Maybe it’s my super-mommy-pregnancy immune system! 😉
    But, we’re doing the similar guidelines as well…

  3. First In Line for Swine-Flu Shots: * Pregnant women
    * Infants’ caregivers and contacts
    * Children ages 6 months through 24 years old
    * People up to 65 years old with medical conditions
    * Health-care workers
    * Emergency medical-services workers

    source: CDC

  4. First In Line for Swine-Flu Shots: * Pregnant women
    * Infants’ caregivers and contacts
    * Children ages 6 months through 24 years old
    * People up to 65 years old with medical conditions
    * Health-care workers
    * Emergency medical-services workers

    source: CDC

  5. We are dealing with something different in our family. MRSA. My nieces husband has it. He only had a sore on his leg but he got ill and passed out at work. They cultured, biopsied or whatever it is they do and diagnosed it as an MRSA. He had literally been around everyone in the family prior to his diagnosis. They also have a new baby that is only a few months old. Granted, I know not much about MRSA except what I have read on the med blogs but I am scared. Not for me, ( I am already old and sick so I don’t really care for myself) but my concern is for the baby.

  6. We are dealing with something different in our family. MRSA. My nieces husband has it. He only had a sore on his leg but he got ill and passed out at work. They cultured, biopsied or whatever it is they do and diagnosed it as an MRSA. He had literally been around everyone in the family prior to his diagnosis. They also have a new baby that is only a few months old. Granted, I know not much about MRSA except what I have read on the med blogs but I am scared. Not for me, ( I am already old and sick so I don’t really care for myself) but my concern is for the baby.

  7. Re: Cathy
    MRSA (oh no) is transmitted through direct and indirect physical contacts. It is usually aggressively treated in the hospital.

    Outside the hospital, sanitation and proper wound care are of essence to prevent accidental transmission. It is POSSIBLE to prevent MRSA transmission to the new born. Please contact your local physician or health professional for more information.

    http://www.mayoclinic.com/health/mrsa/DS00735

  8. Re: Cathy
    MRSA (oh no) is transmitted through direct and indirect physical contacts. It is usually aggressively treated in the hospital.

    Outside the hospital, sanitation and proper wound care are of essence to prevent accidental transmission. It is POSSIBLE to prevent MRSA transmission to the new born. Please contact your local physician or health professional for more information.

    http://www.mayoclinic.com/health/mrsa/DS00735

  9. Let’s see, hubby and I and our boys cover more than half of those guidelines. We have two children, ages 6 1/2 and 3, I’m pregnant. I’m the office manager of a pediatric clinic, and my husband is a health-care provider… firefighter/paramedic. I guess we’re good to go then!

  10. Let’s see, hubby and I and our boys cover more than half of those guidelines. We have two children, ages 6 1/2 and 3, I’m pregnant. I’m the office manager of a pediatric clinic, and my husband is a health-care provider… firefighter/paramedic. I guess we’re good to go then!

  11. In 1999, I started using daily nasal lavage—jala neti—to clean my nose and nasal passages. I haven’t had a cold in ten years, although I did have the flu in 2001, when my son graduated from college. (I forgot that 60,000 people crammed into a basketball arena was one giant germ-fest.)
    This week I am teaching my six-year-old granddaughter how to use the neti pot, before school starts.

  12. In 1999, I started using daily nasal lavage—jala neti—to clean my nose and nasal passages. I haven’t had a cold in ten years, although I did have the flu in 2001, when my son graduated from college. (I forgot that 60,000 people crammed into a basketball arena was one giant germ-fest.)
    This week I am teaching my six-year-old granddaughter how to use the neti pot, before school starts.

  13. I’m not a doctor, but concerns about H1N1 developing resistance to Tamiflu are being reported in the UK too.

  14. I’m not a doctor, but concerns about H1N1 developing resistance to Tamiflu are being reported in the UK too.

  15. Here’s the problem with the swine flu….we have been “crying wolf” for six months now and nobody is listening anymore. I’m fairly sure we have had some cases right here in my town, but they have turned out to be fairly mild and actually less disruptive than the normal flu. So, remind me what was the big deal with swine flu?….more easily transmittable, more resistant to treatment, all of the above?? I need to get refocused on exactly what the threat is?

  16. Here’s the problem with the swine flu….we have been “crying wolf” for six months now and nobody is listening anymore. I’m fairly sure we have had some cases right here in my town, but they have turned out to be fairly mild and actually less disruptive than the normal flu. So, remind me what was the big deal with swine flu?….more easily transmittable, more resistant to treatment, all of the above?? I need to get refocused on exactly what the threat is?

  17. This year’s [swine] flu is causing so much racketing because:
    * genetic study shows that it shares a lot of genetic material with more lethal H1N1s and influenza virus is known to mutate rapidly and unpredictably.
    * this year’s flue also exhibits quite a few atypical clinical and epidemiological patterns such as doesn’t always come with fever (1/3 of known cases) and showing up during wrong time of year.

    These are the medical reasons for additional vigilance during the current Round 2 this year.

    On top of that there’s the media hype and the fact “swine” being fat at and all 😀

  18. This year’s [swine] flu is causing so much racketing because:
    * genetic study shows that it shares a lot of genetic material with more lethal H1N1s and influenza virus is known to mutate rapidly and unpredictably.
    * this year’s flue also exhibits quite a few atypical clinical and epidemiological patterns such as doesn’t always come with fever (1/3 of known cases) and showing up during wrong time of year.

    These are the medical reasons for additional vigilance during the current Round 2 this year.

    On top of that there’s the media hype and the fact “swine” being fat at and all 😀

  19. What people don’t realize about H1N1, is that it is VERY treatable with medications like Tamiflu. Last season’s, Type A human flu was resistant to Tamiflu. At least you can take something with the piggy flu!

  20. What people don’t realize about H1N1, is that it is VERY treatable with medications like Tamiflu. Last season’s, Type A human flu was resistant to Tamiflu. At least you can take something with the piggy flu!

  21. H1N1 is a potential problem because most people have no immunity to it at all. Regular flu kills 30,000 per year, and a more widespread H1N1 outbreak – even if it is milder – promises to kill more than that. If it is more serious (which it still could be with the mutations of the virus being common), then the death rate could be devastating.
    So, David, I don’t think anyone is “crying wolf.” It’s more like they have called for a tornado watch. We need to be ready to react, but we hope there won’t be any tornados. It’s a shame that people think this is an over-reaction. That’s what my next 2 podcasts will talk about.

  22. H1N1 is a potential problem because most people have no immunity to it at all. Regular flu kills 30,000 per year, and a more widespread H1N1 outbreak – even if it is milder – promises to kill more than that. If it is more serious (which it still could be with the mutations of the virus being common), then the death rate could be devastating.
    So, David, I don’t think anyone is “crying wolf.” It’s more like they have called for a tornado watch. We need to be ready to react, but we hope there won’t be any tornados. It’s a shame that people think this is an over-reaction. That’s what my next 2 podcasts will talk about.

  23. I am honestly wondering if I have a case of it, that perhaps came on with allergies at the same time. I thought it was just allergies at first but my allergy armory isn’t working so well and I’ve had an at times debilitating cough from day 2 (of 4 so far) that isn’t usual with an allergy attack. Sneezing, cough (and headache for a couple of days). Didn’t take my temp but may have had one for a couple days, although probably attenuated from the nsaids and tylenol I take regularly for rheumatoid arthritis.

  24. I am honestly wondering if I have a case of it, that perhaps came on with allergies at the same time. I thought it was just allergies at first but my allergy armory isn’t working so well and I’ve had an at times debilitating cough from day 2 (of 4 so far) that isn’t usual with an allergy attack. Sneezing, cough (and headache for a couple of days). Didn’t take my temp but may have had one for a couple days, although probably attenuated from the nsaids and tylenol I take regularly for rheumatoid arthritis.

  25. Thanks Doc for this information. it did make it much more clear to me. The good news is that Nieces husband is getting better and baby has not gotten MRSA.

  26. Thanks Doc for this information. it did make it much more clear to me. The good news is that Nieces husband is getting better and baby has not gotten MRSA.

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