“The emergency room at Good Samaritan Hospital has been so packed with patients suffering from miserable flu symptoms the past few weeks, with incoming ambulances lined up outside and hospital rooms jammed, the staff has gone to its “Code Green” nearly every day.
“It’s all hands on deck,” said Dr. David Feldman, chairman of Good Samaritan’s Emergency Department.
Hospital CEO Joe DeSchryver has picked up a broom to sweep out emergency rooms for the stream of patients. Grace Ibe, a vice president, has wheeled patients in gurneys upstairs. And CFO Jody Dial has come in at midnight to troubleshoot and bring pizza…
At hospitals around the Bay Area and across the country, those on the front lines of what is shaping up to be the worst flu season in a decade are struggling to keep up — and wondering whether it will get worse.
Doctors and nurses are working overtime and double shifts. Some have become sick themselves, causing staff shortages when they are needed most. As one doctor put it, in emergency departments where misery is often hidden behind ubiquitous blue masks, “there’s a lot of coughing, sneezing, crying and fever.”” (B)
“Because the flu is so common, we tend to minimize its importance. Consider the contrast with how the United States responded to Ebola a few years ago. We had a handful of infections, almost none of them contracted here. One person died. Yet some states considered travel bans, and others started quarantining people.
Worldwide, just over 10,000 people died in the 2014-15 West African outbreak of Ebola: a relatively new, frighteningly contagious illness that people feared could become a global pandemic. It’s not surprising that it got a lot of attention. Yet the tens of thousands who died of influenza in the United States the same year barely made the news.”
The C.D.C. estimated that in the 2015-2016 flu season, the flu shot prevented more than five million cases of the flu, about 2.5 million medical visits and more than 70,000 hospitalizations. It was also estimated that it prevented 3,000 deaths.” (C)
“Influenza activity is widespread in all states except Hawaii (and the District of Columbia), according to the weekly flu report released Friday by the US Centers for Disease Control and Prevention.
“Flu is everywhere in the US right now,” said Dr. Dan Jernigan, director of the CDC’s influenza branch. “This is the first year we’ve had the entire continental US at the same level (of flu activity) at the same time.” It has been an early flu season that seems to be peaking now, he said, with a 5.8% increase in laboratory-confirmed cases this week over last.
There were 11,718 new laboratory-confirmed cases during the week ending January 6, bringing the season total to 60,161. These numbers do not include all people who have had the flu, as many do not see a doctor when sick.
Seven additional pediatric deaths were reported during the week ending January 6, bringing the total for the season to 20…
Different states, different responses
Alabama Gov. Kay Ivey declared a state public health emergency because of the flu on Thursday.
Scott Harris, acting state health officer at the Alabama Department of Public Health, said the influenza outbreak includes high activity throughout the state but particularly in metropolitan areas. This “crush” means some hospitals are operating over capacity, leaving some patients sitting in ERs. The public health emergency order helps health care professionals manage resources more efficiently and provides leeway so alternative care can be provided when personnel are unable to offer standard care…
Texas, which laboratory-confirmed 5,585 cases of the flu as of that date, is seeing activity levels “at the highest level — widespread — for a few weeks,” said Lara M. Anton, a press officer for the Department of State Health Services….
“There are reports of hospitals throughout the state that have needed to divert non-emergency ambulances for periods of time because of overcrowding in their ER,” Anton said. With most hospitals coming off “divert status” within the same day, the state’s hospital system has been managing the increased number of patients. The department continues to monitor the situation closely and “will step in with support when it is requested,” she said.
Texas is encouraging “anyone with symptoms to stay home and to see their health care provider, as antiviral medications may shorten the duration of their illness..” (D)
“Big-city hospitals in Texas have been overwhelmed this week by an influx of flu patients, and state health officials say influenza activity is widespread across the state.
At Parkland Memorial Hospital in Dallas, waiting rooms turned into exam areas as a medical tent was built in order to deal with the surge of patients. A Houston doctor said local hospital beds were at capacity, telling flu sufferers they might be better off staying at home. Austin’s emergency rooms have also seen an influx of flu patients.
But high emergency room volumes and filled hospital beds are “not uncommon” for this point during flu season, which runs from October to May, said Lara Anton of the Texas Department of State Health Services.
“We definitely know it’s widespread,” Anton said this week. “We have been at widespread for the past three weeks.” But she added that it’s too early in the season to know whether this year’s flu impact is extraordinary.
On Monday alone, Parkland’s emergency department had seen 930 patients — double what the hospital typically sees for people with flu symptoms by this time of year, Dr. Joseph Chang, associate chief medical officer for Parkland, told CBS11.” (E)
“A shortage of the plastic bags used to deliver fluids and medicine to sick and dehydrated patients is spurring area hospitals to find alternative delivery methods in the midst of a nasty flu season.
Hospitals in Michigan and nationwide have resorted to jury-rigging solutions and even reverting to labor-intensive methods rarely used since the advent of the IV bags that have become indispensable in modern medicine. Those alternatives have increased the workload for pharmacists and nurses, and are forcing some hospitals to beef up staffing to keep pace with the need.
The problem comes in the wake of Hurricane Maria, which devastated operations in Puerto Rico at the major manufacturing plants for the bags.
Hardest hit have been the small-volume IV bags of 100 milliliters or less that are used to infuse antibiotics, cancer medicines and other critical drugs. Prior to the shortage, the five-hospital Beaumont Health system reportedly went through about 50,000 per month. Beaumont gets its small IV bags from Baxter, the nation’s largest supplier of the mini-bags, whose manufacturing facilities in Puerto Rico were idled by the storm. Their operations are expected to be back to full production by the end of January, but experts say it will take time to replenish supplies…
The shortage has been exacerbated by the flu outbreak, which has spiked emergency room visits and hospital admissions across the country. Beaumont Health announced Friday it was imposing visitation restrictions at its hospitals due to high volumes of patients with upper respiratory infections, predominantly the flu.”..
“Some days we’re able to get saline solution, other days we can get dextrose,” he said. “We have to work very closely with our nursing staff and providers to make sure whatever changes we’re making are safe for the patients.”
Some of the alternatives implemented include using portable pumps instead to administer some medicines. Supportive medicines, like those for nausea or to calm anxiety, are given orally when possible. And nurses can hand-push medications into IV lines at the bedside as another alternative.
Communication among staff is critical to ensure patient safety, Smith emphasized. Karmanos uses its internal online communications system, tip-sheets and other methods to keep all staff informed of up-to-the-minute changes.
“Everybody has to be on the same page on what we’re doing,” Smith said. “The nurse at the bedside (needs to know) exactly what you’re doing.” (F)
“According to the numbers, this year’s flu season is in fact worse than usual. It got started early, and it’s been more severe. Twenty kids have died of the flu since October. And in the week ending January 6, 22.7 out of every 100,000 hospitalizations in the U.S. were for flu—twice the number of the previous week.
“Flu is everywhere in the U.S. right now,” Dan Jernigan, director of the Center for Disease Control and Prevention’s influenza branch, said during a Friday press briefing. “This is the first year we’ve had the entire continental U.S. be the same same color”—referring to a map of state-by-state estimate of flu activity. That color is brown, meaning the flu is “widespread” everywhere in the U.S. except for Hawaii and the District of Columbia.
Several factors have come together make this year’s flu worse for patients who get sick and for hospitals trying to treat them.
First, the virus. Fears of a bad flu season first began in the early fall, after public health officials noticed a worse-than-average flu season in the southern hemisphere. The dominant circulating strain this year is H3N2, which hits humans harder than other strains. Scientists don’t really know why, but flu seasons where H3N2 have dominated in the past have tended to be worse. STAT reporter Helen Branswell called it the “problem child of seasonal flu.”
H3N2 (red) makes up the majority of lab-confirmed cases of flu this season. (CDC)
Second, the vaccine. This year’s vaccine was only 10 percent effective against the problematic H3N2 strain in Australia…
In recent years, researchers have tried to stop relying on chicken eggs. This flu season, for the first time, the H3N2 component of one type of vaccine, Flucelvax, was made in dog cells rather than chicken eggs. However, Flucelvax is more expensive and less widely available; most people who got the vaccine this year likely got the ones grown in chicken eggs. Researchers also are pursuing a universal flu vaccine that works against all strains.” (G)
“If you experience flu-like symptoms, you should first call or visit your primary care provider, who can quickly assess your health needs. By taking this step, you can avoid potentially long wait times at your nearby emergency department.
Your physician can also determine whether you need additional care because of the severity of symptoms or other risk factors, such as age (under 2 or over 65), pregnancy, a compromised immune system, or a chronic disease such as diabetes, heart disease or neurological disorders.
Each year, millions of children get sick with the flu and thousands are hospitalized. Some kids are at higher risk of serious complications: those younger than five, and any child who has a chronic medical condition such as asthma, diabetes, or disorders of the brain or nervous system. However, even healthy children can develop complications.
The best way to protect children is a yearly, injectable flu vaccine. It is not too late to get a shot. The vaccine protects your child against flu illnesses, which can reduce visits to the doctor and missed school days, and can prevent hospitalizations.
Symptoms of the flu typically begin one to four days after exposure to the virus and, in children, last one to two weeks. In addition to the typical fever, cough, aches and fatigue, children are more likely than adults to suffer vomiting and diarrhea – which can lead to dehydration.
Call the pediatrician if your child develops a fever; starts breathing rapidly or has trouble breathing; is not drinking enough; is less responsive than normal; or has the flu, gets better, and then relapses with fever or cough.” (H)
“The C.D.C. recommends people who are hospitalized or at high risk for complications of the flu, such as older patients, pregnant women and those who are otherwise immunocompromised, take the antiviral drug oseltamivir, sold under the brand name Tamiflu, because observational data indicate it might reduce the likelihood of death.
Other researchers, including those at the Cochrane Collaboration, disagree, saying that there’s not enough evidence to support taking oseltamivir or its chemical cousin zanamivir (brand name Relenza). They question the wisdom of spending billions stockpiling them as many countries, including the United States, began doing during the swine flu scare in the mid 2000s. Indeed, the World Health Organization last year downgraded oseltamivir from its list of essential medicines. It may or may not help, depending on which study you look at.
For healthy people who get the flu, most researchers agree the data indicates oseltamivir taken within 48 hours of onset can reduce the duration by about two-thirds of a day. But at around $154 for a course of the medication, that may not be worth it, given that the side effects include nausea and vomiting.
“We wish we had better drugs that could wipe out flu,” said Angela Campbell, a medical officer with the C.D.C.’s Influenza Division. But she said oseltamivir is “what we have right now” and in outpatient situations “it’s really the clinician’s decision with the patient based on a number of factors,” including cost and effectiveness, whether it should be prescribed or not.
The C.D.C. also still recommends getting this season’s flu shot, despite its questionable prophylactic value, because it might reduce the severity of the flu should you contract it. In previous years, against strains other than H3N2, flu shots have had reported effectiveness of about 40 percent to 60 percent. (I)
“If ever there was a case where familiarity bred contempt, and that contempt represented grave danger, it is the flu. Our casual references to “cold and flu” epitomize that perilous mindset. We seemingly think of the flu, likely due to its predictably annual impositions and its long familiarity, as a nuisance on par with the common cold. In my years of patient care, this mentality has been confirmed by the frequent, popular conflation of the two conditions; patients who merely have colds routinely self-diagnose the flu…
There is a case to make, and one that has been made, that we are more vulnerable now than in 1918. The global population of humans is vastly greater; the global population of domestic animals is greater; the co-habitation of the two in much of Asia persists; and global travel means that an outbreak anywhere can be everywhere else far more expeditiously now than a century ago. That is all legitimate cause for serious concern.
There are, however, reasons to think we may be less prone to catastrophe than our early 20th century forebears. They experienced a flu pandemic during a grueling world war. While current posturing about nuclear arms and buttons on desks is far from comforting, we may hope to avoid a recurrence of that dire confluence.
There is much less abject global poverty now than in 1918. We have antiviral drugs that are at least often and partially effective against flu. The world’s population is better nourished. And, of course, we have monumental advances in medical care overall that allow for far more effective management of flu complications, such as pneumonia.
That’s all reassuring. But it is by no means a case for complacency. Nor does any resource we have defend against the pernicious corrosion of Internet conspiracy theories and anti-vaccination sentiment run amok. No, vaccines are not perfectly, unfailingly safe, and they are certainly not perfectively effective. But they need be neither to be monumentally safer than and preferable to the diseases they help prevent. That is true of influenza, as it is true of polio, and was true of smallpox. I favor natural approaches to health and medicine when they are known to work, but there is no alternative ever shown to do what vaccines do; arguments to the contrary simply abandon epidemiology for ideology…
That we were catastrophically unprepared to be “flu’d” in 1918 was a surprise for which we may blame the virus. If we are so “flu’d” again, however, then we will need to hold ourselves accountable, and suffer the shame of tragic complacency along with the inevitable cost in lives. We are forewarned; whether or not we choose to be forearmed is up to us.” (J)
“You’ve no doubt heard the saying “feed a cold; starve a fever.” However, the healing power of nourishment and energy through foods is vital when you’re battling an intestinal virus or common cold in order to boost your immunity and give your body the energy it needs to fight off whatever illness is ailing you, particularly if you’re dealing with flu symptoms for several days or weeks.
Here are eight foods that are gentle on your body yet will help you overcome the flu…
Chicken Soup. There’s obviously some truth to the “Chicken Soup for the Soul” phenomenon. Not only is a steaming hot bowl of chicken soup comforting at time when you’re not feeling you’re best—each bowl contains vitamins, nourishment, minerals, and hydration benefits that you can’t get from starving a cold.
According to research from Mount Sinai, in Miami, Florida, chicken soup has the ability to improve air flow and flush out mucus in the nasal passages thanks to the copious amount of hot, steamy liquid within. A 1998 research report entitled “Coping With Allergies and Asthma” also found that a bowl of chicken soup actually contains anti-inflammatory properties that boost the tiny hairs-like follicles (known as cilia) in your nasal passages, which filter and stop the transportation of viruses, fungus, and bacteria from entering the body and causing nasty infections.” (K)
Hospital Pandemic Influenza Planning Checklist (L)
Planning for pandemic influenza is critical for ensuring a sustainable healthcare response. The Centers for Disease Control and Prevention (CDC), with input from other Federal partners, have developed this checklist to help hospitals assess and improve their preparedness for responding to pandemic influenza. Because of differences among hospitals (e.g., characteristics of the patient population, size of the hospital/community, scope of services), each hospital will need to adapt this checklist to meet its unique needs and circumstances.1 This checklist should be used as one of several tools for evaluating current plans or in developing a comprehensive pandemic influenza plan.
Note: This blog shares general information about understanding and navigating the health care system. For specific medical advice about your own problems, issues and options talk to your personal physician.
(A) CDC quietly postpones nuclear war prep briefing to focus on the flu epidemic instead, by Ilene MacDonald, https://www.fiercehealthcare.com/healthcare/cdc-quietly-postpones-nuclear-war-prep-briefing-to-focus-flu-epidemic-instead?mkt_tok=eyJpIjoiT0RjMk56UXpZMlUwT0RnMCIsInQiOiJOSG9PSVk1XC9IZ0JuR3N3eEFwbElmSXlWZkQ0aHprVVFTbTNkVjBIVmNKUGpKcXROZDV3cTdZXC90TDFqVCt2RFBUeUFodDhsS3QwMER2bktyWmNCUU5hdno5ZndKVjdBUXBoU1l2bUhXcitjN2M1S09mbE9aWmc2d3ZaOGRYOGVoIn0%3D&mrkid=654508
(B) Flu deaths rise, patients pack Bay Area emergency rooms: ‘All hands on deck,’ doctor, by Julia Prodis Sulek, https://www.mercurynews.com/2018/01/14/flu-deaths-rise-patients-pack-bay-area-emergency-rooms-all-hands-on-deck-doctor-says/
(C) Still Not Convinced You Need a Flu Shot? First, It’s Not All About You, by Aaron E. Carroll, https://www.nytimes.com/2018/01/15/upshot/flu-shot-deaths-herd-immunity.html?_r=0
(D) Flu stomps the nation, overwhelming ERs and leaving 20 children dead, by Susan Scutti, http://www.cnn.com/2018/01/12/health/flu-surveillance-cdc/index.html
(E) Flu patients leave Texas hospitals strapped, by SYDNEY GREENE, https://www.texastribune.org/2018/01/11/flu-levels-rise-texas-officials-advise-public-be-aware/
(F) Detroit area hospitals’ IV bags drying up in flu season, by Karen Bouffard, http://www.detroitnews.com/story/life/wellness/2018/01/12/detroit-area-hospitals-iv-bags/109411668/
(G) The Perfect Storm Behind This Year’s Nasty Flu Season, by SARAH ZHANG, https://www.theatlantic.com/health/archive/2018/01/the-perfect-storm-behind-this-years-nasty-flu-season/550469/
(H) 2018 Flu Treatment, Prevention and How to Care for Others with the flu, https://www.lifespan.org/centers-services/primary-care-services/2018-flu-treatment-prevention-and-how-care-others
(I) In the Flu Battle, Hydration and Elevation May Be Your Best Weapons, by KATE MURPHY, https://www.nytimes.com/2018/01/12/well/live/flu-h3n2-virus-care-remedy.html
(J) Flu Us Twice?, by David L. Katz, https://www.huffingtonpost.com/entry/flu-us-twice_us_5a58b6f5e4b0d3efcf695772
(K) 8 Foods to Eat When Fighting the Flu, by Emily Lockhart, http://www.activebeat.co/diet-nutrition/8-foods-to-eat-when-fighting-the-flu/