“Think hospitals are under a strain now, from a slightly bad flu season? Wait until a really bad one hits.”

“In a press briefing on Friday, Dr. Dan Jernigan — director of the influenza division in the CDC’s National Center for Immunization and Respiratory Diseases — confirmed that the outbreak can legitimately be called an epidemic. “We have very specific criteria where we can say the epidemic is beginning and ending based on when flu activity goes above a certain baseline. So we’ve clearly passed that baseline back in November and we’re at the peak of it now,” he said.” (A)

Weekly US Map: Influenza Summary Update – highlight and click on
https://www.cdc.gov/flu/weekly/usmap.htm

During week 1 (December 31, 2017-January 6, 2018), influenza activity increased in the United States.
Geographic Spread of Influenza: The geographic spread of influenza in 49 states was reported as widespread; Guam and one state reported regional activity; the District of Columbia reported local activity; the U.S. Virgin Islands reported sporadic activity; and Puerto Rico did not report. (B)

“Think hospitals are under a strain now, from a slightly bad flu season? Wait until a really bad one hits.
Experts agree the U.S. is not ready for a bad epidemic, or even for some other disaster that would affect hospital supplies. And funding cuts mean even a little strain has a bigger impact than in years past…
“Each year, the healthcare system gets a thinner and thinner veneer of preparedness,” said Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
“It takes less and less impact for a healthcare system to go from routine to crisis.”..
Yet, every year, school systems and hospitals get caught short. There are spot shortages of drugs that fight flu such as Tamiflu and for the past three years, there’s been a shortage of certain preparations of saline solution — a hospital staple.
This year, the saline shortage has been made even worse by Hurricane Maria’s devastation in Puerto Rico, the U.S. territory where 40 percent of the saline supply is made…
Infectious disease experts have been urging the U.S. government to do more to keep the country prepared for outbreaks of diseases such as a new strain of flu, Ebola and severe acute respiratory syndrome, or SARS…
Influenza specialists say repeatedly that the chance of a new flu pandemic is 100 percent. Flu mutates constantly, and a major new strain emerges about every 20 years. The last one was H1N1 “swine” flu in 2009, which was fairly mild, but worse epidemics are probable.
No country can be ready without having stockpiles of drugs, vaccines and equipment, plans for deploying them and someone with the authority to make fast decisions…
Last year’s budget provides just $57 million for influenza pandemic planning.
“I think it is in part a sense that until it’s a downright crisis, everybody assumes everything is OK,” Osterholm said. “ (C)

“The huge numbers of sick people are also straining hospital staff who are confronting what could become California’s worst flu season in a decade.
Hospitals across the state are sending away ambulances, flying in nurses from out of state and not letting children visit their loved ones for fear they’ll spread the flu. Others are canceling surgeries and erecting tents in their parking lots so they can triage the hordes of flu patients…
Connie Cunningham and her staff at Loma Linda University Medical Center were triaging so many flu patients after New Year’s that they assembled what looks like a giant, brown camping tent in their emergency room parking lot. Several hospitals in California are treating flu patients in so-called “surge tents” intended for major disasters.
So many people are showing up sick with the flu that Loma Linda hospital put up this giant tent to treat patients in.
On a recent weekday morning, Cunningham walked through the tent, lined with folding chairs and patient beds that are separated by sheets hung from the ceiling.
Cunningham, executive director for the hospital’s emergency services, said she’d thought they would dismantle the tent after a few days, but staff are still treating 60 more patients each day than usual, she said.
“In my career, I’ve never seen anything like this,” she said…
Many hospitals also say they’re too full to accept any more patients or ambulances.
And when paramedics are allowed to drop off patients at a hospital, the emergency room is often so crowded that there aren’t available staff members to transfer care to. So the emergency responders can’t get back on the road to answer incoming 911 calls, said Kay Fruhwirth, L.A. County’s assistant director of emergency medical services.
“If there’s not a nurse available, and/or a bed — it’s usually an ‘and’ — they’re waiting there with the patient,” she said. (D)

“Still, the fact remains that every single year there is a flu epidemic. The principle behind these perennial epidemics is “persistence through plasticity,” said Dan Jernigan, MD, MPH, the director of the CDC’s Influenza Division. To put it simply, the influenza virus is always mutating to get around the vaccine and people’s natural immunities. “These constant changes do allow for adaptation,” he said. This adaptation makes it really hard to match a virus to the flu strain that’s circulating.
So with H3N2 as the major flu strain getting people sick this season, it’s possible you’ll get sick. And if you do, it’s likely you’ll receive antiviral drugs. The CDC recommends drugs belonging to the class called neuraminidase inhibitors, which block the enzyme that the influenza virus needs to reproduce. Clinical trials have shown that neuraminidase inhibitors are effective against both influenza A and influenza B, unlike the older M2 inhibitors. This is good for flu patients because you could still come down with one of the other common flu strains.
Here’s the thing, though: There haven’t been any double-blind placebo-controlled trials of these antiviral drugs on influenza cases, says Alicia Fry, MD, MPH, the chief of the CDC Influenza Division’s Epidemiology and Prevention Branch. They do show some significant positive results, though. According to Fry, early treatment with antiviral drugs does improve outcomes — something that can be seen even without placebo trials. It reduces mortality in adults, it reduces the severity of the illness in children, and it reduces the duration of sickness. (E)

“The most optimistic assumption among government experts is that the season peaked a few weeks ago, marking the apex of what was already an early and severe outbreak. However, such an outlook requires observers to ignore that outpatient doctor visits have continued to climb (albeit more slowly) in the first week of 2018, yielding the most flu cases ever for this time of the year.
Even if the hopeful assessment by the U.S. Centers for Disease Control and Prevention bears out, there will still be another 11 weeks to 13 weeks of flu circulating across the country. “In general, we see things peaking right about now, but that means there is still a whole lot more flu to go,” Jernigan said. “In addition, there are other strains of influenza still to show up that could be a major cause of disease.”
That may already be happening. The CDC is starting to see infections caused by the H1N1 strain of the virus in states grappling with high levels of the H3N2 strain, the predominant version this season. In addition, Jernigan said yet another type of flu, caused by the influenza B viruses, is still expected to show up later in the season.
H3N2 has compounded the damage usually wrought by the annual flu outbreak. It’s known for both its severity and ability to evade the protection provided by vaccinations that are typically more effective against the other types of flu…
The CDC’s latest method to categorize the severity of a flu outbreak, which takes into account indicators including hospitalizations, outpatient visits and deaths across an entire outbreak, already places the current season in the top three. During the 2014-2015 flu season, there were more than 700,000 hospitalizations. The current outbreak is matching the beginning of that period, though it’s unclear what the remainder of the season will look like, Jernigan said. Last year’s entire season saw more than 600,000 hospitalizations.
“You didn’t have this all-at-once phenomena that we’re getting now, where hospitals are having lots of cases all at once all across the U.S.,” he said. Jernigan was forthright about the agency’s inability to accurately predict the intensity of the influenza season.
“We are always expecting there to be an unusual season,” he said. “We are rather humbled by this virus. We are always preparing for a severe season and welcome a less severe season, but it’s difficult to predict what will happen.” (F)

“A modeling program called FluSurge developed by the Centers for Disease Control and Prevention to help hospitals plan generates some pretty sobering scenarios, he noted. In a bad pandemic, hospitals might have four times more people in need of a ventilator than they have ventilators, and far too few intensive care beds for the seriously ill.
“So there would be a big mismatch between demand for care, lifesaving care, and the ability to provide it,” Inglesby said. “We would have a huge problem in this country.”
The problem with influenza relates to the way it attacks, sickening large numbers of people in a relatively short period of time.
A hospital can plan for how much cancer care it will need to deliver based on the size of the nearby population and estimates of rates of various cancers. Affected people will seek care over the course of any given year.
But with flu, most of the severe illness happens in the space of a few weeks in any one location. The pressure that puts on a health system is exacerbated by the fact that some of the people needed to care for the sick fall ill themselves.
Getting help from elsewhere — as a community will often do in the case of a major medical disaster — isn’t really an option during flu epidemics, because other places are either dealing with their own or steeling themselves for a wave that’s about to hit. In the first week of this month, the entire continental United States was reporting widespread flu activity…
But the inability to predict the intervals between flu pandemics makes it easy for officials to shift preparedness efforts into the “should do” instead of the “must do” column.
There were nearly 40 years between the 1918 and 1957 pandemics; then the 1968 pandemic hit 11 years later. And then there was a 41-year interval before 2009. There is virtually no way to tell when the next will occur.
If anyone knew for sure that the next pandemic was coming soon, then society would begin planning aggressively, Inglesby said. “But since we have uncertainty about the timing and severity of the next pandemic, we’re kind of in this relatively modest national effort to prepare hospitals, which is doing what it can with the resources available.” “ (G)

“A company making “smart thermometers” that upload body temperatures to its website claims to be tracking this year’s flu season faster and in greater geographic detail than public health authorities can.
This year’s flu season — which the Centers for Disease Control and Prevention considers “moderately severe” — has left Missouri and Iowa the “sickest states in the country,” said Inder Singh, the founder of Kinsahealth.com.
California has had its worst outbreak in five years, with nearly 1 percent of the state exhibiting flu symptoms on Jan. 2, he added. By contrast, New York, New England and the Southeast have had relatively mild seasons so far, but cases are rising and should peak in two weeks.
Mr. Singh’s data paints a different picture from that of the C.D.C., which held a news conference Friday to announce that flu activity was “widespread” across the continental United States, which is unusual. (Hawaii’s outbreak is smaller, the agency said.)…
The C.D.C. data comes from hospitals and clinics that report how many cases of “influenza-like illness” they treat. Delays can result if clinic statisticians are busy or if state health departments do not pass on the figures quickly.
Kinsa, by contrast, is able almost instantly to spot fever spikes in states — or even in cities and neighborhoods. More than 500,000 households now own its smartphone-connected oral and ear thermometers, Mr. Singh said, and the company gets about 25,000 readings each day.
(Of course, the company cannot measure hospitalizations, deaths, or which strains of flu are circulating, or consistently distinguish flu from other febrile illnesses.)
Kinsa’s technology was approved by the Food and Drug Administration in 2014 and gathered data in subsequent flu seasons; the company hopes to soon publish a study by outside experts assessing its accuracy in measuring the seasonal spread.
Those experts, Mr. Singh said, found the data to be more accurate than Google’s Flu Trends, which Google shut down three years ago after it missed the peak of the 2013-2014 season.
Google tracked internet searches for terms like “flu,” “fever” and so on, but could be misled by, for example, searches triggered by news coverage.” (H)

“One of the best defenses against the flu starts with tissue and hankerchiefs, two Northwest Indiana health professionals say.
For tissues, don’t use them twice. For hankies, don’t use them at all.
Donna E. Ricard, nurse practitioner with Franciscan Senior Health & Wellness at the Dyer Medical Pavilion, and Laura Matthys, manager at Franciscan Senior Health & Wellness, are emphatic about maintaining good hygiene to avoid spread of the virus. That means washing hands, using hand sanitizer, covering the cough and tossing tissues in the trash.
Some seniors need to break their habit of keeping tissues in their sleeves, according to Matthys. Matthys and Ricard both highly recommend everyone use a tissue once and throw it in the trash.
“And no hankies!” scolds Matthys. She’s not joking. Matthys recognizes there is a generation of men and women who still carry handkerchiefs in their purses and pockets.
Though many seniors have made it a lifelong habit to use a hanky instead of tissue, they may not realize how unsanitary it is — especially if they lend them to a friend, the health professionals said….
As the Indiana Department of Health reports widespread influenza-like illnesses, healthcare providers urge everyone to get a flu shot, be fastidious about washing their hands, covering their mouths when they cough and — as Ricard and Matthys said — remembering to throw away used tissues.” (I)

“In 2015, during an interview on the former Opie & Jim Norton radio show, Trump was asked if he gets the flu shot every year, and said no:
“I’ve never had one… Thus far I’ve never had the flu. I don’t like the idea of injecting bad stuff into [my] body, which is basically what they do…I’ve never had a flu shot, and I’ve never had the flu…I have friends that religiously get the flu shot and then they get the flu… I’ve seen a lot of reports that the last flu shot is virtually totally ineffective.”
He also said: “I’ve passed on it, but that doesn’t mean [other] people should.” “ (J)

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) Watch how the flu became an epidemic, by SUSAN STEADE, https://www.mercurynews.com/2018/01/16/watch-how-the-flu-became-an-epidemic/
(B) 2017-2018 Influenza Season Week 1 ending January 6, 2018, https://www.cdc.gov/flu/weekly/index.htm
(C) Flu stresses hospitals, shows we’re not ready for emergencies, by MAGGIE FOX, https://www.nbcnews.com/health/health-news/flu-stresses-hospitals-shows-we-re-not-ready-emergencies-n838086
(D) California hospitals face a ‘war zone’ of flu patients — and are setting up tents to treat them, by Soumya Karlamangla, http://www.latimes.com/local/lanow/la-me-ln-flu-demand-20180116-htmlstory.html
(E) A Monster of a Flu Season Has the CDC Hunkering Down on Strategies, by Peter Hess, https://www.inverse.com/article/40232-glu-tamiflu-antivirals-h3n2-cdc-recommendations
(F) Why the Deadly 2018 Flu Season Could Get Even Worse , https://www.msn.com/en-us/health/medical/why-the-deadly-2018-flu-season-could-get-even-worse/ar-AAuLvdq?li=BBmkt5R&ocid=spartandhp
(G) A severe flu season is stretching hospitals thin. That is a very bad omen, By HELEN BRANSWELL, https://www.statnews.com/2018/01/15/flu-hospital-pandemics/?utm_source=STAT+Newsletters&utm_campaign=6a8b566307-On_Call&utm_medium=email&utm_term=0_8cab1d7961-6a8b566307-150519373
(H) ‘Smart Thermometers’ Track Flu Season in Real Time, by DONALD G. McNEIL Jr. , https://www.nytimes.com/2018/01/16/health/smart-thermometers-flu.html
(I) Don’t want to get the flu? Stop using hankies, experts say, by Nancy Coltun Webster, https://www.mercurynews.com/2018/01/16/watch-how-the-flu-became-an-epidemic/
(J) Did President Donald Trump Get the Flu Shot?, by ALEXANDRA SIFFERLIN, http://time.com/5093600/president-trump-flu-shot/

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