Friday, October 23, 2009

Avoidable deaths

The swine flu may be mild in some people, but in many it is much worse that regular flu. In a number of people, the virus almost immediately attacks the lung tissue. People with underlying conditions such as asthma become severely ill and often need hospitalization to survive. People particularly at risk include those with chronic respiratory problems, including asthma, COPD, and cystic fibrosis. It also includes minorities, pregnant women, people with high blood pressure, and the morbidly obese.

Both my husband and I had what we believe to have been swine flu. Last month, he came home from school with an extremely runny nose and scratchy throat. By the next day, he had overwhelming fatigue and body aches. He ran a slight fever on the third day, but never much of one. I very suddenly came down with it on the fourth evening after my husband came home sick. (Earlier in the afternoon I had actually taken note of how unusually good I was feeling that day.) Once again the symptoms were a very runny nose (a waterfall), scratchy throat, and severe fatigue. Within 24 hours I was extremely short-winded and having to use my asthma rescue inhaler more than ever before. Because I was having so much trouble breathing, we went in to see the doctor – who after hearing my deep cough and listening to my lungs, did a chest x-ray and found me to have ACUTE PNEUMONIA. I had thought it was just really bad asthma – although a danger in and of itself. She said that if I had waited another day to see her, she would have had to put me in the hospital.

It is pneumonia that kills those who die from swine flu, not the flu itself.

It took two rounds – 28 days – of antibiotics to knock out the pneumonia. It took about that long to get over the fatigue. The fatigue was overwhelming – worse than the fatigue I get with my fibromyalgia. I was too tired to do anything – even watching television was too taxing, so I slept a lot. My husband was so worried about me that he did something he never does: he stayed home with me for several days. He wanted to be sure that I was out of danger. It’s now six weeks since I caught that bug, but I am still run down from having had it. And I am one of the lucky ones because I didn’t die. If I had not seen my doctor when I did, and stubbornly tried to control the breathing problem with my asthma meds, I could have died within just a few days.

That’s scary.

What I'm most alarmed about – and the reason for this blog entry – is my fear that current criteria for diagnosing H1N1 will miss significant numbers of infected and contagious people, thus contributing to rapid spread of the illness in the population. Namely, unlike other types of flu, a person can have flu and be walking around with no fever – thinking they only have a cold.

Public health authorities have known since April that a significant number of people – at least 30% – infected with H1N1 have NO FEVER.

The New York Times says, “The standard definition of influenza includes a fever.1 Yet an odd feature of the new virus is the lack of fever in a significant proportion of documented cases, even after some patients become seriously ill. In Chile, it was about half, in Mexico City about a third, according to Dr. Wenzel. Lack of fever has been noted by other observers in several Canadian and U.S. cases, too.

When fever is used as a primary screening measure, significant numbers of people will not be diagnosed and will therefore continue to spread swine flu germs in the general population. Yet, the USA Center for Disease Control has not revised its criteria for clinical evaluation. My understanding is that it is being left to individual school districts to create their own policies. At the present time, in our school district, screening for flu still includes fever as a criterion, even though the evidence shows this will result in a false negative assessment somewhere between 12% and 50% of the time!! If this is correct, it means that significant numbers of H1N1 cases will not be properly diagnosed.

Also, the rapid test that doctors use in their office for regular flu will not show up as having flu over half the time if you have H1N1. A study looking at the effectiveness of a rapid flu test in the first few weeks of the H1N1 pandemic in May found it detected less than half of the cases later confirmed by more sophisticated tests. In September, the CDC said doctors should not wait for laboratory confirmation of H1N1 because quick treatment is important, and because a negative rapid test does not rule out the flu. 2

Our doctor used the regular flu rapid test on both of us – with negative results. But they had to try twice to get a sample from me because I had taken an antihistamine which dried me out. My husband was basically over the flu and, of course, came up negative. So, because the tests results were negative and because we had no fever, the doctor decided that we did not have flu. I love my doctor – she is wonderful – but I think she missed this diagnosis completely. We are both convinced that we had swine flu. This infection was unlike any other we had ever experienced. And my very rapid decline into acute pneumonia was a huge red flag for swine flu. I have an underlying condition – asthma – so this virus went deep into my lung tissue very quickly!

Federal officials recently said that the number of children who have died from swine flu has jumped sharply as the virus continues to spread widely around the United States, striking mostly youngsters, teenagers, young adults, and pregnant women. While most of the children who have died had underlying health problems such as asthma, muscular dystrophy and cerebral palsy that made them particularly vulnerable, 20 to 30 percent were otherwise healthy. Between 46 and 88 children die every year from the seasonal flu, so the fact that more than that have already died from swine flu is disturbing. It is only October.

Because of the potentially deadly side of H1N1, the consequences of leaving a contagious student (without a fever) in the general school population can be very serious. Since older members of the population seem to have some residual resistance due to swine flu epidemics in the 1950's and 1960's, it is the school children who are one of the groups most at risk for swine flu. If children are not screened, diagnosed, and contagious students excluded from school, the virus will continue to spread like wildfire causing many unnecessary deaths before a protective vaccine arrives.