MMS Physician Focus: November 2009
By Bruce Auerbach, M.D.
This year's two flu strains -- H1N1 or swine flu, now widespread
in 48 states, and seasonal flu, yet to arrive but on its way -- are
putting added pressure on health care providers. Hospital ERs are
seeing more patients, and visits and calls to physicians' offices,
particularly pediatricians, have been rising dramatically. The
scarce supply of vaccine, for both strains, has heightened anxiety,
as patients experience confusion and irritation with the inability
to get what seemingly should be a simple preventive measure: a flu
shot.
While more vaccine may ease the frustration of patients and
physicians, emergency departments are likely to continue to see
more visitors, as swine flu spreads and seasonal flu takes
hold.
For most people, a case of the flu - either swine or seasonal -
will not require emergency treatment or antiviral drugs. But both
H1N1 and seasonal flu can cause fatal complications and should be
regarded as serious medical conditions. According to the Centers
for Disease Control (CDC), swine flu has already claimed some 4,000
American lives, including pregnant women and nearly 550 children.
Seasonal flu typically affects 5 to 20 percent of the population
and accounts for some 36,000 deaths and 200,000 hospitalizations
annually.
People should not feel discouraged from going to the emergency
department when they feel it's needed - it's the 'safety net' of
our health care system, open around the clock and ready to care for
all who come. But exercising good judgment is critically important,
especially during flu season, so that emergency physicians and
nurses can first treat those who truly need 'emergent'
care.
Here are some thoughts on how to decide if you should go to the
emergency department.
Know if you're at high risk Those at high risk
for developing flu-related complications are children younger than
5, especially those under 2; adults 65 years and older; and
pregnant women. People with chronic conditions like asthma,
diabetes, heart or lung disease, kidney or liver or blood
disorders, or weakened immune systems are also at high risk. Most
flu-related fatalities - for both H1N1 and seasonal flu -- have
occurred in people with underlying medical conditions.
Evaluate your condition. The flu involves some
or all of the following: fever, cough, runny nose, sore throat,
headache or body aches, chills, or diarrhea or vomiting. If you
think you have the flu, first contact your physician for advice.
You should stay home and avoid contact with others except to get
medical care. Most people with the swine flu have had mild symptoms
and have not required emergency care or antiviral drugs.
When you should go. If you're at high risk or
healthy with those symptoms along with emergency warning
signs -- trouble breathing, chest or stomach pain, skin
discoloration, dehydration, or dizziness -- get to the ER. When you
go, remember two things. First, know exactly where the nearest one
is; some may have closed or moved. And second, plan how to get
there. If you think you'll be admitted to the hospital, don't drive
yourself. Severe pain or dizziness may overcome you on the way,
endangering yourself and others. Get someone to take you.
The best safeguard in fighting flu is vaccination, so get
vaccinated if you're eligible. (Check to see which type - shot or
nasal spray - is right for you.) Clinical studies and monitoring by
Federal health officials indicate the H1N1 vaccine is safe and
effective. It's been made using the same methods as the seasonal
flu vaccine, also safe and effective. Habits are important, too.
Practice good hygiene by frequent hand washing or using hand
sanitizers; control coughing or sneezing; don't share items like
drinking cups, glasses, or straws; and frequently clean surfaces
like doorknobs and countertops that can attract germs. If you get
sick, stay home so you won't infect others.
Flu information -- priority groups for vaccination, vaccine
supplies, and flu clinic schedules -- is widely available and
updated frequently. Among the best places are www.flu.gov (in multiple languages),
Mass. Department of Public Health at www.mass.gov/dph, and the
Massachusetts Medical Society. For more
information on when to seek emergency treatment, read "What to do
if you get sick: 2009 H1N1 and Seasonal Flu," at www.cdc.gov.
Bruce Auerbach, M.D., is a past president of the
Massachusetts Medical Society and Vice President of Emergency and
Ambulatory Services at Sturdy Memorial Hospital in Attleboro.
Physician Focus is a public service of the Massachusetts Medical
Society. Readers should use their own judgment when seeking medical
care and consult with their physician for treatment. Send comments
to PhysicianFocus@mms.org
