Influenza 2016

No influenza cases so far this year in my clinic.

I watch the flu map faithfully each week, as I try to get my stubborn patients to get their influenza vaccine. It takes up to two weeks to get them immune, if it works. It works most years about 80% f the time. When it doesn’t work, it’s because either their immune system didn’t respond or because the influenza virus has traded genes enough that the guess six months before on which way it will evolve, is wrong.

Here is the CDC weekly influenza update link: http://www.cdc.gov/flu/weekly/fluactivitysurv.htm.

If you click on the FluView Weekly Influenza Surveillance Report, scroll down. My favorite to show patients are the Outpatient Illness Surveillance, which maps this year’s rise in influenza in the US each week, compared with past years. We are having a late year.

My other favorite is the next one down: ILIState Activity Indicator Map. It changes color each week by state as the influenza reports come in. Arizona turned red this year about a month ago, after Puerto Rico. Red is high activity level. The rest of the country was dark green, low, or light green, but has steadily been turning yellow green, yellow, orange…. Washington State is still green. But now only a few states are green and it’s still on the rise. If we continue to have unseasonably warm sunny days, like the last four days, we might avoid the influenza. But if it gets wet and cold again: boom. Like a sneeze, spreading. This is the first week we’ve had seven red states. I have been wearing a mask in clinic every time I see someone coughing. And I got a cold anyhow, but it is not influenza and I don’t think it’s strep A, thank goodness.

I said influenza is airborne but it isn’t. Or there is controversy. It is at least droplet spread, but sneezes count. Apparently influenza can get to people 6 feet away. Wear your space suit with the oxygen filter to the grocery store. http://www.cdc.gov/flu/about/disease/spread.htm — lots of information about the influenza virus. Is all of it 100% correct? Don’t be silly, this is science, not a religious text: science changes, just like the flu virus.

This year, a CDC alert was faxed to clinic on February 1: http://emergency.cdc.gov/han/han00387.asp. It is all very calm and clinical, with this sentence in the second paragraph: “CDC has received recent reports of severe respiratory illness among young- to middle-aged adults with H1N1pdm09 virus infection, some of whom required intensive care unit (ICU) admission; fatalities have been reported.” I called my son and said, “Get your flu shot now.” If you read the rest, it says ages 20-50 as the “young” and “middle-aged” adults. Not the group that we expect influenza to hit, but that is the group that got hit in the 1918-1919 influenza.

Get your flu shot… be careful out there.

 

I took the photograph two days ago with my phone: Boa was on my lap and I wrapped her in the shawl I’d knit, and she was so relaxed…. that’s how we need to take care of everyone with influenza.

 

Recovering from influenza exhaustion

Influenza can cause swelling in the lung tissue. This is different from pneumonia, in that it is not fluid in the lung air spaces and different from bronchitis, where there is swelling and inflammation along the tissues lining the lungs.

In really severe influenzal lung swelling, the air spaces swell shut, the lungs are bleeding and bruised, and the person dies. Young healthy recruits in the 1917-1918 influenza would literally turn blue as they were no longer able to breathe and they would die.

If a person is still feeling exhausted after the initial week of influenza, they need testing to find out if they have lung swelling. This can be done at home or in your doctor’s office.

To test at home, the patient should sit relaxed for 10-15 minutes. Take a one minute pulse count: normal is 60-100 beats in one minute. Then the patient should get up and walk until short of breath. Sit back down and repeat the pulse. If the pulse is jumping up 30 points or if it is over 100 after walking, there is still lung swelling. The treatment is rest.

To test in my office, I add a pulse oximeter. I get a resting oxygen and pulse level, walk the person and then watch the recovery. The oxygen level will often drop and then rise to the sitting baseline as the heart rate recovers. Most people do not need oxygen if they have a healthy heart and healthy lungs to start with.

You can see why influenza would be so dangerous to someone with an unhealthy heart or lungs, because the heart can’t make up the difference.

I had influenza in 2003 and had lung swelling to where I could not walk across the room without my heart rate going to 132. Sitting, my heart rate was 100. My normal heart rate is 65-75. It took two months for the swelling to subside and mostly I lay on the couch. Be reassured that if you rest when you need to, you will recover.

The photograph has my father sitting and Andy Makie standing with the harmonica, at a music party at my house in 2009. Both my father and Andy are gone in their 70s, primarily from lung damage from cigarettes. Miss them both. Thanks to Jack Reid too.

Influenza alert!

My small clinic has only been open again with our wonderful Megan Bailey, PAC, for a month, but we’ve already seen two people with influenza. And that is seeing less then ten people daily.

Please get your influenza shot. Yes, it doesn’t cover all of the strains, but most years it covers 80%. And initially Washington was seeing influenza B but now it’s influenza A and that has better coverage.

Remember that the vaccine takes up to two weeks to provide immunity. Consider wearing a mask if you have to go on an airplane — our second patient with influenza had gotten off an airplane that day. If you get a cold within one or weeks of getting the influenza vaccine, that is not caused by the vaccine. You are still at risk for influenza as well, especially the first two weeks.

If you have influenza, stay home and try not to expose other people. If you have frail or elderly or sick family, or very young children in the family, make sure that you get to the doctor early and see if prophylactic treatment is needed for household members who are exposed. If you are in the doctor’s office with any upper respiratory symptoms, put on a mask. That way you will not infect and potentially kill other patients.

Here is the CDC weekly influenza surveillance map: http://www.cdc.gov/flu/weekly/usmap.htm

You can watch it change color as the influenza crosses the country from east to west.

Please take care and Happy New Year!

The picture is the Solstice sunrise outside my house…

Taking care of Ebola is hard

“We may never know exactly how [transmission] happened, but the bottom line is that the guidelines didn’t work for that hospital,” said Frieden. “Dallas shows that taking care of Ebola is hard.”

From the Huffington Post: http://www.huffingtonpost.com/2014/10/20/ebola-hospitals-us_n_6018372.html

And for me, a lowly rural Family Practice physician, from the American Academy of Family Practice: “The first steps in preparing your office for a possible Ebola case are to make sure you have all referral contact information ready to go and that you educate each staff member on his or her role should a case present.”

There is only me and a receptionist. We don’t have hazmat suits. Actually I’ve been off sick, lung and vocal cord problems, for all of October.

We have masks, gloves, I do have a white coat that I almost never wear.

Also from the AAFP:”Appointment clerks and front-desk personnel taking calls for appointments should inquire about African travel history in patients calling for appointments for fever, headache, weakness, diarrhea, vomiting, muscle aches or bleeding,” said Mahoney. “Anyone with a positive travel history should be contacted by a provider to gather additional history and determine if public health authorities need to be involved before a patient even presents to the physician office.”

http://www.aafp.org/news/health-of-the-public/20141017eboladisprep.html

We are both going to get our influenza shots this week. Please get your influenza shot. There is a lot more influenza around than risk of ebola in the United States, and influenza kills many many people every year. And even if you “never get colds” and “have a strong immune system”, you might get a mild case of influenza and pass it on to someone who then dies of it. If you tell me “I got flu the last time I got the shot”, excuse me, but that is hooey. First of all, it takes two weeks for your immune system to respond to the shot, so if you got symptoms the next day it could be influenza but not from the shot. Maybe from being exposed to someone with influenza at the grocery store or your doctor’s office. Secondly, people say “flu” and often they mean stomach flu. Stomach flu is not influenza. Third, influenza changes all the time, so about 80% of the vaccinated people are protected most years. That’s right: two weeks after my influenza shot, I am about 80% protected. Not 100%.

Why are we getting vaccinated? For one thing, we are health care workers and we get exposed. And for another, the initial symptoms of influenza are the same as the initial symptoms of ebola. Actually the United States is really rather lucky that the ebola case happened before influenza really hit, because they look too much the same initially. Suppose that three of the quarentined people had come down with influenza….. confusion and panic initially.

So please get your influenza vaccine, because you not only help to protect yourself, but protect others and prevent panic.

Blessings!