This week, I have blogged quite a bit about official recommendations coming from the CDC and state health departments. They have gone above and beyond in keeping everyone informed.
I thought you all might find it helpful to hear what is going on near "ground zero" here in Texas. I have purposely tried to keep my own opinions out of this because I do not think speculating on an evolving situation is helpful. But, being in the trenches all week dealing with concerns of this flu virus, I can give you a unique perspective. I work in a large pediatric practice in Austin, TX--specifically Travis County, where there have been no confirmed cases of H1N1 (formerly called swine) flu. There have been "probable" and "suspected" cases, but none confirmed. The week started with a flurry of phonecalls which progressed to a flurry of appointments by the end of the week. Appropriately concerned parents brought their children in (as they were told to) if their child had a fever, runny nose, cough, or sore throat.
Here's what I saw this week: a lot of children, none of whom were very sick!
Here are 6 things I have been telling every parent who asks (which is everyone, by the way.. you are not alone!)
1. Who needs to get tested?
Dutifully, I have sent out flu swabs on virtually every child's snot who didn't have a really good excuse to be sick otherwise...partially to ease parents' fears, partially to help identify the magnitude of this infection, and obviously, to treat anyone who truly has influenza infection (and give preventative medication to those exposed to that person). By and large, the kids I have seen and tested just look like they have the common cold and do not look like they have the flu. In ordinary circumstances, I suspect most parents would not have even bothered to bring their child the doctor for evaluation.
2. What does H1N1 disease look like?
Typically, kids with the typical flu we see every year look sick, run high fevers and have body aches and chills before the cough and runny nose starts. It will take some time to figure out if many cases of this new viral illness are mild (like having a cold)--or do all these snot-nosed kiddos just have a run of the mill common cold virus? Our Texas state health department is trying to keep up with all the specimens they are receiving (1500 this week, just from my county alone). Those test results will help us figure it out.
3. Are there other illnesses out there right now?
YES! Right now, both Strep throat and Hand-Foot-and-Mouth (caused by coxsackievirus) have made their annual trek into my community. Both can cause fever without an obvious source (unless you look in your child's mouth or your child has a rash). Hand-Foot-and-Mouth can cause a rash--pimply or ant-bite or flat red dots on the hands and feet (and sometimes around the anus). Strep can cause a sandpapery red raised dot rash on the trunk. (Check out baby411.com bonus material "rash-o-rama" for pictures). So, if your child has a fever and is eating less or complaining of a sore throat, it's quite possible he has a throat infection and not H1N1 virus. Get it checked out. To complicate matters even further, Influenza B--one of the common typical influenza strains-- is also floating around for the annual "end-of-flu-season" sale. A viral nose swab can differentiate whether your child has Influenza A (possibly H1N1) and Influenza B--which is NOT swine flu. Influenza B, like H1N1, is treatable with antiviral medication.
4. Should we be worried?
Concerned and aware—yes. Worried to the point of cancelling a birthday party or locking your doors and windows—no. I am not downplaying the attention to this new virus. The CDC and World Health Organization are right to have concerns about a novel strain of flu virus that almost no human will be immune to. But no one knows at this point whether this flu strain is any more serious than others and if it spreads any more easily than the other germs we are familiar with. I do have great respect for infectious diseases. The typical influenza viruses we see every year kills 36,000 Americans annually. Hence, the reason why I am such a supporter of vaccines—if there is a way to prevent the spread of these illnesses, it would be silly to opt out and risk getting the disease! This current experience is a good reminder of that.
5. What should I tell my child?
Most kids that I have seen in my office this week, as well as my own children, are keenly aware of swine flu. And, if their parents are freaked out, they are too. That is counterproductive. You can explain that there is a flu virus going around and if someone gets the illness, they can take medicine for it. That's the truth.
6. Where should I go to seek medical attention?
If you have a medical home, use it. That's the phrase used to describe your primary care doctor or clinic. Emergency rooms are not the place to go, unless it is truly an emergency. Primary care practices and clinics are all capable of doing appropriate flu testing and sending those specimens where they need to go. We have all been kept well informed by our local and state health departments.
