Swine flu summer could be prelude to a terrible winter

July 29, 2009 

Have you ever had the flu? I don’t mean a weekend of vomiting or gastro-intestinal upset, but true influenza, the respiratory virus.

I experienced influenza once, memorable because I didn’t get dressed during 10 days of 103-degree fever, couldn’t care for my children or self, and wrote “goodbye” letters because I felt certain (for a solid week) I’d be dead by daylight, at 24 years old.

Today we might suspect swine flu, H1N1, in someone so young with a positive Influenza A test, but here in Thurston County we wouldn’t know for sure unless the patient was hospitalized. Thurston County won’t test for H1N1 without admitting orders.

The medical office I manage discovered this in June when an adolescent patient tested positive for Influenza A, and said he sat adjacent to a student with a positive swine flu diagnosis. A teacher at his school confirmed the outbreak.

The patient’s positive Influenza A test warranted treating with an anti-viral drug, but this patient had just battled pneumonia a month before, as had other family members, so the doctor wanted to test for H1N1.

We never did test, however, because my afternoon-long string of phone calls to places such as Capital Medical Center and Thurston County Public Health and Social Services offered no help.

A Capital Medical Center lab worker told me they had a sack full of specimen vials waiting for the state to decide whether or not to run the H1N1 tests.

I told the patient’s parent that the swine flu test was a no-go, but we would treat the patient with Tamiflu. We didn’t know their pharmacy had dispensed its last course of treatment in stock weeks earlier, so Mom had to call several pharmacies to find the drug. This was in June, off-season for flu.

Fortunately she succeeded, because if she had failed, we couldn’t access the state’s stockpile of anti-viral drugs without a positive H1N1 test—which the patient could only get if hospitalized.

Does this seem asinine to anyone? The World Health Organization declared a Level 6 pandemic, and the Centers for Disease Control and Prevention announced last week that in the next 2 years, 40 percent of the population will become infected with H1N1, resulting in up to several hundred thousand deaths without a vaccine. And a doctor can’t test a critically susceptible patient in fragile health unless hospitalized?

We hear of canceled summer camps in other states to avoid transmission, and of China’s traveler quarantines, but here in Washington, local government isn’t reporting H1N1 diagnoses or hospitalizations to the press, as it leaves caches of nasal culture vials in garbage sacks at local hospitals.

See no evil, hear no evil.

How will government-stockpiled, anti-viral drugs such as Tamiflu be distributed when autumn’s certain swine flu resurgence depletes pharmacy inventory? Our medical clinic has no idea. Will every patient have to be hospitalized to receive anti-viral medications?

Even worse, an immunization representative said her company fears a widespread shortage of standard flu shots due to prioritized manufacturing of H1N1 vaccine. Although not as virulent as standard influenza, H1N1 attacks young, healthy people, widening the target of people influenza can infect, and the numbers of people who may need an anti-viral drug.

That is more reason to inform doctors now about how they can access government stockpiled anti-viral medications for patients with positive Influenza A tests this fall. What is the protocol?

Right now we’re concerned with triple-digit summer days and press overexposure of a wedding party dancing down the aisle, but if the World Health Organization’s and the CDC’s worst case scenarios play out, this could be a winter to remember.

Jill Wellock, a local freelance writer, serves on The Olympian’s Board of Contributors and can be reached at mjwellock@aol.com.

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