Swine flu spreads, but still mostly mild

Local health officials are urging residents not to rush to emergency rooms if you suspect you or a family member may have the H1N1 virus.

Dr. Dexter Woods, an emergency medicine physician at Middle Tennessee Medical Center, said H1N1, or swine flu, has become the most common strain of flu virus to catch now that flu season has arrived.

"Once people start feeling sick, they probably do have it. If you're fairly young and healthy, you don't need to be treated with Tamiflu or any other anti-viral drugs," he said. "The vast majority of people can get well with supportive care. Drink plenty of fluids, take Motrin or Tylenol and rest."

Unless a patient is in a high-risk group ' under the age of 5, pregnant, over age 65 or has a chronic health condition like asthma or emphysema ' visiting the hospital isn't necessary, unless shortness of breath occurs.

"The CDC (Centers for Disease Control) is seeing stomach and gastric symptoms, like diarrhea, more than they used to with H1N1. If you're admitted to the hospital, the state will run the test, but it's very expensive. We're treating people based on the symptoms they show," Woods said.

He advised that those who are sick remain out of work or school until the symptoms subside.

The disease is spread by an infected person coughing or sneezing. Symptoms for H1N1 are noticeable sooner but are typically milder than those caused by seasonal flu, Woods said. The illness could last anywhere from seven to 10 days, depending on the patient.

The best preventative measures a person caring for someone diagnosed with the virus can take are washing hands, being sure not to eat or drink after a sick person. Those with upper respiratory illnesses should also be on Tamiflu, Woods said. If you're healthy, there's no need to take it just because you're caring for a sick person.

More than 1 million Americans are believed to have contracted H1N1 influenza, or swine flu, but only about 9,000 people, less than 1 percent of the cases, have gotten sick enough to require hospitalization.

Fewer than 600 have died, according to figures published earlier this month by the Centers for Disease Control and Prevention.

Worries persist

Still, with more and more of the cases being reported ' including more than 80 at Rutherford County schools this week ' many aren't taking any chances.

Unexplained deaths, like the one of a 5-year-old Antioch boy who reportedly had never been diagnosed with any other chronic illnesses, have only heightened concerns.

Going into the last weekend in August, Max Gomez was an energetic, independent kindergartner excited to be starting elementary school. Less than four days later, he was dead. His mother, Ruth Gomez, told The Tennessean this week that Max's flu progressed extraordinarily quickly ' from a fever on a Saturday to an apparent recovery on a Sunday to hospitalization and death on a Monday.

State and local health officials say they are still conducting tests to determine how Max could have died from the disease. Until those tests are complete, they say they cannot determine whether any undiagnosed conditions or infections played a role in his death.

The CDC has found that two-thirds of those children who have died from the flu had an underlying condition that made them more vulnerable. These include epilepsy, muscular dystrophy, asthma or any other disease that suppresses the immune or respiratory systems.

Another possibility is that H1N1 could be exacerbated by a bacterial infection. All six of the children the CDC studied who were over 5 years old but did not have a chronic medical condition tested positive for a bacterial infection in addition to swine flu. Health officials said they did not know enough about Max Gomez's case to say whether a bacterial infection contributed to his death.

But they did say that when influenza combines with a bacterial infection, such as pneumonia, the patient often follows a pattern in which his symptoms start to subside but then suddenly worsen. That pattern ' which includes symptoms such as vomiting, chest pain, a racing pulse, breathing trouble, bluish skin or trouble staying awake ' is an indication that the flu has turned deadly, and it means a sufferer should talk to a doctor immediately.

"What you expect from ordinary flu is that it starts off bad and gets better," said Dr. Bill Paul, Metro's health director. "If that's not the case, it's worth a call."

Vaccine on the way

The Food and Drug Administration approved a new swine flu vaccine Tuesday. The bulk of vaccine will start arriving at 90,000 sites around the country Oct. 15. Studies in children and pregnant women are continuing, but those groups are urged to receive the shot.

Murfreesboro City Council will consider plans at its meeting tonight to provide swine flu vaccines for its employees. One of the city's insurance providers, United Healthcare, has offered to cover the administrative costs for the injection of the H1N1 vaccine, according to a letter to the mayor and council from City Attorney Susan McGannon.

She noted in agenda materials prepared for the council how she and City Manager Rob Lyons and Personnel Director Sue Mahon were prepared to recommend that the city pick up 100 percent of the administrative costs of the shots before learning United Healthcare would pick it up.

The city has 995 full-time employees and 367 part-time workers.

The letter notes the Centers for Disease Control priorities on administering the vaccine to: "pregnant women; caregivers for children under 6 years of age; healthcare and emergency medical services personnel; children and young adults between 6 months and 24 years of age; and, persons between 25 and 64 who have underlying health conditions that might increase their risk for flu related complications."

"It is not known how many persons covered by the city's health plans will meet these standards for priority or how widely available the vaccine will be to others," McGannon's letter states. "We therefore are not able to predict the cost of these recommendations."

Prevention is best medicine

Ellen McCluggage, the chief nursing officer at StoneCrest Medical Center, said emergency room workers there are using a nasal swab to test suspected cases. Because of media attention and added concern about H1N1, the hospital is testing at a higher rate than normal.

"For those who come to the emergency department with clinical indications of flu, we can perform a rapid test ' which is essentially a nasal swab. The test will tell us if the patient tests positive for A or B-type influenza. H1N1 is A-type and seasonal flu is B-type. If the rapid test shows positive for influenza, then anti-viral treatment may be appropriate," she said, adding that the test is not highly sensitive to swine flu and could give a false reading. "The only definitive test for swine flu, also a nasal swab, doesn't yield its results for about seven days. Most people are well again by then so that test isn't useful for diagnosing."


In order to lessen the spread of germs among the school populations, hand sanitizer is provided in each classroom. Daily cleaning procedures were put in place two years ago after several schools were impacted by Methicillin-resistant Staphylococcus aureus, or MRSA, said system spokesman James Evans.

"The precautions the schools are taking because of H1N1 is in line with the CDC recommendations. We separate students who present symptoms into an isolation area, they wear a surgical mask in the isolation area until their parents can pick them up, and they cannot return to school until they are symptom free for at least 24 hours," he said.

Murfreesboro City Schools spokeswoman Cheryl Harris said there have been no reported cases.

"We had a staff meeting (Tuesday morning) and all of the principals were there. No one made a comment about any students or teachers being out with it, so I don't think we've felt the impact yet," she said.