Monday, Oct. 05, 2009

Doctors try to put parents at ease about flu

People are dying. Don't panic.

How do health professionals balance these contradictory messages as they stress the need for concern about swine flu while not fanning the fear that rises with each highly publicized death?

They trot out statistics to show the H1N1 virus, commonly referred to as swine flu, causes fewer hospitalizations and deaths than seasonal flu. They talk about the usual symptoms, the typical duration and the signs that a mild case might be turning serious. They try to downplay the emotion.

"The more we educate them, the better off we are," said Dr. Deborah Beck, director of student health services at the University of South Carolina. "We've had over 150 cases that have tested positive (for the virus), and every one of those has done very well. We haven't had a single hospitalization."

That message sometimes gets lost in the publicity about the recent deaths of Ashlie Pipkin, 11, of Sumter, and Spec. Christopher Hogg, 23, at Fort Jackson, and an unconfirmed death late last week of a woman who had just given birth. They were young and appeared otherwise healthy before coming down with swine flu.

The reality is that flu - whether the annual seasonal flu or the new swine flu strain - can kill. Pregnant women and anyone with asthma, diabetes, heart disease or kidney disease always should rush to a doctor at the first hint of flu symptoms.

That's why health officials plead with people to get seasonal flu shots each year. The first batch of swine flu nasal vaccine should be available in South Carolina next week. Swine flu shots could be offered before the end of the month.

An estimated 36,000 people nationwide, including hundreds in South Carolina, die each year from seasonal flu, which usually peaks for about two months in the winter. So far, the H1N1 virus, which has been considered widespread in South Carolina for six weeks, has been confirmed as a factor in eight deaths in the state.

Yet, seasonal flu got little attention last winter, while swine flu garners front-page headlines or leads broadcast stories almost daily. Doctors try to calm the fears stoked in those stories.

"We tell the parents the facts," said Anna-Kathryn Rye, a pediatric infectious disease physician at Palmetto Health Richland. "We review what's going on in the country, how the symptoms are mainly very mild compared to seasonal flu."

But the actual number of infections is high, especially among young people. The H1N1 strain is new, and younger people haven't built any immunity to it. With every student a potential victim, schools have turned into virus incubators.

"Because so many people are susceptible, there are going to be a lot of cases," said state epidemiologist Dr. Jerry Gibson. "But those who contract the virus are no more susceptible to serious problems than they would be if they had seasonal flu."

The 68 pediatric deaths in the U.S. from seasonal flu last winter drew little media attention compared with the 49 pediatric deaths from swine flu in the past few months.

Why? A new danger is much scarier than an old danger.

Gibson acknowledges emotion can cloud parents' perspective, especially after the death of a child from flu gains publicity. But he said parents should avoid emergency rooms unless their child's symptoms are severe or they have other underlying health problems.

Kim Conant, special needs care coordinator for Palmetto Pediatric and Adolescent Clinics in the Columbia area, said it was difficult to gauge whether the publicity about the Pipkin case prompted more parents to bring in sick children.

"Our offices have all been very busy for the last few weeks, so it's a bit hard to tell if we actually had an upswing, but we certainly are not seeing fewer patients, and 'flu season' isn't even here yet," Conant said. "That said, this is still not cause for alarm."

Some parents are on edge, she said. They balk when doctors tell them simply to make sure their flu-suffering child gets plenty of rest and fluids. They want antiviral drugs such as Tamiflu, which can reduce the symptoms.

But federal health officials recommend Tamiflu only if someone has underlying health problems or is pregnant. They worry about shrinking supplies of Tamiflu and, more importantly, the virus building a resistance to an overused drug.

"You don't write a prescription because a mom says she wants it," Conant said. "We've had some people get angry. You just have to explain it's not good for the community."

She suspects some parents are shopping around to find a doctor who will prescribe the drug.

USC also takes a tough stance on Tamiflu. Few students have complained, Beck said, but there have been a few phone battles with parents.

More common, according to Conant and Beck, are people who trust doctors to know what's best.

When Steven Vinson, 13, of West Columbia came down with flu-like symptoms last week, his mother, Lesley Bennett, took him to their family physician.

"I try not to panic too much," Bennett said. "I figured he had the flu, but I wasn't worried. Kids get sick."

The doctor put her at ease right away with facts about swine flu. He prescribed Tamiflu because Steven also had bronchitis.

Steven was well on his way to recovery in a few days, and now his parents are among the thousands passing on firsthand experiences to friends, family and neighbors about swine flu. Since most cases have been mild, the word-of-mouth should calm some fears.

Unfortunately, talk isn't all people pass along. Steven's 15-year-old brother Christopher came down with flu-like symptoms on Friday, Bennett said. Though he tested negative for H1N1, he's being treated as if he has the flu.

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