Effect Measure

Swine flu comes home

There is no reason why a flu blogger-epidemiologist-physician’s family should be immune to flu in the community. And it appears my family is not. My daughter has had a cough for the last few days and Friday night was suddenly seized by nausea, vomiting and fever. Her HMO’s urgent care directed her to the Emergency Room of the local hospital where a rapid flu test was positive. While waiting to be seen at the ER, her 10 month old, who had a croupy cough, also started vomiting and was warm to the touch. His (slightly) older brother (2 years) was also coughing. Her husband has a cough, too, and is overwhelmed by being the healthiest one in the family. Daughter says she feels awful with headache and muscle aches and pains the usual analgesics (including some opiates) don’t seem to touch. She told me she was talking to a co-worker recently who asked her if she ever had the flu and she said she didn’t know. Her friend then said, “If you had it, you’d know.” She now says she understands what that means. So much for the “mild illness.”

Meanwhile, for the last 3 days Mrs. R. and I have felt like we were rolled over by a truck, and Mrs. R. had a sore throat. Maybe our age is keeping us from worse effects from this one, or maybe we don’t have flu. We’ll probably never know.

So am I justified in thinking my daughter and family have swine flu? I think the answer is “yes.” She had sudden onset of symptoms — she had a cough but I’d seen her just hours before she got acutely ill with fever and vomiting and she had seemed fine — all symptoms typically described with this virus. She had a positive test for flu antigen with a rapid test. And virologic surveillance is showing virtually all of laboratory confirmed influenza A in the CDC NREVSS surveillance system is swine flu. Here’s the latest bar graph:

i-6c9f37469b9d735e9709f2a9b9ef2230-NREVSS.jpg

Source

The data show that only 2.8% of specimens were other flu viruses (seasonal flu A or flu B). Of the remaining 97%, most were either novel H1N1 (75%), not sub-typed (15%) or unsubtypable (7%). So the overwhelming probability is that this is swine flu, especially considering the symptoms (swine flu has an unusual prevalence of nausea and vomiting associated with it).

As for the two children, one at least (the 10 month old) has the same symptoms as their mother and the brother and Dad both have respiratory symptoms. Mrs. R.’s and my feeling of enervation is less sure. We spend a lot of time with the grandchildren and their mother, so it’s plausible.

My daughter was offered Tamiflu at the hospital but also told that at best it would lessen her symptoms by a day or so (true) and that many people were saying it made them feel worse (nausea is a side effect). Since nausea and vomiting are towards the top of the list of things my daughter hates, she decided to decline the Tamiflu offer. I wasn’t with her, or I might have counseled otherwise, but it’s an interesting insight into the behavior of both health care workers and patients.I did (re)send her some of the blog post of the other day, however, where CDC’s Dr. Anne Schuchat summarizes what to look for to tell if someone with (swine)flu is going sour. I told her to keep an eye on the kids. Here it is again:

In children, signs that need urgent medical attention include fast breathing or trouble breathing; blueish or gray skin color; not drinking enough fluids; severe, persistent vomiting; not waking up or not interacting.; being so irritable that the child doesn’t want to be held; and flu-like symptoms improve, but then return later with a fever and a worse cough. Those are warning signs we physicians think about all the time, with respiratory infections. And they’re good to have in mind with this new influenza-like illness caused by the novel H1N1 strain. Just good things for parents to have in the back of their mind.

In adults, we look at another set of warning signs that suggest the need for urgent medical attention: difficulty breathing or shortness of breath; pain or pressure in the chest or abdomen; sudden dizziness, confusion, persistent or severe vomiting that doesn’t go away; and flu-like symptoms that improve, but then come back again with a fever or worsening of cough. (Statement by Dr. Anne Schuchat, CDC Press Briefing, May 28, 2009)

Vomiting and fever have also swept through the grandchildren’s day care center, although my daughter reports children were often back in school after a day or two. Since we know children shed virus longer than adults, the day care center was probably a flu incubator. This is a direct consequence of the inadequate child care and sick leave policies this country has. These are often considered social policies, but they have very direct public health consequences.

Since the only viruses that travel over the internet are the benign kind that wreck your hard drive, destroy your thesis or term paper or latest legal brief or all your email, you don’t have to worry reading this will give you flu. I won’t make any guarantees about your children, grandchildren, spouses/partners or workmates, however. You take your own chances there.

Comments

  1. #1 caia
    June 7, 2009

    Revere, I am sorry to hear this. I take it your daughter is at home again? I hope she, you, and your entire family make a full and speedy recovery.

  2. #2 flounder
    June 7, 2009

    Wow. Something like that really does make an abstract news story become very concrete. I hope your family makes a quick recovery.

  3. Revere
    Fingers crossed that you and your family all come out of this ok.
    Your continued efforts to explain the scientific facts as to why we should not take this new virus lightly are performing an important public service.
    Declan Butler
    Nature
    d.butler@nature.com

  4. #4 ahrcanum
    June 7, 2009

    Just wondering what the rapid flu test was positive for? If they tested for swine it they certainly would have let her know by now. While, “This is a direct consequence of the inadequate child care and sick leave policies this country has,” it is a little something called capitalism and the desire for a paycheck that keeps us going to work and yes, spreading flu.

  5. #5 Florida1
    June 7, 2009

    Best wishes Revere and to everyone who is suffering.

  6. #6 BlueJay
    June 7, 2009

    Revere,
    I hope you and your family make a speedy recovery. Because of your continous efforts to explain the new virus and give detailed background information I hope I know what to keep in mind in case the new H1N1 is going to spread further in Europe.
    BlueJay

  7. #7 Lisa the GP
    June 7, 2009

    Well, it was bound to happen eventually.

    You know the stats. Watch but don’t worry.

    Are you nearby enough (and well enough) to drop off a meal or two for them? That’s a nice thing to have when the whole family is down.

    Its the thyme in chicken soup that helps upper respiratory symptoms, turns out. I’ve found that the ‘isotonic young coconut juice’ sold in cans at Whole Foods doesn’t upset a sick stomach and is more esthetically comforting than watered-down gatorade for informal hydration.

    “Supportive Care”. Aka “acting like a grandma(/pa)”

  8. #8 medmatters
    June 7, 2009

    Best wishes for a speedy recovery to all, regards,

  9. #9 SusanC
    June 7, 2009

    revere,

    I hope your family, especially the little ones, recover quickly! I’m a little surprised (or maybe I missed it). Did they test the kids for flu? If they were positive, shouldn’t these young ones get tamiflu?

    On another note, my daughter was ill recently, about 3 weeks ago. We were on vacation, and she’d been in college where everyone and their dog seems to have been sick. She got ill quite suddenly and quickly, sort of fever, headache, profound fatigue. She had a sore throat on the second day. 2 days later, right on cue, her boyfriend got sick as well. Except he had different symptoms. He had vomiting first, then fever, then diarrhea, followed later by sore throat etc.

    I suspect chances are they both caught the swine flu. Now they are both in NYC, right in the worst affected districts. My husband and I think that the way to tell is, if they don’t get sick in the next couple of weeks, then, retrospectively, they probably already got it from a few weeks ago.

    Way to tell, yeah? Expose them and see what happens! LOL!

    Again, hope everyone recovers and keeps well, especially the wee ones.

  10. #10 Comrade PhysioProf
    June 7, 2009

    Dude, I hope everyone in your family recovers speedily!

  11. #11 DemFromCT
    June 7, 2009

    ahrcanum, a rapid test just says it’s flu A. As revere notes, therefore it is likely swine flu. most states won’t test you beyond that unless you are very ill, or from a school cluster. If you have flu, it’s swine flu. Even the untypable category usually eventually gets sub-typed (it’s a rolling category… old specimens get typed, new ones get added), and these days is likely to be novel H1N1, so you can for practical purposes add the light and dark blue bars together.

  12. #12 Erin Johnson
    June 7, 2009

    Hope everyone is feeling better soon. Sorry to hear your family is sick :(

  13. #13 revere
    June 7, 2009

    Just a quick “Thank you” to all the well wishers. Mrs. R. and I are OK (washed out, a bit, but that’s all). The next two generations are miserable but weathering it. Flu is not fun. I’m keeping an eye on them.

  14. #14 Jon Schultz
    June 7, 2009

    Don’t die, Revere. This is one of the few sites I can post on without getting banned (so far).

    Hope all get better soon.

  15. #15 stillarebel
    June 7, 2009

    I’m so sorry this has happened to your family. You must be concerned. Anyway, they are lucky to have such a compassionate grandpa who critiques all the evidence. I hope everyone is better soon.

    x

  16. #16 Pete A
    June 7, 2009

    Really sorry to hear this has hit so close to your home and wish all your family a speedy recovery.
    I hope the people who have been dismissing this virus as “mild” read this and wake up and smell the coffee.
    Also many thanks for your check list of symptoms I will be copying it for future reference god forbid.

  17. #17 Julie Stahlhut
    June 7, 2009

    Ugh. Flu sucks. I haven’t had it in 25 years or so, and still remember how lousy I felt each time I came down with it.

    Hope the whole family is feeling better soon.

  18. #18 Snowy Owl
    June 7, 2009

    May all of you get trough this Well.

    Snowy

  19. #19 Monotreme
    June 7, 2009

    revere, I hope you and your family make a full and speedy recovery.

  20. #20 Dark Horse
    June 7, 2009

    Revere,

    I wish you and your family the very best. I know what you’re going through. My daughter, a psychologist who works with hospitalized dangerous teens, just got over the same thing and my Dutch son-in-law is taking our grandchildren on a plane to Holland tomorrow: “there are only 16 cases in the Netherlands.” Makes me so mad.

    I had hoped that our new CDC director had some ethics, but I lost that hope when he minimized the recent swine flu deaths by trotting out this bogus 36,000 people die from season flu every year. Great! Unlike Biden, Frieden stays on message and the American public stays ignorant. I can just imagine what kind of influence this will have on CDC briefings the rest of this year. Sounds like Frieden’s a reincarnation of Rupert Blue of 1918 fame.

  21. #21 Tom DVM
    June 7, 2009

    Take Care.

  22. #22 PalMD
    June 7, 2009

    Hang in there. I feel like i’ve seen “your” family a couple of dozen times in the last several weeks, and they’ve all gotten through Ok.

  23. #23 revere
    June 7, 2009

    Again, warm thanks to all well wishers. Daughter feeling better, baby still a little feverish but taking fluids and alert, older brother and dad coughing. Mrs. R. and I are also feeling better. At our age you never feel great. I’ll have more to blog about what I learned from this soon.

  24. #24 River
    June 7, 2009

    Best wishes for a full and speedy recovery, Revere, to you and the Missus, and your family.

  25. #25 Chirp
    June 7, 2009

    Revere,

    Sounding like a broken record, but adding my well wishes. Sorry your family is suffering. As others have noted, if there’s any good to come from it, it can serve as a high-visibility, real-world example for your many readers. I look forward to your future comments about this personal episode: sequence of symptoms, differences by age, day care center’s role, decision re: Tamiflu use, etc.

    Chirp

  26. #26 Blake Stacey
    June 7, 2009

    My degrees-of-separation connection to Bill Ayers and the Weathermen is also my connection to swine flu! Kewl!

    Er, I mean, may you and yours get well soon.

  27. #27 karen
    June 7, 2009

    Revere – Hope you & your family are well soon. I know how hard it is – especially – to see the little ones get so sick. Interesting too about the Tamiflu – I wonder how many don’t take the full 5 (or is it 7?) day course and would this lead to a greater chance of the virus picking up Tamiflu resistance?

  28. #28 J
    June 7, 2009

    I wanted to add something about the ‘mildness’ of the flu: sure it feels like you were hit like a truck and it’s never a breeze to be ANY kind of sick, even the garden-variety cold or diarrhea. What I define as mild, though, is what you get completely better from after a while. So even though it might be hell to go through this flu, as long as most of its victims recover I think it should be called ‘mild’.

  29. #29 Phillip Huggan
    June 8, 2009

    (sorry Revere I can’t find an appropriate thread, and don’t sleep with birds or pigs or it might mutate!)
    I think I’ve figured some likely hypothesees thx to beer can THC residue. If I had welfare income I could become a permanent pandemic sentinel.

    AFAIK Swine and Human flus spread via air droplets while Avian Flu spreads in intestinal tracts and poop. Avian flu likes 40C temp of a bird’s intestines. Pigs are two degrees warmer than humans which probably makes them a more suitable Avian Flu vessel. Maybe our immune system’s fever response (healthy immune systems would have higher fevers?) actually helps these novel pathogens infect us (high temps also raise some immune activity so a suitable host temp might not be too important), maybe even raises temp of our lungs, I dunno.

    70% of our immune system is in our intestinal tract. I think the Spanish Flu was the contagious equivalent of acute “bird fancier’s lung”. Being a bird flu in all 8 genes it infected human intestinal tracts. This triggered an immune system response that coated or whatever our lungs with antibodies. The First (ridiculed at the time) Wave of Spanish Flu.

    Then it died out; maybe it mutated enough to reinfect previously afflicted individuals or maybe it just mutated more contagious or maybe not at all…the Second Wave triggered our immune system’s response much like someone who is allergic to bees getting stung. I don’t think this happens in other flu types because they don’t primarily target immune-packing intestine (but not sure there could still be this effect without intestinal involvement). And it happened again Third Wave. Spanish Flu was an allergy basically. So is H5N1 I think.

    Maybe keep fever down will help. You probably don’t want to be exposed to this Swine Flu if true but I doubt it has enough Avian content to mimic Spanish Flu. Here, a Second Wave would probably show up as more deaths and Stomach Flu. I think the genes of this Swine Flu that come from birds are why there are so many Stomach Flu symptoms here (and maybe not). This is maybe why Pneumonias are slightly atypical: Swine Flu is slightly bird.
    On the bright side I’m more afraid of H5N1 mutating contagious than this mutating especially deadly.

    I think this analysis is worthy of a welfare income until I find a bizness plan. If not maybe I’ll threaten bioterror for ransom. Won’t have resin scrapings next five weeks…
    …hope it doesn’t mutate before July.

  30. #30 Phillip Huggan
    June 8, 2009

    Forgot to mention if this thesis is correct that 1st Spanish Flu wave is initial “bee sting” and subsequent waves are over-reaction, be very careful in testing a vaccine with Avian RNA components. If not correct, oops.

  31. #31 Andrew Jeremijenko
    June 8, 2009

    Revere,
    I am sorry to hear about your family, and I hope they have a mild illness and a speedy recovery. Effect Measure is all the more powerful because you not only put your scientific knowledge but also your thoughts and feelings into your writing. Because you write about your family I worry about my family. My wife is pregnant so I am worried, and I have Tamiflu. I want to protect her and my children from the virus. Your family is lucky to have someone so knowledgeable to guide them through this illness, though I am sure you would prefer you didn’t have to. You have worked for years to make people aware of the pandemic potential of influenza and to help them understand the disease, as well as so many other issues on Effect Measure. Unfortunately in a pandemic, it is difficult to avoid a pandemic virus, and at some stage most of us will have our experience of “Swine flu comes home.” Take care of yourself and your family. Once again I hope they have a speedy recovery.

  32. #32 pft
    June 8, 2009

    Hope everything works out.

    I must say though, I am surprised there are adults who have never had the flu (or do not know if they have had it which suggests they never did). I have to imagine an adult getting the flu for the first time would have more severe symptoms no matter what strain.

    In my 50 years I probably had it a dozen times (down for the count for 2-3 days), every 2-3 years when I was younger, not so often as I have got older). Definitely not fun no matter what age.

  33. #33 Jody Lanard
    June 8, 2009

    Would you take it a little easy already? We need you to not burn out!

    Peter and I hope you and your family feel better soon. Thanks for sharing the personal as well as the medical and socio-political news about swine flu.

  34. #34 M. Randolph Kruger
    June 9, 2009

    Andrew… Are you in Oz or Indonesia?

    Hang tough Revere. One of my emailers just about checked out from the stuff in DC with 103 fevers and 14 days of breaking them. 40 year old. Underlying condition of auto immune. She stayed loaded up with Vitamin C, elderberry juice, and lots of fruit. She said it was the worst she has ever felt. Night sweats with the fever. Doctor told her not to come near his office. No test for a positive confirmation but every symptom in the book. Went to a meeting where an idiot from Texas sat in the back of the room and honked on everyone. Wonder how many cases we got out of that? Wonder if that one made it?

    Anyway, you need to slow it down a bit. There is plenty of disease to go around and it will be here when you get back.

  35. #35 revere
    June 9, 2009

    Thanks, Randy. I”m OK, just tired. The daughter is completely knocked out. She usually walks a mile or two a day, now she can’t go half a block. No work for her this week, despite the need for the hours. She now knows what flu is. Rest of the family continues to cough away and all are out of school and work. Not to mention the $100 in ER co-pays. Four teachers out at the day care center. It may not be in the news, but the virus is sure in a lot of lungs.

  36. #36 Leah Daziens
    June 9, 2009

    What a teachable moment! Last week, a parent told me that there was a case of Swine Flu at Oakridge E.S. in Arlington, VA. She was surprised when I told her that it was everywhere and that, as I understand it, authorities aren’t testing unless someone is hospitalized. It seems to me that most people think swine flu was over-hyped and has come and gone. I wish the MSM would spend more time painting a graphic picture of “mild”. As far as flu, I am almost 40, and I have had the flu exactly ONCE in early January 1994. Both my husband & I will tell you that it is the sickest that we have ever been in our lives. I was a healthy 25 year old in my 2nd year of teaching middle school and my husband was a healthy 26 year old Navy pilot. I had NOT had a flu shot, but he had. We had just moved into our house and were sleeping on a futon on the floor. All I can remember is that occasionally we would crawl on hands and knees to the bathroom, crawl back to the futon, take a swig of Gatorade, and collapse again. Apparently, we had very high fevers, because we had chills and were completely delerious. I do remember having the revelation that THIS must be how people died from flu, which had never made sense to me before – and thinking that we were dying, but being too incoherant to pick up the phone to call my aunt, who lived less than 2 miles away. The only time I have felt that “out of it” was after surgery when they were trying to wake me up from general anesthesia. And, to the point of “presenteeism”, when my husband called medical, he was not given a “MED DOWN”, but told to go to work — technically cleared to fly. Thankfully, his CO immediately sent him home, but my husband says he still remembers firmly gripping the steering wheel to keep himself upright and praying that he wouldn’t pass out while driving. I have religiously gotten my flu shot every year since and have bribed coworkers to do the same. That said, my norovirus experience a couple years ago was the most MISERABLE I have ever been. At least with our flu, we were too far gone to feel pain :)

  37. #37 ssal
    June 10, 2009

    As everyone else, I hope your family recovers very quickly.

    When they are better, I hope you will provide us all with a detailed account of each one of their experiences.

  38. #38 Clare
    June 13, 2009

    Thank God for a bit of truth on the internet. Oh, here in Wales, we only have two cases of swine flu – almost fell off my chair laughing!!! The Govt are so ignorant. I have been telling all my pregnant friends to be careful should they get ill, they arent worried as its hardly over here!! I ask you! Myself and my daughter have had this, My three year old had fever, sickness, the runs, a cough later and fatigue. I had nausea, sickness, dizzyness, tight chest, fatigue and lack of appetite. My eldest daughter simply had stomach pains – husband had nothing.
    My daughters school had lots of children off sick, My Mother in law said her school was the same. It is ridiculous for them to quote these pathetic numbers in regards to infection. Laughable.
    I have read that the high levels of arsenic in the drinking water in mexico could have contributed to the hyper immunne response that some adults died of there, what do you make of that? Research was done on mice and they found that the mice who drank the contaminated water, fought the infection too late and when they did, it was too robust.
    I havent seen this widely printed, but I suppose they dont want it known too much about the Hyper Immune response….am I wrong?

  39. #39 Kathy
    June 26, 2009

    Revere:

    Hoping by now that everyone is over the flu. Can you tell us about first symptoms, how long it lasted, how everyone is doing today.

    Thanks

  40. #40 Kathy
    June 26, 2009

    Revere:

    Hoping by now that everyone is over the flu. Can you tell us about first symptoms, how long it lasted, how everyone is doing today.

    Thanks

  41. #41 revere
    June 26, 2009

    Kathy: I think we are all over it. Son-in-law had minor sx (cough for about a week), daughter was acutely ill for 3 days or so (started with a cough for a few days, then sudden nausea and vomiting requiring 4 liters IV fluids at the ER), then unable to make it to work for a week (and she needed the work), now seems fine, although hoarseness lasted for another week. Mrs. R. and I never had much in the way of symptoms but have had “run over by a truck syndrome” since, although it is easing a bit now. The littlest one was sick with cough and fever for a couple of days and his brother 2 yrs old) had a cough but other than they are both recovered and back to being a hand full. Only my daughter had any testing and she was positive for flu A at a time when almost all of the circulating flu A was novel H1N1. So that’s the saga. Pretty typical, I think.

  42. #42 Juliette
    July 13, 2009

    My boyfriend was diagnosed with swine flu this weekend. He was ill for the last week with cold and flu like symptoms but not very high temperature and we were laughing at him, saying that “he had a swine flu”. Imagine how bad I felt when it turned out that he really did have it…
    Getting tamiflu was not easy, never mind what they tell you on TV. I really had to fight for it. NHS attitude was if you can survive it without- then do so. But my partner was ill for a week already and showed no signs of getting better, so I insisted. On Sunday I was in the shop and I just felt like I was going to pass out. My head hurt, my body felt strange, I felt sick and dizzy. I called my GP who told me I probably had a cold but not to come to the surgery for the next seven days and basically get a friend to look after me. I wonder what planet these doctors are living on? Does she really think that any friend I have will abandon their own kids and family and come to look after a person with a swine flu?
    The illness itself is very strange as one hour I feel like I am getting better and then I feel that it is back to where it was or worse. It is scary when it happens but then i feel better again. Also neither if us had a high temperature, it just went up and down. I asked for something to be given to my son as a prevention but I was told to wait until he gets sick. What a lovely proposition! Also now with both of us ill, I wonder who will go and collect the next batch of tamiflu from a hospital five miles away and not near the underground station. The cat, perhaps?

  43. #43 becky
    July 16, 2009

    My two children (ages 15 months, and 5) and me (28) have just been diagnosed. Started yesterday. Baby had a strong dry deep cough and her temperature came on hard and fast. She went from being fine, to being hot and poorly a few hours later. I had a killer headache all day, felt slightly sick, heavy bodied. My 5 yr old just has a sore throat, that’s it.

    The Tamiflu makes me sick if I eat within 2 hours after taking it, that’s a bit horrible.

    It’s only day 2, so fingers crossed. Thought I would help with th symptoms for some of you.

  44. #44 yolanda
    November 6, 2009

    My daughters are 8, 2, and 1. My 2 year old has had a cough for about 10 days now. She has no fever and is otherwise fine. Should I take her to see a doctor?

  45. #45 revere
    November 6, 2009

    Yolanda: We don’t give medical advice over the internet. But the 2 years and under are a high risk group, so if you have any questions by all means call your doctor.

Current ye@r *