Swine flu comes home

by revere, cross-posted from Effect Measure

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:



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.

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Best wishes to your whole family for a quick recovery!

What's strange is that a lot of states aren't even testing all the cases anymore, at least that's what they're saying on FluCount.org but .. good luck with everything!