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Tue January 15, 2013
Flu Wave Stresses Out Hospitals
Originally published on Wed January 16, 2013 1:32 pm
What does it feel like to be working in an emergency room during this nasty flu season? Monday. Every day feels like Monday, typically the busiest time of week in the ER.
"Now instead of having a Monday peak, it's seven days a week of a Monday," said Dr. Bill Frohna, who runs the emergency department at MedStar Washington Hospital Center in Washington, D.C.
It's still too soon to say whether this is a historically bad flu season. But it's already clear that emergency rooms around the country are filled with a feverish throng that is much larger than the last time around.
Washington Hospital Center had just 20 patients test positive for flu all of the last season. This season, as of Monday, there were already 179 cases positive for flu.
Maria McCoy is one of those patients. She had been miserable for more than a week with a fever, aches and vomiting. She'd had her flu shot, so she didn't think it could be the flu. But she kept getting worse.
"I called 911. They brought me straight here," said McCoy, 52, speaking on Thursday from a hospital bed in the ER, where she was, indeed, diagnosed with influenza. "It's really miserable."
McCoy has plenty of company.
"We started to see a lot of activity in the South and in the Southeast in the middle of November and toward the end of November, which was about a month earlier than what we normally see," said Tom Skinner, a spokesman with the Centers for Disease Control and Prevention. "And since that time, activity really has picked up across the country to where most states are seeing either moderate to severe activity."
According to the CDC, more than 112 million Americans have been vaccinated against flu this season. The vaccine is about 60 percent effective, which is a decent percentage for a flu vaccine. But that means some people who get immunized, like McCoy, will still get the flu. (To find a place offering the vaccine near you, check out this site.)
This year's strain of the flu, H3N2, is particularly virulent, Frohna said. He compared the surge in patients with those in other years.
"Usually there's a week or two ramp up, a peak, and then a week or two downturn," Frohna said. "So far, we've been basically on a ramp up for about five weeks, and I'm not sure if we've seen the peak yet."
According to Frohna, more patients are being admitted to the hospital because their symptoms are so serious. "We've got patients wearing masks, we've got providers wearing masks to protect themselves and each other from the flu," he said.
To cope, he's opened a half-dozen extra hospital beds, made sure patients with flu symptoms are isolated as quickly as possible, and ordered extra supplies like IV poles. He's also beefed up staffing of doctors and nurses.
Dr. Andrew Sama, president of the American College of Emergency Physicians, says this is exactly the sort of situation that ERs train for.
"There are emergency preparedness plans that occur in every hospital," said Sama, whose organization is a trade group for emergency department doctors. "Even with all the excellent planning, you become constrained because of space and technology and personnel."
In Washington, Frohna is eyeing the calendar and hoping that things start getting better soon.
"With inauguration coming, I'd just be tickled pink if the flu was on the downturn when a million visitors come to town," he said. "It's causing me to lose sleep already."
RENEE MONTAGNE, HOST:
This year's flu season is a bad one, what with 47 states experiencing widespread outbreaks. The city of Boston, and the state of New York, have both declared states of emergencies in their public health systems. That makes it easier for more people to get access to the flu vaccine.
Still, emergency rooms have their hands full. Jenny Gold reports on how hospitals are coping.
JENNY GOLD, BYLINE: Maria McCoy had been feeling sick for over a week.
MARIA MCCOY: Nausea, vomiting, diarrhea; can't hold water, juice - anything - on my stomach. So it's really miserable.
GOLD: She'd had the flu shot, so she couldn't imagine it could be the flu. But she just kept getting worse.
MCCOY: I called 911. They brought me straight here.
GOLD: Now, she lies on a hospital bed in the emergency room of Medstar Washington Hospital Center, diagnosed with the flu. And she's got plenty of company. Hospitals across the country are filled with thousands of flu patients. Tom Skinner is with the U.S. Centers for Disease Control and Prevention.
TOM SKINNER: This flu season got off to an earlier-than-normal start. We started to see a lot of activity in the South, and in the Southeast, in the middle of November and toward the end of November, which was about a month earlier than what we normally see. And since that time, activity really has picked up across the country; to where most states are seeing either moderate to severe activity.
GOLD: More than 112 million Americans have gotten the flu shot this year. And the vaccine is about 60 percent effective - which is pretty good, for a flu shot. But that means some people who get it, still get sick. Dr. Bill Frohna runs the emergency department at Washington Hospital Center, where Maria McCoy is being treated.
DR. BILL FROHNA: Right now, our waiting room is fairly busy for this time of morning. We've got patients wearing masks. We've got providers wearing masks, to protect themselves and each other from the flu. It is rampant here in Washington, D.C.
GOLD: Frohna says they've already had 179 patients test positive for the flu, compared to only 20 last year. ER wait times are significantly longer, and more patients are being admitted because their symptoms are so serious.
FROHNA: Usually, it's - there's a week or two ramp-up, a peak, and then a week or two downturn. And so far, we've been basically on a ramp-up for about five weeks, and we've - I don't - I'm not sure if we've seen the peak yet.
GOLD: How do you plan for something like this?
FROHNA: Well, you basically treat it like a Monday, seven days a week. Mondays are traditionally the busiest days of the week. And so now, instead of having a Monday peak, Tuesday a little bit less, Wednesday a little bit less, Thursday - it's now seven days a week, of a Monday.
GOLD: He's increased staffing of doctors and nurses, opened a half-dozen extra hospital beds, and made sure patients with flu-like symptoms are isolated as quickly as possible. He's also had to order extra supplies, like IV poles. Dr. Andrew Sama says this is exactly the sort of situation that ERs train for. Sama is president of the American College of Emergency Physicians, a trade group for ER doctors.
DR. ANDREW SAMA: Now, the flu is one of many types of challenges we could face, in emergency medicine, that would result in a surge of patients for - period of time. We plan for this. There are, you know, emergency incident command systems that are in place, and emergency preparedness plans that occur in every hospital.
GOLD: Real-life events also help them get ready, like the SARS and H1N1 outbreaks of years past. But a flu season like this one can still stress an ER.
SAMA: Even with all the excellent planning, you become constrained because of space and technology and personnel.
GOLD: In Allentown, Pennsylvania, one hospital had to put up a tent outside the ER, to manage all the patients. Dr. Frohna is crossing his fingers that things start getting better soon in Washington.
FROHNA: With inauguration coming, I'd just be, you know, tickled pink if the flu was on the downswing as a million visitors come to town. It's causing me to lose sleep already.
GOLD: And he implores people across the country to get their flu shot. The flu season might already be bad, but it's not too late.
For NPR News, I'm Jenny Gold.
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MONTAGNE: Jenny Gold is a reporter with our partner Kaiser Health News, a nonprofit news service.
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MONTAGNE: This is MORNING EDITION, from NPR News. Transcript provided by NPR, Copyright NPR.