Swine Flu Experiences So Far
by Beril Bayrak Bulucu, MD – October 2009
I am not sure what we would be talking this past year if there were no swine flu. There is no one day without swine flu news in the papers and on TV, there is no one day without swine flu talk. Swine flu worries reached Turkey way before the disease itself. And at this point, many months and some thousand cases later the height of swine flu worries is far more prominent than the disease itself.
When I say `I see swine flu cases` many people would say `Oh really !` with wide open eyes. Because I have an international practice I have been seeing swine flu cases for the last three months. And despite the news and common opinion, my worries get less and less as I see more cases. That is why I wanted to share with you my experience so far as well as the common knowledge about swine flu.
What is H1N1? It is another Influenza A virus. And because of its ability to spread very very rapidly, it has gotten itself a` level 6 epidemic`reputation.
It is a new virus! Most of our initial assumptions were based on the characteristics of seasonal influenza viruses and most are being proven to be wrong. Yes, H1N1 can present without fever. It can be a pretty mild illness and this seems to be making it more confusing and easy to spread. The antigenic structure has not been altering itself yet like the other flu viruses.
Most of the people who have H1N1 have a mild illness. Some have a more severe illness and a great minority might have a fatal illness. The common symptoms are a nasty runny nose, cough, listlessness, fever(from mild to 39-40`ies and shivering chills)The illness seems to be running a course of 3-10 days. Even though 3 days of fever is more usual, like all other flu it can cause 7 days of continuous fever.
It is becoming more and more common. Actually 99% of the flu activity nowadays is H1N1.Many people on the street have H1N1 and really, there isn’t such a big reason to worry.
Febrile or sick looking children should see a doctor. Diagnosing is important especially to follow up for complications. Rapid flu tests can be used when the limitations are kept in mind. The advantage of the rapid flu test is that the result comes in a timespan of five minutes and positive is a positive. However if the result is negative, depending on the test there is 20-50 (usually 20% though) % chance of missing swine flu. H1N1 PCR is a very accurate test, is done at some state hospitals as well as some private hospitals. The result usually takes somewhere between 24-48 hours. The test is somewhat expensive in the private hospitals. In the state hospitals prices are much lower, however there might be a waiting period. Viral culture is not very practical as it takes a very long time. Because of the load PCR is not recommended on any case who has a positive rapid test. It is saved for severe cases or ones undiagnosed despite high fever.
Amazingly H1N1 is milder on the elderly but hits kids harder. The most common
Complication seems to be pneumonia and this is something that we watch kids closely for. The data shows that negative X rays in the beginning of illness are really not reassuring to rule out later pneumonia. It is really important to follow kids closely for this. Most commonly they get better without any complications though.
Many providers including myself seem to be loosing the `Tamiflu reflex`. Increasing viral resistance as well as the mild course of the illness make tamiflu `not so necessary` in a lot of cases. However the decision to treat needs to be done by the medical doctor on a case-by-case basis. Kids younger than 2 or those with chronic illness are candidates for treatment. Also, even though our knowledge from seasonal flu dictates that tamiflu is meaningful only when started early, apparently in swine flu treatment can make the course milder even when started later.
As for protection: We need to teach our kids to wash their hands properly, cover their cough and of course not send them to school when they are sick. Many schools are relaxing their rules and allowing kids to stay out of school even when they have mild symptoms. This of course can help slow down the spread.
No matter what we do, at this point the spread of the virus is inevitable. I feel that the fear and anxiety related to the virus can be even more damaging than the effects of the virus. I think being conscious of the swine flu can help prevent complications however such a high anxiety level is really not necessary.
I think we all need a little bit of cool!
Wishing best of health to all of you.
Beril Bayrak Bulucu, MD FAAP
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