Health - , Flu Widespread, Leading a Range of Winter’s Ills

The country is in the gripof three emerging flu or flulike epidemics:
an early start to the annual flu season with an unusually aggressive
virus, a surge in a new type of norovirus, and the worst whooping
cough outbreak in 60 years. And these are all developing amid the
normal winter highs for the many viruses that cause symptoms on the "
colds and flu" spectrum.
Influenza is widespread, and causing local crises. On Wednesday,
Boston's mayor declared a public health emergency as cases flooded
hospital emergency rooms.
Google's national flu trend maps , which track flu-related searches,
are almost solid red (for "intense activity") and the Centers for
Disease Control and Prevention's weekly FluView maps , which track
confirmed cases, are nearly solid brown (for "widespread activity").
"Yesterday, I saw a construction worker, a big strong guy in his
Carhartts who looked like he could fall off a roof without noticing
it," said Dr. Beth Zeeman,an emergency room doctor for MetroWest
Medical Center in Framingham, Mass., just outside Boston. "He was in a
fetal position with fever and chills, like a wet rag. When I see one
of those cases, I just tighten up my mask a little."
Massachusetts General Hospital in Boston started asking visitors with
even mild cold symptoms to wear masksand to avoid maternity wards. The
hospital has treated 532 confirmed influenza patients this season and
admitted 167, even more than it did by this date during the 2009-10
swine flu pandemic.
At Brigham and Women's Hospital, 100 patients were crowded into spaces
licensed for 53. Beds lined halls and pressed against vending
machines. Overflow patients sat on benches in the lobby wearing
surgical masks.
"Today was the first timeI think I was experiencing my first
pandemic," said Heidi Crim, the nursing director, who saw both the
swine flu and SARS outbreaks here. Adding to the problem, she
said,many staff members were at home sick and supplies like flu test
swabs were running out.
Nationally, deaths and hospitalizations are still below epidemic
thresholds. But experts do not expect that to remain true. Pneumonia
usually shows up in national statistics only a week or two after
emergency rooms reportsurges in cases, and deaths start rising a week
or two after that, said Dr. Gregory A. Poland, a vaccine specialist at
the Mayo Clinic in Minnesota. The predominant flu strain circulating
is an H3N2, which typically kills more people than the H1N1 strains
that usually predominate; the relatively lethal 2003-4 "Fujian flu"
season was overwhelmingly H3N2.
No cases have been resistant to Tamiflu , which can ease symptoms if
taken within 48 hours, and thisyear's flu shot is well-matched to the
H3N2 strain, the C.D.C. said. Flu shots are imperfect, especially in
the elderly, whose immune systems may notbe strong enough to produce
enough antibodies .
Simultaneously, the country is seeing a large and early outbreak of
norovirus, the "cruise ship flu" or " stomach flu ," said Dr. Aron J.
Hall of the C.D.C.'s viral gastroenterology branch. It includes a
newstrain, which first appeared in Australia and is known as the
Sydney 2012 variant.
This week, Maine's health department said that state was seeing a
large spike in cases. Cities across Canada reported norovirus
outbreaks so serious that hospitals were shutting down whole wards for
disinfection because patients were getting infected after moving into
the rooms of those who had just recovered. The classic symptoms of
norovirus are "explosive" diarrhea and "projectile" vomiting , which
can send infectious particles flying yards away.
"I also saw a woman I'm sure had norovirus," Dr. Zeeman said. "She
said she'd gone to the bathroom 14 times at home and 4 times since she
came into the E.R. You can get dehydrated really quickly that way."
This month, the C.D.C. said the United States was having its biggest
outbreak of pertussis in 60 years; there were about 42,000 confirmed
cases, the highest total since 1955. The disease is unrelated to flu
but causes a hacking, constant cough and breathlessness. While it is
unpleasant, adults almost always survive; the greatest danger is
toinfants, especially premature ones with undeveloped lungs. Of the 18
recorded deaths in 2012, all but three were of infants under age 1.
That outbreak is worst incold-weather states, including Colorado,
Washington, Wisconsin, Minnesota and Vermont.
Although most children are vaccinated several times against pertussis,
those shots wear off with age. It is possible, the authorities said,
thata new, safer vaccine introduced in the 1990s gives protection that
does not last as long, so more teenagers and adults are vulnerable.
And, Dr. Poland said, if many New Yorkers are catching laryngitis , as
has been reported, it is probably a rhinovirus. "It's typically a
sore, really scratchy throat, and you sometimes lose your voice," he
said.
Though flu cases in New York City are rising rapidly , the city health
department has no plansto declare an emergency, largely because of
concern that doing so would drive mildly sick people to emergency
rooms, said Dr. Jay K. Varma, deputy director for disease control. The
city would prefer people went to private doctors or, if still healthy,
to pharmacies for flu shots. Nursing homes have had worrisome
outbreaks, he said, and nine elderly patients have died. Homes need to
be more alert, vaccinate patients, separate those who fall ill and
treat them faster with antivirals, he said.
Dr. Susan I. Gerber of theC.D.C.'s respiratory diseases branch, said
heragency has not seen any unusual spike of rhinovirus, parainfluenza
, adenovirus, coronavirus or the dozens of other causes of the "
common cold ," but the country is having its typical winter surge of
some, like respiratory syncytial virus "that can mimic flulike
symptoms, especially in young children."
The C.D.C. and the local health authorities continue to advocate
getting flu shots. Although it takes up to two weeks to build immunity
, "we don't know if the season has peaked yet," said Dr. Joseph
Bresee, chief of prevention in the agency's flu division.
Flu shots and nasal mists contain vaccines against three strains, the
H3N2, the H1N1 and a B. Thus far this season, Dr. Bresee said, H1N1
cases have been rare, and the H3N2 component has been a good match
against almost all the confirmed H3N2 samples the agency has tested.
About a fifth of all flus this year thus far are from B strains. That
part of the vaccine is a good match only 70 percent ofthe time,
because two B's are circulating.
For that reason, he said, flu shots are being reformulated. Within two
years, they said, most will contain vaccines against both B strains.
Joanna Constantine, 28, a stylist at the Guy Thomas Hair Salon on West
56th Street in Manhattan, said she recently was so sick that she was
off work and in bed for five days — and silenced by laryngitis for
four of them.
She did not have the classic flu symptoms — a high fever, aches and
chills — so she knew it was probably somethingelse.
Still, she said, it scared her enough that she will get a flu shot
next year. She had not bothered to get one since her last pregnancy ,
she said. Butshe has a 7-year-old son and a 5-year-old daughter, "and
my little guys get theirs every year."
Jess Bidgood contributed reporting.