Swine Flu: When to Head to the Hospital, When to Stay Home

Have a fever, a sore throat, and flulike symptoms? It could be H1N1, as 46 states now report widespread H1N1 infection, and the president has declared the virus a national emergency. And now, the Journal of the American Medical Association (JAMA) has released a study showing that of those who are hospitalized for H1N1, 30 percent require intensive care, and 10 percent die─and that the flu kills people in all age groups. Scary stuff, enough to make one run to the doctor at the slightest runny nose. But if you get the flu, in most cases you should probably stay under the covers and away from the ER.

That's because, for most patients with H1N1, trips to the ER—or even a primary-care physician—are unnecessary, says Carl Schultz, professor of emergency medicine at the University of California, Irvine, School of Medicine. "A vast majority of people are doing fine even if they get no [medical] intervention, so it seems inappropriate to bring them to ER where negative things could happen," says Schultz. For instance: the chance of infecting someone with a compromised immune system waiting in that ER, or the chance that you—who may just have a cold—could contract H1N1 from someone else.

The JAMA research shows that H1N1 can have very serious consequences for the people it infects, says study author Dr. Janice Louie, chief of the influenza and respiratory-syndrome section for the California Department of Health. The hospitalization rates are similar to those for the seasonal flu, and those who do require hospital care are in pretty bad shape. "We're seeing a rapid progression and onset of illness. People are in the ER within three to four days of feeling sick," she says, noting that all of the hospitalized patients are suffering from pneumonia. "More severe cases of pneumonia result in the patient being intubated, and having fairly long courses of illness, sometimes being hospitalized for months."

Louie's study, which analyzed 1,088 people who were hospitalized or died from H1N1 infection, did not address what percentage of all patients with H1N1 end up in the hospital. But if H1N1 is following patterns set by the seasonal flu, only about 1 to 2 percent of those infected will need emergency services.

If you head to the doctors with a mild case, your doctors may not provide much relief. They most likely won't even confirm the diagnosis. Most individual physicians aren't testing for H1N1, since there are so many cases so early in the flu season, doctors just assume that if you have the flu, it's of the swine variety. Tamiflu, once a readily available prescription for flu sufferers, is being shelved by most doctors. Since the flu is considered an epidemic, and a larger section of the population may become infected, giving the drug to such large numbers at the same time could lead to the emergence of a powerful, more deadly strain of the disease. "Most people will get better whether they get Tamiflu or not, so it's not worth administering and possibly causing a drug resistance," says Shultz.

So those who do head to the doctor will likely hear this advice: Get some rest. Drink some fluids. Stay home until you feel better.

However, there are some people who should seek medical care if they start feeling fluish, and the American College of Emergency Physicians just released guidelines to help determine who they are. Senior citizens who develop symptoms should seek treatment, since, despite earlier reports, the elderly do seem to be at increased risk: the majority of those in the JAMA study who died in the hospital of swine flu were older than 50.

Other risk groups: those with medical conditions that compromise the immune system, such as HIV. Those with chronic respiratory issues, sickle-cell anemia, or chronic heart disease should also get checked out, as should patients on dialysis or those who have recently completed chemotherapy. (A full list of the conditions are available here.) "These individuals are at much higher risk of having something go wrong with them, and we're not comfortable having them make the decision about [whether they need medical attention] on their own, since the odds that they are sick are greater," says Schultz. It's possible that those with these conditions could be suffering from H1N1 and need no extra attention, but it's "better to give primary-care provider a call and get checked out," says Shultz, who is also a member of the ACEP.

Though the guidelines are intended only for adults, many of the concerns are the same for children. If a child with flulike symptoms has trouble breathing, appears blue, can't stay hydrated (due to vomiting or inability to take in fluids) is less responsive than normal, or relapses after a few days of seeming to improve, take her to a doctor, says Dr. Nathan Litman, a pediatric infectious-diseases specialist at Montefiore Medical Center in New York City. The same goes for children with underlying illnesses like heart disease, asthma, lung diseases, kidney disease, or neuromuscular diseases.

"It's not a trivial illness that you shouldn't be worried about at all," says Litman. "[But] it is a minor illness. If a child is doing well, not having difficulty breathing, those children can be managed at home with [a fever-reducing drug] like ibuprofen and the old remedy: chicken soup." Good advice—for most of us.

Swine Flu: When to Head to the Hospital, When to Stay Home | News