Wednesday, September 23, 2009

Texas Hosptial Overflow Has Patients in Tents

A children's hospital in Austin has set up tents to deal with the mass numbers of kids coming to the ER. Most are mildly to moderately sick with the pandemic H1N1.

So far today I have received 5 reports of H1N1 hospitalizations. Prior to this, since April I only had 14. Glancing through the reports, the illnesses do not appear to be terribly serious. None of these 5 were in ICU or in need of ventilation. One was admitted for severe dehydration. Two were asthma exacerbation. One was a pregnant woman. The other one had significant underlying health conditions.

Surveillance shows an incredible amount of influenza-like illness in my area. I take the numbers with a grain of salt, though. Awareness is very high -- let's face it, it's tough to get away from "swine flu" messages right now. Combine that with fear. I suspect (and have in some cases been told) that school nurses are being very cautious with sick kids and reporting them as ILI when they might not have in the past. I also think that due to the hoopla people are more likely to seek health care now that usually. While demand has increased in some of the ERs, the overall level of hospital admission with serious illness is low. To me, the real signal to the severity of this pandemic will be severe illness and death.

Think of the common cold. How many of us get the common cold? I catch one or two cold viruses without fail each winter. Get myself a nasty sinus infection. I typically do not go to the doctor. But if I had reason to believe a particular cold might be something to get alarmed about, I might seek medical attention even though I did not need it. That would be a fear-driven response rather than a needs-based one.

Every time we have a highly publicized outbreak, many more people seek medical attention than would normally. Plus, when there is a highly publicized outbreak, docs are more likely to test for it. Some patients will demand the test even when the doc doesn't really have a medical reason for doing so. I heard about an ER fight this summer where a patient screamed for the test even though they didn't meet the lab criteria for testing, and there was no diagnostic reason for doing so. The poor ER doc ended up collecting a specimen which the lab promptly discarded. During the last peanut butter outbreak, people called me wanting to "get tested" because they felt sick to their stomachs. In our litigious society, many of these want to get in on the eventual class-action lawsuit. Still others like the novelty of saying they had the "peanut butter salmonella" or whatever else is going around.

Someone told me the other day that his kid has "The H." We all decided that sounded cooler than H1N1.

I am not advocating complacency, but rather reasoned caution. I'll keep an eye on severity (heck, H1N1 is all I ever do any more). We'll all wash our hands, because, let's face it, it will stop lots of germs from infecting our bodies. We'll all cough in our sleeves and we'll all stay home when we are sick. And the vast majority of us will be just fine. I wonder if one day this will all be looked upon as the 2009 Y2K, with senate hearings on the vast amounts of money being spent on pandemic control.

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