While EDs across the country remain challenged by flu-related volume, there are finally signs that the peak of this year’s season has come and gone, and the CDC is now able to report weekly decreases in the number of patients with flu-like systems seeking care. Still, by the end of February, data show that flu activity remained widespread in every state except Oregon and Hawaii, and health officials warn frontline providers that flu activity is likely to remain elevated for several more weeks.
Most concerning is the fact that pediatric deaths continue climbing. In the latest figures, the CDC notes 97 children have died from flu-related illness this season. Further, the hospitalization rate for patients with flu-related symptoms remains high. Thus far, the CDC reports there has been an overall rate of 74.5 hospitalizations per 100,000 people in the United States, with the most hospitalizations occurring among patients older than 65 years of age.
“Influenza A H3N2 viruses continue to dominate this season, and these viruses are often linked to more severe illness, especially among children and people aged 65 and older,” noted Anne Schuchat, MD, the acting director of the CDC, during a mid-February conference call with the media. “However, we are seeing an increasing proportion of B viruses circulating as well as smaller increases in the proportion of H1N1 viruses.”
Specifically, the latest figures show that in patients who have tested positive for the flu virus, 65% have influenza type A, and three-quarters of these patients have the H3N2 strain. The remaining 35% of patients have influenza type B.
“It is not uncommon for there to be second waves of influenza B activity during an influenza season,” Schuchat cautions. “In past seasons similar to this one, an estimated 34 million Americans have gotten sick with the flu.”
People at highest risk of serious flu complications include the very young, the very old, pregnant women, and people with conditions such as heart or lung disease, Schuchat advised.
“Clinicians don’t have to wait for confirmatory flu testing and should begin treatment with antiviral drugs immediately if they suspect flu in a severely ill or high-risk patient,” she said. “There is a lot of flu out there right now. If it looks like flu, it probably is. Antivirals could mean the difference between a milder illness and a hospital stay or worse, and [these medications] work better if they are started earlier.”
While there have been spot shortages of antiviral medications in some areas experiencing high influenza activity, Schuchat noted that manufacturers say there is product available.
“Staff here at the CDC have been working closely with the commercial supply chain and pharmacies to address gaps in the market and increase access to brand products when the antiviral generics aren’t available,” she observed. “Flu continues to be a priority for the CDC, and we are working 24/7 to protect Americans from it. This is a difficult season, and we can’t predict how much longer the intense flu activity will last.” To cope with flu-related volume, hospitals in many regions have been creating additional treatment areas, canceling elective surgeries, modifying visitation, and boosting staff. For instance, Midtown Medical Center in Columbus, GA, installed a portable clinic outside its ED to manage the intense influx of patients in mid-February. The clinic, which was set up in a trailer in the hospital parking lot, was designed to both expedite care and to separate flu patients from other ED patients to prevent transmission of the virus. The hospital said it was treating as many as 100 patients per day who were presenting with flu-like symptoms.
Other hospitals that have set up mobile units or surge tents to decompress their EDs include Palmetto Health Richland in Columbia, SC, Grady Memorial Hospital in Atlanta, and Lehigh Valley Health Network’s hospitals in Salisbury Township, PA, and Bethlehem, PA.
On the other side of the country, Kaweah Delta Medical Center in Visalia, CA, established two surge tents outside its ED to deal with flu volume that was related in part to the recent closure of a nearby medical center.
In Maine, where flu season often peaks later than in other parts of the country, epidemiologists report that Maine Medical Center in Portland already has had to divert incoming flu patients to other hospitals several times thus far this year. The hospital also has taken steps to pair flu patients in double rooms, and it is using specialty beds from other parts of the hospital to manage flu-related capacity.