Flu officially reaches epidemic level in NC

Published January 2, 2015

by Jay Price, News and Observer, December 30, 2014.

Cases of flu and similar illnesses across North Carolina are at their highest levels in more than five years, according to data from a network of health care providers, and the U.S. Centers for Disease Control and Prevention declared a national flu epidemic Tuesday.

An epidemic means that the proportion of deaths blamed on pneumonia and flu nationwide has reached the threshold of 6.8 percent. It’s typical of flu season, though not usually this early. In its weekly flu update, the CDC also noted that there were elevated levels of infection in every region of the country.

For the Triangle, this means emergency rooms and doctors’ offices are jammed with flu patients.

“It generally means longer waits,” said Dr. David Messerly, assistant medical director of the emergency department at Rex Healthcare in Raleigh. “And to be honest, there’s not a lot we can do for someone like a 24-year-old male who otherwise is in good health.”

Antiviral drugs such as Tamiflu, Messerly noted, typically are reserved for use on patients whose age or underlying conditions – such as respiratory illness or heart trouble – put them at risk of serious complications from the virus. That means patients with no other problems may have a long wait simply to be sent home with a recommendation for rest and over-the-counter medicine.

And state health officials are still receiving reports of low supplies of Tamiflu in some areas.

The surveillance network of outpatient health care providers is called ILINet. The CDC uses it to help it and local and state health officials monitor the nature of the flu season.

The most recent statistics released this week show that about 10 percent of patients had symptoms consistent with flu. Those numbers, though, were for the week ending Dec. 20 and were released late because of the holidays.

The ILINet statistics are in record territory, said Zack Moore, an epidemiologist with the N.C. Division of Public Health. The numbers could be adjusted lower when some late reports straggle in, and other indicators aren’t quite as dire, Moore said. But there is no doubt that the volume of cases remains high, something that should be clear when newer statistics are released Friday.

Messerly and other local health care providers said that things actually seemed to get worse last week, though the number of cases may now have flattened out.

“Our volume has increased the last two weeks, and we’re definitely slammed,” said Victoria Harris, a certified physician assistant and owner of Urgent Care of Smithfield. “We’re having tremendous numbers of positive flu tests, many more than last year.”

To help hold down transmission of the virus, her practice is handing out face masks in the waiting room and urging liberal use of hand sanitizer, Harris said.

With flu season clearly spiking, Duke Medicine announced Tuesday that it was joining other area hospitals in barring children from visiting patients until the virus begins to subside. Under the temporary policy, children younger than 18 aren’t permitted to visit hospitals or wards, except in special circumstances and with prior approval from health care providers.

UNC Hospitals in Chapel Hill announced a similar policy for children younger than 12 last week, and Rex Healthcare had earlier banned children from patient care areas of its emergency department. WakeMed in Raleigh had enacted a no-kids policy for some parts of the hospital since September, though that was because of high levels of respiratory illnesses generally, rather than just flu.

All local hospitals are asking anyone showing symptoms of respiratory illness to stay away.

The main flu strain this year has undergone an unexpected mutation, and as of last week it appeared that this year’s vaccine formulation would likely be less effective than hoped in perhaps two-thirds of cases, Moore said.

Public health experts are still urging people to get vaccinated, though, as the vaccination will be good against the remaining third. It also may help blunt the force of the virus and could be effective if another strain crops up later in the season, Moore said.

According to data released this week by the state Department of Health and Human Services, eight people have died so far this season from complications of the flu, though those statistics include cases only through Dec. 20.

Even though the number of flu cases popping up is unusually large, state public health officials hope the number of deaths this year won’t be as bad as last flu season, when the toll exceeded 100.

Still, more deaths are expected, especially among elderly patients because they are generally more vulnerable to the current H3N2 strain.

This is the third consecutive year that there have been dramatic increases in the number of flu cases around Christmas. The reasons for the twists and turns of flu seasons are often mysterious, but such sharp, early escalations would have been considered unusual until recently. In the past they would have come in January or even February.

“This may be turning into the new normal,” Moore said.