For Your Health

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Flu kills 34 more people, including a 1-year-old, in San Diego

The number of deaths associated with this year’s severe flu season has quadrupled in a week, according to the latest update from the county Health and Human Services Agency.

An additional 34 deaths were added to the tally Wednesday, including a one-year-old boy, as influenza raged throughout the region in what experts say is the fiercest battle with the rapidly-mutating virus they’ve experienced since 2009, when a pandemic filled emergency rooms from Oceanside to Chula Vista.

That has been the case this year, as well. A feverish mob began arriving at local emergency rooms right around the holidays, creating long waits and forcing some facilities to set up tents in their parking lots to relieve pressure on their emergency waiting rooms — just as they did in 2009 when the H1N1 epidemic hit.

Most hospitals reported that they have instituted, or will soon put in place, visitation restrictions barring children and finding other ways to limit the number of people visiting hospitalized patients.

“I think we’ve already surpassed what we thought was busy in 2009,” said Michelle Gunnett, director of emergency services at Palomar Medical Center in Escondido, which set up a special flu tent just outside its emergency department entrance over the weekend.

Dr. Kristi Koenig, medical director of the county’s emergency medical services system, said her office has been monitoring emergency room traffic on a near real-time basis for weeks and has seen many hospital have to bypass ambulance traffic from areas outside their core territories due to the number of flu patients arriving.

“Definitely there is stress on the system,” Koenig said. “The waiting rooms are full, there are long waits to be seen and a high proportion of the patients are testing positive for flu.”

A staggering number of flu cases — 3,334 — were reported last week, besting the previous week’s total of 2,338, which was itself the highest single-week tally on the books. That’s eight times as many cases as last year.

The increase in flu activity spurred interest from several San Diego County supervisors during a meeting Tuesday. They agreed to explore the idea of doing more to combat the flu, even broaching the possibility of declaring a local health emergency as they did in September during the region’s hepatitis A outbreak, if necessary.

In an email Wednesday, board chair Dianne Jacob said the latest report strengthens the board’s resolve but does not move up the timeline.

“The spike in deaths is alarming and further evidence that we should take a hard look at how this is impacting the region,” Jacob said. “I want to know more about our response and if an emergency declaration is needed, which is why I asked to hear from our public health officials at the Board of Supervisors meeting next Tuesday.”

A total of 55 flu outbreaks, defined as locations where at least two flu cases have been reported and at least one case has been confirmed through testing, are listed in the county’s latest weekly report released Wednesday morning.

Dr. Sayone Thihalolipavan, the county’s deputy public health officer, said that assisted living centers and skilled nursing facilities make up the majority of those outbreak sites. The largest so far involved 33 cases at a local skilled nursing facility which the county has not identified.

Many of these facilities, Thihalolipavan said, are working to get all of their residents and workers vaccinated and are taking steps to reduce the amount of contact in shared spaces from day rooms to dining rooms.

“At this point, given the flu season we’ve had overall, we would advise that, yes, people should avoid contact where possible,” Thihalolipavan said, adding that many of this year’s flu-related deaths have occurred among long-term care facility residents.

Last week, with news that there had been more than 2,000 new flu cases in a single week, the county added six to the death toll, pushing the season total to 11. Last week, local health facilities reported 34 more, bringing the total to 45.

That’s nine times as many deaths as were recorded during the same six-month July-through-December span last year and nearly 15 times the prior three-year average.

The average age of those who have died this year has been 82 with an even gender split.

According to the county, 71 percent of those who died were unvaccinated.

The youngest flu victim was a one-year-old boy said to be from central San Diego. He was “partially” vaccinated and had other underlying health conditions which the county did not specify, citing a need to protect the patient’s privacy. During the 2016-2017 flu season, two teens, ages 17 and 14, died.

Vaccination has been and remains the main focus of public health departments in the growing number of states where flu activity is increasing. However, the dominant strain this year, called H3N2, is known to be one of the more difficult versions to vaccinate against. A study out of Australia where H3N2 caused a severe flu season this summer, indicated that the current vaccine was only about 10 percent effective.

Lynnette Brammer, lead of CDC’s Domestic Influenza Surveillance Team, said that preliminary research is still underway to determine how well this year’s vaccine is working against several different types of flu in circulation this year. She said she expects about 30 percent effectiveness against H3N2.

“We’re still in the process of collecting that data,” Brammer said. “Some of our sites are starting to see a lot of cases, and some of them aren’t. I think we’re probably on track to have a preliminary estimate sometime next month.”

As to why the flu has been most active in southern and western states this year?

She said no researcher has yet figured out why the flu seems to hit certain geographies harder than others. So far, she added, there is no national shortage of flu vaccine or of the antiviral medications that can make the flu less severe if taken within a few days of first symptoms appearing. That doesn’t mean, she added, that some won’t still be turned away when they show up at their local Target for a flu shot. In areas where there is a high demand, getting the goods may take a little more searching.

As to those who say they don’t bother to get vaccinated because the overall effectiveness of the flu vaccine is less than 50 percent in many cases, Brammer said that, even at a 10 percent effective rate, the vaccine still helps many people.

“You still end up preventing tens of thousands of cases and hospitalizations, and you prevent a lot of deaths when you’re looking across an entire nation,” she said. “It’s not as good as we would like, but it still has a lot of benefit.”

Koenig, the county emergency medical services director, added that getting vaccinated isn’t always about protecting yourself.

“Even if you don’t feel that you need a flu shot to protect yourself, you can still pass the flu to someone else before you even have symptoms, and the flu could end up being deadly for that person, especially if they’re older or very young,” Koenig said.

A survey of local health systems by email Wednesday afternoon showed that several local providers are taking steps to limit visitation:

Palomar Health, which operates hospitals in Escondido and Poway, is barring children younger than 16 unless there are extenuating circumstances and is generally limiting visitors to immediate family.
Scripps Health, with four hospitals on five campuses, requires all visitors to be age 15 or older.

UC San Diego Health barred children younger than 12 on Dec. 20 from all health care areas including cafeterias and other public areas.

Prime Health Care, which operates Alvarado Hospital and Paradise Valley Hospital, has a general “no children” policy for inpatient floors.
Kaiser Permanente listed no visitation restrictions for its two hospitals.

Sharp HealthCare and Tri-City Medical Center did not specify their visitation restrictions.

All hospitals reported asking any patient showing flu symptoms to wear a mask while present in inpatient or outpatient facilities and all said they are asking anyone known to have the flu to avoid visiting loved ones until they are well.

http://www.sandiegouniontribune.com/news/health/sd-no-flu-update-20180103-story.html#nws=true