For Your Health

[mr40]

Flu-related deaths hit record-high 142 as epidemic surges in San Diego County

Despite welcome signs that flu activity in the community may be waning, deaths continue to mount in San Diego County, according to the latest weekly snapshot from the county health department.

Public health officials announced Wednesday that there were 51 flu-related deaths last week, pushing the season total to 142. Most of those who have died during this influenza season have been age 65 or older, and 90 percent have had other illnesses that have contributed to their deaths.

But younger people have not come through unscathed. An 18-year-old man and a 26-year-old woman, both unvaccinated but with no other health problems, have died in what county officials and the U.S. Centers for Disease Control and Prevention are now calling a flu epidemic.

Another 2,070 confirmed flu cases were reported to the county last week, a sharp decline from the 3,046 cases reported two weeks ago and the 3,354 tallied three weeks ago. Last week’s total is still four times larger than the three-year average for the second week of January.

Nearly 11,000 of the 12,446 confirmed flu cases reported since July came in the last month.
Such a surge in activity, said Dr. Sayone Thihalolipavan, the county’s deputy public health officer, usually means a secondary surge of reported deaths even if the number of new infections has started to decline.

“When you see these spikes in cases, we typically expect to see, in the weeks afterwards, an elevated death rate,” Thihalolipavan said.

The long New Year’s weekend seems to have been the deadliest period for the current flu season. According to county records, there were a total of 29 flu-related deaths during the three-day span from Dec. 30 through Jan. 1.

Severe influenza infections have filled 200 intensive care unit beds this season.
Because the county switched to automatic electronic infectious disease reporting during the 2014-15 flu season, comparable long-term numbers are not available. But, Thihalolipavan said, none of the previous three seasons, all which used the new reporting system, have produced more than 155 ICU cases.

The difference, said Scott Evans, chief executive of Sharp Grossmont Hospital in La Mesa, was felt most strongly a few weeks ago.

“When we were at our peak, we had 50 flu cases in the hospital at any one time,” Evans said. “Last week, we were down to 15. That’s still a lot, but we have seen some decrease in the numbers.”

The tough thing, he added, has been staffing the hospital when many employees have themselves come down with the flu and have had to call in sick. That puts pressure on those who are healthy to extend their shifts.

“It really taxes the ones that are well, and we’re very thankful for them,” Evans said.

The aches and pains, cough and fever brought on by the flu is bad enough. But in some cases what starts as an influenza infection can turn into pneumonia when fluid trapped in the lungs becomes a breeding ground for pneumococcus bacteria.

Last week, the ratio of deaths registered with pneumonia jumped from 11 percent to 14 percent in San Diego County, according to the latest county flu report. Patients with clogged lungs often require the help of breathing machines called ventilators to help boost the amount of oxygen entering their lungs while antibiotics help their immune systems fight off secondary infections.

The amount of ventilator use, Evans said, has boomed in recent weeks.

“I’d say we’ve seen probably a 40 percent increase in the number of patients at Grossmont who have required ventilators,” Evans said.

Thihalolipavan said watching out for a secondary infection is important, especially for the very young or the very old. The key, he said, is symptoms that don’t seem to get better.

“Typically, you see that the flu fever goes away after a few days,” he said. “If nothing is better after several days of rest and hydration, it’s important to call your doctor and re-evaluate.”

Some hold to a rule of thumb that if a person can take a full breath without coughing, pneumonia is not present. But the physician said that approach is not universal.

“Though coughing is the most common symptom of pneumonia, one may be able to go a few full breaths without coughing,” Thihalolipavan said.

The county has investigated 101 flu outbreaks this season with most of them occurring in the last month. Defined as any group setting with at least one test-confirmed case and at least one additional suspected case, most flu outbreaks have occurred in local skilled nursing and assisted living facilities.

However, several have occurred in schools, Thihalolipavan said. No official count of local schools’ flu outbreaks was available Wednesday, but Dr. Howard Taras, professor of pediatrics at the UC San Diego School of Medicine who consults with many local school districts, said there have been lots of empty chairs in classrooms as students have returned to campuses after the holidays.

“This is definitely not the worst year we’ve seen for the flu and children, but we’ve definitely had a lot of attendance problems,” Taras said.

Having worked with local schools for more than 15 years, he said the 2009-10 pandemic year, when the H1N1 virus was not part of the annual flu vaccine, was noticeably more severe.

“That year, we actually closed a handful of schools because there were so many kids with symptoms,” Taras said.

http://www.sandiegouniontribune.com/news/health/sd-no-flu-update-20180117-story.html#nws=true