FLU BLUES

January 11, 2000
		This year the flu season has hit hard and early. Susan Dentzer reports from St. Luke's Emergency in Manhattan. Gwen Ifill leads a discussion. The Health Unit is a partnership with the Henry J. Kaiser Family Foundation.

Focus: Internet Rx Focus: Patients' Bill of Rights Feb. 9, 1999: The Common Cold The NewsHour's Health Spotlight. Browse the NewsHour's coverage of health.   Centers for Disease Control and Prevention Centers for Disease Control and Prevention's Info Sheet University of Rochester Medical Center	SUSAN DENTZER: The flu is hitting especially hard this year, and sending millions with flu and other complications to overcrowded emergency rooms. This one is at St. Luke's-Roosevelt Hospital in Manhattan. HEALTH CARE PROVIDER: Take a deep breath for me. SUSAN DENTZER: Dr. Stephan Lynn directs the residents in emergency medicine at St. Luke's. DR. STEPHAN LYNN: I think this is the worst flu season that I've seen in my career. We, literally, had to close the emergency department to ambulances. We went on diversion. We had so many patients in the emergency department, and so many beds filled, we didn't think that we could legitimately invite any additional patients to come into our facility. SUSAN DENTZER: Most otherwise healthy individuals with flu can be treated in physicians' offices or at home with fluids, pain relievers, and plenty of rest. But for others who develop complications, such as pneumonia, the flu can be deadly, killing as many as 20,000 Americans a year. DR. STEPHAN LYNN: We had a 72-year-old female who had been sick for three or four days. Her temperature was 104, her blood pressure was 70, almost so low we couldn't measure it. She was near death in the emergency department as a result of the flu. SUSAN DENTZER: The Federal Centers for Disease Control says the flu outbreak has now spread to more than 35 states, and is especially pronounced in the South and West. The culprit is known as the type "A" Sydney variant of influenza virus. The strain has been circulating around the world since at least 1997. It was one of several viral strains that the flu vaccine administered this year was specifically designed to protect against. The flu vaccine is considered highly effective at preventing flu for all but many of the elderly, or others whose immune systems aren't functioning at peak. Yet early estimates suggest that this year many Americans, including at least four out of ten at high risk for the flu, did not get vaccinated. SUSAN DENTZER: Did you get a flu vaccination this year? MAN: No. SUSAN DENTZER: What are you going to do next year? MAN: Make sure I get it. SUSAN DENTZER: With so many suffering, physicians this year are turning to two new flu drugs. Called Relenza and Tamiflu, they have just come on the market in the United States. Known as neurominidase inhibitors, these drugs block a key enzyme that flu viruses use to permeate cells and spread throughout the body. If taken within two days of the onset of symptoms, they can shorten the period of illness by a day or two. Studies indicate they may also be effective as flu preventatives, but not all physicians are convinced that the drugs are worth it. PHYSICIAN: I think they are too expensive for most patients, and they have limited efficacy. I don't prescribe them. SUSAN DENTZER: Since the flu season normally lasts six to eight weeks, it won't be known for a while how much worse this year's outbreak was than normal, and why.
	What's the difference?
	GWEN IFILL: For more on what's ailing us, we're joined by Dr. Keiji Fukuda, chief of epidemiology in the influenza branch of the Centers for Disease Control and Prevention, and Dr. John Treanor, an associate professor of medicine in the infectious diseases unit at the University of Rochester. Dr. Fukuda, as we saw in Susan Dentzer piece, there's a lot of anecdotal evidence that people feel sicker, that emergency rooms are closing, that there's a flu raging throughout this country. The question is, are we in the middle of an epidemic really? DR. KEIJI FUKUDA: Sure. Over the past I would say three to four weeks I would say we've seen increased flu activity spreading throughout the country. I think it would be fair to say we're in the middle of the influenza season and the middle of the epidemic season. GWEN IFILL: Being in the middle of the epidemic season, is this typical of what we're seeing right now? DR. KEIJI FUKUDA: Well, you know, with influenza, we can see a wide range of seasons and some seasons can be fairly mild and other seasons can be really quite severe. I think the season that we're seeing this year, in the overall scheme of things is fairly typical for the kind of influenza season that we've seen with this kind of virus. GWEN IFILL: Dr. Treanor, in Rochester, away from out there in the real world, I suppose, what kind of evidence have you been seeing that this is a particularly difficult flu year? DR. JOHN TREANOR: Well, we're seeing the usual sorts of things that we see as flu season starts to pick up, which it certainly has here in town. We're seeing more admissions to the emergency room, more visits in doctors' offices. Occasionally we've had to temporarily turn new ambulances away from the emergency room because of overcrowding although we work hard at keeping the flow going well through those emergency rooms, all of which are very typical for this time of year when flu hits town. GWEN IFILL: So, what is different about this strain of flu? Are people sicker? Are they getting sicker earlier? What's different this year? DR. JOHN TREANOR: Well, actually, I think this is very, very similar to what we saw last year, as Keiji was saying. This is very similar to the virus that was around last year, seems to be causing the same kind of illness. I wouldn't characterize at least in Rochester this particular epidemic as being more severe, but I would point out that influenza epidemics generally are severe. Lots of people get sick. There are lots of hospitalizations, deaths, and this is the reason why flu shots are so important. GWEN IFILL: Dr. Fukuda, is this a national epidemic, or is this just a series of regional outbreaks? DR. KEIJI FUKUDA: Well, I think that one thing to understand about flu is that typically when it hits the country, it doesn't hit the country all at the same time. We frequently see pockets where the activity is particularly severe and then other areas where it's less severe. You know, we typically see all of this occurring during the winter months. So again like Dr. Treanor was describing, there were some parts of the country which we know were hit very hard this year and I think other parts of the country which were hit less severely. GWEN IFILL: What is it that differentiates the flu from a garden variety winter illness, Dr. Fukuda? We have all suffered some sort of a setback in the winter, colds, a influence but we always call them the same thing. What's the difference? DR. KEIJI FUKUDA: Sure. I think -- let me start out with telling you what flu is not. People frequently use the word flu to describe almost anything ranging from mild cold-like illness to diarrhea. And it is neither one of those things. Influenza is caused by a group of viruses, the influenza viruses. And typically what people develop are symptoms such as fever, which can often start quite abruptly and go up quite high -- severe fatigue, headache, body ache, dry cough, sore throat and those sorts of symptoms. But what distinguishes influenza from other respiratory illnesses is that in a large number of people it can really lead to more serious complications, and these are things like pneumonia or dehydration. In people who have underlying conditions like heart disease or lung disease, asthma, it can really exacerbate those or set them off. And each year, to drive this home, you know, we see about 20,000 people on average die from influenza. And we see over 110,000 people, on average, get hospitalized for complications resulting from it. GWEN IFILL: So it's still a deadly disease. Dr. Treanor, what about flu shots? We're told if we get flu shots, that will solve the problem? Is that not the case? DR. JOHN TREANOR: Well, no, they're very effective and certainly recommended for anyone who doesn't want to get the flu. As we recognize, they're not perfect. And it is still possible to get the flu even if you've had a flu shot. But fortunately your illness would typically be much less severe if you've been vaccinated. So, it's something we really recommend for anyone.
	Pushing Flu Drugs
	GWEN IFILL: We heard a lot this fall about new flu drugs. We saw the mention of them in our piece -- Relenza, and Tamaflu. There's been quite a run on those drugs I gather this year. Is that something that is curbing the problem or changing it in any way, Dr. Treanor. DR. JOHN TREANOR: Well, of course, the new drugs are not designed to prevent influenza. They're designed to treat people who have influenza. And I think people who take these drugs will experience a less severe illness which will be shorter in duration. They'll be able to get back to work faster and back to doing the things they want to do earlier than they would if they weren't treated. GWEN IFILL: The drug companies seem to be very much involved in a big marketing epidemic on both of those drugs right now. DR. JOHN TREANOR: Well, it's critical, if you want to be treated with an anti-viral, to take it as early in the course of illness as possible. And for this reason, the companies that make these products have been very interested in making sure people recognize when they have the flu so that they can seek treatment early so that it will be effective. GWEN IFILL: Dr. Fukuda, at this stage of the disease spreading this winter, is there still anything that folks can do who haven't contracted the flu yet to guard against getting it? DR. KEIJI FUKUDA: Well, I want to emphasize what John said which is that the most, by far, the most important thing that anyone can do to prevent the flu is to get vaccinated. This is the single most important thing. I think at this time of year, if you're a person who is in, you know, one of the high-risk groups, a person who is at risk for developing serious complications, you know, you're an older person, you're a person who has underlying heart or lung disease-- and this includes children with asthma-- and you have not been vaccinated against flu, then it's worth contacting your local health care provider to find out whether vaccine is available. At this time of year, you know, much of the vaccine which is produced has been distributed already. So you need to call your physician or your health care provider and find out whether it is available. But if it is, it makes sense to still get vaccinated. GWEN IFILL: Is there a chance of another wave of flu before this year is over, perhaps in a few months? DR. KEIJI FUKUDA: Well, we still don't know when the season is going to peak. Some seasons have a long sort of period in which they're active and other seasons we see sort of this short, very intense period of activity. We won't really know that until later on. GWEN IFILL: And how about around the world? Just one last question to you, Dr. Fukuda, do you have any sense as this is something which is limited to the United States, or is it happening in other places as well? DR. KEIJI FUKUDA: No, clearly influenza is a worldwide disease. The types of problems that we see in the United States are typically the types of problems that you see in other countries. And the viruses that we're seeing in the United States are pretty much the same viruses that we're seeing circulating around the rest of the world. GWEN IFILL: Dr. Fukuda, in Atlanta, Dr. Treanor in Rochester, thank you both very much. DR. JOHN TREANOR: Sure.