Folks, despite the name, I try really hard not to be overly paranoid and dramatic, but there is reason to be overly vigilant this flu season anyway. Despite what you may hear, and what you may think about the H1N1 flu, this is NOT like any other bug.
A week ago here in Nashville, there was a 5 year old boy who died from H1N1. While it is not unusual for a young child to die of the flu who has a pre-existing health condition, this child was not known to have any. What's more alarming is that he first showed symptoms on Friday, and was dead by Monday night.
Update [2009-9-14 9:34:14 by Tin hat mafia]: The original Tennessean article has is now available on their web site and featured on their front page. I know I wrote this in the middle of the night, but please rec this up so that others can see it!
The Tennessean article I am about to quote appeared in today's paper, but it is apparently behind a pay wall (although I didn't know they had one). I found a copy here.
September 12, 2009
How did swine flu kill a healthy boy?
Kindergartner’s death leaves parents, doctors with questions
By Chas Sisk
THE TENNESSEAN
The most remarkable thing about the death of Max Gomez was that it could happen at all.Going into the last weekend in August, the Antioch 5-year-old was an energetic, independent kindergartner excited to be starting elementary school. Less than four days later, he was dead.
snip....
Ruth Gomez described Max’s flu as progressing extraordinarily quickly — from a fever on Saturday to an apparent recovery on Sunday to hospitalization and death on Monday.
When he fell ill on the weekend of Aug. 28, Ruth and her husband, Marco, saw little to fear. Max woke up with a fever that Saturday — a fever that peaked at just over 102 degrees, his mother recalled — but he otherwise seemed energetic. His parents suspected it was a routine childhood illness, an ear infection or a sore throat, one that would get better with a dose of Tylenol and rest.
snip...
By Sunday, Max’s fever had subsided. To be cautious, the family decided not to let Max join a zoo trip with his church group, the Eager Beavers, but Ruth recalled he was playful that day and showed ample signs of recovery.
Monday, however, began worrisomely. Max’s fever returned, and he had chills. Ruth and Marco, an independent contractor, couldn’t afford health insurance for themselves, but they had enrolled Max and his two younger sisters in TennCare, the state’s health insurance program for low-income children, pregnant women and the disabled. Ruth took Max that day to a walk-in clinic in Antioch, where he was seen by a doctor and released. But by the time Marco came home from work at 5 p.m., Max’s perpetual energy had given way to unrelenting fatigue. The family rushed Max to Monroe Carell Jr. Children’s Hospital at Vanderbilt, where he was admitted around 6 p.m., Ruth recalled. The doctors seemed to sense the urgency of Max’s case almost immediately. Still, he was dead less than three hours later."This happened so fast," Ruth said.
But a recent article in The Lancet (behind a paywall...but an excerpt can be viewed here) about the recent experiences of British pediatricians also concurs that they are seeing children that don't fit typical flu symptoms.
The study suggests that instead of looking for the typical symtoms of swine flu like fever, cough and a running nose before recommending a test, doctors could go in for the same if a child has complaints like an earache and swollen eyes and suffers from underlying illnesses.
The Birmingham doctors found that besides cough, fever and running nose, many children who were later diagnosed with H1N1 came with symptoms like ear ache, photophobia, chest pain, swollen eyes and blood in vomit.
The report indicated that if the issued guidelines alone had been used, 40% of the children who were later verified to have H1N1 would have never been diagnosed at all!
The complete breakdown of symptoms listed was as follows:
Twelve of the 64 children reviewed did not have temperature of at least 38°C or a history of fever. After fever, cough (49/67) and a runny nose (45/73) were the most common symptoms. Other symptoms included blood in vomit, photophobia, earache, infection and eye inflammation, chest pain and acute abdomen pain. Thirty-one of the 77 patients had significant pre-existing disorders.
The combination of the uncertainty of diagnosing H1N1 in kids, and the lack of access to health care is, for me, the 800 pound gorilla in the room in the health care debate. Meanwhile down in Memphis, a local hospital has had to erect a tent to triage all the children they are getting with flu symptoms.
The emergency room, which will be replaced by one about twice as big in the new hospital, already was undersized for the 160-180 children it normally receives each day.
On some days this week, however, the patient load has exceeded 350 -- at least half of them being children with flu-like symptoms. After waiting for hours in the cramped emergency room, many have gone home without being seen by medical personnel.
snip...
Under the CDC recommendations, children with swine flu don't need emergency care or hospitalization unless they have some underlying medical condition -- such as immune deficiencies or heart or pulmonary problems -- or are experiencing severe symptoms, such as breathing difficulty and skin discoloration.
Also, 90% of the confirmed flu cases in the state are H1N1 (which I suspect is low due to the fact it is not flu season yet....negative results are apparently more likely to be false than positive results, see here)
Apparently the CDC guidelines, like their British health counterparts, do not reflect the most recent intelligence from the field, so to speak, as found in the Lancet article. Something to keep in mind if you are a parent arguing with a doctor because your child seems to fit the symptoms in the recent article rather than the CDC guidelines...remember that doctors don't have time to read every journal so they may not know!
With the Nashville case, I don't believe the autopsy reports have yet come in, so we don't know for sure if he had some undiagnosed underlying condition. I will post a followup diary as soon as I hear....