Disclaimer/Notice: I posted this diary two days ago in the middle of the night, not exactly the best time to bring important things to people's attention. I am reposting it now so that more people can be aware of some recent news/observations about the symptoms exhibited by children who have contracted H1N1, and realize the severity of this pandemic threat.
A week ago here in Nashville, there was a 5 year old boy who died from H1N1. While it is not unusual for children with pre-existing health conditions to die from typical influenza, this child was not known to have any such conditions. What's more alarming is that he first showed symptoms on Friday, and was dead by Monday night, and it appears that during that time his temperature never got above 102.
The Tennessean article can be found on their web site here, and a copy on flutrackers 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.
Also, in a recent article in The Lancet (behind a paywall...but an excerpt can be viewed here) British pediatricians state that they are seeing children that not only don't fit typical flu symptoms, but that wouldn't pass the criteria for diagnosis under their health organizations updated H1N1 guidelines!.
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! That's no statistical anomaly folks, that's pretty near half of the children they definitively diagnosed with H1N1!
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.
Since we live in a metricaphobic nation, I will translate for you. 38°C is only ~100.5°F! That's not even enough of a fever to normally warrant staying home from school! I can only hope that school officials will be alerted to this fact....
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....
Update [2009-9-15 23:7:8 by Tin hat mafia]: I want to make one thing perfectly clear. This is not a 'freak-out' diary. This is an 'everyone remain vigilant' diary. I am not saying that doctors don't know what they are talking about, but I am saying that they are experiencing a high volume of people with flu symptoms...which I say only to illustrate the point that they may not have time to read up on the latest medical journals. People with concerns about their health or that of their children should always discuss them with their physician. I am just of the opinion that informed concerns are far more useful than uninformed ones. If your children are feeling ill but do not have a 'high grade fever' they may still have the flu and be contagious. Whether or not they go to school will be between you and your doctor, of course, but I am just trying to help people make that decision.
And as for children who look like they are getting better, but develop a second fever later, this is apparently the sign of a secondary infection...as per the Tennessean article, so call your doctor!
But they did say that when influenza combines with a bacterial infection, such as pneumonia, the patient often follows a pattern in which his symptoms start to subside but then suddenly worsen. That pattern — which includes symptoms such as vomiting, chest pain, a racing pulse, breathing trouble, bluish skin or trouble staying awake — is an indication that the flu has turned deadly, and it means a sufferer should talk to a doctor immediately.
"What you expect from ordinary flu is that it starts off bad and gets better," said Dr. Bill Paul, Metro's health director. "If that's not the case, it's worth a call."