With virtually every state experiencing the effects of a rampant flu season, clearly it’s an overwhelming time to work in a hospital, doctor’s office or an outpatient clinic. Being on the front lines of the flu fight, you may not have extra time or energy to keep up with the details of this national story.
Centers for Disease Control and Prevention (CDC) reports from mid-January showed that this flu season is “tracking closely” with the 2014-2015 season, when there were more than 35 million symptomatic cases in the United States, with 710,000 hospitalizations and roughly 56,000 deaths. Like the 2014-2015 outbreak, this season is being impacted by the particularly lethal H3N2 strain that was first identified in 1968, the year of the Hong Kong flu pandemic.
“If you go back decades, you can see that H3N2 is always associated with more impact,” said Daniel Jernigan, MD, MPH, and director of the CDC’s influenza division, during the CDC’s monthly Grand Rounds presentation, available online.
In more than 12,400 flu-positive specimens, H3N2 has accounted for 78 percent of infections so far this season. Other strains circulating this year include the influenza A strain H1N1 and two influenza B strains. Given that the H1N1 and B strains tend to hit later in the season, it looks like we still have a long road ahead.
To help manage the deluge of patients, we’ve seen hospitals implement traditional responses, like diverting ambulances and limiting visitors under certain ages, as well as those with flu-like symptoms. In the hardest-hit areas, hospitals are setting up beds in conference rooms, hallways, next to nurses’ stations and inside tents in parking lots. For less-severe cases, technology is playing a larger role in diagnosing and treating patients.
On-demand, internet-based services like HealthTap, TelaDoc and Doctor on Demand allow patients to be seen in real-time virtual appointments. Patients need to have internet access through a smart phone, tablet or computer with a camera. Depending on the service they select, patients may choose from a list of physicians and are seen online within a matter of minutes. Many insurance plans are accepted but not required, in most cases. Patients may view up-front costs before the visit. Some of the services offer lab tests, imaging services and prescription medications, which are additional charges.
Technology is also helping doctors to make house calls again. In 2016, Fortune reported on the trend and featured the California start-up, Heal.
“At first glance, Heal is quite similar to the rest of the so-called “on-demand economy,” wrote reporter Kia Kokalitcheva. “Customers simply pull out a mobile app, and with a few taps, can summon a doctor right to their doorstep. But Heal’s approach is actually rooted in more than one growing trend in the health care industry.” The service reduces the number of patients that a doctor sees daily, and it provides an in-person alternative to the virtual services described earlier.
The challenges of flu vaccines
Eerily, the current epidemic coincides with the 100th anniversary of 1918’s flu pandemic. We have learned a great deal in the past century, but some things still elude us. Despite the best efforts of science and data, the intensity of this year’s outbreak was not predicted. The virus’ constant mutations, known as antigenic shift, make forecasting a flu season, and developing the right formulation for the vaccine, nearly impossible.
At the Grand Rounds presentation, Dr. David Wentworth, chief of the virology, surveillance and diagnosis branch at CDC’s influenza division, explained a few of the challenges created by flu viruses, especially H3N2. “Virtually every flu virus is different from every other flu virus because the replication of the virus is error-prone,” he said. “It’s not just one variant that attacks a person; it is hundreds of flu variants attacking. Multiply this by the number of infected people, and you get a sense of the millions of flu-virus variants that exist in the population.”
Development of a one-time vaccine continues with some recent progress reported. In the online video presentation, Wentworth said there are different approaches to a universal vaccine, including a multivalent-type approach that would get more proteins into the vaccine. Others focus on the part of the virus that does not change as rapidly as the top of the virus does. But with as formidable of a foe as flu, we know the fight will continue for years to come.
You may be wondering if getting a flu shot still makes sense for this year. The answer is a resounding “yes,” especially with the expected uptick in H1N1 and B strains. Public health officials note that deaths could be reduced by 50 percent by getting vaccinated. The CDC also noted that spot shortages of the vaccine may occur, requiring calls to multiple pharmacies, but the national supply is ok.
In the meantime, wash your hands frequently, cover your coughs, and perhaps most importantly, stay home from work or school if you or a family member comes down with the flu.
About the author. In her role at Vizient, Stephanne Hale provides clinical expertise in competitive procurement processes to promote safety and quality in the health care supply chain. In addition, Hale is responsible for developing tools and educational resources for Vizient members and partners that support member and national initiatives as well as disease prevention. Her varied clinical background includes experience in palliative care, liver-kidney transplantation and traumatic neuro-rehabilitation.