H1N1 puts hospitals, patients in bind

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WATERBURY — New rules implemented to combat the spread of the H1N1 virus at Saint Mary’s Hospital have at least one parent asking for answers.

The hospital has restricted the young, who spokespeople say are the primary carriers of the virus, from visiting intensive care and neonatal units.

But the issue in question is Saint Mary’s refusal to authorize routine H1N1 testing on the grounds that the test available is simply not accurate enough. Other area hospitals have implemented similar measures to abate the diffusion of H1N1, more commonly known as swine flu.

David Scott of Applewood Lane in Naugatuck has seen firsthand what he perceives as negative side effects of these policies. Scott’s 15-year-old son, Andrew, got sick on a Saturday. Scott said he spiked a fever of 103 degrees. He drove Andrew directly to Saint Mary’s, where he was told that only admitted patients could be tested for H1N1.

Andrew wasn’t admitted.

He was sent home with a recommendation for an over-the-counter medication and told to follow the same recommendations our mothers always gave us—get plenty of rest, drink lots of fluids, etc.

But Scott took Andrew to the family’s pediatrician on Monday, where he tested positive for H1N1. The doctor told Scott that Tamiflu, the antiviral drug often prescribed to combat various strains of influenza, would only have been effective within a 48-hour window after the onset of symptoms.

Had Andrew been tested and prescribed the drug at Saint Mary’s, Scott argues, he may not have been sick for more than two weeks.

“This is crazy,” Scott said. “If I didn’t think my son was that sick, I wouldn’t have taken him to the emergency room.”

Dr. Peter Jacoby, chairman of the hospital’s Department of Emergency Services, said Andrew’s triage recommendations were, in fact, nothing out of the ordinary. Except for children younger than 2, the elderly, pregnant women, and those with underlying chronic conditions, Jacoby said, patients presenting flu-like symptoms are rarely admitted.

“Hospitals are a funny place,” he said. “If we don’t think someone is sick enough to get in, they probably wouldn’t be helped much [by hospital care] … clinical judgment is an art, not strictly a science; one and one are not always two.”

He said flu patients not only pose a risk to other admitted patients but also to themselves, as they’d be exposed to any other illnesses dormant in the hospital.

“If the [H1N1] test was 99 percent accurate, we’d administer it,” Jacoby said. “But if someone tests negative, it doesn’t tell me anything.”

The test is only 50 to 60 percent reliable, he said.

And the prescription of Tamiflu, the real crux of Scott’s dissatisfaction with Saint Mary’s handling of his son’s case, is also a matter of clinical judgment, according to Jacoby.

The Center for Disease Control (CDC), he said, has instructed hospitals and practitioners to reserve prescriptions to “those who really need it”—as in those most at risk for serious complications or even death. People don’t die from the flu itself, only from complications arising from the illness—often pneumonia.

The average flu patient will do just as well, if not better, recovering at home, Jacoby said. There’s little a hospital can do to treat mild to moderate flu symptoms that the afflicted can’t do for themselves.

He said the H1N1 strain is only a cause for alarm because of its virulence and how widespread it’s become. It’s not necessarily a particularly robust strain; the only difference, he said, is its “preponderance to hit younger people” and the prevalence of GI symptoms like vomiting and diarrhea.

Flu sufferers need only be concerned if they have difficulty breathing, persistent vomiting, a reemergence of symptoms, or some other abnormality.

Jacoby indicated that all influenza strains, not just H1N1, are dangerous. H1N1 has gotten so much attention simply because it’s a new strain; we have no tolerance for it, so more and more people are coming down with it.

“All flu is cause for alarm,” Jacoby said. “I’m a big proponent of vaccination … More people die each year from flu than from breast cancer. If we told women there was a vaccine for breast cancer, what do you think would happen? They’d be knocking the doors down.”