UPDATE: with new N.C. flu-death data from Thursday, Jan. 9
By Sarah Ovaska and Thomas Goldsmith
Time to break out the hand sanitizer – flu season is officially underway with initial reports predicting it could be among the worst flu seasons to hit in a decade.
Health officials in North Carolina and beyond are watching hospital admissions and doctor visit reports closely to see if the 2019-2020 season could indeed turn out to be a blockbuster one for influenza, as many worry.
This year’s activity has so far eclipsed what was experienced at this point in previous years, with the CDC estimating 6.4 million cases of the flu, 55,000 hospitalizations and at least 2,900 deaths so far. That count includes 27 children, the highest number of pediatric deaths seen since the CDC started keeping records 17 years ago, according to CNN.
“We’re pretty much in full swing with cases that even exceed the numbers we saw this time last year,” said Christopher Ohl, an infectious disease expert at Wake Forest Baptist Health.
The deadly threat the flu brings was made apparent this week, with the state releasing data Thursday afternoon showing nine additional flu-associated deaths last week, the worst week in terms of casualties this season. The state also reported the first pediatric influenza-associated death this season, with a child in the western part of the state dying in December from flu complications.
There have now been 21 people to die from influenza complications. The remainder of the deaths consist of 3 adults between the ages of 25 and 49, and 17 people over the age of 50, according to data kept by the N.C. Department of Health and Human Services.
Risk not always age related
Health demographers consistently see high percentages of flu-related mortality among older people in North Carolina and elsewhere. And you don’t have to be all that old to be at risk.
Of 285 flu deaths in the 2018-2019 season, 88 percent came among people 50 and older, according to DHHS. That means nearly nine in 10 such deaths happened among a North Carolina age group that makes up only about a third of the state’s population.
The flu, or influenza, is a viral disease that strikes the United States seasonally, leaving those affected with high fevers, coughs, runny noses, body aches and fatigue that tend to come on quickly. But it’s not just a week in bed for some – the flu can turn deadly and is particularly dangerous for those over 65, young children and those with compromised immune systems.
In addition to the 50-plus crowd dubbed “older” under the Older Americans Act, anyone with other active health problems can be particularly vulnerable to serious effects of flu, according to Dr. Graham Snyder, an emergency department physician at WakeMed Health and Hospitals. So, if you‘re sick, you could well get sicker, he said in a phone interview.
“If you’re vigorously healthy and all your systems are healthy, then the flu will be just like the flu is for everybody — body aches, fever, a cough and runny nose that lasts a week or so and then goes away,” Snyder said.
“But if any systems of your body are compromised in another way, then simple things like the dehydration from the fever, the body aches messing up your balance, all those things can tumble into making it a much more serious illness.”
Those who have problems breathing, experience confusion or who are at high-risk for flu complications (including young children, seniors, pregnant women and those with compromised immune systems) should seek medical attention to see if an antiviral medication such as Tamiflu can help stave off the full brunt of the illness, said David Weber, an epidemiologist and infectious disease specialist in charge of infection prevention at UNC.
Regardless, plan on keeping those germs to yourself.
“If you’re sick, stay home,” he said. “Don’t affect your coworkers.”
If a healthy person’s flu symptoms respond to the standard recommendations — plenty of fluids, nine hours of sleep, and over-the-counter treatments for fever and a stuffy nose — a trip to the doctor is likely not in order, Snyder said. But a patient’s unusual confusion or shortness of breath while at rest could call for professional attention in addition to consideration of Tamiflu, as could the incidence of flu in someone with diabetes.
“Diabetes is a problematic disease because it, especially uncontrolled diabetes, affects all the systems of the body,” Snyder said. “It makes your blood vessels narrow … it can mess up your balance, it can mess up your vision, and it can also cause accelerated heart disease.”
Switch in patterns this year
There are two main types of influenza that occur cyclically in humans, Types A and B. Most years usually see the A strain emerge first, followed up by an increase of B-strain viruses. But this year is a bit different.
The B-strain, which has two lineages called Victoria and Yamagata, has been most prevalent in these first few weeks of the flu season, according to the CDC.
North Carolina is following that trend with nearly half of the cases tested so far proving to be the B strain (Victoria lineage), according to the N.C. DHHS data. Anita Valiani, the influenza epidemiologist who tracks flu activity for the N.C. DHHS cautions that North Carolina’s data isn’t all that robust given that the state doesn’t require that all flu tests be sent in for further analysis.
So why does it matter what strain you have? Sick and miserable is sick and miserable, no matter what strain you have, but there are important differences for public health officials. The A-strain can undergo rapid changes once it’s out there in the world, making it the virus strain that prompts pandemic flu as the mutated virus jumps and shifts.
Children are more susceptible to Type B, for reasons that are largely unknown.
One good aspect of this is that the cases doctors are treating right now appear to be less severe, Ohl said. This year’s vaccine seems to be working so far, meaning those who got their flu shots have a decreased chance of contracting the virus or, if they do, are less sick than if they were unvaccinated, he said.
“People can usually get up and go back to work or school quicker,” he said.
But this early appearance of Type B is now giving way to increased numbers of Influenza Type A, the more unpredictable strain that mutates quickly and is historically linked with flu pandemics, Ohl said.
“The severity will go up, particularly for people who are older or people who have underlying health problems,” Ohl said.
If you haven’t yet gotten a flu shot, get one, he said. Even if you’ve had one strain, there’s no guarantee you’d avoid a separate strain of the flu.
And if there’s one thing worse than getting the flu, it’s getting it twice in a season.
Activity high in the Old North State
North Carolina is among the 37 states with high flu activity, according to the CDC. Medical centers and medical practices around the state are seeing studied numbers of people in their waiting rooms with high fevers, sore throats, aches, chills and general malaise indicative of the flu.
All areas of the state are experiencing what’s considered widespread flu activity, said Valiani.
But it’s likely too soon to say how the rest of the flu season will go, given the unpredictability of the flu virus and how it behaves, she said.
“Flu seasons are very unpredictable,” Valiani said. “It could look bad and end up moderate or look moderate and end up bad.”
She also stressed that it’s not too late to get a flu shot and said there are steady supplies of vaccines across the state.
Hospitals around the state aren’t taking any chances, with most of the state’s major hospital systems enacting their annual policies during flu season to bar children under the age of 12 from visiting people. Among the systems who have enacted the visitor restrictions: UNC Medical Center facilities in Chapel Hill and at its Rex/Raleigh campus, Duke University Medical Center in Durham, WakeMed in Raleigh and Cary, Cone Health hospitals based in Greensboro, Wake Forest Baptist in Winston-Salem along with its affiliated community hospitals, and Atrium Health in the Charlotte area. (The N.C. Healthcare Association maintains an updated list of hospitals with visitor restrictions here.)
Children are barred from hospital visits because they tend to pick up and spread the viruses. They’re also less likely to cover their coughs, wash their hands, or know they’re sick and contagious to begin with, Weber said.
“You can’t really ask a 2-year-old to blow into a tissue” and expect it’ll happen, Weber said.
Regardless, anyone with a fever or cold should refrain from visiting people in the hospital, given how dangerous a bout with the flu can be for a cancer patient or someone else with a compromised immune system, he said.
Flu patients with existing lung disease can face particular danger, Snyder said bluntly.
“If you have COPD, emphysema, chronic bronchitis, or you just have smoked cigarettes for 30 or 40 years, it’s going to be much harder and it could be fatal,” he said.
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