Many doctors in US had been warned by CDC not to delay administering
Tamilflu, because it is found that 25% of those with confirmed Swine
Flu were not administered with Tamilflu.
The author also recommends Tamilflu even after 48 hours because there
were cases that Tamilflu was effective.
When to take a sick child to the ER
Children and youths are especially hard-hit by swine flu. It is
important to watch for danger signs, as the onset of respiratory
failure can be swift.
By Rong-Gong Lin II
November 21, 2009
For parents worried about a child sick with the flu, deciding when to
head to the emergency room can be difficult.
Unlike the typical seasonal flu, which is generally most dangerous to
infants and the elderly, the H1N1 strain has hit children, teenagers
and young adults unusually hard and with little warning.
The U.S. Centers for Disease Control and Prevention estimated earlier
this month that more children have died from the H1N1 flu than people
over 65, about 540 children as of mid-October compared to 440 seniors.
And the agency recently reported that flu-related pediatric deaths
were continuing to rise. An estimated 2,900 adults between 18 and 64
have died. Most years, 90% of people who die of the flu are 65 or
older, officials said.
Life-threatening cases, however, remain unusual. As concern grows
about the danger of H1N1, doctors also are seeing an uptick in what
they call the "worried well," parents who seek emergency care for
perfectly healthy children.
So when should you take your child to the emergency room? Doctors say
parents and guardians should assess how sick a child is in part based
"Is there something really different about your child that's different
from the seven or eight viral infections your kid gets every year?
Those are the changes to look out for," said Dr. Mark Morocco,
associate residency director for emergency medicine at UCLA.
Warning signs include significant difficulty breathing; inability to
drink fluids or urinate for more than six hours; change in the color
of the mouth or lips; or unusual behavioral changes, such as a crying
child who cannot be consoled, or a child who doesn't wake up or walk
or talk normally.
If any of those symptoms show up in children, parents should take them
to the emergency room, Morocco said, noting that "respiratory
infections are often things that are the most life-threatening in
Lung inflammation is particularly dangerous to infants and young
children because their airways are smaller. According to the
California Department of Public Health, the flu virus replicates in
the airways and lungs, causing them to swell. The inflammation makes
it difficult for the lungs to work, reducing the body's ability to
take oxygen into the bloodstream.
In California, the most common causes of deaths associated with H1N1
flu have been viral pneumonia and acute respiratory distress syndrome,
state health officials wrote in a recent report in the Journal of the
American Medical Assn. Experts are telling clinicians to treat the
H1N1 strain differently than the seasonal flu.
In a Journal of the American Medical Assn. editorial published earlier
this month, former CDC director Julie Louise Gerberding wrote that
patients who have a five- or six-day history of flu-like illness and
whose ability to breathe is worsening "appear to be at risk for rapid
deterioration" and should be treated with antiviral drugs and admitted
to the hospital.
"Clinicians should not be falsely reassured by previous good health,
young age and absence of major comorbidities because these
characteristics do not exclude the potential for respiratory failure
and death," Gerberding wrote.
The CDC has also warned that some physicians are not prescribing
antiviral drugs to H1N1 patients, pointing to studies that show that
about 25% of hospitalized patients with lab-confirmed H1N1 did not
receive Tamiflu or similar drugs.
Even among those who did get antiviral drugs, medication was often
delayed for one or two days after they were admitted to a hospital,
the CDC said. California health officials have also said that
antiviral medication can reduce mortality even when given late, which
is defined as more than 48 hours after symptoms begin.
Although most people who are hospitalized or have died from H1N1 have
underlying medical conditions, a significant proportion of H1N1
victims are otherwise healthy.
"What's surprising about this flu is . . . we're seeing patients
between the ages of 10 and 47 with no underlying medical problems that
are getting into trouble. And that's scary for us, because it's hard
to know who is going to get in trouble," said Dr. Gail Carruthers,
director of the pediatric emergency department at Long Beach Memorial
Medical Center and Miller Children's Hospital.
Sometimes, patients will report flu-like symptoms for as little as
three hours or as long as two weeks, then quickly become significantly
worse. Their lungs begin to fail and fill up with fluid, requiring
Carruthers recalled two recent patients, a teenager and a middle-aged
person, whose lungs began failing even though they had no underlying
"It's almost like watching them drown," Carruthers said. "They feel
like they can't get any air." But, Carruthers added, "if you don't
feel short of breath, and you have a dry cough, you're probably fine
staying at home."