Flu patients crowd into Maine emergency rooms, clinics as season starts early

By Jackie Farwell, BDN Staff
Posted Jan. 03, 2013, at 7:57 p.m.

Hospital emergency rooms and walk-in clinics are filling up as the flu grips Maine earlier than usual this season, causing sustained misery and serious symptoms in many patients.

More flu patients are winding up hospitalized this season, according to a number of Maine health professionals. Even some patients who were immunized against influenza are falling ill, though with shorter and less severe symptoms than those who skipped their annual flu shot.

At The Aroostook Medical Center in Presque Isle last week, flu patients visiting the emergency room and walk-in care departments triggered an all-time high in patient volumes, said Daryl Boucher, TAMC’s director of emergency services. The influx, about 120 patients a day at the busiest, prompted the hospital to initiate “internal disaster” protocols on Dec. 28.

Outpatient surgeries were delayed for several hours so surgical staff could help with overflow patients from the emergency department, he said. Inpatient volumes at the 89-acute-bed hospital also swelled because many flu patients were admitted with complications including pneumonia, Boucher said.

“Even though most of them are being discharged after rehydration, we are having to actually admit patients and transfer patients because there’s nowhere to really put them,” he said.

The flu has hit northern Maine hospitals hard, Boucher said. This season’s flu virus, first confirmed in Maine in late October, is sickening many patients for longer — up to two weeks — and causing more severe symptoms, he said.

“As we’re trying to get patients transferred to other hospitals, they’re calling us and asking us for beds,” Boucher said.

At Penobscot Community Health Care’s walk-in clinic in Brewer, extra staff was called in last Saturday to help treat patients, said infection control nurse Christine McGlinchey. About 60 percent of the clinic’s patients that day suffered from flu-like symptoms, she said.

Last year’s season was mild, but a predominant flu type known as influenza A is making a comeback this year, she said.

“It’s starting earlier, people seem to be sicker, and there is much more of it,” she said.

At Affiliated Laboratory Inc. in Bangor, which serves many hospitals and health facilities north of Waterville, positive flu tests began ticking up the week of Dec. 9, said Kirk Doing, director of clinical and molecular microbiology. The flu typically peaks in January and February.

Since that week, 54 percent of the 653 samples the lab has tested came back positive for the flu, a significant jump from last year’s mild season but a moderate showing historically, he said.

Doctors don’t always test for the flu, and may treat patients based on symptoms alone.

The lab, which is affiliated with Eastern Maine Healthcare Systems, is seeing more cases of immunized patients getting sick with the flu in what’s known as “vaccine breakthrough,” Doing said. Like many other vaccines, the flu vaccine doesn’t fully protect 100 percent of those immunized against the disease, he said.

“In any given season, the flu vaccine really only has an efficacy of a little over 70 percent in total,” Doing said.

The vaccine is reformulated each year to match emerging strains of the illness. The U.S. Centers for Disease Control and Prevention has said this season’s vaccine is likely to offer good protection against all three strains circulating nationally. The CDC monitors the virus for changes, and hasn’t reported that this season’s flu is mutating and thwarting the vaccine’s effectiveness, as it has in previous years, Doing said.

With the CDC now recommending that everyone over 6 months of age be vaccinated against the flu, a higher number of immunized people are bound to get sick, Doing said.

“The more people you see vaccinated, you’re going to see more breakthrough,” he said. “So some of these things are just a numbers game.”

Even with the flu season already off to a brisk start, health care providers and public health officials still urge Mainers to get vaccinated. Available as a shot and a nasal spray, the flu vaccine is offered at hospitals, pharmacies, doctor’s offices and clinics.

“It is available practically on every street corner,” said Kathy Knight, director of the Northeastern Maine Regional Resource Center.

The vaccine takes full effect about two weeks after it is administered, but is believed to offer some protection within 48 hours.

Most flu patients who were vaccinated are experiencing less severe symptoms and getting well faster, Boucher said.

Symptoms of influenza include fever, cough, sore throat, runny or stuffy nose, muscle or body aches, headaches and fatigue. Complications can include dehydration, pneumonia and bronchitis.

Tamiflu, a popular drug used to treat the flu, is also widely available, though pharmacies in the Millinocket area reported difficulty obtaining the medication over the holidays, Knight said. The Maine CDC stepped in to ensure adequate supplies, she said.

Emergency department staff at Eastern Maine Healthcare Systems’ six hospitals, including TAMC, estimated this week that about half of their patients showed up with flu-like symptoms, Knight said. Not all of those patients necessarily tested positive for the illness.

Roughly 15 percent of all admissions at EMHS hospitals were patients with influenza, influenza-like symptoms, or a related illness, she said.

Rockport’s Pen Bay Healthcare, a member of MaineHealth, has seen a substantial number of influenza-like illnesses as well as confirmed flu cases in its outpatient practices and among patients admitted to Pen Bay Medical Center, according to infectious disease physician Dr. Cheryl Liechty.

Doctors aren’t required to report individual cases of influenza, but must inform public health officials about clusters of the illness. As of Wednesday, seven new outbreaks over the prior week were reported to the Maine CDC, including six in long-term care facilities. That brings the 2012-2013 flu outbreak total to 32, topping all of the prior season.

Doing said he expects influenza A cases, which typically peak over three to four weeks, to subside within the next couple of weeks. The influenza B strain or other respiratory illnesses may crop up as influenza A wanes, he said.

At TAMC, hospital staff are encouraging people with minor illnesses or injuries to contact a primary care doctor rather than risk catching the flu by visiting the emergency room. Try to get better at home, Boucher advised, but call a primary care provider if symptoms don’t improve after a few days.

“We’re seeing a lot of people with minor symptoms coming into the [emergency department] and it’s just hard to manage that,” he said. “We’re not doing much for them, we’re giving them fluids and giving them Tylenol.”

People with severe flu symptoms, especially those with underlying medical conditions, should not hesitate to seek medical treatment.

http://bangordailynews.com/2013/01/03/health/flu-patients-crowd-into-maine-emergency-rooms-clinics-as-season-starts-early/ printed on August 22, 2014