Thursday, November 12, 2009

The most dangerous cases of H1N1

by Sally Kneidel, PhD

As I wrote about a couple of weeks ago, my daughter and her boyfriend both had H1N1 recently. They both had fever, headache, severe muscle aches, fatigue, a sore throat and dry cough. They were both pretty miserable for a few days, but then made a very speedy recovery.  Neither one of them ever went to a doctor, because by the time we figured out what they had, it was too late for Tamiflu to have any effect.  A nurse told me that Tamiflu is effective only if taken in the first day or two of a viral illness, because all it does is shorten the duration and severity of the illness.  My daughter and her boyfriend did take elderberry extract capsules (800 mg, 3 times a day) which they felt hastened their recovery.

The same nurse friend I mentioned above also told me that, of all the people she sees in her job, those with H1N1 are in general not as sick as those with the seasonal flu. The population she treats is mostly teens.

When H1N1 Can Be Fatal
But soon after my daughter and her boyfriend recovered, the college-age son of a friend became ill with H1N1. He went to the college infirmary, and was soon in the hospital.  I'm not sure exactly what symptoms he had at first, except that they included a cough, sore throat, and runny nose.  Then, within just a couple of days, I got the word that he was in critical condition, in the ICU with pneumonia!!  There was a day or two after that where no one was sure whether he would live or die.  It was very frightening. He was able to breathe, but due to fluid in his lungs he was not getting enough oxygen, which can lead to organ failure and death.  So he was put on a respirator, which forces air into the lungs. The respirator was put on a high setting, meaning that a lot of air was being forced into his lungs. He was teetering on the brink of life for a couple of days, then I heard that the respirator had been turned down a notch, which was good.  After another day or two, a tracheotomy was performed and the respirator was attached to that instead of being stuck in his mouth.  I'm not sure what the purpose of that procedure was, except that it was a considered a step toward healing, and he was more comfortable having the respirator out of his mouth.  He started writing notes to the nurses, texting his friends, and generally coming around.  Next thing I heard, the respirator was removed, the tracheotomy was closed up and he was going home!  Seems like as soon as he began to get better, the recovery was remarkably fast.

Studies say my friend's experience was typical of serious cases of H1N1
I just recently read articles in the Journal of the American Medical Association (JAMA) and in Science News that detailed a typical scenario in the most serious cases of H1N1. They described cases remarkably similar to that of my friend's son. The articles said that young adults are the most vulnerable.  The most critical patients are those who get pneumonia. The article said inflammation in the lungs leads to fluid build-up in the airways and the lungs.  Says Dr.Robert Fowler of the University of Toronto, "Most patients are still able to take breaths, but those breaths are ineffective."  In a Canadian study reported in JAMA, 168 patients critically ill with H1N1 (average age 32) received intensive treatment, including antivirals such as Tamiflu and ventilators, but 17% of them died.  In another study, patients in Australia and New Zealand with an average age of 34 who were critically ill with H1N1 had a mortality rate of 21%.  In a third study, this time in Mexico, critically ill patients with H1N1 had a mortality rate of 41%, although these patients too were treated with ventilators and antivirals such as Tamiflu or Relenza. In one final study, in California, 11% of patients who became critically ill with H1N1 died - the most common cause of death was "viral pneumonia and acute respiratory distress syndrome."  Note that these percentages are percentages of people who were already critically ill with H1N1, not just percentages of all people with H1N1 flu.

The most important factor seems to be pneumonia. I am not sure what steps can be taken to keep H1N1 from turning into pneumonia, but if I had H1N1, I would see a doctor as fast as possible to get a prescription for an antiviral, and I would stay home and rest, drink lots of fluids, and do whatever the doctor said to help keep my lungs clear. 

The CDC and other sources recommend these steps for keeping well and keeping others well:
Wash hands frequently.
Don't touch eyes, nose, mouth.
Leave the room if someone else is coughing, because inhaling airborne droplets can lead to infection, and that factor is more likely in cold weather. (See my previous post below on why that's true.) 
If you are sick, cover your mouth or nose with a tissue when you cough and throw it away, or with the inside of your elbow, not with your hands.
Stay home if you're sick until you've had no fever for at least 24 hours.
Try to avoid touching doorknobs or things that other people touch constantly when out in public or at work.  Use your own pen to sign receipts.

See the CDC's website for more information on staying well.

Anand Kumar, MD, et al.  "Critically Ill Patients with 2009 Influenza A(H1N1) Infection in Canada". 2009.  Journal of the American Medical Association 302(17):1872-1879. Published online October 12, 2009  

Janice K. Louie, MD, et al. "Factors Asssociated with Death or Hospitalization Due to Pandemic 2009 Influenza A(H1N1) Infection in California". 2009.  Journal of the American Medical Association 302(17):1896-1902.

Nathan Seppa. "Reviewing H1NI flu's worst cases: Antivirals, ventilators help, but fatalities show lungs hit hard."  Nov 7, 2009. Science News. 

My previous posts on H1N1: 

Why is swine flu likely to return in winter?  It's not because we're cooped up together in winter

My daughter says elderberry got rid of her H1N1 flu 

Keywords:: H1N1 flu swine flu worst cases pneumonia ventilator how to protect yourself from H1N1 CDC JAMA

No comments: