Focus on Flu

by Rod Moser PA, PhD, a primary care physician assistant with more than 35 years of clinical experience.

Cases of H1N1 influenza in my office have diminished. We were getting several dozen cases a day in early December, but now only seeing a few, random people with characteristic symptoms of influenza. We are not rapid testing “obvious cases” but will test for Type A influenza if there are any diagnostic doubts or if the patient or family insists. Experts hope that this lull in cases will be permanent, but also fear that this may be the calm before the storm – the next wave of cases expected after the busy, travel holidays. As always, diseases are as unpredictable as the people who get them.

I can’t say that we have seen the usual, garden variety, seasonal flu strain yet, but I do not doubt the virus is lurking around out there. Since the seasonal strain historically causes most of the cases and deaths, it is important to keep on high alert. Last year, seasonal strains did not rear their ugly heads until February in our practice. It hung around causing havoc for a month or so then went away. I hope this will the case this year as well.

I think we are more prepared now than ever before. We have hand sanitizing stations everywhere in our office, maybe a hundred. We have a “flu station” with masks, information, and more sanitizers. We isolate suspected cases from others. I see medical assistants scrubbing off chairs, tables, door knobs, faucets, etc. all day long. After each patient leaves the exam room, the room is sanitized. I have to say, that before H1N1, these expected hygienic practices were not as diligent and thorough. There is nothing like a good pandemic to get your attention and challenge your customary practices.

If the H1N1 Pandemic did anything, it raised public awareness of this stealthy killer among us. The population at large sees the importance of vaccination, and for the most part, trusts these public health efforts. There were no flu vaccines in 1918 when the Spanish Flu Pandemic swept across the globe, killing the young and old with lightening speed. Now, we have the means of preventing influenza, but the science is far from perfect, namely because viruses are so terribly unpredictable. We do tend to learn from our past mistakes. If we don’t we get to do those wrong things again…and again.

Because I am on the front line (a large percentage of my available appointments are for same-day, urgent visits), I needed the break from working these 14 hour days. I was tired of making excuses as to why we didn’t have any vaccines…or enough vaccines….or the right vaccine (mist or injection). Our supplies have increased now, so most people who want the vaccines will be able to get them. We had a huge waiting list needing vaccines; vaccines that were not delivered to us in a timely manner.

I heard stories of patients going from pharmacy to pharmacy trying to fill Tamiflu prescriptions. One pharmacy (one that I will not be using anymore) charged some of my patients a “compounding fee” of $75 extra per prescription when they ran out of the liquid formulation of Tamiflu for children and had to open an adult capsule and mix it with some cherry syrup! That was so exploitive. Yes, compounding takes a little more time, but in a pandemic, it should have been a criminal offense to hold medicines captive in order to make a few extra bucks. I bet that some parents on a tight budget in this economy gave up a lot of things just to pay for these prescriptions.

It broke my heart to see people – old people in walkers or pregnant mother’s pushing strollers and holding children’s hands – standing in long lines for vaccinations. We are a rich country. We are a smart and proactive country. We are also a country that tends to be caught time and time again with our pants down, from breaches of airport security to our public health efforts. I love when the experts jump in AFTER the fact, explaining what went wrong. Great, now fix it.

I am not a big fan of fully, socialized medicine, but I am a fan of a socialized public health system. Immunizations should be free (paid for by the government) for everyone, and readily available. Money spent in these efforts to have an ample supply of safe, well-tested vaccines will save thousands of lives, and umpteen millions in health care costs. Don’t they see this? Vaccines are condoms. Vaccines are seat belts or motorcycle helmets. Vaccines are policemen and firemen. Vaccines are the brave men and women in our military.

There will always be wackos out there claiming that vaccines are a government plot to control us, or that even the flu vaccine causes autism. Perhaps we can’t shove vaccines into the arms and up the noses of all people in a free-society, but we can do better. We can try harder next time through ongoing, well-funded, scientific research and public education.

For the militant, vaccine-refusers, I wish them the best. I hope they don’t get sick, or die. If they do get sick, I hope they don’t freely share it with innocent people who will get sick and/or die. And, I hope I don’t have to pay for their paranoia and mistrust, directly or indirectly. I hope that someday they will do their part – their share – to protect the population from unnecessary illnesses. For those of us who do get vaccines, who do see the benefits, who do take those tiny risks of vaccine side effects, I hope we get the “thanks you’s” for doing an important part in strengthening our human herd.