H1N1 Influenza: One New York City Pediatrician's View

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H1N1 Influenza (Swine Flu) & Kids

Medical Author: David Perlstein, MD, FAAP
Medical Author: Melissa Conrad Stöppler, MD

Updated time-line of H1N1 swine flu news October 27, 2009

Six months have passed since my last posting about swine flu, now known globally as the novel H1N1 virus. We in New York City experienced a very significant increase in the number of patients evaluated in our Emergency Departments and offices last spring. Interesting, though, we did not see a huge increase in the number of "sick" patients requiring admission to our hospitals. Overall, my own hospital experienced a 95% increase in pediatric visits to our Emergency Department, and a 35% increase in adult visits. We admitted 17 patients who tested positive for H1N1. We did see some critically ill individuals, all with known risk factors for complications of H1N1 infection (pregnant women, obese individuals, and very young children), but no elderly patients.

Between April and June 2009, New York City reported 990 flu-related admissions to hospitals and 54 deaths. Since August, the rest of the nation has experienced increases in novel H1N1 cases similar to the increases NYC experienced between April and May. Looking at the CDC US Surveillance Map, there is widespread illness in the USA; however a closer look at the current numbers reveals that since August, in Region 2, (which includes New York), there is next to no activity when compared to the rest of the country. In the NY Region there have been only 91 cases of H1N1 and 72 seasonal flu cases. That compares to an average of 2000 cases of H1N1 in all other regions.

We are still preparing for huge surges in volume. Most New York City hospitals have Pandemic Influenza Working Groups. In my own hospital we have developed a multi-phased response to our expected increase in visits which to date have not materialized.

• We meet weekly to discuss both how to respond to influenza and how to prevent it in our staff and patients.
  
  
• We are currently limiting visitation to our labor and delivery units as well as our neonatal ICU.
  
  
• We have educational and informational posters up all over our facilities, recommending hand hygiene and flu-prevention measures.
  
  
• We are vaccinating both our patients and our staff with both seasonal flu vaccine and H1N1 vaccine (when available).
  
  
• We are routinely isolating and testing patients for influenza in the hospital (52 suspected, but 0 positive for influenza using PCR, which is a highly sensitive and specific test).
  
  
• We are prepared.

I personally have also been very impressed by the fact that despite the publicity regarding the flu right now, including President Obama's declaration of an influenza emergency, it has not resulted in mass hysteria in New York City. Children are getting colds, and other viruses such as respiratory syncytial virus (RSV) are circulating, but our clinics and Emergency Departments are not inundated with unnecessary visits. Cool heads are prevailing, and that is good. Last May New Yorkers were panicking. Now that we have experience, we are not.