Diagnosing flu symptoms still confounds us — and that can be deadly

Via:  perrie-halpern  •  one month ago  •  12 comments

By:   Vin Gupta, assistant professor of pulmonary and critical care medicine at the University of Washington

Diagnosing flu symptoms still confounds us — and that can be deadly
We're at risk for an epidemic of underdiagnosed influenza in which people don't receive potentially helpful treatment or take proper precautions.

S E E D E D   C O N T E N T

It was awful. Fever approaching 104, body aches everywhere, an unremitting headache. It seemed that last week I, like   9.7 million   other Americans   in the months before   me, had caught the flu.

Luckily, as a clinician, I had already   taken the flu shot   months earlier. And luckily, as a clinician, I knew that when my primary care doctor took a rapid-analysis flu swab in her office that came back negative, I nevertheless most likely had the flu. Accordingly, I still took the antiviral medication Tamiflu because I knew it could help   diminish   the length or the severity of my symptoms, and crucially, I was very cautious to avoid exposure to those near me by using a face mask and practicing good hand hygiene.

Accurate and prompt diagnosis of flu is key for patients to improve their likelihood of survival.

We already face many challenges in fighting a common but potentially deadly disease, one that is   particularly potent this year . One of the most insidious is that many people are often carriers of flu without even knowing it (even if they feel it).

Just because you’ve gotten a flu shot doesn’t mean you can’t get the flu, so that possibility shouldn’t be dismissed when you come down with flu-like symptoms. Moreover, the rapid tests utilized in doctors’ offices nationwide to confirm its presence   often give misleading results   — as they did in my case — reassuring someone that they aren’t infected when the reverse is true. These phenomena put us at risk for an epidemic of underdiagnosed flu — people not receiving potentially helpful treatment and not taking proper precautions to avoid its spread because they don’t know any better.

This complicated problem of underdiagnosed flu is seen in the inpatient setting, as well.   One recent analysis   noted that nearly half of patients admitted with shortness of breath and fever that were ultimately found to have flu were not initially tested for it on presentation to the hospital.

The   rapid influenza diagnostic test   given in doctors’ offices, which detects the presence of proteins found on the surface of flu viruses, is increasingly common nationwide as it becomes available in most clinical settings. But it is   commonly falsely negative , particularly when overall rates of flu are high in the surrounding community.

These delays in diagnosis or underdiagnosis can clearly put the public at greater risk of flu outbreaks. Flu is easily transmissible by air droplet: A simple cough from an infected source will expose an entire cabin filled with passengers in a jetliner within minutes.

Second, accurate and prompt diagnosis of flu is key for patients to improve their likelihood of survival. While commonly prescribed medications like Tamiflu cannot completely treat flu like an antibiotic can treat a bacterial illness, it does reduce the length and severity of symptoms if started within   48 hours of symptom onset .

Further, with a host of new and potentially dangerous mimickers of flu on the horizon, such as the   new SARS-like virus   seen in China this month, it is important to understand quickly whether influenza is present or not so that attention and treatments can shift accordingly.

We should be moving away from the broad use of this test, as major organizations such as the   Infectious Diseases Society of America   have recommended , given that false negative rates can   approach 30 percent   (!). That’s unacceptably high and makes a negative result virtually worthless as a guide for what to do.

Instead, we should be encouraging the adoption and affordability of innovations that are starting to address the limitations of the existing rapid test, including a   relatively new rapid molecular assay   associated with lower false-negative rates. Right now, this test is not as widely available nationwide as the original rapid flu test in outpatient clinics, likely because of the   added cost   to utilize it at scale, thus limiting its impact.

And while getting a flu shot doesn’t fully innoculate you from the illness, it is still tremendously beneficial. The   evidence is clear that the   vaccine diminishes risk of infection by at least half depending on the season (this year, it’s near that threshold   per the CDC ). Moreover, in cases when infection still occurs, it reduces the severity of the illness considerably. Regrettably,   skepticism   about   flu vaccine efficacy   remains disappointingly widespread, even though none of the counterarguments on vaccination are remotely rooted in science.

While getting a flu shot doesn’t fully innoculate you from the illness, it is still tremendously beneficial.

Influenza has reached almost mythic status as a potential cause of human extinction for a good reason: The last time a large swath of humanity died in short order, it was the result of the   1918 Spanish Flu Pandemic . One-third of the world’s population (500 million at the time) became infected, and nearly 50 million people died globally; that’s 10 million more than were killed in the Great War that preceded it.

We don’t need to panic. But we do need our health care professionals and elected leaders to ensure that our nation’s providers and clinics have the right tests and resources to safeguard public health. Meeting this need should be a requirement of effective leadership, especially given the gravity of a potential flu outbreak for Americans of all ages


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1  sandy-2021492    one month ago

My assistant's son had similar symptoms several weeks ago, and tested negative for flu.  I don't believe he was prescribed Tamiflu, but perhaps he should have been.

Locally, several nursing homes have been on quarantine due to flu - their residents have it, and they're trying not to spread it through the community.  Unfortunately, it prevented some from being able to see relatives over the holidays.

charger 383
2  charger 383    one month ago

This stuff is hard to get over,  3 weeks, 3 Dr visits and on second round of antibiotics and I still don't feel good.  Not sick in bed anymore but still not over it.  I had the flu shot    

2.1  XDm9mm  replied to  charger 383 @2    one month ago
I had the flu shot

Be happy you had that!!   Many are getting the "flu" even after having had the shot.  The good part is while you still feel like crap, it's not as bad as it would have been without having gotten vaccinated.

Hopefully, you didn't come into contact with that virus that's making itself known in China and other Asian countries.   It also creates cold and flu like symptoms but then dives down and hits the lungs with pneumonia.  Nasty bug.    My son and his family in Thailand are doing the best they can to self quarantine, but working in the Embassy there makes that difficult, plus they have their housekeeper to deal with.  (Fortunately, they're coming home this summer for good!!)

2.2  Kathleen  replied to  charger 383 @2    one month ago

Hope you feel better Charger.

Perrie Halpern R.A.
2.3  seeder  Perrie Halpern R.A.  replied to  charger 383 @2    one month ago

Really sorry to hear that Charger. Hope you get better soon. 

Raven Wing
2.4  Raven Wing  replied to  charger 383 @2    one month ago

I hope that you will soon feel much better, charger. It seems as soon as they come up with a vaccine to fight a disease a new mutation comes out. Almost like someone in the background is playing around with the stuff and making changes to keep going. jrSmiley_55_smiley_image.gif

3  Kathleen    one month ago

We had our flu shots, hoping that we dodge the bullet this year.

4  Ender    one month ago

I shouldn't say this but I haven't been sick in several years. My body doesn't handle it well. What happens to me now is I get like a severe case of strep throat with it. My throat closes up, gets inflamed and I can barely swallow.

People think I am nuts but when I go places I wipe things down. Like the handle of grocery carts.

Even when I am in a hotel I bring wipes and wipe every thing down. Tv remote, switches, doorknobs...

If someone walks in that I think is sick I spray Lysol around and on anything they touched.

It seems to be far worse than when we were kids. I don't remember people dying from it back then.

4.1  XDm9mm  replied to  Ender @4    one month ago
It seems to be far worse than when we were kids. I don't remember people dying from it back then.

Oh they did.  I'll posit very likely in far greater numbers than today, but we never heard about it as it wasn't broadcast nationally almost instantly.    Unless of course you're too young to remember only rabbit ears for antennas and 3 channels of local TV and have always had Cable TV and the internet.

PS:  Do you remember to use hand sanitizer after you go through a restaurant menu, or anything you touch in a plane?

4.1.1  Ender  replied to  XDm9mm @4.1    one month ago

Yep. Old black and white. I remember the first remote I saw was attached with a wire.

Menus are nasty. I have had ones sticky and gross. One time I watched a woman clean them and she was just wiping them with a dirty rag. Someone always has some sanitizer or I have some in the car.

Another one I thought of, those keypads/touch screens for atm cards. Those probably never get wiped off.

Transyferous Rex
5  Transyferous Rex    one month ago
While getting a flu shot doesn’t fully innoculate you from the illness, it is still tremendously beneficial.

Anecdotal at best, but ironically, the only time I have ever had the flu (diagnosed) happens to be the only year that I got the vaccine. I generally suffer no more than some sniffles. 

6  Kavika     one month ago

My grandmother and her 1 week old daughter died in 1918 from the Spanish Flu pandemic. 

My grandfather told me that so many had died that the bodies were kept in a ice house. Blocks of ice in sawdust until they could be buried. 


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