Influenza normally hits community pediatricians hard in the winter months with the usual set of symptoms. But this year community practices started getting flooded with flu-related cases as early as early September, and reportedly with greater numbers of worried well than in recent flu seasons. Underlying the rush for care, pediatricians say, is an anxiety among parents fueled by news reports of the H1N1 virus, the so-called “swine flu,” and the availability and safety of vaccines to prevent it.
“The media blitz at this point has everyone a bit panicky, and there’re a lot of rumors flying around H1N1,” says East Baltimore, Md., pediatrician Andrew Swiderski. “Our most pressing challenge may be avoiding a crush of patients to be seen when it’s not really necessary.”
“We’re answering many, many more telephone calls than usual,” adds Lutherville, Md., pediatrician Lauren Bogue. “People are frightened. We’re trying to inject a voice of reason.”
Swiderski, who practices at Highlandtown Community Health Center, says the clinic’s main effort has been the development of a telephone triage and information line to push practical health and flu-prevention tips to parents. The clinic is also exploring appointing a staff member to act as a liaison with city and state health departments and the Centers for Disease Control and Prevention (CDC) to ensure that information regarding the H1N1 strain and vaccines is accurate, up-to-date and shared among staff.
“The most critical thing is to get everyone, our triage nurses and our front-desk staff, all on the same page in allaying families’ fears,” says Swiderski.
Like Swiderski, Bethesda, Md., pediatrician Paul Peebles, who says he had seen “a ton of cases” by early October, employs a telephone tree with prevention tips and updates on vaccine availability. But he takes flu precautions a step further by having possible infectious cases come in through the office’s back door. From there patients are masked and escorted by gloved and masked nurses to designated isolation-exam rooms thoroughly sanitized between visits. The approach appears to be keeping infections at bay. Peebles is also paying particular attention to patients with underlying chronic conditions like asthma, which may be exacerbated by the flu and place patients at higher risk of bacterial infections. Following CDC guidelines, these patients are being given anti-viral medications when presenting with the flu. Other patients, Peebles explains, are being treating symptomatically with lots of fluids and no cough suppressants. How is he managing the anxiety piece?
“Through long conversations,” he laughs. “This has been a stress on families and our nurses and doctors.”
Lutherville, Md., pediatrician Travis Ganunis reports that anxiety levels and the number of phone calls are high, but the good news is most cases have been mild to moderate flu. Aside from a flu hotline and a patient kiosk stored with masks and hand-sanitizers, he adds, it’s business as usual.
“Regardless of the name of the germ,” says Ganunis, “we watch and ask our parents to watch how the child is handling the germ.”
Bel Air, Md., pediatrician Paul Rogers shifted the schedule to fill more acute slots, and designated one-half of the office for infectious cases. Rogers modified his answering service, too, to include flu updates, which, he says, has reduced unnecessary office visits by 50 percent. So, how will H1N1 play out?
“For now we anticipate seeing more kids earlier in the year with mild flu symptoms,” says Rogers. “Later on we’ll probably be overwhelmed with a pretty heavy, double flu season.”