Archive for October, 2010

A year ago

Tuesday, October 19th, 2010

I am not one to observe anniversaries or reminisce about things on the day they occurred in the past, but the second week in October 2009 is important for flu. That is the week that the Fall H1N1 outbreak began, and it changed the way hospitals do things.

Our hospital had a large surge of patients come to the Emergency Department on one afternoon and evening. Most were not really sick, but they were slightly sick and very worried. The news story of the H1N1 outbreak had run that day, and many people convinced themselves that they had it and they were scared. Moreover, they decided to go to the hospital Emergency Department to be evaluated rather than their own doctor. Perhaps they did not have a doctor. Some doctors told their patients to go to the hospital. Regardless, we saw a large surge of patients that night, and we have since improved our ways of dealing with a sudden surge of people arriving at the hospital for any reason.

Another thing that changed was the way we look at influenza. Some of the people with H1N1 were severely ill and required care in the critical care unit. Some died. That was very unusual. Most people with flu in the past were not very sick, certainly not sick enough to require critical care-level care. This influenza could kill, and we learned to treat it with much more respect.

We changed how we diagnose flu. The popular rapid antigen tests (the “quick test” done on a throat swab) did not detect H1N1. Doctors had to use their clinical judgement and classic tests like culture rather than the quick tests. If it looked like flu and acted like flu, you assumed it was flu until proven otherwise, and you had to act immediately because of the severity of this new disease.

We also learned to treat flu early. If the patient was severely ill or getting worse quickly, the sooner the patient got antiviral drugs the better they did. You could not wait until more tests were done to begin treatment. Now we “pull the trigger” on treatment right away. The virus does most of its damage to the lungs early in the infection, and the earlier you treat, the more lung you can save.

Hospital staff learned to better protect themselves from contagious diseases during the H1N1 outbreak. Doctors and nurses learned to wear their masks and eye protection more often when doing patient care, and our policy requiring staff to be immunized against influenza every year was shown to be a pretty good idea.

You never want bad things to happen, but we learned some things in the H1N1 outbreak of October 2009 that made us a better hospital and enabled us to give better care to our patients.