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Yes, Lots of People Are Getting Flu Symptoms. No, This Season Isn’t So Unusual. Here’s Why. In an ‘Intense’ Flu Season, Hospitalizations Are Rising. Here’s Why.
(8 days later)
At the moment, the 2017-2018 flu season is considered “moderately severe.” Large numbers of Americans have fallen ill, and every state except Hawaii has reported widespread flu activity. But some regions have been hit harder than others. More important, the number of people hospitalized or dying from flu nationwide is not unusually high. This season is closely paralleling the 2014-2015 season, which was dominated by the same H3N2 flu strain and was also “moderately severe.” As of late January, the 2017-2018 flu season was called “intense” by Dr. Brenda Fitzgerald, director of the Centers for Disease Control and Prevention. Large numbers of Americans have fallen ill, and every state except Hawaii has reported widespread flu activity. After a slow start, the number of people hospitalized or dying from flu began rising rapidly in mid-January. This season has now surpassed the infection rates of the 2014-2015 season, which was dominated by the same H3N2 flu strain, and during which 710,000 Americans were hospitalized and 56,000 died.
H3N2 is the most dangerous of the four seasonal flu strains, but it is not new nor uniquely lethal. A typical season mixes two Type A strains — H1N1 and H3N2, and two Type B strains — Victoria and Yamagata. (The B strains normally arrive later and are rarer.) As of Jan. 7, about 78 percent of all samples genetically sequenced have been H3N2, according to the Centers for Disease Control and Prevention. That strain first emerged in Hong Kong in 1968 and killed an estimated 1 million people around the world that year. But it has circulated ever since, constantly undergoing small mutations. Many people have had it, and an H3N2 strain is a component of every season’s flu shot, so partial immunity is widespread. H3N2 is the most dangerous of the four seasonal flu strains, but it is not new nor uniquely lethal. A typical season mixes two Type A strains — H1N1 and H3N2, and two Type B strains — Victoria and Yamagata. (The B strains normally arrive later and are rarer.) As of Jan. 20, about 77 percent of all samples genetically sequenced have been H3N2, according to the C.D.C. That strain first emerged in Hong Kong in 1968 and killed an estimated 1 million people around the world that year. But it has circulated ever since, constantly undergoing small mutations. Many people have had it, and an H3N2 strain is a component of every season’s flu shot.
Almost 6 percent of all Americans seeking medical care now have flu symptoms. That is tracked by the C.D.C.’s Outpatient Influenza-like Illness Surveillance Network, to which about 2,000 doctors’ offices and clinics around the country report weekly how many of their patients have fevers of at least 100 degrees plus a cough or sore throat. The 2014-15 and 2012-13 flu seasons also peaked at close to 6 percent. By contrast, the mildest recent season, 2011-2012, barely surpassed 2 percent. In 2009, during the H1N1 “swine flu” pandemic, almost 8 percent of visits were flu-related, but they peaked in October, not in January. That never happens in seasonal flu but is typical of pandemic flus. About 6.6 percent of all Americans seeking medical care now have flu symptoms, and the number is still rising. That is tracked by the C.D.C.’s Outpatient Influenza-like Illness Surveillance Network, to which about 2,000 doctors’ offices and clinics around the country report weekly how many of their patients have fevers of at least 100 degrees plus a cough or sore throat. The 2014-15 season peaked at close to 6 percent. By contrast, the mildest recent season, 2011-2012, barely surpassed 2 percent. In 2009, during the H1N1 “swine flu” pandemic, almost 8 percent of visits were flu-related, but they peaked in October, not in January. That never happens in seasonal flu but is typical of pandemic flus.
In some places, including Southern California and central Texas, some hospitals have seen so many flu patients that they had to set up triage tents or turn other patients away. But overall there have not been reports of regional shortages of antiviral medications, patients dying because a city ran out of respirators, or other signs of a major crisis. Not across the country, but in some places — including Southern California, Pennsylvania and central Texas — some hospitals have seen so many flu patients that they had to set up triage tents or turn other patients away. Local shortages of antiviral medications and flu vaccines have been reported.
This year’s outbreak began in Louisiana and Mississippi, then spread across Texas to California and up the West Coast from San Diego to Seattle. It also stretched into the Midwest. Kinsahealth, which makes internet-connected thermometers and builds its database from 25,000 daily fever readings, says the current hot spot is the St. Louis area. The Northeast has been largely spared so far, as have Minnesota, the Dakotas and some Rocky Mountain states. This year’s outbreak began in Louisiana and Mississippi, then spread to California and up the West Coast. The C.D.C. believes it has peaked there; California reported four times as many people hospitalized with flu as were seen three years ago. The flu is now widespread across the Midwest and South, and intensity is still increasing in the Northeast, including in New York City.
No, although it may appear so right now. The deaths of a few apparently healthy people — notably those of a 21-year-old fitness buff in Latrobe, Pa., a mother of three in San Jose, Calif., and a 10-year-old hockey player in New Canaan, Conn. — have been widely publicized, and some areas, like San Diego, have reported record numbers of deaths. But it is still too early to say how high mortality will be nationally. It can take weeks to confirm all flu-related deaths. As of now, the mortality rate for victims under age 18, a bellwether C.D.C. category, is well below that seen in the 2014-15 season. Not yet, but hospitalization rates have risen sharply, and those presage high death rates. The deaths of a few apparently healthy people — notably a 21-year-old fitness buff in Latrobe, Pa., a mother of three in San Jose, Calif., and a 10-year-old hockey player in New Canaan, Conn. — were widely publicized, as was the fact that 37 children have died. Also, San Diego reported record numbers of deaths. It is still too early to say how high mortality will be nationally. In 2014-2015, flu and its consequences, including pneumonia, meningitis and sepsis, killed 148 children.
Even in a mild year, flu kills about 12,000 Americans, the C.D.C. estimates. In a bad year, it kills up to 56,000. Most of those deaths are among the elderly, but flu also kills middle-aged adults with underlying problems like heart or lung disease, diabetes, immune suppression or obesity. It is also dangerous for pregnant women, children under age 5 and children with asthma. And, every season, flu and its complications, including pneumonia, meningitis and sepsis, kill some apparently healthy people. Even in a mild year, flu kills about 12,000 Americans, the C.D.C. estimates. In a bad year, it kills up to 56,000. Most of those deaths are among the elderly, but flu also kills middle-aged adults with underlying problems like heart or lung disease, diabetes, immune suppression or obesity. It is also dangerous for pregnant women, children under age 5 and children with asthma. This year, Americans aged 50 to 64 — part of the baby boom generation — are being hospitalized at unusually high rates, for reasons that are still unclear.
Its H3N2 component is a bad match for the circulating strain. Australia just had a severe flu season with many deaths, and the vaccine there had the same mismatch. Experts estimated that the vaccine prevented infection only 10 percent of the time. The shot’s efficacy here has not yet been calculated because the virus is still spreading, but experts expect it to be about 30 percent. In Australia, vaccination failed partially because it is urged for only the most vulnerable, while in the United States millions of healthy people are vaccinated. Its H3N2 component is a bad match for the circulating strain. Australia just had a severe flu season with many deaths, and the vaccine there had the same mismatch. Experts estimated that the vaccine prevented infection only 10 percent of the time. The shot’s efficacy here has not yet been calculated because the virus is still spreading, but experts believe it to be about 30 percent. In Australia, vaccination failed partially because it is urged for only the most vulnerable, while in the United States millions of healthy people are vaccinated.
Experts say yes, because even when the shot does not prevent you from catching the flu, it may save you from dying of it. And while getting it in October is best, because it takes about two weeks to build immunity, it is still not too late, because the virus persists all winter and into spring. Experts say yes, because even when the shot does not prevent you from catching the flu, it may save you from dying of it. And while getting the vaccine in October is best, because it takes about two weeks to build immunity, now is still not too late, because the virus persists into spring. Because some doctors and pharmacies are out of vaccine, the C.D.C. suggests consulting vaccinefinder.org.
Yes. Of all the samples tested so far by the C.D.C., only 1 percent were resistant to oseltamivir, zanamivir, and peramivir, the ingredients in Tamiflu, Relenza and Rapivab. But to be effective, these medicines should be taken as early as possible after symptoms appear. (Rapivab is given intravenously, usually in hospitals.) Yes, to the extent that they ever do. Of all the samples tested so far by the C.D.C., only 1 percent were resistant to oseltamivir, zanamivir, and peramivir, the ingredients in Tamiflu, Relenza and Rapivab. But to be effective, these medicines must be taken as early as possible after symptoms appear. (Rapivab is given intravenously, usually in hospitals.)