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4/29

Yesterday was the day when things really changed around here.  Nearly every visit seemed to have discussions about flu, and many of the phone calls revolved around it as well.

I got a note from my nurse saying that a patient was having diarrhea and so was worried he had the “swan flu.”  Not sure who was at fault (nurse or patient), so I responded asking if she meant “swan flew.”  Really, she was probably just writing it like it sounds with the Georgia southern drawl.  I reassured the patient that this didn’t sound like influenza.

“Did you hear that they have a case of swine flu at the medical college?” a patient asked me.  My nurses had heard the rumor that our local teaching hospital was housing a new case of the dreaded virus.  Things were quieter for a while after this sunk in.  Later in the day we found out that it was a positive flu test that was being tested for swine flu – not yet confirmed.

“What are we going to do about this for the doctors and the staff?” I asked my office manager and partner.  “How are we going to keep ourselves from getting sick?  Should we get Tamiflu to use prophylactically?  Do we have masks?”

My office manager showed me recommendations from the CDC website.  They were a bit vague, but suggested wearing protective masks and possibly taking medication.  How long would we have to take the medication?  Could we even get it?  Nobody knew.  My partner did say that our medical supply salesman told him that we cannot get masks at all.  They are totally sold out.

A while later, my partner showed me recommendations by the AAFP regarding the treatment of swine flu.  It recommended that Tamiflu be combined with Flumadine.  The recommendation, however, didn’t agree with what I got directly from the CDC which said to just use Tamiflu.  He seemed miffed that I would not trust the AAFP, but their document sited the CDC document that said to use monotherapy.

The nurses fended off a number of requests to call in Tamiflu to people who weren’t sick.  Our policy will be that people have to come in to be treated.  It’s always been our policy, but the fear seemed to make our patients forget.

“Do you think it’s coming here?” a patient asked me during a routine recheck.

I paused to find the best words, “Yes I do.  I don’t think there is much question that it is coming here; it’s just a question of what it will do when it does.”  He was quiet for the rest of the visit.

The pandemic warning level was raised to 5.  I had to look up what that meant.  I didn’t talk with my patients about it.

4/30

This morning started with a discussion about plans.  What will we do when the flu hits?  I am pretty sure that most routine visits will be canceled – and a lot of them should be.  I really don’t want healthy babies coming to an office with a virus that could really cause them harm.  We’ve already had a couple of cancellations for that reason, but not a whole lot.

Here’s what we decided:

• Once flu is in the area, we will go into “sick mode.”  We will cancel all routine appointments and only see scheduled and walk-in visits for acute illnesses.
• We will somehow secure masks and/or medication to give to anyone with direct patient contact.  We’ll also minimize the number of people with close contact.
• We will consider reducing staff numbers to decrease their risk of exposure.
• If we don’t have any protection for the providers, we will consider shutting down.  I don’t want to take flu home to my own family.  I don’t want my staff and colleagues to be infected.  It’s OK to take risk, but we shouldn’t be foolishly standing in the faces of hundreds of influenza patients without any protection.

One of my morning patients, a nurse from the local hospital, told me she could get me a box of the anti-viral masks.  Another patient is part of the Georgia National Guard, and told me that his task is to guard the stockpile of medication at the CDC, should the pandemic become acute.  It’s hard to think that it would come to people storming the CDC for Tamiflu.  I don’t know if he’s right, but it isn’t beyond belief.

I did my first flu test of this outbreak this morning on a patient with fever of 102, body aches, and a stiff neck.  It wasn’t classic flu, but I certainly felt like the test was needed.  I didn’t have a mask as I did my exam and wondered how much risk I was taking.  The test was negative, and I sent the person on to the ER so that labs and a possible spinal tap could be done.  That was good news for me, but I am not sure how good it was for the patient.  Maybe just a little good.

I saw my first person in a mask today.  It was the parent of a kid I was seeing (who wasn’t wearing a mask).  I was tempted to make a comment, but thought better of it.  Could I really blame her for wearing a mask?  I am at much greater risk than they are, but I take that risk every day.  When do I start wearing a mask?

We got news today that we could give Tamiflu to children under 1 year of age.  I was relieved, as I had a hard time dealing with questions from parents of happy little infants.  The parents would do anything to prevent the child from getting sick, but without treatment, the only way to prevent potentially serious illness is for the parents to avoid getting sick.  At least now I can give them a little more to hold on to.  I still wonder how much medication will be available.

At the end of the day today we heard that Georgia had its first confirmed case in Atlanta.  Atlanta gets everyting before we do.