Physician Focus: ERs, the flu and you

Dr. Bruce Auerbach

This year's two flu strains -- H1N1 or swine flu, now widespread in 48 states, and seasonal flu, yet to arrive but on its way -- are putting added pressure on health care providers.

Hospital ERs are seeing more patients, and visits and calls to physicians' offices, particularly pediatricians, have been rising dramatically.

The scarce supply of vaccine, for both strains, has heightened anxiety, as patients experience confusion and irritation with the inability to get what seemingly should be a simple preventive measure: a flu shot.

While more vaccine may ease the frustration of patients and physicians, emergency departments are likely to continue to see more visitors, as swine flu spreads and seasonal flu takes hold.

For most people, a case of the flu -- either swine or seasonal -- will not require emergency treatment or antiviral drugs. But both H1N1 and seasonal flu can cause fatal complications and should be regarded as serious medical conditions. According to the Centers for Disease Control and Prevention, swine flu has already claimed some 4,000 American lives, including pregnant women and nearly 550 children. Seasonal flu typically affects 5 percent to 20 percent of the population and accounts for some 36,000 deaths and 200,000 hospitalizations annually.

People should not feel discouraged from going to the emergency department when they feel it's needed -- it's the "safety net" of our health care system, open around the clock and ready to care for all who come. But exercising good judgment is critically important, especially during flu season, so that emergency physicians and nurses can first treat those who truly need "emergent" care.

Here are some thoughts on how to decide if you should go to the emergency department.

Know if you're at high risk

Those at high risk for developing flu-related complications are children younger than 5, especially those under 2; adults 65 years and older; and pregnant women. People with chronic conditions like asthma, diabetes, heart or lung disease, kidney or liver or blood disorders, or weakened immune systems are also at high risk. Most flu-related fatalities -- for both H1N1 and seasonal flu -- have occurred in people with underlying medical conditions.

Evaluate your condition

The flu involves some or all of the following: fever, cough, runny nose, sore throat, headache or body aches, chills, diarrhea or vomiting. If you think you have the flu, first contact your physician for advice. You should stay home and avoid contact with others except to get medical care. Most people with the swine flu have had mild symptoms and have not required emergency care or antiviral drugs.

When you should go

If you're at high risk or healthy with those symptoms along with emergency warning signs -- trouble breathing, chest or stomach pain, skin discoloration, dehydration or dizziness -- get to the ER. When you go, remember two things. First, know exactly where the nearest one is; some may have closed or moved. And second, plan how to get there. If you think you'll be admitted to the hospital, don't drive yourself. Severe pain or dizziness may overcome you on the way, endangering yourself and others. Get someone to take you.

The best safeguard in fighting flu is vaccination, so get vaccinated if you're eligible. (Check to see which type -- shot or nasal spray -- is right for you.)

Clinical studies and monitoring by federal health officials indicate the H1N1 vaccine is safe and effective. It's been made using the same methods as the seasonal flu vaccine, also safe and effective. Habits are important, too. Practice good hygiene by frequent hand washing or using hand sanitizers; control coughing or sneezing; don't share items like drinking cups, glasses or straws; and frequently clean surfaces like doorknobs and countertops that can attract germs. If you get sick, stay home so you won't infect others.

Flu information -- priority groups for vaccination, vaccine supplies and flu clinic schedules -- is widely available and updated frequently. Among the best places are (in multiple languages), and

Bruce Auerbach, M.D., is a past president of the Massachusetts Medical Society and vice president of Emergency and Ambulatory Services at Sturdy Memorial Hospital in Attleborough. Readers should use their personal judgment when seeking medical care and should consult with their personal physician for treatment. Physician Focus is a public service of the Massachusetts Medical Society. You are welcome to e-mail comments to