Winter 2017-2018 Mid-Flu Season Update

I was just on a trip involving air-travel, and it was interesting to see how many travelers were wearing surgical facemasks in the airport and aboard the planes. One is used to seeing this in Asia, but not on this scale in the US. A friend went to the dentist last week and mentioned that all the office workers were wearing masks and were handing them out to patients when they walked in the waiting room door. My eldest uncle, who recently graduated to Assisted Living, was in a lock-down at the facility and they were delivering food to the rooms – no congregate dining was being served. This has been an unusual flu season.

According to the CDC Flu update dated 5 February 2018: The proportion of deaths attributed to pneumonia and influenza (P&I) was above the system-specific epidemic threshold in the National Center for Health Statistics (NCHS) Mortality Surveillance System.

The proportion of outpatient visits for influenza-like illness (ILI) was 7.7%, which is above the national baseline of 2.2%. All regions reported ILI at or above region-specific baseline levels. New York City, the District of Columbia, Puerto Rico and 43 states experienced high ILI activity; “This is the first year we had the entire continental U.S. be the same color on the graph, meaning there’s widespread activity in all of the continental U.S. at this point,” CDC Influenza Division Director Dr. Dan Jernigan said during a briefing.

Most US States (43) reported high flu activity. The following were exceptions:

 - Three states experienced moderate ILI activity (Hawaii, Idaho, and Washington).

 - Two states experienced low ILI activity (North Dakota and Utah).

 - Two states experienced minimal ILI activity (Maine and Montana).

One might guess that the higher latitudes helped restrict virus spread, perhaps by temperature, or people tended to not go out (and share germs) quite as much. Hawaii is fairly isolated and that probably helped reduce spreading, although the Virgin Islands had even less, and Puerto Rico had significant more flu activity.  We’ll probably have to wait for a season review by the CDC to get the studied details.  https://www.cdc.gov/flu/weekly/index.htm

Here are some other articles providing additional insights:

National Geographic provides some interviews on how the viruses and vaccines work: https://news.nationalgeographic.com/2018/01/flu-influenza-h3n2-virus-outbreak-vaccine-spd/

In cases where the flu is fatal, most are where it advances to pneumonia. "Influenza and its complications disproportionately affect people who are 65 and older. They account for 80% of the deaths," said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University during a CNN interview. (https://www.cnn.com/2018/01/24/health/how-flu-kills/index.html)

Flu can combine with other ailments to be more dangerous together than individually. As an example, the probability of a heart attack increased sixfold during the first seven days after a flu infection, a new study published 25 January 2018 in the New England Journal of Medicine (*1) found. Lung disease and diabetes are also risk factors.

An interesting January 2018 article in the Washington Post (https://www.washingtonpost.com/national/health-science/the-bad-flu-season-has-revealed-  a-dangerous-problem-with-our-medical-supply-chain/2018/01/19/2489973c-fc6b-11e7-ad8c-  ecbb62019393_story.html?utm_term=.d1df806a84fd) discusses not only the strong ability of the H3N2 virus to mutate and its aggressive attacks on adults over 50 years of age, but also the inability of a “just-in-time” medical supply chain to handle epidemics outside of normal demand parameters. Having supplies and medication, with their associated expiration dates, in stock increases costs, and in today’s reimbursement climate, no one wants to pay for it.