Boston declares public health emergency

  • Article by: DONALD G. McNEIL Jr. and KATHARINE Q. SEELYE
  • New York Times
  • January 10, 2013 - 7:11 AM


It is not your imagination -- more people you know are sick this winter, even people who have had flu shots.

The country is in the grip of three emerging flu or flulike epidemics: an early start to the annual flu season with an unusually aggressive virus; a surge in a new type of norovirus; and the worst whooping cough outbreak in 60 years -- all against the backdrop of the normal winter highs for the many viruses that cause symptoms on the "colds and flu" spectrum.

Influenza is widespread and causing local crises. On Wednesday, Boston's mayor declared a public health emergency as cases flooded hospital emergency rooms. There have been about 700 confirmed cases of influenza already this year, 10 times more than the 70 seen in all of last year's flu season in the city. The state has reported 18 flu-related deaths so far.

"This is the worst flu season we've seen since 2009, and people should take the threat of flu seriously," Mayor Thomas Menino said. "This is not only a health concern, but also an economic concern for families."

Google's national flu trend maps, which track flu-related searches, are almost solid red (for "intense activity"), and the Centers for Disease Control and Prevention's weekly FluView maps, which track confirmed cases, are nearly solid brown (for "widespread activity").

The number of flu cases began to rise in November and reached an elevated level in December, a month earlier than usual, said Michael Jhung of the CDC. About 5.6 percent of doctor visits now are for influenza, compared with 2.2 percent of visits at the peak of the season last year, the CDC said.

"Yesterday, I saw a construction worker, a big strong guy in his Carhartts who looked like he could fall off a roof without noticing it," said Dr. Beth Zeeman, an emergency room doctor for MetroWest Medical Center in Framingham, just outside Boston. "He was in a fetal position with fever and chills, like a wet rag. When I see one of those cases, I just tighten up my mask a little."

Massachusetts General Hospital in Boston started asking visitors with even mild cold symptoms to wear masks and to avoid maternity wards. The hospital has treated 532 confirmed influenza patients this season and admitted 167, even more than it did by this date during the 2009-10 swine flu pandemic.

At Brigham and Women's Hospital, 100 patients were crowded into spaces licensed for 53. Beds lined halls and pressed against vending machines. Overflow patients sat in the lobby wearing surgical masks.

"Today was the first time I think I was experiencing my first pandemic," said Heidi Crim, the nursing director, who saw both the swine flu and SARS outbreaks. Adding to the problem, she said, many staff members were at home sick, and supplies like flu test swabs were running out.

Nationally, deaths and hospitalizations are below epidemic thresholds. But experts do not expect that to remain true. The predominant strain circulating is an H3N2, which typically kills more people than the H1N1 strains that usually predominate.

No cases have been resistant to Tamiflu, which can ease symptoms if taken within 48 hours, and this year's flu shot is well-matched to the strain, the CDC said. Flu shots are imperfect, especially in the elderly, whose immune systems may not be strong enough to produce enough antibodies.

The CDC continues to advocate getting flu shots. Although it takes up to two weeks to build immunity, "we don't know if the season has peaked yet," said Dr. Joseph Bresee, chief of prevention in the agency's flu division.

Bloomberg News contributed to this report.

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