"I need to talk to you" was the greeting I was met with this morning as I walked into the office.  There were "a large number of flu cases in a local school" and we need to prepare for it.  These are supposedly "documented" H1N1 influenza.

My nurse and I sat down and we batted around scenarios that would possibly come up.  Our expectation is that the phones will be ringing constantly today, as word of this alleged outbreak spreads through the community.  Prepare for the worst and hope for the best.

  • When do we make people come in?
  • When do we call in medication?
  • When do we call in prophylactic medication?
  • What do we do about our staff who is seeing patients?

Here are the decisions we have made thus far (based on CDC recommendations):

  • Any child under 5 and high-risk people with symptoms must come in.
  • Symptoms of "flu-like illness" are defined as fever (over 100.5) with sore throat and/or cough.
  • For our lower-risk patients with symptoms who has had direct contact with a confirmed case of flu, we will call in antiviral medications as long as symptoms have been there less than 48 hours.
  • For high-risk people without symptoms who have direct contact with a confirmed case of flu, we will call in prophylactic antiviral medication.
  • We will refuse medication outside of these guidelines.
  • Patients with fever and cough in the office will be asked to wear a mask we provide

Even if today's initial news turns out to be negative, we have been seeing a good amount of confirmed influenza cases.  This is far outside the norm for this time of year, so it is likely the H1N1 variety.  The good news is that it has been relatively mild.  The bad news is that very few people have antibodies against this and nobody has been immunized.

Panic?  No, but we do need to prepare for whatever onslaught of phone calls we face.  Our nurses bear the brunt of community fears, and we need to cover most every contingency.

We haven't seen any sick pigs yet.

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