Sara Jimenez, left, a patient at Houston Methodist, was turned away from two emergency departments.
Photo: Jon Shapley, Houston Chronicle
Intense flu season strains Houston-area care centers
By Todd Ackerman
With five deaths reported Thursday in the region, the flu season is raging in Houston yet weeks away from its peak, according to local experts.
After an earlier-than-usual arrival in November, the heightened activity, stemming mostly from a particularly nasty strain of the virus circulating this year, is overloading area hospital emergency departments, hospital rooms and doctor’s offices with mostly pediatric patients. Doctors say they expect the activity to pick up now that kids have returned to school.
“We are fuller than full,” said Roberta Schwartz, executive vice president of Houston Methodist Hospital, where staffers are going through face masks at record numbers because so many patients have the flu. “We have patients in rooms that we haven’t used in a long time.”
The surge of patients has become so intense emergency department leaders, such as those at Texas Children’s Hospital, urge parents to take their non-severely flu-ridden kids to urgent-care centers or doctor’s offices. They estimate those without a life-threatening case will wait hours for care.
Sara Jimenez, 60, could have been a casualty of flu’s burden on hospitals. Suffering from flu-like symptoms that made her COPD and asthma worse, she was turned away from two emergency departments – both put her on a waiting list and told her she probably wouldn’t be seen until the next day – before finding better luck at Methodist, where doctors saw her in the emergency department promptly, then admitted her into a room.
“I felt helpless,” said Jimenez, doing better Thursday evening after treatment for fever, chest pains, a weakened pulse and difficulty breathing. “I didn’t want to be selfish, but I couldn’t imagine people at the other ERs were in as bad shape as I was.”
Jimenez turned out not to have the flu but another viral infection, one of a number of bugs circulating, from RSV (respiratory syncytial virus) to four strains of the flu. The most prevalent is the H3N2 flu strain, which hit hard in the Southern Hemisphere and was the basis for the CDC prediction that the U.S. flu season is likely one of the worst in recent years. It is considered the most dangerous and hardest to vaccinate against.
Flu can be a killer
The CDC estimates the flu is an underlying or contributing cause of death in about 36,000 people a year, mostly the elderly. As of Dec. 31, there have been 1,155 such deaths in Texas this season, according to the state department of health, including 258 in a 16-county region including Houston.
Local health departments in Houston, Harris County and Montgomery County reported a total of five more deaths Thursday, most involving people in their 60s and 70s, one in his 50s.
The national flu season begins in October and ends in May. Houston’s starts later and becomes most active in January through March, officials said.
Dr. Michael Chang, infectious disease specialist at Children’s Memorial Hermann Hospital, said he hasn’t noticed flu cases are abnormally severe – there have been no pediatric deaths in Houston this season – but doctors worry that could change.
The last time H3N2 circulated in Texas, 2014-2015, there were 19 pediatric deaths, according to the state department of health. There were eight in 2016-2017 and seven in 2016-2017.
The H3N2 strain is notorious for causing more deaths, hospitalizations and care facility outbreaks than other viruses, experts say. It mutates more rapidly than the H1N1 or influenza B viruses, all circulating in Houston.
“H3N2 is characterized by an earlier start to the season and more severe disease,” said Pedro Piedra, a professor of molecular virology and microbiology at Baylor College of Medicine. “This season is definitely tracking with the 2014 season – more active, more intense.”
Peak to come in late January
The CDC is reporting the flu is widespread in 46 states, including Texas, which was among the nation’s first states to receive the classification.
Houston doctors say the season’s peak should come in late January.
Patients not sick enough to need the ER may face a wait for the doctor’s office too. UT Physicians, the clinical practice of the University of Texas Health Science Center at Houston, has seen 1,198 flu patients between Dec. 1 and Jan. 10, compared to 93 in the same time period a year ago, a spokeswoman said.
And Kelsey Seybold, the city’s largest network of clinics, recorded 650 to 750 positive flu tests both of the last two weeks, five times the amount a year ago. Its telemedicine appointments tripled.
“It’s definitely a worse season than the previous few,” Chang said of Children’s Memorial Hermann. “Not only are we really busy – flu admissions are significantly up – lots of staff are out because their kids have it.”
The surge of flu cases comes amid a national shortage of intravenous bags that are used by hospitals to deliver fluids and medications to patients. A major manufacturer of the IV bags is in Puerto Rico, where factories were damaged or destroyed by Hurricane Maria in September. Though such bags are rarely used to treat the flu itself, the virus can worsen the overall health of patients with other health problems, typically the elderly, and make them more in need of other medications delivered by IV.
Pharmacy leaders at a number of Texas Medical Center hospitals said the shortage has caused significant scrambling, but added they are making do with other bags ordered from vendors in the U.S. and stopgap solutions such as the use of syringes.
Piedra, from Baylor College of Medicine, downplayed the flu vaccine’s seemingly limited protection this season – studies out of Australia found a 33 percent effectiveness rate against H3N2 – because the vaccine provides significantly better coverage against the H1N1 and B strains. He also said he wants to wait on data from the vaccine’s effectiveness against H3N2 in the United States. He urged everyone 6 months and older who has not been vaccinated to get the vaccine.
In a news release Thursday night, the admonition was echoed by Mayor Sylvester Turner, who said: “It’s important to protect yourself and your family against the flu. The best thing you can do is to get a flu shot since it offers the best protection.”
There is no area-wide breakdown of the flu strains afflicting Houstonians, but Houston Methodist reports nearly 75 percent of its positive flu tests have shown the H3N2 strain, nearly 20 percent the H1N1 strain and 6 percent have shown B strains.
Chang said that flu seasons that start early – Houston’s was two months ahead of usual – often end early, but added the flu is too unpredictable to assume that. He said he expects the season to continue strong through at least February.
Know the symptoms
The city health department reported that 13 percent of ER visits at 40 Houston-area hospitals the last week of December were due to flu-like symptoms, up from around 10 percent in previous years. Children 4 and under accounted for 42 percent of them.
The most common symptoms are fever, congestion, sneezing, coughing, vomiting, diarrhea and muscle aches, said Dr. Kay Leaming, medical director of Texas Children’s West Houston emergency center.
She said cases most appropriately treated at emergency centers are those characterized by symptoms like those exhibited by Jimenez – weakened pulse, difficulty breathing, shortness of breath – as well as persistent vomiting and an inability to drink anything.
source: Houston Methodist