Swine Flu: When to Head to the Hospital, When to Stay Home

Have a fever, a sore throat, and flulike symptoms? It could be H1N1, as 46 states now report widespread H1N1 infection, and the president has declared the virus a national emergency. And now, the Journal of the American Medical Association (JAMA) has released a study showing that of those who are hospitalized for H1N1, 30 percent require intensive care, and 10 percent die─and that the flu kills people in all age groups. Scary stuff, enough to make one run to the doctor at the slightest runny nose. But if you get the flu, in most cases you should probably stay under the covers and away from the ER.

That's because, for most patients with H1N1, trips to the ER—or even a primary-care physician—are unnecessary, says Carl Schultz, professor of emergency medicine at the University of California, Irvine, School of Medicine. “A vast majority of people are doing fine even if they get no [medical] intervention, so it seems inappropriate to bring them to ER where negative things could happen,” says Schultz. For instance: the chance of infecting someone with a compromised immune system waiting in that ER, or the chance that you—who may just have a cold—could contract H1N1 from someone else.

The JAMA research shows that H1N1 can have very serious consequences for the people it infects, says study author Dr. Janice Louie, chief of the influenza and respiratory-syndrome section for the California Department of Health.

The hospitalization rates are similar to those for the seasonal flu, and those who do require hospital care are in pretty bad shape. “We’re seeing a rapid progression and onset of illness. People are in the ER within three to four days of feeling sick,” she says, noting that all of the hospitalized patients are suffering from pneumonia. “More severe cases of pneumonia result in the patient being intubated, and having fairly long courses of illness, sometimes being hospitalized for months.”

Louie’s study, which analyzed 1,088 people who were hospitalized or died from H1N1 infection, did not address what percentage of all patients with H1N1 end up in the hospital. But if H1N1 is following patterns set by the seasonal flu, only about 1 to 2 percent of those infected will need emergency services.

If you head to the doctors with a mild case, your doctors may not provide much relief. They most likely won’t even confirm the diagnosis. Most individual physicians aren’t testing for H1N1, since there are so many cases so early in the flu season, doctors just assume that if you have the flu, it's of the swine variety. Tamiflu, once a readily available prescription for flu sufferers, is being shelved by most doctors. Since the flu is considered an epidemic, and a larger section of the population may become infected, giving the drug to such large numbers at the same time could lead to the emergence of a powerful, more deadly strain of the disease. “Most people will get better whether they get Tamiflu or not, so it’s not worth administering and possibly causing a drug resistance,” says Shultz.