Flu Cases Rising, Outside Testing

Flu Activity

Flu activity is spiking at Four Seasons Pediatrics.  We have had 27 of our patients test positive to the Flu in the last 8 days.   Please see below for more information about Tamiflu, an antiviral medication.   For Tamiflu to be effective, treatment should be given in the first 48 hours of symptoms.   Please note, it is NOT too late to be immunized to the flu.  

Testing

Four Seasons Pediatrics will continue to perform examinations in automobiles and our Medical Shed at the present time.  We continue to assess the circulating COVID strain and current recommendations.  Children are at lower risk of complications.  Until we see more studies on MIS-C ^[1], one of the benefits of testing is knowing if COVID exists, so that you can monitor the next 6 weeks for signs of MIS-C.  This can be the most important thing to watch for if your child tests positive for COVID.   As of March 1st, 7,459 children ^[2] have been reported to have MIS-C.  

We continue to do testing outside at the office.  One of the primary considerations for outside testing was reduction in exposures to other patients as well as to our staff.   Staff who become ill with COVID, flu or other illness can result in shortages in the care we want and need to provide.  In addition, we are evaluating more children with a vomiting illness than ever before, as vomiting can be a symptom of COVID in children.   Vomiting is not a desirable symptom to see frequently in an office space.  When appropriate, we may test and bring patients inside after testing (e.g. unable to visualize the ears due to the need to remove wax), or an exam that cannot be performed outside such as special staining of the eye.  We will continue to evaluate our approach.  

Information about the Flu

TIP 1: Prevent Infection: The predominant way that respiratory illnesses like the Flu are spread is from person to person in respiratory droplets of coughs and sneezes. Germs can also spread when a person touches something contaminated and then touches their eyes, nose or mouth.  To help stop the spread of germs:

• Avoid touching eyes, nose, or mouth. Consider greeting with a nod rather than a handshake
• Avoid close contact with people who are sick. 
• Stay away from crowds when you have a choice

TIP 2: Hand washing: Hand washing is a simple habit, something most people do without thinking. Yet hand washing, when done properly, is one of the best ways to avoid getting sick. This simple habit requires only soap and warm water or an alcohol-based hand sanitizer.

TIP 3: Cough Etiquette: Cover your mouth and nose when coughing or sneezing, using tissues and disposing of them in a trash receptacle immediately. 

TIP 4: Boosting Your Immune System: Your immune system responds to how you treat your body.  Reducing stress, getting consistent rest, and eating plenty of fruits and vegetables are important.

TIP 5: Get the Flu Vaccine: Even when the vaccine leads to breakthrough cases, it is very effective in preventing serious complications.

When to Call the Office for the Flu³:

It may help to start with a view of current flu activity.  You can click here  ^[3]for a map which shows the current flu activity in the United States.  Click here  ^[4]for current week activity.  In the mean time, we wish to alert you to signs of the Flu.   Please remember, those who are most at risk of a serious complication are:

• Children under age 5 and especially under age 2 years
• Those between the ages of 5-24 who look extremely ill
• Those with a chronic disease, especially an underlying respiratory (lung) disease such as asthma, heart disease, kidney disease, liver disease, blood conditions (such as cancer) or metabolic problems including diabetes
• Those with conditions that can compromise respiratory (lung) function (cerebral palsy, spinal cord injuries, seizures, neuromuscular disorders)
• Those who are immunosuppressed (e.g. HIV) or on medications that can cause immunosuppression
• Children who are on long term aspirin

With all that said, please make the following considerations to be seen in the office:

Symptoms of the Flu:

The flu will cause a fever (which tends to be higher than other viruses) along with a cough and or sore throat.  Other features to look for include:

• a prominence of body or muscle aches, headache and chills more than most other viruses
• an appearance of illness with a glassy look to the eyes
• a runny nose that will tend to be profuse

Most healthy people who develop the flu recover completely and do not need treatment, but the CDC and American Academy of Pediatrics encourage a discussion about the risks and benefits of an antiviral, when the flu is diagnosed in the first 48 hours. 

Treatment with Anti-Viral Medications (Tamiflu)

Tamiflu is a medication that specifically stops the flu virus from multiplying.  It shortens the duration of illness by about 1 day if started in the FIRST 48 hours of the illness, and reduces severity by reducing secondary complications.  This is most beneficial in high risk groups.  See Influenza Antiviral Therapy ^[5] for information about Tamiflu if it has been prescribed.  Our practice will CONSIDER the use of Tamiflu for children (especially during peak influenza activity) for high risk children or if there is a high risk family member living in the home

Please remember that a course of Tamiflu will only protect you while you are on it.  After it leaves your body, you or your child can contract the flu.  The flu vaccine is still the most effective strategy to prevent the flu or at least cause a less serious infection.  When should I call 911?

• If you see severe difficulty breathing (struggling for each breath, making grunting noises with each breath, unable to speak or cry because of difficulty breathing, severe retractions/sucking in between the ribs)
• Bluish lips or face
• Not waking up or interacting
• Your young child is so irritable that they will not be held

You should call us to be seen now (if the office is open) if:

• There is difficulty breathing, not relieved by cleaning out the nose
• Fever >105°F, rectal or oral

We should see you today in the office if:

• You feel your child is sick enough that you want them seen
• Yellow scabs are around the nasal openings (possible impetigo)
• Fever is present >3 days – to make sure there is not a secondary infection like an ear infection
• Fever returns after going away for 24-48 hours – to make sure there is no secondary infection
• Symptoms have been present for 48 hours or less AND you fit one of the groups for consideration of Tamiflu (see at risk groups above)

What can I do to help treat symptoms at home?

HOME ADVICE FOR INFLUENZA

For most people, the treatment of influenza is based on the symptoms.

1. Bedrest is not necessary, but helpful for some.
2. For a runny nose with profuse discharge, blow or suction the nose.  The nasal discharge is natures way of washing out the virus.  Blowing the nose is all that is needed.
3. Apply petroleum jelly to the nasal openings to protect them from irritation.  Clean the skin first
4. For a Blocked Nose, Use Nasal Washes.  A young infant cannot nurse or drink from a bottle, unless the nose is open.  Use warm water or saline nose drops to loosen up the mucous followed by suctioning or blowing.  Repeat until clear.  Most stuffy noses are blocked by dried mucous.  Suctioning alone or blowing will not remove it.  Neither can medicines.  Do nasal washes especially to help with eating or sleeping.  We usually don’t advise suctioning for more than 3-5 days.    For Saline Nose Drops: 1/2 teaspoon of salt to 8 ounces (1 cup) of warm water.
5. Humidifier: Use if the air is dry to sooth the air passages.
6. Fever Medicine:  For fever over 102 degrees F or less than 102 if uncomfortable – use acetaminophen or ibuprofen (buffer with some food).  See the medication dosing area of our website or click here ^[6].  The goal is comfort, fever does not need to be eliminated.  Do not use aspirin for fever due to the risk of Reyes Syndrome.
7. Cough Medicine: For mild cough or hoarseness use 2-5 ml of corn syrup or buckwheat honey for younger children > 1 year old, or cough drops for children > 4 years.  We want to encourage a productive cough, not suppress it.
8. Sore Throat Relief:  For mild sore throat, give warm chicken broth for children > 1 year old, or cough drops for children > 4 years.
9. Contagiousness:  Spread can be rapid because the incubation period is only 24-72 hours, and the virus is very contagious.
10. Expected Course:  The fever lasts 2-3 days, the runny nose 5-10 days, and the cough 2-3 weeks.
11. Call back if:  the fever lasts > 3 days, the fever returns after going away for 24-48 hours, the nasal discharge last > 10 days, or you feel your child becomes worse.