View transcript of WBUR online flu forum
September 21, 2009
Wondering how influenza is affecting other colleges in the area? Read the transcript below of the online Friday Flu Forum hosted by WBUR.org. The forum, which featured David Diamond, M.D., associate medical director at MIT Medical, was hosted by WBUR health and science reporter Sacha Pfeiffer.
Sacha Pfeiffer: Hello out there, and welcome to WBUR's first Friday Flu Forum. This is Sacha Pfeiffer, WBUR's health and science reporter. We'll get started in a few minutes.
Sacha Pfeiffer: Our guest today is Dr. David Diamond, the associate director of MIT's Medical Department. Thanks for joining us.
David V Diamond: Thank you, happy to be with you today.
Sacha Pfeiffer: So, Dr. Diamond, could you start by telling us how many flu cases you're seeing among MIT students so far this school year?
David V Diamond: We are seeing about 20-30 students a day with influenza like illness in our Urgent Care area for the last week or two. Not all have Influenza H1N1 however.
Sacha Pfeiffer: When you say "influenza-like illness," what type of symptoms does that mean?
David V Diamond: Fever over 100.5 and another symptom such as muscle aches, cough, sore throat, fatigue.
Sacha Pfeiffer: And if those aren't all cases of H1N1 flu, then what else might they be?
David V Diamond: They could be another virus such as adenovirus or rhinovirus, in other words simple "colds".
David V Diamond: Also, there could be strept throat or mononucleosis, often seen in our student age group.
Sacha Pfeiffer: Why isn't it possible to determine if those are cases of H1N1 flu or seasonal flu? Can't you test for that?
[Comment From Michael Malone]
Who are most prone to the worst cases of H1N1?
David V Diamond: Yes, we can test and we have had 10 positive tests for Influenza A. However, the test can be falsely negative in 30% of H1N1 cases, and if positive in an otherwise healthy person it does not change our treatment plan, so we are not doing alot of testing.
Sacha Pfeiffer: And what about this question from our commenter: who is most vulnerable to H1N1?
David V Diamond: Persons under age 25 seem most susceptable to this H1N1 strain. Those with underlying conditions that weaken their immune system are most prone to complications. The CDC website has excellent information and specifics on this point, and in general on the H1N1 situation.
Sacha Pfeiffer: You've said you've had ten positive tests so far. Do you consider that a lot or a little, or somewhere in between?
[Comment From Jeffrey A. Newman]Is anyone tracking the virus "real time" to watch for mutations into different strains, which might be more virulent than the H1N1 virus now circulating?
David V Diamond: Since we are only testing persons with underlying conditions, our testing represents only a small fraction of those with the flu. We have done only 27 tests total. So it is not alot of postive tests but it is not a good tracker for how many are sick.
David V Diamond: CDC is doing alot of tracking and testing of the H1N1, as is the WHO.
Sacha Pfeiffer: In answer to Jeffrey Newman's questions about mutations, one way to track infectious disease outbreaks, including H1N1, is to go to this flu-tracking application available free on the iPhone: http://www.wbur.org/2009/09/02/phone-app
[Comment From curious]
i read somewhere in the news today that seniors were somehow immune to swine, therefore they weren't on the top of the 'should get vaccinated' list. why do you suppose elderly folks are able to ward this particular strain away?
David V Diamond: NEJM published study that showed that older people have immunity to H1N1, using samples from blood donors. This is consistant what was seen with the attack rate in different age groups of the first wave last Spring.
[Comment From Jacob A. Korzun]
Is this strain of the H1N1 influenza virus another case of "death by cytokine storm" a la Influenza Pandemic of 1918?
David V Diamond: This strain does not seem to be causing the severe illness seen in the 1918 strain.
[Comment From Michael Malone]
Ive heard of an inflated amount of infected cases during the next few months, what do you think is a reasonable estimate for the actual number of confirmed H1H1 cases
Sacha Pfeiffer: Our commenter Michael Malone raises an interesting question: have H1N1 fears been overblown. What do you think, Dr. Diamond?
David V Diamond: Hard to know, as most cases likley mild and are not being seen by or reported to health system.
[Comment From Jacob A. Korzun]
So, if it's not terribly virulent, and not causing severe illness, why should one be worried about it?
[Comment From cr] "Seem"? From the start, (see the WHO Epidemiological Report for May 22), the small percent of cases that are, "severe" do become as dangerous as the H5N1.
David V Diamond: We worry because a high percentage of the population are susceptable to this strain, so we may see a surge in illness, mild to severe. Also we worry that the strain may mutate during the outbreak and become more virulant.
[Comment From cr] Last month US govt said that "60 % " of Firstwave panflu deaths so far have been "under age 49".
[Comment From Jeffrey A. Newman]
When a student at MIT has a confirmed case of H1N1, what time frame is recommended before they re-enter the student population?
[Comment From cr] 1/3 of hospital cases and 1/3 of deaths in the US have been in healthy people, according to the CDC.
Sacha Pfeiffer: Jeffrey Newman raises another interesting question: how are colleges keeping sick and healthy students apart?
David V Diamond: If a student at MIT becomes sick with "ILI" [influenza like illness] we tell them to self isolate during their illness until 24 hours without fever, according to CDC guidelines. What they do is another matter!
Sacha Pfeiffer: At Brandeis, if a sick student lives in a two-person dorm, the healthy student is being asked to find another place to live temporarily. Dr. Diamond, what do you think of that approach?
[Comment From cr]
to Jacob: The US lacks any surge capacity; too many cases and medical systems will not be able to function. Too many essential/critical infrastructure people sick at a time (or die) and infrastructure will have cascading consequences.
David V Diamond: Most colleges are not moving sick students routinely into alternative housing, though some are. Sending students home is an option for many, not so much for MIT where 80% live more that 5 hours drive away, and we have a large international group too.
Sacha Pfeiffer: The number of suspected flu cases at local colleges campuses varies widely. Boston University, for example, has only had about a dozen cases among 30,000 students. But at Bowdoin in Maine, which only has about 2,000 students, there are apparently more than 100 cases of the flu. Why are we seeing this variation?
David V Diamond: Much of what we are trying to do is "flatten the curve" by doing social distancing and slowing the spread. If 30% of the population gets sick over 3 months, easier to deal with than all being sick in 2 weeks.
[Comment From Diane Austin] I am the Dean of Student Affairs at Lasell College, and we are handling students with ILI much the same way as MIT; although we are also encouraging those students who are able to go home, to do so.
David V Diamond: Variation is due to the H1N1 being introduced into various closed communities at different times, also differences in definition and detection I suppose.
[Comment From Jeffrey A. Newman]
So, is it voluntary that a student who may have flu symptoms decide themselves, whether to stay away from other students or away from classes? This raises some difficult legal issues and certainly if the virus worsens in severity!
David V Diamond: If the virus worsens, our plans change. That is one of the scenarios we are planning for. On the other hand, if we over react to this outbreak, we lose credibility and energy for a worse epidemic.
[Comment From Jeffrey A. Newman]
Is there anything more that our colleges could or should be doing to monitor the numbers of H1N1 cases and severity of illness as well as any changes in the virus itself?
[Comment From Michael Malone]
So, if it's not terribly virulent, and not causing severe illness, why should one be worried about it?-- Jacob Korzun
David V Diamond: Depends on the school and its resources. We have 150 specially trained "Med Links" - students with knowledge of our health care system and first aide trained. They are in every dorm and residence, we are using them to track what is happening other than who comes to see us in the Health Center.
Sacha Pfeiffer: Dr. Diamond, when you and I spoke last week about the flu situation at MIT, you said that you "treat" some students, but for others you just offer "symptomatic support." What's the difference?
David V Diamond: Though not deadly, persons with Influenza are pretty miserable for 3-4 days or more, something we would rather prevent if possible.
[Comment From cr] Schools were told by US Dept of Education in March, 2006 that pandemic flu preparedness was "critical" and to go prepare schools, (and staff, and tell school parents) for up to 3 months of dismissals, per wave, if necessary. Why weren't (if it's "credibility" you are worried about) these preparations made ready and workable, and why wasn't the public made familiar with "Community Mitigation" "NPI" plans? If this is only a Cat.2 severity as CDC claims, "up to 4 weeks" dismissals should have been triggered; to avoid filling up ICU units and ventilators, while the first-priority group waits for any panflu vaccine.
Sacha Pfeiffer: To interject, I'm interested in hearing from our web guests about their level of concern about H1N1. What are your thoughts -- has it been overhyped, or is there an appropriate level of caution?
[Comment From Jeffrey A. Newman] By way of observation, even the comments in this forum demonstrate the Catch 22 faced by the colleges and universities. Many feel the issue has been overblown and yet the virus can be variable and change. If they do too little and more students become ill as a result, the universities will come under criticism. However, if they take measures considered too strident, given the present moderate symptoms, they will come under criticism. It is a difficult position without more data.
Sacha Pfeiffer: Dr. Diamond, the H1N1 vaccine is expected to be available at some point in October. Do you think that will be too late in the flu season to offer much protective benefit?
David V Diamond: The H1N1 strain circulating is Pandemic Level 6, it is world wide, but it is not the worse case scenario of a severely pathogenic strain. We saw last spring that over response caused more disruption than the illness itself. It is a delicate balance.
David V Diamond: By the time we get the vaccine it is likely to be early November, by that time this outbreak may be fading but many will still be susceptable and it will be of benefit for them at that time and for the next wave in the Spring or after.
Sacha Pfeiffer: Several college medical directors I've spoken with say they're seeing a lot of cases of the "worried well" showing up in their clinics. Can you tell us, Dr. Diamond, what they mean by that?
David V Diamond: We are seeing otherwise healthy people with minor upper respiratory symptoms coming in wondering if they have "Swine Flu".
Sacha Pfeiffer: So when do you, as a medical director, want a student to actually come to your clinic? Because, presumably, if every student who feels slightly ill makes a visit to the doctor, the medical system could become overwhelmed.
David V Diamond: Our visit rate to Urgent Care area is double baseline these last two weeks. Some of those we are seeing might not otherwise have come if it were not for the flu headlines.
David V Diamond: We want them to call first and get advice. We have set up extra phone lines and staff to handle that. If they have significant symptoms or if they have underlying conditions and even minor symptoms we want to see them.
Sacha Pfeiffer: On a personal note, Dr. Diamond, you told me shortly before our web chat began that you put in a very long night last night. So this is a busy time for you, even if it's hard to confirm actual flu rates?
David V Diamond: I should add that we are using a special website we set up to channel alot of inquiries and keep our messaging accurate and up to date: http://medweb.mit.edu/about/news/flu/index.html
[Comment From cr]
Since antivirals need to be started within 48 hours of onset to be most effective, what else are they supposed to do? it is harmful to dismiss people as "worried well". 1/3 of the hospitalizations and deaths have had zero underlying conditions
David V Diamond: Busy for all our staff, we are coping for now but if outbreak doubles in intensity we will have to redirect many more resources.
David V Diamond: We are following CDC guidelines. Overuse of the anti-virals will accelerate resistance, and cause side effects themselves in some. While it is true that otherwise well may become sick enough to need hospitalization, the vast majority do not. We have had 5 admissions to our infirmary, none intensely ill, and none sent to hospital.
Sacha Pfeiffer: And related to the previous guest's question: Dr. Diamond, if you don't think a student is sick enough to be given a drug such as Tamiflu, what advice do you give them to help them get well? Is it: just hunker down and wait until you feel better?
David V Diamond: Basically, rest and fluids, Tylenol or Mortin, and keep in touch. We give them an information handout which includes what to look out for. We also, with their permission, alert the Dean of Student Life office, and the residental life staff [housemasters,etc.] of the ill student and have them check in regularly. We also have spoken to the faculty about taking the pressure off of the students during their illness and recovery.
Sacha Pfeiffer: When it comes to preventive behavior, what should the general public be doing to prevent the spread of flu, regardless of whether it's seasonal flu or H1N1?
David V Diamond: Again, I would refer all to the CDC website for excellent information including how to take care of yourself and others with ILI.
Sacha Pfeiffer: But I assume it's many of the usual things, such as frequent hand-washing and covering coughs and sneezes?
David V Diamond: We have had a campaign on cough etiquette [covering your cough] and hand washing up and running, ran it last year to in effort to prepare for flu and also lower the frequency of common colds, etc. New posters and notices went up last week.
Sacha Pfeiffer: Dr. Diamond, many thanks for taking time away from student medical appointments to do this web chat with us today. We're going to wrap up now, but we hope to do more of these Friday Flu Forums in the future, maybe even as early as next Friday. Thanks to everyone who participated, and please join us again.
David V Diamond: My pleasure, thanks Sacha. Definitely stay tuned!
WBUR: We hope you enjoyed the discussion. Follow all of WBUR's coverage of H1N1 Swine Flu: http://www.wbur.org/news/swine-flu
And you can view a permanent archive of this discussion at any time: http://www.wbur.org/2009/09/18/friday-flu-forum-1
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