Swine Flu? Don't Ask: Doctors Usually Can't Tell for Sure.

By Rachel Saslow
Washington Post Staff Writer
Tuesday, July 14, 2009

Sheila Morris is almost certain her 13-year-old son Evan got the H1N1 influenza virus at summer camp two weeks ago -- but she'll never know for sure. And neither will the Centers for Disease Control and Prevention.

The Fairfax County mother suspected H1N1, or swine flu, when her son came home with a temperature of 104. An e-mail from the camp director confirming eight cases of H1N1 among campers solidified her hunch.

"That night we called the doctor's office, and she said, 'Sure, it's probably swine flu,' " Morris says. But the doctor did not suggest that Evan come in for testing. "She didn't think the CDC was interested in anything unless you died."

Parents in the Washington area and beyond are having similar experiences, leaving some angry and others, like Morris, confused.

Private doctors, such as Morris's pediatrician, can't run their own tests for H1N1. That falls to private laboratories and the public-health system, which wants to track the pandemic, not help doctors make treatment decisions.

As of Friday, the CDC had reported 37,246 cases of swine flu and 211 deaths from the illness nationwide. The District has 45 confirmed cases of the virus, Maryland has 686 and Virginia 306, but officials have said the actual number is probably much higher, because not everyone who gets sick goes to the doctor and because it's not practical to give an H1N1 test to everyone with a flulike illness. The CDC estimates that more than a million people worldwide have contracted H1N1.

Last Thursday, the federal government hosted a "flu summit" to talk about vaccinations and preparedness. Health and Human Services Secretary Kathleen Sebelius called H1N1 "a serious virus capable of causing severe disease and death" and said, "We must avoid complacency and ensure we are prepared to deal with whatever the fall flu season brings."

Diane Dubinsky, the medical director of Fairfax Pediatric Associates, gives her patients with flu symptoms a rapid diagnostic test: a nasal swab that detects all flu, including swine flu. (Dubinsky is not Morris's doctor.) The results are clear in about 10 minutes, and if the test is positive for influenza A, she assumes that the patient has the H1N1 virus, which is a type of influenza A.

On a conference call with reporters on June 26, Anne Schuchat, a CDC physician helping to lead its pandemic response, said virtually all of the influenza circulating this summer is the H1N1 variety; 99 percent of the positive samples tested by the CDC are H1N1. Schuchat said the CDC is performing "virologic sampling" to get infection numbers rather than testing every single person with a flulike illness.

"We've had cases where patients have been angry, demanding to get tested for swine flu," Dubinsky says. "We calm them down and say who we test and who we don't test."

Today, a month after the World Health Organization declared a swine flu pandemic, the CDC recommends H1N1 testing only for people with flulike symptoms who are at high risk for complications, including infants, the elderly, pregnant women and those with chronic illnesses. The D.C. health department adopted those guidelines June 22.

Not all doctors are following the guidelines. Foxhall Pediatrics in Northwest Washington sent influenza A-positive swabs to a private laboratory for testing through the end of June, even for children older than 5, according to an administrator at that office. The practice did it because doctors and patients both wanted to know the results. Still, the practice plans to follow the CDC guidelines for all future patients.

Diane Helentjaris, the acting director of the Virginia Department of Health's Office of Epidemiology, guesses that some patients are eager to get the swine flu test because they're curious, even "a little excited about having something new."

Conducting the H1N1 test is not simple. Doctors must transport samples in special containers; the test costs $40 to $200, depending on the exact type and various laboratory issues; and the whole process can take a week. By then, most patients are on the mend. Compare that process with the 10-minute rapid flu test, which costs about $15.

In this context, many local doctors, including Dubinsky, have been telling any patient who tests positive for influenza A that he or she probably has swine flu.

Doctors recommend that patients treat flu symptoms by taking over-the-counter medicines and staying home for a week after falling ill. The antiviral drug Tamiflu is recommended only for at-risk patients who seek treatment within the first 48 hours of symptoms, Dubinsky says.

In Morris's case, she picked her sick son up from camp and prepared for the flu to spread through her family. She kept her son at home and monitored him closely. She bought Tamiflu for her elderly father, who lives with her and is in fragile health. She acted as if her son had swine flu, even though she probably would never know for sure. So far, nobody else in her family has gotten sick.

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