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Swine Flu Surge Closes Schools, Tests Hospitals

By Rob Stein
Washington Post Staff Writer
Sunday, September 27, 2009

In Austin, so many parents are rushing their children to the Dell Children's Medical Center of Central Texas with swine flu symptoms that the hospital had to set up tents in the parking lot to cope with the onslaught.

In Memphis, the Le Bonheur Children's Medical Center emergency room got so crowded with feverish, miserable youngsters that it had to do the same thing.

And in Manning, S.C., a private school where an 11-year-old girl died shut down after the number of students who were out sick with similar symptoms reached nearly a third of the student body.

"It just kind of snowballed," said Kim Jordan, a teacher at the Laurence Manning Academy, which closed Wednesday after Ashlie Pipkin died, and the number of ill students hit 287. "We had several teachers out also. That was the reason to close the school -- so everyone could just be away from one another for a few days."

After months of warnings and frantic preparations, the second wave of the swine flu pandemic is starting to be felt around the country, as doctors, health clinics, hospitals and schools are reporting rapidly increasing numbers of patients experiencing flu symptoms.

"H1N1 is spreading widely throughout the U.S.," said Thomas R. Frieden, director of the federal Centers for Disease Control and Prevention in Atlanta during a briefing on Friday. At least 26 states, including Maryland and Virginia, are now reporting widespread flu activity, up from 21 a week earlier, the CDC reported. "H1N1 activity is now widespread," Frieden said.

While so far most cases are mild, and the health-care system is handling the load, officials say the number of people seeking treatment for the flu is unprecedented for this time of year. Even though some parts of the Southeast that started seeing a surge of cases first now seem to be showing a decline in cases, that could be a temporary reprieve, Frieden said. And other parts of the country are likely just starting to feel the second wave.

Maryland health authorities on Friday said a Baltimore-area youth with an underlying health problem had died of swine flu, the state's first such fatality involving a youth.

Despite new federal guidelines aimed at keeping schools open, the pandemic has already prompted scattered school closings around the country in recent weeks, including 42 schools that closed in eight states on Friday, affecting more than 16,000 students.

Many colleges and universities have been hit particularly hard, forcing some to open separate dorms for sick students. Ninety-one percent of the 267 colleges and universities being surveyed by the American College Health Association are now reporting cases.

At the Le Bonheur Children's Medical Center, the number of patients coming in each day shot up from about 180 to a peak of more than 400, prompting officials to erect a 2,500-square foot tent in the parking lot to handle the surge. More than 300 patients are still coming in every day.

"What we initially did was try to bring in extra folks, but you soon run out of extra people and extra spaces to put people," said Barry Gilmore, the hospital's medical director for emergency services.

Doctors, nurses, paramedics or other workers screen patients in the tent and decide who can safely go home. Anyone with other health problems that put them at risk, such as asthma, heart disease or kidney disease, is sent immediately to the emergency room. All patients who are sent home are contacted within 24 to 48 hours to make sure they are recovering.

"We are mostly dealing with the worried well or kids who are mildly ill but not severely ill," he said.

At least 14 patients, however, were admitted to the hospital and perhaps six required intensive care, he said. One teenager died.

Swine flu, also known as H1N1, tends to strike more younger people than the usual seasonal flu. At least 49 children have died from complications caused by the virus so far in the United States.

At the Dell Children's Medical Center, the number of patients coming in each day shot up from about 180 to more than 340, prompting the hospital to require staff to work extra shifts and erect two tents outside the emergency room to handle the overflow and keep possibly infected patients separate from others.

"We are able to take care of them really rapidly without a long wait, and they don't have to be mixed in with other patients who do not have the flu," said Pat Crocker, chief of emergency medicine. "It's been highly efficient."

But Crocker, noting that the hospital is already busier than it was in the wake of hurricanes Katrina and Rita, said the hospital has a third tent ready to be set up.

Individual doctors' offices are also reporting a surge of patients in many parts of the country.

"We're completely swamped," said Ari Brown, an Austin pediatrician whose office had to call in extra nurses to handle the volume of patients. "It's been extraordinarily busy. We have a small parking lot to begin with. People now are circulating the neighborhood to try to find a place to park and the waiting room is completely packed."

Unless patients are seriously ill or have other conditions that put them at risk, Brown and other doctors say they tell parents to take their children home, give them Motrin or Tylenol for their fevers, headaches and body aches, and lots of fluids, and wait it out. Some doctors report that children tend to recover within about four days, a day or two shorter than with the typical flu.

Nevertheless, "people are so worried about this," Brown said. "There's clearly a certain level of hysteria."

Although no hospitals in the Washington region have yet had to activate their emergency plans, many are reporting an increase in patients, as are individual doctors.

"Some of that is because of the swine flu and some of it is because of phobia about the flu," said Steven Mumbauer, a Waynesboro, Va., pediatrician. "But we definitely are seeing sicker kids and have treated more kids with pneumonia than we typically would this time of the year. There have been some days where we've been absolutely swamped."

At the University of Maryland Medical Center in Baltimore, some children have gotten so sick that they have required intensive care, and that includes some children with no other health problems.

"We have some very sick children," said Ina Stephens, a pediatric infectious disease specialist at the hospital. "I'm concerned it's just the tip of the iceberg -- that we're just seeing the beginning of it."

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