Inside the pediatric flu deluge at Children's hospital

With a daily caseload that has surged as much as 80 percent, the emergency room at Children's National Medical Center has become a local ground zero for the pediatric treatment of the H1N1 virus.
By Donna St. George
Tuesday, November 17, 2009

Her work day started before 7 a.m., when three flu-sickened children were being treated in the emergency room. Ready for another 12-hour shift, pediatric nurse Lindsay Wheeler donned her stethoscope and noticed, with some surprise, that there was no long waiting line of coughing youngsters and parents in surgical masks.

That would change as the hours ticked by and worried families from across the region made their way to what has become a local ground zero for pediatric treatment of H1N1, a flu pandemic that particularly afflicts the young.

With a daily caseload that has surged as much as 80 percent, the emergency room at Children's National Medical Center allowed a glimpse on two recent days inside the deluge, at a time when lab-coated doctors and scrubs-clad nurses tend the flu-stricken, round-the-clock.

Beyond the ER's sliding glass doors, a onetime billing office has become a rapid screening unit for the flu. Overflow patients are treated in chairs set up in hallways. The waiting room is divided in two by a large blue curtain, separating children with flu symptoms from those without.

The sick tend to arrive in waves -- in the morning, after school, after work -- bleary-eyed mothers and fathers and grandparents with toddlers in arms, with infants in strollers, with stuffy-nosed school-age children. Little ones cry and pull off their miniature-size surgical masks. Some stare absently at a television overhead showing "Dora the Explorer." Many have been awake half the night.

The peak came Oct. 26, a Monday that brought in 429 patients, including 232 with flulike symptoms.

"These are just unheard-of numbers for our department," said Stephen Teach, associate chief of emergency medicine, eyeing the statistics at his computer. Although most children are cared for and sent home, a small number are hospitalized, usually for respiratory problems. The day before Halloween, 39 children were in hospital beds for longer stays with confirmed H1N1 -- the most in a single day.

No children have died during the fall flu surge at Children's, although one patient succumbed to H1N1 in the spring, the hospital said.

Nationally, pediatric H1N1 deaths are estimated at 540 during the past six months, federal officials reported Thursday.

Last week, an average of more than 90 flu patients a day streamed into the Children's emergency room, and the hospital remained in pandemic mode, using three times as many surgical masks and rubber gloves as it did before H1N1 and relying on preprinted forms to write prescriptions for Tamiflu, the main drug used to treat swine flu.

For pediatric nurses such as Wheeler, 29, a former high school swimmer and runner who grew up in McLean, the H1N1 surge has meant constant motion -- taking temperatures, counting heart rates, listening for wheezing, pouring doses of Motrin, setting up IVs for children who need fluids quickly, and giving out cartoon stickers and soothing words.

Most children with flu symptoms are not tested for H1N1 because rapid tests are too unreliable, doctors say, and the treatment would not change. For many parents, this can be hard because they want certainty: Is it swine or not?

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