Regional Hospitals Brace for Flu

By Kelly Burch
THE KEENE SENTINEL
Around the Monadnock Region, doctors in outpatient clinics and emergency departments are beginning to see patients experiencing flu-like symptoms.

“It’s sooner than we expected it,” said Dr. Kathleen McGraw, chief medical officer at Brattleboro Memorial Hospital. “It’s sooner and a little more [volume].”

Brattleboro Memorial Hospital, as well as Monadnock Community Hospital in Peterborough and Cheshire Medical Center in Keene, also reported that they’ve seen more patients with flu or other respiratory illness symptoms over the last few weeks.

The small but rising number of influenza cases in the region, coupled with data about an early flu outbreak in the southern United States, have local doctors and New Hampshire health officials bracing for what could be a severe flu season. As of early November, rates for flu hospitalization nationwide are higher than they have been since the 2010-2011 flu season, according to data from the Centers for Disease Control and Prevention.

“Reports from the CDC show this is slated to be one of the worst flu seasons going back decades,” said Dr. Aalok Khole, an infectious disease physician at Cheshire Medical. “We’ll have to see how that prediction pans out.”

Typically, flu cases rise in the southern U.S. before they rise in the Northeast, said John Dreisig, influenza surveillance coordinator with the state health department’s Division of Public Health Services (DPSH).

Eight southern states and Washington D.C. had “very high” rates of influenza (the highest of five classifications on the scale), according to CDC data for the week that ended Nov. 5, the most recent data available. New Hampshire and Vermont both had “minimal” activity (the lowest measure on the scale), but Dreisig said that’s likely to change soon.

“Because flu activity is now increasing in the Southern part of the U.S., we expect to soon see increasing flu in New Hampshire in the coming weeks, and we’re already seeing early indicators of this starting, which is earlier than normal,” he said.

Predicting the season

Influenza is not a reportable disease in New Hampshire and many other states, meaning that doctors do not need to make health officials aware when patients have the condition. Still, flu is carefully tracked, both by the state and federal governments.

The most recent state report, for the week ending Oct. 29 showed “local” flu activity in New Hampshire. Local is the middle of five classifications that the state uses, and means one area of the state saw increased activity, according to the state health department. At the time, Grafton County had rising flu cases, said Caitlin Adams Barker, manager of infection prevention at Dartmouth Hitchcock Medical Center in Lebanon.

Overall, the state is “about where we are every other year,” said Adams Barker.

Yet, the current rates in southern states are higher than they’ve been since the 2010 flu season, she said. Historically, high rates in one area of the country are soon reflected nationwide, according to Adams Barker.

When thinking about what makes a severe flu season, McGraw considers the volume of cases, and whether the illness is more intense, meaning that people get sicker. At this point, she said it’s too soon to say how the current influenza strain will shake out both in terms of severity and volume.

In addition to the flu, there has also been an earlier surge this fall of other respiratory illnesses, such as respiratory syncytial virus (RSV). Though the illness has resulted in more infections nationally and locally, McGraw said “the RSV that’s out there is not making people more sick.”

Most of these cases at Brattleboro Memorial, she said, have been among children, who typically have more severe symptoms with RSV than adults. These can include fever, runny nose, loss in appetite, coughing, sneezing and wheezing.

She stressed that, unless a child has trouble breathing or is unable to take fluids, there is no need to bring them into the emergency department if they have RSV symptoms.

“They can have their cold treated at home. They don’t need to be tested to see if they have RSV,” McGraw said.

Cheshire Medical and Monadnock Community Hospital also have seen more RSV cases earlier than usual, according to hospital officials.

Dr. Geraldine Rubin, chair of pediatrics and a pediatrician at Cheshire Medical, said the Dartmouth Health affiliate has had “many admissions” related to RSV over the past two months of infants, toddlers and school-aged children.

Outpatient volume has also increased in the pediatrics and emergency departments, she said.

The hospital has the capacity to admit kids if needed, but Rubin said the same nursing staff covers the labor and delivery department, which could hinder staffing levels if inpatient numbers increase while the baby census is high.

Even outside of that department, Rubin, McGraw and Khole said patients getting sicker — whether it’s from influenza, RSV or other respiratory infections — and a higher volume of patients results in greater demand for health care and puts a strain on hospitals.

“This predicts trying times for sure,” said Khole.

That was the case last winter, when hospitals across the country grappled with an unprecedented influx of COVID-19 patients.

The pandemic refined the logistics and operations for responding to infectious disease outbreaks, Khloe said, but area hospitals already dealing with staffing shortages and pandemic-related worker fatigue could struggle this flu season.

“Even if you’re prepared on paper, putting that into practice, there is a different set of challenges,” he said.

Vaccines, hand washing help

Health care providers who spoke to The Sentinel urged people to get a flu vaccine as soon as possible. Everyone over the age of six months is eligible for the shot, according to the CDC.

“Getting vaccinated is the number one thing you can do,” Adams Barker said.

Flu vaccines are most effective soon after they are administered, and their effectiveness drops with time. In the past, people in New England may have waited until November or December to get their vaccine in order to be protected during the peak of flu season, McGraw said. But, with an earlier onset, getting the shot now is ideal.

“The sooner you get it the sooner your protection will begin,” said Liza Drew, manager of occupational health at Monadnock Community Hospital. “Now as we enter the holiday season, it’s a perfect time to get vaccinated.”

The flu vaccine won’t entirely protect you from contracting the flu: The vaccine is 40-60 percent effective at preventing flu during years when the vaccine is well-matched to circulating flu strains. However, the vaccine can reduce your risk of being admitted to the intensive care unit by up to 82 percent, according to the CDC.

This year, many early cases of flu are a strain known as H3N2, said N.H. State Epidemiologist Benjamin Chan. That strain is one of four that the flu vaccine for this season protects against.

“Therefore, it’s important for everybody six months of age or older to get the updated seasonal influenza vaccine,” Chan said.

When illness does strike, it can be difficult to tell the difference between influenza and other respiratory infections including COVID and RSV, McGraw said.

Khole recommends that anyone with symptoms of a respiratory infection — like coughing, fever or sore throat — test themselves for COVID-19. Once you’ve ruled that out, contact your healthcare provider if you still have flu-like symptoms. While not everyone needs a test for the flu, some people do, including those who are immunocompromised, pregnant, or otherwise at high risk for complications from the flu, according to Khole.

Throughout the colder months, precautions that people have become accustomed to during the pandemic can help keep illness at bay. Regular hand washing and staying away from others who are sick can help prevent flu, according to the CDC. Masking also can help slow the spread of influenza, Khole said.

“There’s no debate that masking works,” he said. “When levels are going up and you’re concerned about what you’re giving to others or what others are giving you, that’s when it boils down to the right precautions. The time is now.”

In addition, it’s critical that people who are sick stay home, even if they’ve tested negative for COVID-19, McGraw said.

“Keep your friends and family healthy by not going out if you’re not feeling well,” she said. “Take personal responsibility for keeping your germs to yourself.”

Sentinel staff writer Olivia Belanger contributed to this report.

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