U.S. Doctors Handle The Swine Flu Outbreak The number of confirmed swine flu cases in the U.S. has topped 100. People with flu-like symptoms are heading to doctors' offices and hospitals. If you work in an ER, clinic or doctors' office, we want to hear from you. What are you seeing?
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U.S. Doctors Handle The Swine Flu Outbreak

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U.S. Doctors Handle The Swine Flu Outbreak

U.S. Doctors Handle The Swine Flu Outbreak

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The number of concerned - confirmed swine flu cases in the U.S. has topped a hundred, and a few schools in New York, Texas and California are temporarily closed. People with flu-like symptoms are rushing to the doctor's office or the emergency room, or at least so we're told.

Well, if you work in an ER, a clinic, in a doctor's office, call and tell us what you see. Our phone number: 800-989-8255; email us, talk@npr.org. And you could join the conversation on our Web site. That's at npr.org, click on TALK OF THE NATION.

Joining us now from Texas Children's Hospital in Houston is Dr. Jeffrey Starke. He's director of infection control, chairman of the infection control committee at the hospital.

And Dr. Starke, it's nice to have you with us today.

Dr. JEFFREY STARKE (Texas Children's Hospital): Thank you. It's a pleasure to be here.

CONAN: And what's it like in your ER?

(Soundbite of laughter)

Dr. STARKE: Busy. Very, very, very busy.

CONAN: Are people scared?

Dr. STARKE: People are scared. And you know, we happen to have the child who was the first recorded death in the United States. But we also now have children in the community who have had confirmed swine flu as well. So it's here, and so we're learning how to deal with it really kind of on the fly.

CONAN: But I presume that most of the people coming into your emergency room who think they might have it don't.

Dr. STARKE: That's exactly right. We have a wonderful virology lab here, so we know what we're seeing. And we're seeing many, many, many other viruses in the community now. And so we are seeing a lot of different things, and differentiating the probably swine flue cases from the other normal kids' illnesses we see is in fact very difficult.

CONAN: And what happens when you find out one of your patients has swine flu?

Dr. STARKE: Well, you know, it's interesting, because one of the basic principles of swine flu mitigation in the community is social distancing. But schools can close but hospitals can't. And so we have to figure out how to deal with this without being able to do many of the measures that other things can.

And one of the most important things we can do is protect our environment, protect the patients, and protect our staff and physicians, to do everything possible to make sure we're not transmitting the infection inside of the hospital.

In fact, we have fully invoked our pandemic influenza plan, have a command center, and the place is a beehive to protect the environment.

CONAN: As you said, you're seeing an awful lot of other kinds of viruses, and I assume other illnesses too. The people who come in - we forget, 30,000-plus people die every year of regular, ordinary, run-of-the-mill flu.

Dr. STARKE: Absolutely. And as an infectious disease person, you know, for years we've said we've had a difficult time controlling something that we know is going to happen every year and is fairly predictable.

This is something that's completely unpredictable, with no vaccine, and so it's just - we're trying to predict the future to know where it's going to go next. I tell the residents and medical students I work with, you are watching medical history being made.

CONAN: Do you have sufficient supplies of Tamiflu and the other kinds of drugs that can mitigate the effects of this?

Dr. STARKE: We do. And Texas Children's Hospital fortunately had a superb plan and is a wonderful organization at putting together plans for disasters. We have experience, unfortunately, with hurricanes and other things.

I think the biggest bottleneck, to be honest, is going to be, if we have many, many cases, is figuring out how to distribute the national stockpile through state and local health departments. And it just takes some time to get those systems together. But they will come together.

CONAN: Are you telling people not to panic?

Dr. STARKE: Oh, absolutely not panic. The number of cases is very, very low. We know what we're looking for. We know what to do. And we give doctors' offices and others guidance as to what to do. And again, the vast majority - vast, vast, vast majority - of ill children in Houston, Texas do not have swine flu.

CONAN: Dr. Starke, thanks very much. We appreciate your time.

Dr. STARKE: My pleasure. Thank you.

CONAN: Dr. Jeffrey Starke joined us from Texas Children's Hospital in Houston, where he's director of infection control and chairman of the infection control committee.

With us now from Huntsville Hospital in Alabama is Dr. Thomas Calvert, co-director of the hospital's emergency department.

And Dr. Calvert, nice to have you on the program today.

Dr. THOMAS CALVERT (Huntsville Hospital): Oh, thanks for having us.

CONAN: And you're a little further away from the border. How are things going today in Huntsville Hospital?

Dr. CALVERT: Oh, Huntsville - today the day is nice. It's 82 degrees, warm, slight breeze. And we are starting to become the recipient of, you know, concern by the community about influenza, and we're having our share of positive influenza strain tests coming about.

CONAN: So you're seeing some positive results?

Dr. CALVERT: Oh, yes, sir. We certainly are. We've picked up about 10 last night, and we expect to see a lot more.

CONAN: And I assume, like Dr. Starke, who we just talked to in Houston, you're seeing an awful lot of more ordinary viruses too.

Dr. CALVERT: Oh, we are. There's a concern about the community as to whether they do or they do not have this kind of virus. And so we're getting folks coming in quite a lot with a variety of different complaints.

CONAN: And a lot of people, I assume, bringing in their children?

Dr. CALVERT: Oh, they are. You can tell an adult not to come in, but when you try to tell a parent not to bring their child, that's a different story.

CONAN: And do they come in - do you do triage? Do you have somebody out there talking to them before they bring them back?

Dr. CALVERT: Yeah. Actually, we have two hospitals on our campus here. One is a dedicated (unintelligible) hospital. The other one is in a dedicated adult hospital. The (unintelligible) sees about 35,000 pediatric patients a year, and the adult sees about 85,000 patients a year.

So we have a total of over 100 beds dedicated for emergency department services.

CONAN: That's pretty large.

Dr. CALVERT: Oh, it is. Actually, the best (unintelligible) we're the largest in the state.

CONAN: By the way, we want to hear from you if you're on the frontlines of the swine flu scare as well, if you work in an ER, if you work in a doctor's office, if you work in a clinic. 800-989-8255, email us: talk@npr.org.

Call and tell us what you're seeing. We know you're busy, but we want to hear from you.

And Dr. Calvert, as you look at these people coming in, what can you tell them?

Dr. CALVERT: The majority of the folks that come in are coming in with fairly mild to moderate symptoms, mostly aches and pains and low-grade fever, and a runny nose. And our biggest concern is to make sure that they understand that the illness that they have, by all accounts, is something that can be easily treated and safely handled at home.

CONAN: Safely handled at home. And if somebody's fever goes up over 102, 103, that's a little hard to persuade them?

Dr. CALVERT: Oh, it is, and we understand that. And that's why we have our open door policy here. And we will certainly take care of those at any time, day or night.

CONAN: Are people asking for masks?

Dr. CALVERT: Well, they're being given masks. The moment they come in to the door of the emergency department, they're being given a mask. And the community is then extremely cooperative. And there's been absolutely no complains about it.

CONAN: That same concern that we'd heard from Dr. Starke, about somehow the fear that you could find this infection in the hospital and start spreading it inside the building.

Dr. CALVERT: Oh, yes, sir. And he had a great definition, great description of that. And we are very much in the same mode of thinking as they are.

CONAN: And as you're looking ahead, the cases are beginning to come in. Are you expecting that it's going to be a very tough weekend?

Dr. CALVERT: Oh, I expect the cases to significantly increase over the next several weeks. We start off with one or two, then we went to 15. And I just don't see it slowing down for several weeks or maybe even a month or two.

So those figures that we're seeing of confirmed cases from the CDC, of course, they are, by nature, very cautious. You think that's - they're lagging behind the actual results?

Dr. CALVERT: I think they'll - part of the issue with the CDC is that they're wanting to report confirmed cases. The diagnosis of the non - the diagnosis of swine flu for places such as ours requires that once somebody has a positive test for influenza A, the a second sample is sent to a state lab.

We do not - although we're a big hospital and we're a good hospital, we do not have the PCR capabilities that the state lab has, so our cases have to be sent to the state lab, and then the state have to evaluate the tests and then get back with us. So there's a lag there. But we're seeing a significant, sudden increase in the influenza A cases. And we're making the assumption that it's probably going to be in the direction of the nontypeable or the swine flu illness.

CONAN: Dr. Calvert, good luck.

Dr. CALVERT: Oh, thanks a lot. We appreciate it. And we're lucky that this community - the Health Department is the single voice, so we have one person speaking for us, so that the - we're very fortunate in that way.

CONAN: Dr. Thomas Calvert joined us from Huntsville Hospital in Alabama, where his co-director of the hospital's emergency department.

And let's get some callers in on the line. Robert(ph) joins us now. Robert calling from Charleston in South Carolina.

ROBERT (Caller): Hi. Good afternoon.

CONAN: Good afternoon.

ROBERT: I'm a emergency physician in Charleston, South Carolina at a relatively small community hospital, Summerville Medical Center. I'm actually in the car, on my way to a shift now. I'm going to be coming in about an hour early. It's like - I had a shift yesterday, which was one of the busiest that I've experienced in a long, long time, mostly because people coming in concerned, mostly, about their children having a fever, cough, and worried, obviously, about the swine flu.

And the - we haven't seen any cases here in Charleston. As a matter of fact, I haven't seen an actual influenza case for a number of weeks, although we are testing for it.

But it's a concern because we're seeing an incredible overload of amount of patients that we can handle without seeing actual disease in the swine flu or even influenza.


ROBERT: And it concerns me about emergency in general, because of the volume that we see on a daily basis, and the concern that we wanted to have if we do actually see swine flu in any proportions in it for several weeks.

CONAN: It's going to be very difficult, isn't it?

ROBERT: Yes it is. And, you know, the concern obviously is for staff. If they get ill, what's, you know, what's the pack-up? You know, it very well could become a tremendous crisis, although, you know, so far, fortunately we haven't seen much disease. And I hope we don't.

CONAN: Are there any set, you know - can you say, look, if you don't have a fever over 104, you don't have swine flu?

ROBERT: There is. You know, a lot of people are very reassured just by having, you know, nurses and physicians look at them, talk to them, take some vital signs and say, you know, that you're doing fine. He'll follow up with your primary care in a day or two, or return if you're doing worse.

But people waiting four, five, six hours just to even get back to the emergency room, sitting in stretchers in the hallway which, you know, alone is concerning because the waiting room is full. So now, people that are potentially sick are sitting around with other people who aren't potentially sick.

And, you know, coming to an environment which is overcrowded at the best of times. So, you know, we're making do - people working extremely hard, but it's, you know, a system which is taxed to its maximum at the best of times and now, you know, without even seeing influenza or swine flu so far, we're being pushed even further.

CONAN: Robert, we wish you the best of luck on your shift.

ROBERT: Thank you, sir.

CONAN: Bye-bye. Here's an email we have - well, anonymously, I guess, asking me to point out that the World Health Organization would like us to stop using the name swine flu to prevent the panic slaughter of pigs. H1N1 is preferred. It has been designated H1N1. There is no reason to slaughter pigs. We call it swine flu because that's what people call it. That's how they know the name.

You're listening to TALK OF THE NATION from NPR News.

Bruce(ph) is with us. Bruce, calling from Livermore in California.

BRUCE (Caller): Hi there.

CONAN: Hi, Bruce. Go ahead, please.

BRUCE: Okay. I'm a pediatrician. I have (unintelligible) in North Livermore and Pleasanton, California, which is about 40 miles east of San Francisco. And our office was inundated on Monday morning with telephone calls. We couldn't handle them all - very worried people.

Our office has continued to have that problem. We've been working overtime and calling even up to 9:00 at night, trying to help calm the people's nerves. Large portion of the difficulty is the way the media have handled this, and it's really been frightening that the people come in with the newspapers saying we have to do something. We want the Relenza. We want the Tamiflu.

And so it takes time to explain to them that the treatments of these two medications only makes the illness milder if you have it. Just like with any flu, it does not cure swine flu.

And the other problem is testing at a facility. They think they can walk into our office to - and say they wanted to be tested for swine flu, and that's really difficult to do in a private office because you have to have it handled in certain media, and it has to be kept cool, or it has to be sent into the county.

Another problem we've been seeing, too, is, again, sort of the media where the WHO Director-General Margaret Chan…

CONAN: Mm-hmm.

BRUCE: …(unintelligible) headline in our newspaper - it really is all of humanity that is under threat during a pandemic. Well, putting it up to a level five and it sounds for people like this is really, really bad. And none of the newspapers have really said what a level five means, which is basically the number of countries that's been in. It doesn't mean, like DEFCON 5 we're going to come at this point and protect the whole country, et cetera, sort of a miscommunication.

CONAN: Well, it sounds like it's going to be a busy time for you in the next few weeks no matter what happens.

BRUCE: Oh, it absolutely, definitely will be. And also for the local emergency facilities and the labs - all the labs that are out there can't do this test either. It has to be sent into quite a few labs, you'll find out three days later whether it's swine flu or not. And by that time, even if you were going to get the…

CONAN: Tamiflu or whatever, it's probably too late, yeah.

Bruce, thanks very much and good luck to you.

Well, Bruce, we - sorry to cut him off. But tomorrow, join Ira Flatow on SCIENCE FRIDAY for an exploration of the most perfectly preserved baby mammoth ever found. Plus, a look at CSI for animals, and how to investigate crimes against other species.

Today, we say farewell to one of those colleagues whose voice you don't know. You hear his name from time to time: Richard L. Harris. Why the L, you wonder? And the title, director of afternoon programming, which you probably figure means an empty suit.

Well, when he first came to NPR from Iowa in the mid-'70s, he was just Rich Harris, a production assistant on ALL THINGS CONSIDERED. If we had known he was really from Boston and a Red Sox fan, well, what the statute of limitations on hiring discrimination?

This was a much smaller company in those days, and we missed Rich dearly when he left to make a career in television - first at NBC News, then for many years with Ted Koppel on "Nightline" at ABC.

He returned to radio a few years ago to a considerably bigger NPR, so big that we had a well-known science correspondent who'd already taken that Richard Harris moniker, which meant that our new boss had to use the middle initial on email and on those weekly production credit announcements to avoid confusion.

And, yes, the quick translation of director of afternoon programming is boss of TELL ME MORE, TALK OF THE NATION and ALL THINGS CONSIDERED. All three of those programs recently recorded the largest audiences in their history - and that's no coincidence.

Rich leaves all three better than he found them. He leaves us, again, tomorrow. We wish him, if not his Red Sox, well. And again, we will miss him dearly.

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