No visiting

In the wake of a flu outbreak, the Crook County Memorial Hospital will be keeping the doors to the nursing home closed for the time being for the protection of patients and residents. Not everyone realizes the prolific effects that flu can have if it infiltrates a nursing home, says Dr. Heath Waddell.

“It looks like this flu season has been fairly bad for people and there have been lots and lots of hospitalizations, but the people most at risk and are dying are those over the age of 65,” he says.

“Not everybody over 65 is unhealthy, but I think they are more apt to be. The older you get, the more you have other conditions such as COPD or heart problems, and your body just doesn’t have the immune response you did when you were younger to help fight off something like the flu.”

The potential impact to the elderly population in the long term care facility (LTC) is simply too severe to ignore, explains Charity Lindholm, Infection Control RN.

“If we have a resident who gets the flu, they have an increased risk of heart attack, stroke and other cardiovascular issues for several weeks after that,” she says.

“A lot of these people, if they catch the flu, they just don’t bounce back. Our dementia residents catch it and that decline is their new normal, so that’s why we’re so quick to shut things down.”

Visitation is closed even to people who feel healthy, because this doesn’t necessarily mean you are not carrying the virus. A person can spread the virus from up to a day and half before symptoms appear to five days after they subside; young children can be contagious up to a week after they feel better.

“You may come in and say you are healthy and don’t feel bad, why should you not be able to visit? It’s because you may actually have it but you don’t know it,” Waddell explains.

“There’s a pretty big timeframe for that and this time of year we just want people, if you’re sick or around sickness, to be careful where you are at.”

Even if you got your flu shot this season, says Waddell, “It’s still a no-go”.

“Unfortunately, we don’t have a glass ball, so we can’t predict what the flu season is going to be like or even what the virus does. Viruses morph, so we make a flu shot that we think is going to work and it doesn’t always work the best,” he says.

Creating the annual immunization is “a little bit of a guessing game”, he continues.

“They look at the core virus and it has essentially a capsule around it. They try to determine what’s going to destroy that capsule,” he explains.

“What we do know with very good accuracy is that is does decrease mortality. People may still get it, but it may not be as bad.”

Timeframe

Waddell does not anticipate the shutdown will last much longer, but says it won’t be lifted until staff are confident flu cases are on the decline.

“Every week, the CDC as well as the Wyoming Department of Health puts out how many cases are in each county,” he says. “Unfortunately, the cases are still on the rise. We want to see that peak and come down.”

Such a late peak is unusual, he adds, though the season does vary every year. Flu season generally begins in October, peaks in January or February and then declines by April or May.

“In this part of the country, we usually see it start in December and taper off in April or May. Some of that is how far it travels, some is how well the flu vaccine works – it can be really variable, so we don’t have a timetable,” he says.

“We just want to make sure it’s on the downhill slide when we decide to lift restrictions. That way, we keep our patients and our residents, as well as our community, safe.”

Lindholm suspects the late flu season may be partly due to the weather.

“We had those negative temperatures for all of February so everyone was inside. It seems like, when we can start getting the kids outside and the windows open, we’re not breathing in all that circulated air and it kind of helps the diseases from spreading,” she suggests.

Containment

Staff are pleased to report that, while the LTC did experience an outbreak this year, they were able to prevent it from becoming facility-wide.

“One great thing about our staff is that, to my knowledge, we haven’t had a single staff member with influenza this year. That tells us our staff has taken the appropriate precautions, are washing their hands appropriately and haven’t brought the flu in,” says Waddell.

Staff members also change their masks every 15 minutes, as research shows this is when a mask ceases to offer protection, and use sanitizer after every contact. Residents are encouraged, though not obligated, to stay in their rooms.

“Basically, the rule of thumb is that, if there is an outbreak, if there isn’t any [flu] within five days we can start letting people come back out,” says Jean Snow, Nursing Home Nursing Supervisor.

There is no hard and fast rule as to whether residents stay in their rooms, she adds – many are perfectly capable of making the decision for themselves and are invited to do so.

“Those people that are cognitive can make their own decisions and we give them a choice. There is flu present, by all means you are more than welcome, but you’re going to be more at risk,” she says.

“Some came out, some didn’t.”

Flu Shots

The time has passed to get a flu shot this season, but Lindholm strongly encourages every member of the community to visit the hospital or public health for their flu shot this fall, starting October 1.

“All our employees are healthy people, we could recover easily from the flu. We don’t vaccinate for us – we vaccinate because we might recover fine, but what about our babies and our residents?” she says.

Flu spreads easily, says Waddell, carried by droplets in the nose and mouth through sneezing, coughing – sometimes even just through talking.

“I’ve had several people come in this year with flu and say, ‘I wasn’t immunized and I wish I would have been because this is absolutely miserable’,” he says.

“But we certainly leave that to people, whether they want to be immunized or not.”

Snow encourages people to get their shots as soon as possible once they become available.

“If people wait until the flu outbreaks and then think they’ve got to get their shot, they don’t realize that if you get your shot today, it doesn’t mean you are covered. It takes a little bit for that to build up in your system. It’s better to get it earlier before the outbreaks start happening,” she says.

Lindholm points out that getting a flu shot is as much about your community as it is yourself, as you cannot spread the virus to more vulnerable members. The CDC reports 20 deaths among children from flu this season, says Waddell, and even one would be too many.

For those worried about the potential side effects, Waddell suggests they are less of a gamble than catching the flu.

“What people don’t realize is that, when you get the flu shot, you prevent that influenza transmission. If you get it, you’re going to have sweats, cough, fevers, chills, you’re going to feel absolutely fatigued and that’s a risk you have to take if you decide not to get it,” he says.

“I think if you look at people who have side effects from it, it’s relatively small in the grand scheme of things and most side effects will be gone within a day, [whereas] I have people who have had the flu or flu-like symptoms now for ten days.”

If you are unsure about the flu shot, Waddell encourages you to speak to a health provider.

“My job as a health professional is not to twist your arms and force you to do things, it’s actually to give you the recommendations and data and let you choose for yourself,” he says, adding, “I realize there are people who don’t want to get flu shots, get their kids immunized and things like that. That’s fine, we are still here to take care of you if something happens.”

Treating Flu

As with most viruses, the only real cure for the flu is rest and plenty of fluids, says Dr. Waddell. He would like the community to be aware that healthcare providers in Crook County do not always prescribe anti-virals to patients suffering from flu.

“The CDC recommends that Tamiflu® be given to children who are at high risk – you can consider under five, but certainly under two as the most important – or the over-65s or people who have asthma, COPD, heart conditions, diabetes or whose immune systems are really broke down,” he says.

For anyone who is not immune-suppressed, Dr. Waddell recommends heading home, taking Tylenol ® and ibuprofen and waiting for your body to mount a response to the virus.

“Unfortunately, it’s just time – time will get you through this,” he says. “I don’t want to put people off and tell them not to come in – if they think they need to be seen, we are always happy to see them. But we won’t always give you Tamiflu, we have to look at the bigger picture.”

Unless that bigger picture suggests you are at higher risk, he says, you likely do not need Tamiflu. It’s also unlikely to help you as much as you might think, he adds.

“If you look at the data, what you will find is that Tamiflu in adults, particularly ones who have a robust system, only reduces symptoms by about 12 hours,” he says.