Claudia Meininger Gold

A healthy respect for the flu

By Claudia Meininger Gold
July 27, 2009

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IF SWINE FLU comes back with a vengeance when children return to school in the fall, schools and doctors are going to have to treat flu with more respect than I saw at my daughter’s sleep-away camp in upstate New York.

“I’m not afraid of swine flu,’’ the camp’s doctor of the week, the father of another camper, said to me when we dropped our daughter off. My conversation with him indicated he was unaware of the Centers for Disease Control guidelines for summer camps.

The camp director said, “It’s no big deal. Just three days in the infirmary,’’ when I asked him how the camp would handle a flu case.

I was due to be the camp doc the third week of camp. Their cavalier attitude made me uneasy. The CDC recommends that any child with influenza-like illness should be isolated from well campers until seven days after onset of symptoms. I thought of saying something, but I had no idea what the summer would bring.

From practicing pediatrics for over 20 years, I can spot the flu a mile away. Kids are miserable, with a deep chest cough that sounds like it hurts.

When I arrived for my stint as camp doctor at the beginning of the third week, I was horrified. Reading the newspaper doesn’t compare with seeing it with your own eyes. In bed after bed in the infirmary lay children huddled under quilts, coughing. This was highly unusual. Kids don’t commonly get flu-like illnesses during the summer.

I spoke with the nurses about my concerns that these kids were not being effectively isolated. One slept in a supply room and they all used a common bathroom. Both areas are heavily trafficked by well staff and campers.

When I said they should not come out into the common area to talk on the phone, one nurse was outraged. “But the parents demand to speak to their child!’’ I suggested they get an extension cord.

But the stage was set. From top down, a “head in the sand’’ approach prevailed. I was accused of not considering the children’s mental health. The nurses supported their laid-back stance by telling me that the kids were better in just a few days. I agreed that even if this were swine flu, it tends to be a relatively mild illness. Testing is not routinely recommended, but isolation is, because of the high likelihood that some kids with influenza-like illness will have swine flu. I explained that this was a public health issue, and we needed to identify kids with chronic illness such as asthma or diabetes who are at risk for more serious disease, and are candidates for antiviral medication.

The head of the camp took me aside and asked me to “go easy on the nurses.’’ I was concerned about the influx of visitors and new campers at the end of the third week. I notified the local health department, and told the camp director that if the camp did not make a drastic attempt to bring this illness under control before opening up to the outside world, I could not in good conscience be the camp doctor. He thanked me for my suggestions, but said he would arrange for a different doctor.

That night my daughter developed a fever and cough, and we went home in the morning. The health department came in that day and implemented all my recommendations.

Earlier in the summer, I read the book “Year of Wonders’’ by Geraldine Brooks. This historical novel depicts both the best and the worst of human behavior in response to a deadly plague in 17th-century England. The village reverend, struggling to find meaning in this devastation, suggests that the sick have been asked by God to perform a staggering act of good. He proposes that they voluntarily isolate themselves from the surrounding communities to prevent the spread of illness. This sacrifice gives purpose to their suffering. Perhaps this book offers some lessons for our current situation.

The World Health Organization has declared swine flu “unstoppable.’’ Plans are being made to vaccinate large numbers of people. Still, if we each do our small part, suffer the inconvenience of missing whatever we were supposed to be doing, perhaps we will prevent one person from getting sick. If that one person has an underlying illness and is particularly vulnerable, we may, in fact, save a life.

Claudia Meininger Gold, MD, a pediatrician, practices in Great Barrington.

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