Into the Belly of the Beast: My Family's Experience with Swine Flu

Late on a Tuesday afternoon in June, I received an e-mail saying a granddaughter had tested positive for swine flu and that her mother, my pregnant daughter, was also ill. Hearing the words ’swine flu’ in the same breath with the name of two family members caused a pang of anxiety and concern – perhaps even a bit of fear.

We were lucky. My daughter and granddaughter were not hospitalized. Although my daughter’s case was more severe than her daughter’s, neither was ever life-threatening. My wife and I, who rushed to help care for them, did not catch it.

This is the story of my journey into the “belly of the beast” in the hours and days following that e-mail. As the media frenzy again suggests an impending crisis, perhaps some of what I learned may benefit you and your family. This begins a series of four articles. Other articles in this series include:

• Getting Ready for Swine Flu
• What to Do If You Get Swine Flu
• What to Do If Your Family Gets Swine Flu

Why You Should Read This Article

The World Health Organization reported in late August that clinicians from around the world are reporting a very severe form of swine flu in young and otherwise healthy people.

• In these patients, the virus directly infects the lung, causing severe respiratory failure.
• Saving these lives depends on highly specialized and demanding care in intensive care units, usually with long and costly stays.
• In recent months several countries in the Southern Hemisphere (which is just coming out of winter) have viewed the need for intensive care as the greatest burden on health services.
• Some cities in these countries report that nearly 15 percent of hospitalized cases have required intensive care.

On August 24, 2009, the President’s Council of Advisors on Science and Technology released a report laying out a “plausible scenario” for swine flu. The numbers are probably overblown – but if you or a family member are among those who get it, it won’t matter how accurate the predictions are. Even a “mild” case of swine flu is not something you want to have a repeat experience of.

Here’s what the feds say could happen in the next couple months.

• Swine flu could infect half of all Americans. In a normal flu season, 5 to 20% get sick. In a pandemic, 50 to 70% get sick.
• Almost 2 million could end up in hospitals.
• 300,000 could end up in intensive care (filling all available ICU beds in some areas).
• Deaths could be double the number caused by normal flu. Most will be children and young adults – not the over-65 group that flu normally hits hardest. While in a normal flu season, 90% of the deaths are those over 65, so far 83% of swine flu deaths have been under 65. The infection risk for those under 25 is 4 to 5 times greater than those between 25 and 49 and 20 times greater than those over 65.
• It will pose special risks for pregnant women. Pregnant women so far account for 8% of deaths and 6% of swine flu victims admitted to a hospital even though they are only 1% of the population.
• It also poses increased risks for people with certain health problems – neurological and respiratory problems, diabetes and the severely obese.
• This pandemic could peak around October 15 – just as the swine flu vaccine is supposed to start showing up.

This last point poses an interesting question. Every vaccination has certain risks. If the pandemic peaks before you’re able to get the vaccine, do you still get the vaccine – and take the risks associated with it?

A Wall Street Journal article earlier this summer suggested that up to 30% of American workers will stay home during a widespread flu outbreak. Some would be sick themselves. Others would stay home to take care of sick family members. Still others will stay away from work out of fear of getting sick.

With swine flu, you can be contagious a day before you start showing symptoms – which may cause more panic than the flu itself. When the media starts reporting that millions are sick and people see many empty desks around them, will they want to get away from a ‘risky’ environment?

Based on my experience earlier this summer, swine flu is nasty. But fear of it may be worse than the illness itself.

The WSJ article goes on to say that according to a 2007 study only 13% of US companies are prepared for the disruption that a flu outbreak would cause. Is your company prepared? Leave a comment to share what plan your company has.

Sunday, June 14

Back to my story. While my involvement in this story begins with the Tuesday e-mail, we must go back a couple days earlier to catch the start of the story itself.

My daughter, Amanda and her husband, Josh, have three children and are expecting their fourth later this fall. They were living in married student housing at the University of Michigan in Ann Arbor.

That Sunday morning Anna, at five years the oldest of the three children, was a little irritable and lethargic. Amanda, like most parents, knew not to get too concerned. Kids get sick. Kids get better. And they do both much more quickly than grown-ups.

Anna wasn’t feeling bad enough to keep her home from church. But during church she began to feel worse. She seemed a little warmer than normal – and quieter. In fact, she fell asleep during church. Quieter for Anna was unusual; falling asleep in church was unheard of.

Amanda chalked it off to some bug or another – just like you probably would do. And, like most people – at least before recent months and before reading this article – she didn’t give the first thought to swine flu. Swine flu is something you hear about on TV and read about in the newspaper. But it’s not something you or your family would actually get.

By Sunday evening Anna definitely was feeling worse. She was not just warm. She was feverish – though she responded well to over-the-counter pain medicine. She started to complain of a sore throat and was coughing. She was obviously tired.

Amanda did what any of us would do. She made sure Anna got lots of liquids, medicine for the pain, some cuddle time and lots of sleep. “Take two aspirin (or ibuprofen for kids) and call me in the morning…”

Monday, June 15

When Amanda woke up Monday she was feeling similar symptoms and began to suspect something more than a cold or the ‘common’ flu. And now she remembered a note earlier from Anna’s pre-school saying a student had tested positive for swine flu. The preschool had a lot of kids in it and there were many different classes so it was unlikely that Anna had had contact with the one with swine flu. Nevertheless, Amanda was pretty sure Anna did have swine flu because the symptoms were flu symptoms but the ‘normal’ flu season did not include June – at least not in the northern hemisphere.

Amanda decided to do what anyone in their 20s would do – she turned to the Internet. What were the symptoms of swine flu? If it was swine flu, what was the treatment? What were the risks the other children would catch it? And did she have any special risks herself because she was pregnant?

The most common symptoms of swine flu are similar to ‘regular’ flu: fever, fatigue, lack of appetite and coughing. However, as noted in a May New York Times article, many people with swine flu, even those who are seriously ill, do not have a fever. Amanda, for example, never had a fever. Anna did. Some people also develop a runny nose, sore throat, vomiting or diarrhea. There are often body aches, headache and chills.

Swine flu develops very quickly – often in just a matter of hours. The symptoms usually start within 1-4 days after exposure – though it can take as long as 7 days.

My daughter decided to take Anna to the doctor, who thought it might be strep and suggested they do that test. Amanda didn’t think the symptoms were anything like strep but the test results would be available “quickly” so it was worth ruling out strep.

“Quickly” turned out to not be fast enough – especially with a sick kid, a Mom getting sicker by the hour and two rambunctious toddlers in tow. When the strep test came back negative, Amanda asked if Anna could be tested for swine flu. The doctor was hesitant – perhaps not wanting to scare a concerned mother – and told Amanda that the test results would not be available until late the next day. It was clear she thought this was a long shot but was willing to do it “if you really want me to.” Amanda did want the test done.

The culture for the swine flu test is done by swabbing the inside of the nose. Most five-year olds don’t like it; Anna did not.

The culture taken, the doctor asked if Amanda would like a Tamiflu prescription as insurance in case it was swine flu. Tamiflu is an anti-viral drug commonly used to shorten how long someone with flu is sick.

The doctor apparently saw resolution in Amanda and understood that she would start it immediately and not wait for the results tomorrow. The doctor wrote the prescription. But Amanda did not fill it on the way home. Not only was she increasingly tired but Anna and the two healthy kids had been out much longer than expected. The thought of stopping at the pharmacy, getting everyone out of the car, waiting in line to give the pharmacist the script, waiting for them to fill it, loading everyone back into the car and driving home was just too much at the time. They went directly home.

By late that afternoon, Amanda was convinced that not only Anna had swine flu, but that she had it also. She was so beat she asked a friend to go pick up Anna’s prescription – she didn’t have the energy to do it herself. She remembered an NPR report she had heard where a woman with swine flu said she felt like she had been hit by a truck. That was just what she was feeling.

And there was little promise of relief. She had many friends. But you can imagine how the conversation might have gone had she asked for help.

“Mary, this is Amanda. I think Anna has swine flu and I probably have it myself. I’m having a hard time taking care of the two who don’t seem to be sick (yet). You know, you can be contagious for 24 hours before you start showing symptoms so my two healthy kids might have swine flu but we just don’t know it yet. Do you think you could take care of them for a few hours to let me get some rest – and so you can potentially expose yourself and your kids to swine flu?”

No, she wasn’t going to ask friends to do that unless things got dramatically worse.

Those who are already sick with the flu take Tamiflu twice a day for five days. After her friend dropped off Anna’s prescription, Amanda saw that it had more medicine than needed for the five days treatment.

Because of her increased risk of complications because of her pregnancy, she decided she had better start taking Tamiflu herself – Tamiflu is most effective if started within 48 hours after the first symptoms show up. She was confident she would be able to get her own prescription – she just wasn’t sure how long it would take.

As this point it’s probably helpful for you to know that Amanda graduated in chemical engineering – she is one smart cookie. She went back to the Internet to find the adult dosage of Tamiflu and to figure out how much of the liquid Tamiflu (used for children) was equal an adult dose (usually in pill form). Despite the fog of being ill herself, she calculated that Anna’s prescription had enough medicine to take care of Anna as well as the equivalent of two adult doses. In other words, she could start taking Tamiflu and would have 24 hours to get her own prescription to finish her own five day treatment.

That evening Amanda spoke with my son-in-law who was serving an internship with a government agency in Washington, D.C. She hardly had the energy to talk about the day.

Tuesday, June 16

Feeling more and more like she was in the middle of a train wreck, Amanda called her obstetrician and described the symptoms that both she and her daughter had. She explained that Anna was on Tamiflu and asked if she could get a prescription as well. The doctor’s office said it was probably some other viral infection; after all, she didn’t have a fever. They clearly hadn’t read that New York Times article. They told her to call back if she got worse, developed a fever, yada yada.

She spent the entire morning sprawled on the couch. She was so achy she didn’t even want to move – and didn’t have the energy to do anything even if she could. The two healthy kids watched movies. She took some Tylenol; she knew that two active preschoolers weren’t going to make it all day watching movies.

That afternoon, Anna’s doctor called with the test results. Positive for swine flu. They said they would call in Tamiflu prescriptions for the other two children but suggested not starting it until they showed symptoms. But from her research, Amanda knew that Tamiflu is not only used once you already have swine flu, it can also be used to help prevent it among those who have close contact with confirmed cases. [Update 9/8/2009. The CDC revised its recommendations on using Tamiflu as a preventative measure. It now suggests anti-viral medicines only be used, for those not already sick, by those in high risk groups.]

Having been turned down by her obstetrician, Amanda called her family practice doctor and explained the situation. No questions asked. Pregnant and a confirmed swine flu case made it no contest. They offered to call in a prescription. No, they did not need her to come in. In fact, they did not want her to come in. No surprise there – who wants to expose staff and other patients to this little bug?

And now it was time for Amanda to update my son-in-law. Josh knew Anna had been sick on Sunday and that my daughter was not feeling well at all. He didn’t yet know about Anna’s positive test for swine flue. She emailed him a summary of the days’ events. He forwarded them to me and to his parents.

That afternoon I had been packing. I was leaving early Wednesday morning to help chaperone a church youth conference trip to upper state New York. I took a break to check e-mail. That’s when I saw the e-mail.

I picked up the phone and called Amanda. All those stories on the nightly news, in the newspapers and on the Internet were swirling through my mind. I knew that swine flu is usually a mild flu. But I also knew that it could be particularly nasty for pregnant women. She assured me that she was feeling a better – though she was still tired. Anna was doing lots better. Almost in passing, Amanda said she was having a little trouble breathing. She wasn’t too worried about it. It wasn’t, she said, serious enough to warrant a visit to an ER. The alarm bells started going off. Did she hear what she was saying? In my book, any trouble breathing is serious.

When I learned earlier this year that Josh would be serving that internship in Washington, D.C., I had offered to go help her if being a pregnant ’single’ Mom of three preschoolers became too much to handle. [Earlier this year Genworth Financial laid off some 1,000 employees. I was part of that 'reduction in force' and, while looking for another opportunity, had plenty of free time. I've since been rehired by Genworth in another department and will be going back to work on September 14^th.]

Now, with this new development, I repeated that offer. She thought it probably wouldn’t be necessary. I think she didn’t want to interfere with that youth conference. I told her that if she did need me, I could easily rent a car and drive from New York.

After hanging up, I called my wife (a recovery room nurse) and forwarded the e-mail to her. We agreed to talk when she got home in a couple hours.

I also emailed Josh and reminded him of my earlier offer. And I expressed concern that my daughter might be hesitant to ask for help when she really might need it. He called and asked me to go help her. I said I would gladly do it, but was concerned about her hesitancy. I did not want to barge in if that would make her uncomfortable. He said he’d talk with her and get back to me.

Things were getting complicated. A perfect storm began to form.

I emailed the leaders of the youth conference to give them a heads up that I might have to leave during the middle of the conference to drive to Michigan – or might even not make it at all.

When my wife got home that evening, we called Amanda. My wife, ever the nurse, quizzed my daughter and found the shortness of breath especially concerning. We spoke with Josh and he asked us to go help her.

We decided to jump into the belly of the beast. The decision was not especially hard to make. It is a decision that, I believe, any parent would make – even if it means walking into an environment filled with infectious bugs. Our daughter and our grandchildren needed us more than we needed to avoid being exposed.

Having decided to go, things began to happen quickly. Should we leave that night and make the 10-hour drive so we could be there in the morning? After talking about the risks of driving through the night, we decided to leave early the next morning.

While I gathered phone numbers for the youth conference leaders, my wife called the two hospital recovery rooms she was scheduled to work in the rest of the week to let them know she wouldn’t be in – and couldn’t be sure when she would be back.

I called the youth conference leaders to give them the bad news.

These phone calls brought me to the first of several ‘aha!’ moments of this experience. People are good and even when it creates significant problems for them, people cut you a lot of slack when you need to bail out on them because of a family emergency. My wife not showing up at the hospital and my not showing up for the youth conference was going to be very inconvenient for others. But everyone responded with understanding and kindness. No one objected.

The second ‘aha!’ moment was realizing how modern communication lets us react much more quickly and efficiently to a crisis – whether it’s a family crisis or one in the community, whether it’s a big one or just big because it affects us personally. We were able to quickly talk with or email people living in many different places not only to find out what was happening, to let others know what was going on and to coordinate everything that needed to be done. It’s not too far distant in the past that those calls would have been much more difficult to complete – and much more expensive.

It was time to do some homework.

First a quick trip to Google to check the latest status of swine flu – particularly in the Ann Arbor area where Amanda lived. The CDC was reporting that the county had had 43 confirmed cases of Swine Flu and a couple deaths. Google News said one of those deaths had been just a couple days earlier – a police officer who had been flown to University Hospital and who died after 10 days treatment. He was in his late 20’s or early 30’s – one of the prime ‘targets’ of this particular virus.

Next a quick look at the CDC site to check on the current status of swine flu. What precautions did they recommend? What are the recommended treatments?

There’s a whole list of instructions for caregivers. Good.

I notice they suggest that caregivers who are entering the belly of the beast should take Tamiflu as an ‘antiviral chemoprophylaxis‘ – big words that mean, “take this medicine to help you ward off the beast.” [Update 9/8/2009. The CDC revised its recommendations on using Tamiflu as a preventative measure. It now suggests anti-viral medicines only be used, for those not already sick, by those in high risk groups.] They even have a table that told us we should take 75mg a day during the entire period we would be exposed and for 10 days after. We figure we’ll be there at least four days. That means we’ll each need a two-week prescription.

It was now after 9 pm. Finding a doctor to call in a prescription shouldn’t be hard. If we can’t get a hold of someone in the practice we normally go to, as a nurse my wife knows several docs we could call on. There are even some who live in our neighborhood so it wouldn’t even be inconvenient.

Finding a pharmacy late at night is something different. It’s not a good time to find either an open pharmacy in Lynchburg (we are not a big city!). Before we disturb a doctor’s evening, we probably should see if there’s a pharmacy open at 10 pm. I think there’s a Kroger somewhere in town with an all-night pharmacy. Check Kroger’s website and their store locator. Limit the search to stores with 24-hour pharmacies. Whoops. Nothing. Guess I was wrong. My wife thinks there’s a 24-hour Walgreen pharmacy and calls them. Yes, they’re normally open 24 hours a day. But tonight they’re short staffed and will be open only until midnight.

With someplace to get the medicine, now all we needed was a doctor to write a prescription. It was by no means certain that we would be able to get a prescription. Remember we were not calling to get medicine because we have swine flu – or any flu. We were calling to get a medicine to keep us from getting it. And we live in a city where there had been only a single confirmed case of swine flu. Would the on-call doc know the CDC had recommended that all close family members in such a situation take Tamiflu?

The first call is to the on-call anesthesiologists at the hospital my wife works with constantly; she thinks they’ll be the least inconvenienced at that time of the night. But no one answers; they must be on a case. Next we call the clinic where our family doctors practice. We leave a message with the answering service and get a call back just minutes later.

The on-call doctor was very understanding, especially when he learned we were leaving early the next morning and would be staying in a home with a confirmed swine flu case and another probable case. It was probably also helpful that we could give him the phone number of a pharmacy open that late, the dosage and how many capsules we needed.

While my wife started packing, I ventured out to get the medicine and make a swing by a grocery store to pick up a few things to eat on the way up.

Wednesday, June 16

We started the 10-hour drive a little after 7 a.m. and got into Ann Arbor a little before 6 p.m. We had stopped little along the way – just to get gas and a little to eat. When we got there, Anna was over the worst of it. She was still a little tired and took naps. But no fever. No cough. No other outward symptoms.

Amanda continued to be the hardest hit. But that’s what they say about swine flu, don’t they? It is not the young and the elderly that take the brunt of this flu – as would be with the ‘regular’ flu. Instead it is those in their 20’s and 30’s.

We visited for a while and then tucked everyone into bed.

Thursday, June 17 through Saturday, June 19

Amanda had an appointment scheduled for her OB doctor at 11:00 a.m. About 9:00 they called and asked her not to come in. They didn’t want to expose either other patients or their staff.

Because Amanda and Josh were getting ready to move (to wherever Josh was able to get a job), they needed to paint some of the walls in their apartment. They needed to be out of married student housing by July 1^st and Amanda had done most of the packing. My wife spent most of these days painting and packing while I entertained the kids. (I remembered once again why you’re supposed to have kids when you’re young!) Anna took a few naps here and there and Amanda slept a good deal of the time.

Saturday morning, I was feeling nauseous and was starting to worry that despite taking Tamiflu faithfully I was going to be a victim of swine flu. But none of the other symptoms of swine flu were appearing. I didn’t want to say anything to alarm either my wife or my daughter. Early that afternoon I did throw up – but was able to do so without anyone noticing. One of the possible side effects of Tamiflu is nausea – so I attributed it to the drug. I then began to feel better and stopped worrying.

By Saturday afternoon everyone was feeling much better. Amanda was well over the worst of it – though still tired enough to nap frequently. The younger children showed no signs of being sick. We decided that as long as no one else got sick, we could leave on Monday.

Sunday, June 20

Jonathan, the youngest woke up with a fever. But he didn’t have a cough and his appetite seemed to be as good as ever. The fever was gone in a few hours. We decided it was probably nothing to worry about – though we continued to watch him carefully. Two-year olds have a hard time communicating medical symptoms…

We spent the rest of the day playing with the kids and getting ready to leave Monday morning. We chose not to go to church. While everyone was probably beyond the infectious stage, no sense tempting fate. I’m sure that if any of us had been contagious, those at church would appreciate our not being there.

Monday, June 21

We left early Monday home, grateful for having had the opportunity to help – and thankful that we had dodged the bullet.

Final Thoughts

Swine flu is no fun. It’s not fun for those who are sick. It’s not fun for those who take care of the sick. If the Centers for Disease Control and the World Health Organization are right, we could see a second wave of swine flu in September and October. The number of people who get sick could be significantly higher than the number of people who normally get the flu.

I’m no doomsayer. But I do think being prepared is better than not being prepared. And being prepared helps minimize fear. Our next article will be about what you can do to be prepared.

If you’ve had a personal encounter with swine flu, please share your experience by leaving a comment.

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Related articles from WalterBristow.com:

1. What to Do if Your Family Gets Swine Flu
2. What to Do If You Get Swine Flu
3. Getting Ready for Swine Flu: Ready or Not Here It Comes
4. Swine Flu: A Good Excuse to Rotate My Emergency Water Supply