Announcement

Collapse
No announcement yet.

As Flu Suspicions Spread, Necessity of Test Is Weighed

Collapse
X
 
  • Filter
  • Time
  • Show
Clear All
new posts

  • As Flu Suspicions Spread, Necessity of Test Is Weighed

    Source: http://www.nytimes.com/2009/05/21/he...diagnosis.html

    As Flu Suspicions Spread, Necessity of Test Is Weighed
    By DONALD G. McNEIL Jr.
    Published: May 20, 2009

    A 16-month-old boy is brought to Elmhurst Hospital Center?s emergency room blue and motionless, and is pronounced dead 40 minutes later. A preliminary swine flu test is performed within hours ? and turns out negative.

    An 8-year-old, the son of a flu expert at Weill Cornell Medical College, runs a high fever and starts coughing heavily at 4 a.m. His mother, the flu expert and also a pediatrician, diagnoses it as swine flu without testing him.

    These two moments, which played out within 24 hours of each other, illustrate the difficulties pediatricians all over New York City face as worried parents of sniffling children ask for the swine flu test ? which most times cannot be done and which the Centers for Disease Control and Prevention says there is no need for.

    They also illustrate how important the tests can be.

    In the case of the boy who died, Jonathan Zamora Castillo of Corona, Queens, it was crucial to establish the cause of death. His rapid decline ? from a generally healthy child in the morning to cyanosis and death by evening ? matched reports from the 1918 Spanish Flu epidemic of patients who drowned in their own lung secretions. Although a few dozen children die that way in the United States each year from seasonal flu, said Dr. Anne Moscona, the flu expert, having such a rapid death in the middle of a generally mild swine flu outbreak would have been very worrying.

    In the case of her son, Ari, Dr. Moscona had every reason to suspect swine flu. His school, Horace Mann in Riverdale, shut down on Tuesday after positive cases were found, and he had the same symptoms as schoolmates.

    ?Medically, it was the right thing to do,? Dr. Moscona said when asked whether she would have treated a patient who was not her son the same way. ?If I?d thought it might be seasonal influenza, I would have ordered a test. But there were 40 kids sick in his school.?

    Rapid flu tests are right only 70 percent of the time when they are positive anyway, she added.

    The C.D.C.?s position is that if a child?s symptoms are serious and exposure to the swine flu is likely, a doctor should prescribe the antiviral drug Tamiflu without waiting. If the symptoms are mild, neither a test nor Tamiflu is called for.

    Some states cannot even perform the new test that the C.D.C. created only three weeks ago. It has been shipped to all 50 state laboratories, but only 44 have been certified to perform it thus far, Thomas Skinner, a C.D.C. spokesman, said.

    Dr. Max Kahn, a Manhattan pediatrician, says his office performs a simple nasal swab test that can distinguish influenza from more than 100 other viruses that can cause cold symptoms.

    ?We can?t do anything more,? he said. ?If the child is significantly ill, we?ll give an antiviral medication.?

    If the parent asks for the new swine flu test, he tells them that the only laboratory performing it is the state?s, ?and they?re swamped and only doing people who are hospitalized or have underlying disease.?

    Asked whether that satisfied all his worried parents, he paused, then said, ?People are different.?

    Several diagnostics companies, like Diatherix Laboratories and Quest Diagnostics, have developed their own tests for the new swine flu. Only the C.D.C.?s test is approved by the Food and Drug Administration, but an F.D.A. spokeswoman said that if other tests are done in a laboratory certified by the Department of Health and Human Services as having met a 1988 law governing clinical labs, it is legal for doctors to order them.

    Dr. Diane Hochlerin, a Manhattan pediatrician, said she had had only one parent insist on a test.

    ?I told him I couldn?t do it, but if he wanted to go to Elmhurst Hospital in Queens, they might,? she said. ?He said, ?Oh, it?s not worth it.? ?
Working...
X