Swine flu getting a foothold in state
Patient visits suggest H1N1 cases on the rise
Massachusetts patients stricken with the chills, coughs, and fever that are the calling card of influenza are streaming into physician offices at a higher rate than at any time during the past two flu seasons, state disease trackers reported yesterday.
It is, said disease specialists and doctors on the front line, strong evidence that swine flu has the state in its crosshairs once again after subsiding in late summer.
The proof can be found in Davis Square, inside the waiting room of the Harvard Vanguard Medical Associates building.
“We’re having people waiting much longer than we usually do, and we’re having schedules that are overflowing and having doctors and nurses staying longer than normal,’’ said Dr. Benjamin Kruskal, who treats children in the Somerville clinic. “We’re already starting to push the capacity of the system.’’
Statewide, the Department of Public Health’s tally of flu misery showed that last week, 4.75 percent of visits to physicians were prompted by influenza-like symptoms. That was almost double the week before.
Even during the peak weeks of the past two flu seasons, barely 4 percent of visits were attributable to influenza-like symptoms.
“I think that we could tell the public that it’s going to be a long season,’’ said Dr. Lauren Smith, medical director of the state health agency. “We are just at the beginning of the increase.’’
The figures on patient visits are gleaned from a network of 31 medical offices that report to the state. In most cases, patients haven’t been tested specifically for the H1N1 strain, but because seasonal flu is not typically seen in early fall, health officials are attributing the cases to swine flu.
There’s no surefire way to know how firm a hold swine flu has on the state. It could be that some of the increase in medical visits reflects greater anxiety among patients who, in past flu seasons, would have just pulled the covers higher and stayed home.
“We do think that a significant portion of the demand, particularly for emergency department care, is related to the concern and the media attention to influenza at this time,’’ Dr. Thomas Frieden, director of the US Centers for Disease Control and Prevention, said during a conference call with reporters.
The state survey suggests doctors offices on the fringes of Greater Boston may be experiencing an especially high volume of flu patients, a trend seen in other years.
A Catholic school in Norwood, St. Catherine of Siena, sent a letter to parents alerting them that the facility will be closed next week because a wave of respiratory illness has washed through classrooms. By yesterday, more than 140 students - about 25 percent of the total - were absent, as were 14 of 40 faculty members.
But specialists, including Dr. Vicky McEvoy, medical director and chief of pediatrics of Mass. General West Medical Group in Waltham, speculated that the high number of visits in the suburbs may say as much about the patients’ affluence and attitudes toward medical care as about the disease.
“I would think some other people who are a little more low-key and don’t want to pay a copay and are not likely to rush into the doctor are more likely to stay home and just deal with the flu,’’ McEvoy said.
Patients with relatively mild flu symptoms typically don’t need to visit a doctor, but patients with asthma, heart disease, diabetes, and other underlying conditions are urged to seek care if they develop symptoms. And if otherwise healthy patients experience a recurrent fever or suffer from severe breathing problems, they, too, are advised to see a doctor.
To prevent flu from spreading in their corridors, Boston’s major teaching hospitals began restricting visitors this week, hoping to protect vulnerable patients. Massachusetts General Hospital barred children and teenagers from its obstetrics unit because young people are at greater risk for catching and transmitting swine flu.
Brigham and Women’s Hospital asked that anyone with a cold, cough, or fever not visit patients, and banned children and teenagers from the neonatal intensive care unit. Beth Israel Deaconess Medical Center began screening and excluding sick visitors in the labor and delivery, postpartum, neonatal intensive care, transplant, and cancer units. Most healthy children under 12 also are prohibited from visiting patients in these units.
Liz Kowalczyk of the Globe staff contributed to this report. Stephen Smith can be reached at stsmith@globe.com. 
