Cases without fever - what the heck?!?

indigo girl · Sep 9, 2009

I do not envy you.

Do we send kids home because they need care or because they are going to spread infection? Probably for both reasons, I would think.

With this virus, you are not likely to prevent the spread because it does manifest with mild symptoms in many, and it is very transmissible in that age group to boot. The flu is just about everywhere by now, and you may very well be seeing mild cases. I do not think that there is much that you can do about it. Some kids may have sore throat, and respiratory s/s, some will have conjunctivitis, and some will present with GI s/s. Even tonsilitis has been seen with H1N1, and co-infections with strep. It seems to exacerbate whatever the kid is prone to...If it looks like typical flu, it will be much easier for you, but it might not look that

way. I suspect that most of the kids that you see will be fine, even if they do not go home.

I think that your approach sounds very reasonable. If you think that they need more care, you are going to recognize this, fever or not, just from your expertise in the field, and mostly you will be right. I do not doubt that you would be able to spot a kid that might be in trouble either unless it was very early in the process.

I am reminded of a June commentary written by the Reveres, those public health docs over at Effect Measure addressing how to tell if a flu victim is in trouble. The post was written with info from a CDC press conference informing the lay public on how to tell if a sick person was getting critical.

http://scienceblogs.com/effectmeasure/2009/06/swine_flu_warning_signs_that_s.php

About two weeks after the kids go back to school is when we start seeing the outbreaks in most places. Good luck, purplescrubs.

You are going to be very busy.

Purple_Scrubs, BSN, RN · Sep 10, 2009

Thank you! I was hoping you would respond :) I respect all the research you have done on this subject and your factual, reality-based responses. I too think that this will be a very busy season. We already have a suspected case in an adult visitor to our building, and another staff member is feeling very ill. I am lacing up my roller skates and getting ready to roll!

I do wish my district would supply N-95's for us, I have not been able to find any myself. As of now we only have surgical masks, which I understand will not be highly effective.

Good luck to us all!

indigo girl · Sep 10, 2009

Thank you! I was hoping you would respond :) I respect all the research you have done on this subject and your factual, reality-based responses. I too think that this will be a very busy season. We already have a suspected case in an adult visitor to our building, and another staff member is feeling very ill. I am lacing up my roller skates and getting ready to roll!
I do wish my district would supply N-95's for us, I have not been able to find any myself. As of now we only have surgical masks, which I understand will not be highly effective.
Good luck to us all!

Check out your local big box paint department. They have the N95 mask, as does the local Sams. If you know your size, you are in business. I keep a few in my locker at work, because my manager does not stock them on our unit.

I do not want to be caught without the right PPE just because mgmt thinks we won't get those cases. I think that we have seen them already, but she is using fever as the criteria...Obviously, she has not read the info freely available on the CDC website addresssing the afebrile cases. You can't educate someone that is invested in denial about what is happening no matter how often you present the evidence to them. They just are not able to see it...

Multicollinearity, BSN, RN · Sep 12, 2009

Have we heard of any confirmed cases of H1N1 in adults with GI symptoms and headache but zero respiratory/sore throat/fever symptoms?

indigo girl · Sep 12, 2009

That kind of case would never be tested in this country, multi. But, I can tell you that those s/s were exactly like what some staff and patients on my floor experienced while others had the full range of respiratory symptoms also. One person also developed strep and tonsilitis, all within the same time period. Just a coincidence, I'm sure...

Maybe it was just coincidence that two different viruses were attacking us at one time, I asked mself. No one was ever tested, meanwhile our anorexic patient had a week's stay in the ICU due to the vomiting and diarrhea.

We will never know because it did not look like classic flu in all the cases. What has been really curious to me since the spring, is that we have been reading accounts where one child is diagnosed with flu, and is seriously ill, yet other kids in the family test negative yet had some but not all of the same s/s. Doc tell family, only one kid has swine? Seems stupid to me.

I think that this is all the same virus with a constellation of s/s, and not everyone gets every symptom.

Just my two cents.

Multicollinearity, BSN, RN · Sep 12, 2009

Since Tues. I've had GI symptoms. Then the significant GI symptoms waned on Thurs. and the body aches/headache/emotional lability typical of a virus set in. Even my skin hurts now. Hoping it's swine flu because it'd be really hard to get sick again this semester with our attendance policy. I'm thinking I probably don't have swine flu, though, because I don't have a sore throat or cough. Never had a fever, either. Well, might have had a super-mild fever at the beginning.

Morning-glory · Sep 16, 2009

Mine started with aches and pains for about 5 days. Then I started feeling like I was brewing something. Sore throat, persistant and productive cough, wheezing, SOB, GI involvement and lethargy. Still no fever. Off work for a week. Still the occassional cough. Overall about 2 weeks of not feeling right. I'm thinking the flu.

Nobody else at work is sick, so I was able to keep my germs to myself, but I'm wondering about the incubation period on this thing. The only person I was in contact with that was ill was a week before I got sick.

indigo girl · Sep 16, 2009

https://allnurses.com/pandemic-flu-forum/how-long-you-424242.html

llg, PhD, RN · Sep 16, 2009

I got the body aches, headache, and chills last night -- with a very low-grade fever and very mild GI symptoms. So, I stayed home from work today. I'm trying to decide how long I should stay home assuming I am feeling better tomorrow. I already feel 80% better this afternoon and my temp at noon on no meds was 98.4.

My Occupational Health department was of no help. (We have to call them if we have flu-like symptoms.) All she could say was, "Gee... your temp isn't over 100. So, you don't meet that criteria. That doesn't help me much. I am going to use my best judgment and go to work tomorrow if I feel like it. I have something I really need to do there tomorrow and don't want to miss it -- but would miss it if I really felt I was a danger to anyone. This might just be a little 24 hour virus ... or it could be a very mild case of influenza. There is no way I am going to know for sure one way or the other.

Frustrating.

Morning-glory · Sep 16, 2009

Indigo,

Is there anything on the actual incubation period? From the time of exposure to the time of having symptoms? Seems that this one took longer to "cook" before showing itself. I am glad that no one else at work has it yet though.

Thanks.

Morning-glory · Sep 16, 2009

LLG,

I was getting better at 3 days and I thought it was over, but the next morning, I was sick again. I hope you are better soon.