It may be happening more than we ever realize, those negative test results occurring in patients with real flu like symptoms, that is. The CDC admits these flu tests are not always accurate. It took 3 tests for them to get a positive result in this now terminal case. Now, this is not so unusual a happening, say with the H5N1 bird flu virus, and there it is certainly cause for concern with such a virulent virus, but this Utah woman was diagnosed eventually with the supposedly "mild" swine flu virus. It is not really so important that we always know if someone has swine flu or not, UNLESS they are very sick. If they are, and it really is influenza despite that negative test result, not treating with Tamiflu within the first 48 hours could cost a life.
Indonesian physicians experienced by now in treating H5N1, bird flu cases already know about this. We could benefit from their experience. If they have a very sick patient, and the case looks like bird flu, they treat it with Tamiflu even if the test comes back negative especially if there is another positive case in the family. If they don't, the patient dies. This seems rather elementary, but I guess it is not.
There are many reasons why truly positive cases will return a negative test result. Poor technique in the collection process, improperly stored or handled specimens, a primer that is not up to date with the strain of virus being tested, and even collecting the specimen during the wrong stage of illness will affect the results.
One other reason not relative to this post, but something probably seen rather often in Indonesia, is that if you treat with Tamiflu and then test, your patient is likely to test negative. This is what is seen when "the Tamiflu Blanket" is applied. The Indonesians would blanket a family or an entire village with Tamiflu sometimes when it appeared that cases were spreading human to human in certain parts of the country.
I am fairly certain that there are some other terminal cases that were misdiagnosed or diagnosed only after death. I do know that Judy Trunnel, that unfortunate pregnant woman who died in Texas was only diagnosed at autosy, but I don't know if she was tested before that so if anyone does know about this please post it, or I will look later today. And, the other terminal pregnant case in El Paso, Texas, who died is another one to check on...
I would like to get a sense for how often this may be happening.
Cyndi Bemis, a spokeswoman for the Utah Department of Health, confirmed the adult who died Saturday was a woman but said she did not know if underlying health problems were a factor.
A family member identified the woman as Francine Rushton, 47, and said she contracted the flu about two weeks ago but was initially told it was not the H1N1 type, despite her mother's diagnosis with H1N1 that week.
"She tested negative, so they sent her home and told her to get fluids and rest," said Craig Whitehead, Rushton's brother. Because her mother's health had improved on Tamiflu, the family "begged them to administer Tamiflu" to Rushton, Whitehead said. Doctors said they would not without a positive flu test.
Rushton's third test came back positive, more than a week after she first fell ill, Whitehead said. "By then it was too late," Whitehead said.
Rushton's family is urging flu patients to be vigilant about their symptoms and assertive in seeking treatment.
"Don't take it lightly," Whitehead said. "I sat at work three weeks ago and scoffed, 'What's the big deal?' ... Now I feel differently about it."
There have been 688 confirmed cases of the flu in Utah, including 25 cases among health care workers. A majority of those diagnosed with the virus in Utah have been between the ages of 5 and 24.
