With Swine Flu, The Thing Hospitals Fear Is Fear Itself

Swine flu is circulating widely in Boston, especially among young people. Children’s Hospital has opened an overflow site to help manage the number of patients coming to its emergency room with flu-like symptoms. But most of those children are just being told to go home, drink fluids and get lots of rest. So the hospital finds itself flooded by sick kids who’d often be better off staying home in bed.

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There’s no doubt that 2-year-old Jonathan Parades feels lousy. His eyes are glassy and his brown curls are damp on his forehead, a sure sign of a fever. His mother, Janice, suspects he has the flu.

“In the afternoon he started coughing,” Janice Parades recalls, “and he’s very playful, very active, and all of a sudden he just was laying on the floor, very tired.”

So she brought him to the Children’s Hospital emergency room — and, sure enough, he has almost an 103-degree temperature and a likely case of the H1N1 swine flu. But the treatment he gets is pretty simple: some fever-reducing medicine and a cup of water.

Then Dr. Margot Shuman sends him home. “I think a lot of the not-feeling-well is just the fever at this point,” Dr. Shuman explains to the boy’s mother.

Shuman is a pediatrician at Children’s Hospital, which earlier this week saw a 50 percent jump in sick kids in its emergency room, most of them with presumed cases of H1N1.

But for most children, Shuman says, the swine flu does not call for a trip to the ER. In fact, of the 50 or so kids she’s treated for the flu in the past few weeks, only a handful have been hospitalized. One, for example, developed pneumonia. Another was a three-month-old with a fever.

“There’s a lot of panic on the part of parents when they’re hearing all about the children who are really having the serious complications of this,” Shuman says. “But it’s still the vast minority of kids who are having these horrible complications.”

Shuman says only a small percentage of children with H1N1 need to go to a hospital. Those include kids with trouble breathing, dehydration, a fever that goes away and comes back or kids acting delirious or lethargic.

Still, at least 100 children nationwide have died from swine flu and those horror stories have many parents racing to the ER.

Dr. Mark Waltzman wishes they’d think twice before making that trip. He’s the assistant medical director of the Children’s Hospital emergency department, and he’s walking through a new, makeshift space at the hospital that has six beds, a doctor and two nurses.

“This used to be meeting rooms that, because of the H1N1 outbreak, we have proactively converted to actual examination rooms,” he explains.

Any child who comes to the ER with flu symptoms who’s over two years old and has no other medical problems gets sent here. Without this “alternative care site,” Waltzman says, the ER could be overwhelmed by minor flu cases.

“Families are obviously scared,” Waltzman says. “They’re getting mixed signals. They’re not sure what to do, so they assume, ‘We’ll just go to the teaching hospital down the street and either they’ll reassure us or they’ll give us the magic medicine.’ And, unfortunately, there’s no real magic medicine out there.”

Waltzman says that’s why an emergency room is not the best place for most kids with the flu — especially since being in a hospital exposes them to more germs and might spread the virus.

“This is a disease that should be started off in the primary care’s office,” he says. “The phone call first should be: ‘My child or I have these symptoms: cough, fever, runny nose. What do I do?’ ”

What you do in most cases is just rest, hydrate and hold tight. Otherwise, hospitals are at risk of being swamped not by a deadly virus, but by overreaction to what so far is mostly a mild disease.