Don’t over- or under-estimate preventive medicine as flu epidemic rages

influenza-virus-fulltext-300x203As the flu epidemic rages across the country, it also may be testing the oft-tenuous public respect for preventive medicine, especially as patients get hit with surprise medical bills and experts struggle to explain the complexities and limits of protections afforded by vaccinations.

Are flu shots useful or not?, many Americans may be asking, as this season’s infections hit marks not seen for at least a decade. (Spoiler alert: Yes, get that shot!) Flu kills many more patients than many realize, and this year, the virus is on track to claim as many as 4,000 lives a week.

The toll among children has been scary, with the deaths of 84 youngsters blamed on flu. Three out of four of the youngsters who died from flu had not been immunized, officials say.

For grieving parents, it also may be scant comfort to know that the season’s flu shot is faring better than experts expected in kids. But it’s doing less so in adults.

The federal Centers for Disease Control and Prevention reported that the shot is 52 percent effective in youngsters but just 39 percent effective overall.

The Associated Press has explained how these figures were derived, reporting that:

The effectiveness estimates come from the tracking of about 4,600 children and adult patients in five states. To make the effectiveness calculations, researchers tracked who got the flu, and who among them had been vaccinated.

The AP has noted that data show the shot is all but ineffective in protecting Americans 65 and older from the most common type of flu that’s infecting so many nationwide.

To be clear, experts are recommending — in the strongest terms — that the public get the flu shot, even with its limits.

What’s going on? Here’s where medical scientists need Americans’ eyes not to glaze over about details on diseases and their prevention.

First, what most of us think of as a flu infection isn’t that simple. The illness can be caused by different kinds of flu viruses. The current shot protects well against varieties known as Type A H1N1 and Type B flu viruses.

Most inoculations protect less well against another kind of flu bug — H3N2 viruses. That’s because much of the globe’s population grew up when H1N1 flu was common, and, as a result, their immunities against this and Type B strains are stronger and get bolstered better by a flu shot.

H3N2 flu not only came on the scene later but it also grows differently in eggs, the medium that’s the basis for many vaccinations. Flu shots for H3N2 are less effective because experts can’t get the product they need because the virus keeps mutating as it’s cultivated and before it’s killed off for vaccines. Experts are working now to develop a different way of prepping vaccines to deal with this and other egg-based vaccination flaws, including the prevalence of allergies that prevent many patients from taking many common shots.

Meantime, though adults may get less H3N2 protection with a flu shot, they will be better off as H1N1 and Type B flu also infects the nation.

Those felled by the flu also are feeling some surprise and nasty fiscal side-effects as they get billed for their medical care. Patients are learning that they may be receiving emergency room treatments uncovered by their health insurance because select providers — including specialists like respiratory therapists, infectious disease doctors, and anesthesiologists — may be out of their insurer-approved “medical networks.” Insurers typically insist that patients receive advance approval, especially from a primary care doctor, for out of network treatment, and they make patients pay hefty bills if they don’t.

But if someone is so sick that they feel they must seek ER care, it’s unlikely that they’re going to have the wherewithal to grill each medical provider about their network status.

Similarly, patients in sufficiently dire straits to need an ambulance to get them to the ER are unlikely to stop and determine that this transportation may ding them for thousands of dollars, no matter how short or long a trip they take.

The profiteering of insurers and ambulance companies has provoked patients’ ire and led to regulatory and legislative crackdowns in some areas.

In my practice, I see not only the major harms that patients suffer while seeking medical services but also their big struggles to access and afford medical care. ER care can be exceedingly costly, with doctors and hospitals seeking to justify its sky-high expense by noting the extensive equipment and intensive staffing such care can demand.

It makes little sense for partisans to try to slash at Americans’ health insurance if a lack of such coverage drives them into ERs as a pricey, last-ditch option. It’s also unacceptable for insurers, as Anthem had tried to do, to second-guess or pre-guess the severity of patients’ conditions by imposing harsh restrictions on their ER use. But it also makes bad common sense for patients to dawdle as they feel progressively worse and to use ERs in place of earlier, office-based interventions.

Translation: If you’re starting to feel worse than usual due to the flu, call your doctor, stat. If she and her practice can’t squeeze you in, ask them to recommend a nearby pharmacy clinic where you might at least be seen by a nurse practitioner or physician’s assistant. They can handle many medical needs, or determine if your situation requires more medical attention. You also can ask your doctor to recommend not a clinic but urgent care — a next-level medical service that can be akin to a free-standing ER. Your insurer also may recommend clinics and urgent care centers for you, or perhaps a phone or telemedicine consulting options. The clinics and urgent care facilities often are in network and can be cheaper than hospital ERs.

If you’re feeling well, take a few steps that may benefit you greatly, if you later do get the flu. These just might save you some good sums of money. It’s crucial with the infection to stay warm and get lots of fluid. So, go the grocery now and buy orange juice concentrate and toss it in the freezer. Load up on some tea, hot chocolate, and milk. If you’re not such a gourmet that you’ve already made a batch of soup and frozen in it convenient to use portions, buy a half a dozen cans of commercially prepared soups, preferably varieties with less sodium than the salt-laden kinds. Stock up on aspirin (including the kid varieties), tissues, a digital thermometer, and maybe cough drops.

The strong but unstated message in this shopping trip: If you’re felled by flu, or a cold, or any other infection that can be spread, stay home, please. This year’s flu epidemic is serious, and it shouldn’t be fueled by bad company policies that decline to provide employees sick leave — as occurs with roughly a third of Americans on the job — or with workplace cultures that make sick staff feel like they “just gotta drag themselves into the office,” even if it makes everyone else there ill. We don’t need more hospitalizations or fatalities due to the flu.

Patrick Malone & Associates, P.C. listed in Best Lawyers Rated by Super Lawyers Patrick A. Malone
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