Dr. Christian Tomaszewski, Professor, UC San Diego Department of Emergency Medicine
Related Story: Four More Die From Flu In San Diego County
CAVANAUGH: This is KPBS Midday Edition. I'm Maureen Cavanaugh. The spread of the flu has been big national news for weeks after a very moderate flu season last year. This year's flu has hit the east and central part of the country pretty hard. And it's headed our way. San Diego County is out with a new update on the flu, and county health says so far the number of people who have come down with the people who have come down with the flu is at "expected levels" but sadly six people in the county have died because of the flu season. Joining me is my guest, Christian Tomaszewski. He is UC San Diego planner of medicine, and thanks for coming in.
TOMASZEWSKI: Thanks for having me again.
CAVANAUGH: When does our flu season usually start?
TOMASZEWSKI: Instead ever being ahead of the times in the trends like we usually are with car styles and things like that, we're behind just because we're the last place to get cold and dry.
CAVANAUGH: That's the kind of weather the flu season likes?
TOMASZEWSKI: Yes, it loves the Winter. It's not just because of the season and the holidays. It's because the cold dry conditions let the virus spread a lot better.
CAVANAUGH: I see. If it's going to be a particularly bad flu season, do you start seeing signs in the emergency room?
TOMASZEWSKI: Yeah, we start seeing cases come in. The last week, we have had essentially a surge. We've seen a 10% rise in cases that are attributable to the flu.
CAVANAUGH: Is that what you expect to see this time of year or is this out of the ordinary in some way?
TOMASZEWSKI: This year's flu season is a little earlier. But it's getting cold, so the temperature is right. I've been watching the map. The east got it, and I'm saying we're holding out, we're holding out, and California was always isolated in a different color if you look on the CDC map. And finally it's hitting.
CAVANAUGH: Right. And you see some of those states, the amount of flu they have. How bad is it back east?
TOMASZEWSKI: It's bad enough they have had to actually set up tents outside some emergency departments because so many people are going there for help with the disease.
CAVANAUGH: Is that unprecedented or just a bad flu year?
TOMASZEWSKI: It's just a bad flu year. This is going to be on par for the course.
CAVANAUGH: I have read that this is a nasty flu strain; is that right?
TOMASZEWSKI: It's on the worst side. It can result in people who have other diseases. It can cause death, as you just quoted. Most people get by and survive the flu. Very few end up getting complications or dying. We just need to pick out those people and make sure they're treated well and vaccinated.
CAVANAUGH: Are you advising everyone to get vaccinated?
TOMASZEWSKI: Absolutely. I believe in the vaccine. It's not 100% protective, nothing is. But at 60%, that's a lot of protection and that prevents the virus from spreading as quickly.
CAVANAUGH: Right. Usually if I remember correctly, during flu season, people can compromised immune systems and over the age of 55 are routinely advised to get a flu shot. But this year you're basically saying probably everybody should get one.
TOMASZEWSKI: Why not? Low side effects, gives pretty good protection, get it.
CAVANAUGH: We have had reports that some local pharmacies and clinics have run low on flu vaccine. Is there a shortage or is that just sort of of a lapse in the line of delivery?
TOMASZEWSKI: Distribution is always an issue. When you're talking about supply chain. And there are areas that have run out of the vaccine. Check with the clinic that you plan to get it from before you go. They may be out already.
CAVANAUGH: But there's a difference between a flu vaccine shortage and just maybe one or a region not having that flu vaccine distributed in the proper way just now.
TOMASZEWSKI: Right now we're not sure.
CAVANAUGH: Oh, really.
TOMASZEWSKI: We're at that tipping point. But there's probably going to be enough. If you have an opportunity to get it, grab it.
CAVANAUGH: When is it too late to get a flu shot? I don't mean if you have -- well, I guess I do mean if you have the flu already, it's not going to do any good, right?
TOMASZEWSKI: No. But you may not have the flu. But of course you're not going to get a shot when you're sick.
TOMASZEWSKI: So be careful. A lot of things get misidentified as the flu. But right now is not too late. We're right on the shoulder of the flu season. Now would be a good time to get it. The sooner the better.
CAVANAUGH: This is a silly question F. You've already gotten the flu and gotten over it, do you need a shot?
TOMASZEWSKI: I'm going to play this game. How do you know you had the flu! There's a lot of masqueraders out there. We had people with RSV, and that can look like the flu. The we had a family this week that came in thinking they had the flu. They have been having headaches, vomiting feeling bad for days. Guess what they had? They had a bad furnace. Carbon monoxide poisoning. Just because you had the flu doesn't mean you have it.
CAVANAUGH: So how do you know that you have a flu?
TOMASZEWSKI: The only way to know for sure that you have the flu is we do a rapid test on you to see if you have the virus in your nasal passageway. I'm not saying you need that. Most of the time, for a reasonable, healthy adult, it's not going to make a difference if we know or not whether or not you have the flu. Of course you said the elderly, we need to focus on the people that are high risk for complications. The people over 65. Pregnant women, and anybody that has another coexisting illness.
CAVANAUGH: Right. It's remarked upon that healthcare workers in emergency rooms and other workers usually don't come down with the diseases that they treat other people for. In the case of the flu, it may be because they're all vaccinated. Are there other precautions that healthcare workers routinely make that we don't normally in our everyday lives?
TOMASZEWSKI: Well, we enter a faith in the impossible that we won't get sick. But we obviously avoid letting people get the aerosolized particles on us, stay out of the line of fire. And if you look at any hospital now, outside every room there is a container of hand cleanser. So we clean our hands between every patient.
CAVANAUGH: Is there a right and a wrong way to actually wash your hands to make sure you don't have -- that you're as clean from any potential virus or disease that you might have picked up?
TOMASZEWSKI: If you really want to clean your hands complete, you're going to do soap and water and a good scrubbing underneath your nails. But normally for most viruses and germs that we're worried about, hand cleanser with alcohol, and avoid drying them out from washing them too much.
CAVANAUGH: And that really does cut down on the spread of disease. It's a simple way, right?
TOMASZEWSKI: I continuing really does. I don't think you need to ban high-fives. Some schools have banned high-fives thinking it spreads the disease.
[ LAUGHTER ]
TOMASZEWSKI: Just good hand cleansing. And don't cough in the direction of other people. Cough into your sleeve or arm.
CAVANAUGH: Just because we're clear, how does the flu differ symptomatically from the common cold?
TOMASZEWSKI: Common cold, a slight snivel. The flu is getting hit by a truck. Muscle ache, you feel lousy, you usually have a fever which you don't get with the cold. It's like a bad cold where your whole body aches and you have a fever.
CAVANAUGH: Is the fever the distinctive element?
TOMASZEWSKI: Yes, even though nothing is 100% in life.
CAVANAUGH: Some people say I have the stomach flu. Is that a variety of flu or is that a different illness all together?
TOMASZEWSKI: You can have gastrointestinal symptoms with the flu. But we just had an outbreak all over the country of Norovirus that looked like the flu but was a bad GI illness with diarrhea and vomiting. And not that much fever and respiratory symptoms. The flu tends to have more respiratory stuff.
CAVANAUGH: This is more complicated than I thought.
[ LAUGHTER ]
TOMASZEWSKI: Sorry! This virus is clever.
CAVANAUGH: As you mentioned, sadly six people have died from the flu here in San Diego already. And I'm wondering, I know that most of the people, I don't know that all, but I did read that most of these people were elderly. So the elderly, are they at highest risk for developing complications that could turn out to be deadly from contracting the flu?
TOMASZEWSKI: Absolutely. Now, when we say deadly, most of these people will survive the flu. It kills only a minority of people if it's going to do that. And it's usually the high risk population. And like you said, that's the elderly. Absolutely. So most people, I would tell them stay home and tough out the flu or call your doctor or go to a local clinic. But if you're elderly or in a high risk group, it's time to step up the game and call for help.
CAVANAUGH: You've got the flu shot, the muscle aches, the fever, feeling terrible, when should you make a decision? When does it come to the time when you think I should go and see my doctor or go to a clinic about this?
TOMASZEWSKI: When it starts getting out of hand, when you can't take care of it at home on your own. You can't keep downliquids, you're having trouble breathing, wheezing, coughing, or if you're having stomach or chest pain.
CAVANAUGH: What about going to work if you have the flu? I just heard a report this morning about some employers in the east really struggling with whether or not to encourage their workers to come in because their businesses are suffering or having them stay at home because they didn't want to get their other employees sick?
TOMASZEWSKI: I mean, don't let the flu win the game! Stay home! Do not spread it! If you have to really go to work and you feel well enough to do it, wear a mask. But that's a stigma that a lot of people aren't willing to endure.
CAVANAUGH: What if you're seeing a coworker who obviously is struggling with some sort of illness that you don't want to catch? Obviously you want to stay away from them. Are there any other tips? Anything else that you can do to keep yourself healthy?
TOMASZEWSKI: Stay out of the line of fire, take care of yourself so your immune system is well. Get enough sleep and good nutrition, and make sure you get vaccinated if you haven't.
MAUREEN CAVANAUGH: How protective is this particular flu vaccine?
TOMASZEWSKI: So far in this outbreak, it looks like it's about 60 percent effective. And I think we shouldn't focus on the 40% failure rate.
CAVANAUGH: That's a big failure rate, though, isn't it?
TOMASZEWSKI: Yeah, but still, that's over 60% of the population that's going to be protected. And that's that many less people that are going to spread the disease.
CAVANAUGH: But it sounds as if you have gotten vaccinated, you still should take precautions against the flu.
TOMASZEWSKI: Absolutely. No. 1, it's not 100% protective. There's some strains that it doesn't protect against, a few. And there's other viruses that are out there that would like to take advantage of the situation as well.
CAVANAUGH: I see. You mentioned there were some emergency rooms back east that set up tends outside just to take the overflow of flu patients. Officials are also advising people to avoid big gatherings, rent a movie instead of going to the movies. How bad would our health outbreak have to be before officials started sending out advice like that?
TOMASZEWSKI: Probably a little bit worse. But I would start now. I don't want it to get to that point yet. I'd be careful now. I'd avoid going to the hospital if you don't need to. I don't want you bringing the flu to our sick patients and I don't want you to get it from the other patients in the waiting room.
CAVANAUGH: Okay! I think you've given us a good overall view, and it's time to get that shot.
CAVANAUGH: Thank you very much.
TOMASZEWSKI: You're welcome, Maureen. Thanks for having me. And