As the flu sweeps the USA, the death toll climbs daily and offices and classrooms face empty chairs while hospital emergency departments struggle with overflow crowds.
By Thursday, there were 23 flu deaths in Minnesota, raising the state's total to 27 flu-related deaths reported so far this season. Other states reporting deaths included Pennsylvania at 22; Massachusetts, 18; Oklahoma, eight; and Illinois, six. Nine nursing home residents have died in New York. Two children in Florida were among 18 pediatric deaths nationwide.
The annual influenza death toll varies steeply -- from fewer than 3,000 to nearly 49,000 -- according to the Centers for Disease Control and Prevention. The center will release this season's mortality numbers on Friday.
But it appears the speed of the flu's spread this winter "has been pretty much unparalleled," said one physician on the flu front lines, John Hick, an emergency physician at Hennepin County Medical Center in Minneapolis.
He thinks uptick in Hennepin's flu cases came after people returned from holiday travel and children returned to school, where they might have been exposed. Worse may be coming. "My general sense is that we have not peaked. We've probably got a few weeks to go on this," Hick said.
So far this season 42 states have reported widespread levels of the illness with the hard-hit areas in the East, South and Midwest, said Michael Jhung with CDC's influenza division. The West and Southwest have had very little flu.
That's small consolation to the miserable. For those who do fall ill, the flu is a head-burning, cough-wracked, muscle-aching experience. It's particularly dangerous for the elderly, young children and people who have compromised immunity because of other illnesses or chronic conditions such as diabetes or cancer.
Businesses struggle with missing staff and canceled sales. In Des Moines, West Bank tried to ward off illness by spending $3,000 to provide 300 free flu shots to workers and their families. Even so, CEO Dave Nelson told the Des Moines Register, 15 of his 175 employees in the region called in sick on Friday. While he would rather they stayed home than spread their germs at the office, Nelson says, "People resist staying home because they care. Instead of taking one for the team, they're really hurting the team."
Schools, which can be like germ-aquariums for the young, see kids too feverish to concentrate -- or they don't see them at all. In Kiefer, Okla., when the absentee rate hit 25%, then tiny school district announced it would cancel classes Friday, said Steve Mathis, the school district's spokesman -- and its attorney.
Mathis said the district's three schools would get "a good, thorough cleaning" Thursday night, in hopes that students would spend the three-day weekend recovering. "Monday we can start fresh," he said.
The district has no nurses, so teachers were called upon to diagnose flu cases on Thursday. "Teachers can just do the touch test and feel their heads," Mathis said.
Donna Mazyck, executive director of the National Association of School Nurses, says school nurses nationwide are "looking at fevers, they're looking at aches and pains, they're looking at some of the respiratory symptoms. They just feel bad."
The 2013 season is particularly wretched because one of the major strains in this year's flu mix hasn't been seen for five to nine years and people's antibodies for it have waned, said Arnold Monto, a professor of epidemiology and member of the Infectious Diseases Society of America's Influenza Advisory Group, which works with the CDC.
There are three types of flu circulating in the USA: H3N2, H1N1 and Influenza B. H3N2 is by far the most common and most likely to put people in the hospital with complications. All three are included in this year's flu vaccine.
For those who haven't been vaccinated, the chances are they don't have antibodies for H3N2. It's been nine years since the 2002-2003 flu season, when H3N2 was in high circulation in the country. That season, about 95% of the flu was made up of H3N2. In 2007-2008, it was 75%, the CDC's Jhung says. Since then, other strains have been more common, so resistance to the strain has ebbed. The virus has also mutated.
"Flu viruses change all the time. They change in big ways, which gives them a different H and N designation, and they change in small ways. So last year's H3N2 can be a little bit different from this year's H3N2 virus. If you've been exposed to a similar virus, you'll have some protection, but not full protection," Jhung said.
In Albany, Gov. Mario Cuomo bravely submitted to a flu shot, which was administered in front of the news media by Dr. Nirav Shah, the state health commissioner.
In New York and New Jersey, which contain some of the nation's most congested areas, the flu has spread earlier and faster than any time in the past decade. New York City Health Commissioner Thomas Farley told New Yorkers to visit their doctor's office for treatment, rather than increasingly busy emergency rooms.
During last year's flu season, 4,400 cases were reported in the state; so far this season, there have been more than 15,000. Hospitalizations are up 169% from the same period last year. Reports of patient visits for influenza-like illness from was 6.82%, more than three times higher than usual. Hospitals said flu cases among their in-patients was up 55% over the last week in December.
But there were rays of hope. The New York State Health Department reported that last week's total of 4,059 reported cases of laboratory-confirmed flu represented a 7% decrease from the previous week.
Massachusetts's picture was not so bright. Boston has declared a public health emergency. The city has had more than 700 cases of flu - "the worst season we've seen since 2009," according to Mayor Thomas Menino. The city plans a free vaccination campaign this weekend in an effort to slow the virus spread. The mayor pleaded with people, "If you're sick, please stay home from work or school."
Each year, vaccine manufacturers make an educated guess about the strains of flu likely to circulate worldwide. CDC Director Tom Frieden says that even if the vaccine is not perfect, "it is, by far, the best tool we have to prevent influenza, which remains a serious and potentially fatal disease."
But last year the season was the mildest flu season on record so people may have been lulled into skipping the vaccine. -- and forgetting how vile influenza can be.
"The average person forgot what influenza is like," says William Schaffner, a professor at Vanderbilt University School of Medicine, who describes this year's season as only "moderately" severe.
Not to Pat Meadors, network director of emergency department. at Piedmont Atlanta Hospital."This is the worst flu season I've seen in all my practicing years," said Meadors who graduated from medical school 35 years ago.
Piedmont's physicians are seeing a particularly virulent strain of the virus. Patients are becoming sicker for longer periods of time, up to three weeks in most cases. Meadors knows. Even though she had a flu shot, she was flattened for three weeks with influenza in October. "It's the worst I've ever felt in my life," she said.
"This is definitely an unusual year for us," says Patsy Stinchfield, a registered nurse and director of infectious diseasefor Children's Hospitals and Clinics of Minnesota, which operates hospitals in Minneapolis and St. Paul and several clinics.
The facilities are seeing young flu patients earlier than in a normal year and "we're seeing more of them and they tend to be sicker kids," she says. A 12-bed unit that's usually closed at this time of year has been opened for patients with respiratory problems, Stinchfield says, and extra nurses were hired from an agency to staff it. Visitors younger than 5 are not allowed to visit and other visitors are screened before they're allowed in, she says.
Massachusetts General Hospital, Boston's largest, sees 40 to 80 patients with flu-like illnesses daily in its clinics and emergency department - an "extraordinary number," said chief nurse Jeanette Ives Erickson.
At Boston's Beth Israel Deaconess Medical Center, Jim Heffernan, chief of primary care, faced an overflowing emergency room without "enough places to put people. It just snowballs." The hospital hotline rang ceaselessly, and Beth Israel spokeswoman spokeswoman Kelly Lawman said, "We had to open a new unit to accommodate all the patients."
The emergency room at Ohio State University's Wexner Medical Center in Columbus developed a fast-track system to move college students with the flu quickly through the emergency room to keep beds free for more vulnerable patients. It directed others to urgent care centers and their family physicians. "It's tough when the hospital is totally full and there's nowhere to put patients," said Mark Moseley, Wexner's assistant chief operating officer. "For good or ill, society perceives the emergency room as the place to go when you have a cold or the flu."
In Cleveland, a flu task force meets for 20 minutes every morning to handle the crisis at the University Hospitals Case Medical Center. "This is a really extreme challenge to the system," says Michael Anderson, chief medical officer at University Hospitals, who leads the 20-person meeting with doctors from regional hospitals, nursing directors, pharmacists, ambulance supervisors and others.
The medical system's senior leaders discuss hospital bed capacity, the health of its staff, where to shift patients in the regional hospital system and supplies of crucial items such as Tamiflu and face masks. Thursday morning, the task force decided to limit patient visitation, keeping away from the hospital any visitors who have flu-like symptoms, Anderson said. Computer systems report a census of hospital beds hourly and manage patient surges by directing ambulances and physician referrals to hospitals with capacity.
In Houston, executives at Memorial-Hermann have instituted a mandatory flu policy where all of the system's 21,000 employees at 12 hospitals are required to get a flu vaccine, said James Campbell, a spokesman with the health care system. If employees decline to get the vaccine for religious or other reasons, they're required to wear a mask during work hours.
The CDC says it's too early to estimate how many billions of dollars this year's flu will cost the U.S. economy.
The most recent CDC study , published in 2007 and based on a 2003 population, put the direct medical cost at an average of $10.4 billion and projected lost earnings at $16.3 billion. The total estimated economic burden, including the lost lifetime earnings of people who die from the flu, hit $87 billion, the study said.
At $87 billion, it was 0.79% of the USA's 2003 gross domestic product, the study says.
Since then, many more people are being vaccinated each year against the flu, which could reduce the economic impact, CDC health economist Martin Meltzer says.
Another CDC study, published last year, found that parents of flu-stricken children younger than 5 had medical expenses ranging from less than $300 to about $4,000, and missed 11 to 73 hours of work, depending on whether their child was hospitalized. Those estimates were based on 2009 costs.
Many colleges offered flu shots for students in the fall and encouraged students to get vaccinated on campus or at home. Now university officials are bracing for students to return from winter break.
Alfred University in New York issued a health alert Thursday encouraging students to get a flu vaccine before returning to campus. Meredith College in Raleigh, N.C., where classes started Wednesday is setting aside space in campus housing for students who may need to recover.
Campuses are particularly susceptible to flu outbreaks, says Dr. James Turner, executive director of the Department of Student Health at the University of Virginia and founder of the College Health Surveillance Network, which tracks student health concerns on 21 campuses.
"Our students live together in relatively crowded conditions, they eat together, they learn together in large classrooms, and they tend to socialize in large groups, and all of these facilitate the spread of germs," Turner says.
Many schools routinely offer free flu shots in the fall, Turner said, and some are planning to give more. The University of California-Riverside has ordered more than 11,000 shots and as of Wednesday had just 140 left, said chief physician Kenneth Han. Classes started this week. "We're still trying to gear up for it," Han said. "It's coming."
But UC-Riverside senior Michael Baker, 22, says he hasn't had the flu in six years and won't be getting a flu shot this season. "I haven't met anyone who is sick," he said.