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Cold and flu sufferers could swamp hospitals

Los Angeles City fire department hazardous materials team member washes off another firefighter after the team was dispatched to a false anthrax alarm Wednesday. PHOTO: AP

Worried that people with flu-like symptoms who fear they may have anthrax will flood hospitals and clinics this year, a federal health official said on Wednesday there are some easily recognizable differences between the two diseases that should help doctors allay patients' fears.

"One of the more helpful things to remember is that among the cases of anthrax that have been seen so far, these cases have not presented with rhinitis or runny nose," said Dr. Keiji Fukuda, a medical epidemiologist at the flu branch of the Centers for Disease Control and Prevention (CDC).

"One of the things for physicians to look out for -- if you develop something which feels like a cold, you have a runny nose, this is very likely to be a cold," he added.

Flu kills 20,000 people in a good year and twice as many in a bad one. But they are usually people known to be at high risk of complications, such as people with weakened immune systems, the frail elderly, cancer patients, and children with asthma.

"Particularly in the fall and winter months lots of people go to the hospital anyway for influenza-like illnesses. We recognize that some hospitals in some cities just get inundated with people coming in for respiratory illnesses," Fukuda said.

This year's flu season may bring even more people into the hospital complaining of symptoms they fear could be anthrax. Since early October, four people have died of inhaled anthrax and 12 others have been infected with either the skin or inhaled form of the disease that looks a lot like the flu at first.

Anthrax symptoms include achy muscles, a headache, a dry cough and a feeling of being deeply tired.

The CDC has on its Internet site, at www.cdc.gov, a Web cast tutorial for doctors who want to learn how to diagnose anthrax, as well as a series of fact sheets.

It is important for them to learn, as untreated cases of inhaled anthrax quickly become deadly. The family of one Washington postal worker who died of anthrax says he was at first treated for flu and sent home.

"In some instances it can be difficult to tell the difference between early inhalational anthrax and flu-like symptoms from other causes," Fukuda said.

One way to screen out patients is by where they live. Anthrax cases so far have been limited to New York, New Jersey, the Washington area and southern Florida.

"There has been an awful lot of attention on those cases," Fukuda said. "Anthrax really has not been diagnosed in most of the country whereas we have seen millions of millions of flu cases."

"It's really important to understand that every year there are tens of millions, if not more, people who develop so-called flu like illness."

Not only are these cases very unlikely to be anthrax, they may not be flu, either. Many cases will be colds, adenovirus infections and other viruses.

Earlier this month a few public health experts suggested that people worried about anthrax should get a flu shot, to rule out at least one possibility. But the CDC has been discouraging this idea.

The CDC says 85 million doses of flu vaccine will be available this year but urge the young and healthy to wait until December to be vaccinated so those most at risk can get their shots first.

They urged the elderly, pregnant women and others at risk of flu complications to get the flu vaccine, but stressed the vaccine would not protect against anthrax. Influenza is caused by a virus and anthrax is caused by bacteria.

"The reason to get vaccinated against influenza is to either prevent ... influenza or, if you get influenza, to decrease the severity of the disease," Fukuda said.

"The vaccine ... is not protective against other viruses and it is not protective against anthrax."
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