The nation's public health system, typically swamped during the cold and flu season, is bracing for an influx of jittery patients who have influenza-like symptoms but want to be tested for anthrax.
Though Illinois has no reported incidents of anthrax exposure, health officials are expecting increased anxiety when the flu season starts in November and peaks in January, because the initial symptoms of inhalation anthrax mimic the aches, sniffles, chills, fever, cough and fatigue of the influenza virus.
Even as the number of anthrax cases remains small, daily developments are only feeding the anxiety. Postmaster General John Potter said Wednesday that he could not guarantee the safety of the mail, and the FBI acknowledged that despite its massive investigation, it cannot say who is behind the anthrax attacks.
Just as the false alarms over "suspicious white powder" are declining, hospitals worry that the flu season could stir up new fears.
"There's a tremendous use, overuse and abuse of emergency rooms during the flu season in general, and this season, with the concern about the flu meaning something more deadly, we may see even more inappropriate use of ERs," said Dr. Richard Levinson, executive director of the American Public Health Association. "They're already partially overwhelmed. Now they could be absolutely overwhelmed."
Even doctors have trouble clinically differentiating flu from anthrax in its initial stages.
Over the weekend, a Washington postal worker was sent home from a hospital after doctors told him he had the flu. Joseph P. Curseen, 47, died Monday of anthrax inhalation, illustrating the tremendous difficulty--and importance--of distinguishing between the inhaled form of anthrax and the flu.
"Early on, it may be impossible to tell the difference between the [flu and anthrax], especially since none of us have seen a case of inhalation anthrax before," said Tina Stosor, an infectious disease specialist at Northwestern University Medical School. "Our big concern is that we'll be so worried about anthrax we'll miss people who have pneumonia or influenza."
In part to ease the anxiety, health officials are pushing flu vaccinations more than ever, especially for people over 65 and those with weak immune systems. However, because of delays in vaccine distribution, healthy people are urged to wait until November when supplies should be more plentiful. Illinois will have 60 percent of its projected vaccine supply by the end of October and will get another 30 percent in November, according to the Illinois Department of Public Health.
"People should do what they did last year," said Public Health Director Dr. John Lumpkin. "If they're so sick they can't keep down fluids, they have a high, persistent fever or cough and they bring up blood or something green, that would indicate the fluid getting worse and going for medical treatment would make sense.
"The aches, the chills, the fever, cough, sore throat, and other non-specific symptoms could be the flu, a cold virus, or any number of things."
Educating hospital staff
Most area hospitals are educating their staffs--from primary care doctors to emergency room personnel--about the signs and symptoms of bioterrorism, including the three forms of anthrax, inhalation (breathing), cutaneous (skin) and intestinal (eating). The hospitals of Evanston Northwestern Healthcare system and many other facilities are following treatment guidelines issued by the Illinois Department of Health and the U.S. Centers for Disease Control and Prevention, which advise not to test for anthrax unless there is a documented exposure.
Some primary care doctors and emergency rooms are prepared to take more cultures and rapid diagnostic tests for influenza.
Still, despite the look-alike symptoms, most people will be treated as if they have the influenza virus, unless there is a clear indication that they could have been exposed to anthrax, according to health officials. A person's background, history and environmental factors will be key pieces of information for doctors.
"It would be inordinately cumbersome, expensive and unnecessary to put every person with viral symptoms through an anthrax work-up," said Ronald Hershow, associate professor of epidemiology at the University of Illinois at Chicago. "It's a more difficult question in a city with isolated episodes. It's incumbent on anyone evaluating flu symptoms to inquire about an epidemiology linkage to a high-risk setting. But it's obviously a very dynamic situation."
Flu more deadly
Unlike the common cold, influenza, a respiratory illness caused by three types of viruses, can lead to serious medical complications, such as pneumonia. Patients develop a rapid onset of muscle aches, fever and cough, and in most cases, retreat to bed in a few hours.
During an average year, 10 to 20 percent of the population is infected with the influenza virus, and about 20,000 people die from flu's complications, making it much more deadly than anthrax.