Cautious Doctors Use Telemedicine to Diagnose Flu

— -- Some doctors in Tennessee are asking patients with flu-like symptoms not to come into their offices to avoid spreading the virus to other patients in their waiting room.

Instead, these doctors are evaluating patients over the phone or on computers as part of something called "telemedicine."

"If you're really feeling crummy and you have the symptoms of influenza, your chances of having influenza are very, very high -- over 90 percent," Dr. William Schaffner, chair of preventive medicine at Vanderbilt University Medical Center in Nashville, Tennessee. "Doctors are saying I don't need to do a test because sometimes the test is negative even if you have influenza."

Although the rapid influenza test is effective at determining whether children have the virus (as opposed to some kind of bacterial infection), it's wrong 25 percent of the time in adults because their bodies don't produce as much of the virus when they're sick. Children, on the other hand, have weaker immune systems and become little flu distributors even before they start to feel sick. As a result, they have very high viral loads.

So Schaffner said many doctors will discuss symptoms over the phone and prescribe an antiviral medication. But they ask that sick patients have a family member pick it up at the pharmacy.

He said this approach is cost effective because patients avoid the cost of the test and the doctors visit. And they don't spread the virus to other people by coming to the doctors office. The influenza virus is highly infectious and can be spread to people within 3 feet of a sick patient when that patient coughs, sneezes or talks, he said.

The Centers for Disease Control and Prevention declared a flu epidemic this week with 22 state reporting high amounts of "influenza-like activity."

Tennessee has seen epidemic levels for two weeks, and three children have already died, Schaffner said, adding that one child was 8 months old and the other was 11 years old.

Although children die from the flu every year across the nation, Schaffner said "even one is something that we are distressed about."

"Each of those is a tragedy" he said. "Three is a large number in our state."

He said in years like this when flu activity is high and one of the strains is H3N2, it's bound to be fatal in both children and adults with underlying medical conditions.

It's not too late to get a flu shot, which though not perfect can still be effective against the B strain, which tends to crop up in late January and February.

"If you haven't been vaccinated, go ahead and do it," Schaffner said. "And then on Jan. 1, make a new year's resolution that when this fall comes around in September, October 2015 be sure to get vaccinated. Go to the front of the line and get vaccinated.