Patient prognosis during pandemic influenza

Patient prognosis during pandemic influenza

One thing that is different about a major pandemic is just how hard it hits patients and how rapidly it kills. Patients affected by the flu can be broadly categorized into 3 prognostic types. The first type has a poor prognosis no matter what is done for them. The second might survive if there was full access to high technology medical care and resources. The third type is highly likely to recover from the flu as long as they are provided with consistent low-technology supportive measures that can be administered in home settings.

Type 1 patients have the poorest prognosis and almost all will die within 2 or 3 days of the development of their first symptoms. The cause of death in these patients during the 1918 flu was massive respiratory failure from overwhelming lung-destroying viral pneumonia. There was no effective treatment for this in 1918, and there is none today despite all the advances in medicine that have occurred over the last 90 years. Signs and symptoms of type 1 patients include rapid onset of severe shortness of breath, cyanosis (bluish discoloration of the skin of the hands, feet, and around the mouth and spreading centrally), or bleeding from the lungs, stomach and rectum.

Type 2 patients are similar to type 1 patients except they do not die after 3 days. Some but not many of these patients would survive if they had access to an ICU, ventilators and expert medical care but if we have a severe pandemic, those resources will not be widely available. Even if they had access to these services, many of them would die anyway. Remember, no matter what you do, they are likely to pass away in a week to 10 days after becoming ill.

Type 3 patients make up the majority of those that become ill with influenza. Fortunately, these patients have a good prognosis if they receive timely and diligent supportive care that can be provided well in a non-medical setting such as the home. Most of these pandemic flu victims will be severely ill and weakened by the infection such that they will be too ill to get out of bed. Many type 3 patients will be completely dependent on others for care. Without simple care, some of these patients will die from preventable causes like dehydration but with simple care, most of these patients will recover. No matter how good the care provided, some type 3 patients will die. This is not your fault. This happens usually because they develop a serious secondary condition that actually becomes the cause of death. Examples of these secondary conditions include bacterial pneumonia, stroke, and heart attack. There is nothing you can do but keep doing the best you can and let nature take its course.