Healthy Choices

February 3, 2014

Hospitalized flu patients rise to 91 in Sacramento County; death toll at 21 under age 65

Sacramento County’s hospitals are caring for 91 area flu patients whose symptoms are severe enough to land them in intensive care units. Researchers say H1N1 makes the body’s immune system turn on itself, flooding lungs with fluid.

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When Sacramento County public health officer Dr. Olivia Kasirye visited News10 studios last week at the invitation of co-workers concerned about a colleague’s sudden death from the flu, she was hit by a barrage of questions:

“What is this flu?”

“Why is it acting so differently?”

“Why does it take the life of someone so young and healthy?”

Kasirye could see the crew was not only anxious about getting the flu themselves, but they were grieving. And, to some extent, so too was the community. Word had spread quickly through social media about the death of Nancy Pinnella, 47, an otherwise healthy News10 ad executive who recently succumbed to the flu. Even California’s first lady, Anne Gust Brown, tweeted that she was so moved by Pinnella’s story, she went to get her first flu shot ever.

Since then, things have gotten worse. Three more people have died in Sacramento County, bringing the flu fatality count of those under 65 years old to 21. That compares to 16 dead (under 65) in the county last season, and there are several weeks yet to go in the current flu season, which may extend through March, Kasirye said. State law does not require hospitals to report deaths of residents 65 and up, but county officials confirmed that two in that age group also had died.

At area hospitals, another 91 people under the age of 65 are battling the virus in intensive care units – a far greater number than during any other week this season. Typically, doctors treat those with flu-like symptoms with anti-viral medications such as Tamiflu, the sooner the better.

In fact, the flu has hit the entire country so hard that saline solutions are in short supply due to H1N1 hospitalizations, health experts say. Nationally, the Centers for Disease Control and Prevention said flu and pneumonia cases are running “above the epidemic threshold.”

In H1N1, the country is confronting a particularly virulent strain of influenza. Once in the lungs, it replicates more quickly than other strains, triggering the body’s immune system. The immune system then overreacts to the force of the virus. A phenomenon called a “cytokine storm” kicks in. Cytokines are proteins that promote inflammation in response to infection.

Normally, cytokines help the body by flushing out fluids from blood and lymphatic vessels. But, Kasirye said, “When the vessels are inflamed, they start to leak fluid, and so people get more fluid in their lungs. It creates a perfect storm. The immune system reacting to the virus goes haywire and attacks the body.”

Researchers in 2007 found the same pattern while studying the H1N1 virus that was circulating in 1918, when a notorious pandemic sickened 115,000 California residents.

The journal Nature reported, “A virus recovered from victims of the 1918 influenza pandemic kills by replicating so rapidly that it revs the immune system into overdrive, turning the body against itself.” Historical accounts from the era describe victims drowning from within as their lungs filled with blood and fluid. Autopsy records described victims as “having lungs that resembled sodden sponges,” the journal article said.

The same cytokine-storm effect was discovered in fatal H1N1 cases from 2009. Scientists reported in the American Journal of Pathology that “peak levels of virus in the victims’ lungs correlated with ‘remarkably’ high levels of certain cytokines in the same tissues.”

Kasirye said some who died so far from H1N1 did not have underlying medical conditions, and were both relatively young and healthy – a demographic hit hard by this year’s H1N1, the same influenza A strain that wreaked havoc during the 2009 worldwide pandemic. Health experts suggested that one reason residents 65 and up may not have been as affected by the flu this year is that they had built up immunity from years of faithfully getting their flu shots.

After Pinnella’s death, her family said she had made a point of not getting a vaccine, and they shared the same philosophy. But in reaction to their loss, they changed viewpoints and all got flu shots, urging friends, co-workers and the public to follow suit.

One of Pinnella’s brothers, John Pinnella, told The Sacramento Bee, “The problem was, in our minds, we weren’t little kids and we weren’t 65 years old,” referring to groups thought to be the most vulnerable. The Pinnellas were taken aback by how quickly Nancy Pinnella deteriorated.

She went home sick from work one day, was hospitalized in intensive care the next day and within three days, suffered three strokes and died. “It just hit all of a sudden,” John Pinnella said. “Within 12 hours, she was really, really sick” with doctors saying she was in bad shape.

Of the 21 people the county confirmed dead from the flu so far, 12 were women and nine were men. Three of those deaths were between the ages of 30 and 39; five were between 40 and 49; and 13 between 50 and 64.

The 91 people who had been admitted to the intensive care units include 13 patients ages 0 to 19; five people ages 20 to 29; 12 patients from 30 to 39; 19 people from 40 to 49; and 42 people from age 50 to 64.

“We are concerned that young and healthy individuals are not getting vaccinated, because their demographic group is not typically severely impacted by influenza,” said Kasirye. “What is different with H1N1, compared to the other strains, is that we are seeing severe disease in young and healthy people.”

To honor their colleague, News10 executives will host a free flu clinic on Thursday at noon at a voter registration office, 7000 65th St. in Sacramento.

In the meantime, Kaiser Permanente is holding a free flu vaccination clinic today from 3 p.m. to 5 p.m. at Kaiser Permanente Point West Medical Offices, 1650 Response Road in Sacramento. The location is across Exposition Boulevard from Cal Expo. Kings basketball point guard Isaiah Thomas will make an appearance. Non-members and members alike are welcome.

Wednesday, the Yolo County Health Department is offering a free flu vaccine clinic from 4 p.m. to 8 p.m. at West Sacramento City Hall, 1110 W. Capitol Ave.

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