Untreated Swine Flu (H1N1) in Drug Rehabilitation Facility Due to Lack of Immunization Program

This virology case involves a woman who was admitted to a drug rehabilitation facility and developed flu-like symptoms that went unnoticed for a prolonged period of time. The patient complained of unrelenting fever and extreme fatigue and pain mimicking symptoms close to that of H1N1, which was prevalent at the time of the case. The patient’s condition went unaddressed until her condition deteriorated to the extent that she became severely cyanotic and oxygen saturation was between 70-75%. The patient was so poorly managed that once the doctor on call at the facility was finally notified the condition had reached the critical point requiring mechanical ventilation.

Question(s) For Expert Witness

1. Did the patient show signs of swine flu?

2. Considering H1N1 alerts were issued at that time, should the treatment center have taken active steps to prevent the infection?

Expert Witness Response E-000626

The symptoms of 2009 H1N1 flu virus in people include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, and fatigue. Some people may have vomiting and diarrhea. People may be infected with the flu, including 2009 H1N1 and have respiratory symptoms without a fever. Severe illnesses and deaths have occurred as a result of illness associated with this virus. Pneumonia was one of the prevalent causes of death especially in adults older than 65, those with COPD or asthma or other chronic conditions such as congestive heart failure. The year this occurred affects what the facility should have been doing. 2009 - 2010 were certainly years when broad spread immunization was recommended. Patients in a drug rehab center often have suppressed immune systems secondary to malnutrition as well as high rates of hep C. They should have had an immunization program in place as this is a high-risk population.