As the flu sweeps the USA, offices and classrooms face empty chairs while hospital emergency departments confront overflow crowds.
By Thursday, there were six deaths reported in Illinois and 18 deaths reported in Massachusetts and 41 states reported high levels of illness.
Hardest hit: The East, South and mid-West, said Michael Jhung, with the Center for Disease Control and Prevention's influenza division. The West, Southwest and some parts of Maine and Wisconsin have had very little flu so far.
That's small consolation to the miserable. For those who do fall ill, the flu is a stomach- churning, head-burning, cough-wracked, muscle-aching experience. It's particularly dangerous for the elderly, young children and people who already have compromised immunity because of other illnesses or chronic conditions such as diabetes or cancer.
The 2013 season is particularly wretched because one of the major strains in this year's flu mix hasn't been seen for five to nine years and people's antibodies for it have waned, said Arnold Monto, a professor of epidemiology and member of the Infectious Diseases Society of America's Influenza Advisory Group, which works with CDC.
Currently there are three types of flu circulating in the United States, H3N2, H1N1 and Influenza B, with H3N2 being by far the most common and most lively to "put more people in the hospital with complications.. All three are included in this year's flu vaccine.
However for those who haven't been vaccinated, the chances are they don't have antibodies for H3N2. It's been nine years, since the 2002-2003 flu season, that H3N2 was in high circulation in the country. That season about 95% of the flu was made up of H3N2. In 2007-2008 it was 75%, said CDC's Jhung. Since then other strains have been more common, so resistance to the strain has ebbed. The virus has also mutated.
"Flu viruses change all the time, they change in big ways which gives them a different H and N designation and they change in small ways. So last year's H3N2 can be a little bit different from this year's H3N2 virus. If you've been exposed to a similar virus you'll have some protection, but not full protection," said Jhung.
Boston had declared a public health emergency with more than 700 cases of flu -- "the worst season we've seen since 2009" according to Boston Mayor Thomas Menino. The city plans a free vaccination campaign this weekend in an effort to slow the virus spread. The major also pleaded with people, "If you're sick, please stay home from work or school."
Each year, vaccine manufacturers make an educated guess about the strains of flu likely to circulate worldwide. This year, the Centers for Disease Control and Prevention says the match is about 90%. CDC Director Tom Frieden says even if the vaccine is not perfect, "it is, by far, the best tool we have to prevent influenza, which remains a serious and potentially fatal disease."
Massachusetts General Hospital, Boston's largest, is seeing between 40 and 80 patients with flulike illnesses daily in its clinics and emergency department -- an "extraordinary number," said chief nurse Jeanette Ives Erickson .
And at Boston's Beth Israel Deaconess Medical Center. Jim Heffernan, chief of primary care faced an overflowing emergency room without "enough places to put people. It just snowballs." Their hospital hotline rang ceaselessly and Beth Israel spokeswoman spokeswoman Kelly Lawman, "We had to open a new unit to accommodate all the patients."
This can take creativity -- and the ability to retain lessons of past flu epidemics.
The emergency room at the Ohio State University's Wexner Medical Center in Columbus developed a fast-track system to move college students with the flu quickly through the emergency room to keep beds free for more vulnerable patients and directing others to urgent care centers and their family physicians. "It's tough when the hospital is totally full and there's nowhere to put patients," says Mark Moseley, Wexner's assistant chief operating officer Wexner Medical Center. "For good or ill, society perceives the emergency room as the place to go when you have a cold or the flu."
In Cleveland, a flu task force meets for 20 minutes every morning to handle the flu crisis at the University Hospitals Case Medical Center. "This is a really extreme challenge to the system," says Michael Anderson, chief medical officer at University Hospitals, who leads the 20-person meeting with doctors from regional hospitals, nursing directors, pharmacists, ambulance supervisors and others.
The medical system's senior leaders discuss hospital bed capacity, the health of its staff, where to shift patients in the regional hospital system and supplies of crucial items such as Tamiflu and face masks. Thursday morning, the task force decided to limit patient visitation, keeping away from the hospital any visitors who have flu-like symptons, Anderson says. Computer systems report a census of hospital beds hourly and manages patient surges by directing ambulances and physician referrals to hospitals with capacity.
Around the country, the challenges mount:
-- Rhode Island's health director Michael Fine said the state has had 380 flu hospitalizations so far this season compared to 90 for all of flu season last winter. But only 40% of the state had been vaccinated so far., Fine said, and he urged people to step up and take care of this quickly.
-- At many Milwaukee area hospitals, emergency rooms were so overwhelmed with high demand on Wednesday that five to eight of the county's 11 hospitals were forced to temporary, periodic shutdowns of emergency departments except for life-threatening cases.
-- In Springfield, Ore., more than one in four of the 138 residents and 57 on staff at an assisted living facility reported flu symptoms, and 13 of people were hospitalized, Lane County chief health officer Dr. Patrick Luedtke told CDC. Jessica Knox executive director at Emeritus at Springfield - The Briarwood to the The Register-Guard newspaper that their on-site clinic had offered vaccines to residents but many had elected not to get a flu shot.
-- Springfield, Mo., has seen 500 cases in the past five weeks. That's more than double the rate of sickness they saw during last year's flu season when there were 500 cases in 12 weeks, according to Mike Brothers, spokesman for the Springfield-Greene County Health Department.
-- In Chicago, Northwestern Memorial Hospital was one of eight hospitals that put out word they could not accept ambulances because their emergency rooms were inundated with flu patients and operating at capacity, said Rahul Khare, an emergency physician. Normally, no more than two hospitals in the area night be in that condition, he said.
-- In Salisbury Township, Pa., Lehigh Valley Hospital-Cedar Crest normally admits 10 to 20 patients with influenza-like illness in a week at this time of year. After admitting more than 100 from Dec. 31 to Jan. 4, the hospital erected a tent.
At the surge tent, as it is called, flu patients who are not sick enough to be admitted can be treated more efficiently and quickly, said Terry Burger, a nurse who is director of infection control for the hospital's parent, the Lehigh Valley Health Network. "People with a milder illness ... can be seen in a surge tent relatively quickly and then discharged."
The CDC says it's too early to estimate how many billions of dollars this year's flu will cost the U.S. economy.
The most recent CDC study , published in 2007 and based on a 2003 population, put the direct medical cost at an average of $10.4 billion and projected lost earnings at $16.3 billion. The total estimated economic burden, when including the lost lifetime earnings of people who die from the flu, hit $87 billion, the study said.
However, even at $87 billion, it was 0.79% of the USA's 2003 GDP, the study says.
Since then, many more people are being vaccinated each year against the flu, which could reduce the economic impact, says CDC health economist Martin Meltzer.
Another CDC study, published last year, found that parents of flu-stricken children under age five had medical expenses ranging from under $300 to about $4,000, and missed between 11 and 73 hours of work, depending on whether their child was hospitalized. Those estimates were based on 2009 costs.
WHAT TO DO:
-- If you feel sick, stay home. Don't go back to work or school until 24 hours without a fever. Consider wearing a face mask if you must go out.
-- If you're fine, but still didn't get a flu shot, get vaccinated now. The Centers for Disease Control and Prevention influenza experts say a shot now could ward off the flu, make a case of it less severe, and minimize the likelihood of spreading the virus to others. Call ahead to your provider to be sure they have supply in stock.
--Wash your hands often, particularly after you've been in public places. This sharply decrease the chances you'll get the flu from those around you.