# 3781
Unlike the UK, where just about everyone who gets the flu this season has been given the drug Tamiflu, the decision has been made here in the US to restrict the use of antivirals. Tamiflu, like any drug, has the potential for adverse side effects.
And there is always the worry of overuse leading to antiviral resistance.
Accordingly, those who are hospitalized with severe symptoms, and those who have `risk factors’ such as pregnancy or other high risk medical conditions, are recommended to get the drug.
But the CDC believes that most people would not benefit from taking the antiviral.
As stated by Dr. Anne Schuchat in a CDC briefing on September 8th, `the vast majority of us that have an influenza-like illness don't need the antiviral medicine.’
And no doubt, that is true. For 99 out of 100 flu victims, recovery is uneventful even without antivirals.
But for that 1 case in 100, the timely administration of antivirals could prove life saving. And we don’t have a really good way to indentify who those rare individuals might be.
Antivirals work best if given early in the course of an infection, but as we’ve seen, it is often 3 to 5 days into the infection when these patients really begin to deteriorate and the need for treatment becomes obvious.
By the time they show up at the hospital, antivirals are of limited use.
And so we end up with tragic stories, such as this one out of Fort Worth, Texas (hat tip Crof on Crofsblog).
FW girl not given Tamiflu, dies with flu
03:52 AM CDT on Tuesday, September 29, 2009
By CHRIS HAWES / WFAA-TV
FORT WORTH - Five days ago, Fort Worth eight grader Chloe Lindsey came down with a fever. She was diagnosed with the flu Friday and died Sunday.
The 14 year old didn't get Tamiflu at her doctor's visit because she wasn't considered high risk.
Chloe's mother, Tammy Osborne, said it all happened so fast.
She said she did everything medical professionals told her to do and can't understand how a touch of a fever turned so deadly in just a few days.
This is a heart wrenching story (particularly viewing the video on the website), and I couldn’t help but think about my 4 teenage grandnieces as I watched it. My heart goes out to the family.
We don’t know, of course, whether the early administration of antivirals would have made a difference in this case.
But it might have.
The catch-22 for those influenza victims without pre-existing medical conditions is they don’t generally qualify for Tamiflu under the CDC’s guidelines.
Unfortunately, to be effective, antivirals must be started in the first 24-48 hours of the illness . . . and most people don’t begin to show signs of actually needing the medication until much later into their illness.
Catch-22
From a `population’ standpoint, the CDC’s recommendations make sense. The alternative is to give the drug to 99 people out of 100 who don’t really need it.
And that involves risks as well.
But inherent in our policy is the knowledge that some people who might benefit from the drug are not going to get it when they really need it.
I wish I had a better answer here.
One that would ensure that this sort of tragedy never happen, while protecting the greater population from unwanted drug side effects or worse, a resistant mutation of the virus.
But I don’t.
Which means we are likely to see many more stories like this one over this fall and winter, simply because there are no perfect solutions for dealing with a pandemic.
