Heading to the doctor with flu-like symptoms? You just might be able to get that Tamiflu prescription without enduring the sneeze-provoking flu test.
As supplies of the tests become more difficult to get, some doctors in central Ohio are forgoing the procedure, which involves collecting nasal discharge by inserting a cotton swab in the nose.
At OhioHealth, a huge jump in flu-test requests prompted lab and infectious-disease doctors to advise physicians to treat patients who have flu symptoms without running the test. That way, the tests are reserved for the sickest patients.
"We were beginning actually to run short on the tests," said Dr. Susan Fuhrman, director of clinical laboratories for the health system. "We were doing 1,800 tests a week."
She and Dr. Joseph Gastaldo, an infectious-disease physician, decided to put out the alert, which pops up on the computer whenever a doctor orders a flu test. The advisory to go ahead and treat patients, based on a recommendation from the federal Centers for Disease Control and Prevention, reduced the number of flu tests requested by one-third, Fuhrman said.
"This flu season is unusual in that it's not that there are pockets of flu here and there," she said. "There's flu everywhere, so that the demand for that test had gone up pretty dramatically, and the manufacturer is having problems keeping up."
The CDC has called this flu season the worst in nearly a decade; hospitalization numbers as of Feb. 3 were the highest ever seen at that point in the season. Sixty-three children had died as of that date.
The number of suspected flu cases at doctors' offices and hospitals in that week matched that seen in 2009, when a new swine-flu epidemic swept the country and panicked many people. However, CDC officials have not labeled the current flu season a pandemic.
Across Ohio, flu remains widespread, and 9,738 people had been hospitalized due to the virus from the beginning of October to Feb. 3, according to Ohio Department of Health data. Three children in Ohio have died.
The OhioHealth lab has been receiving 30 percent to 40 percent more flu tests this season than last. As of the end of January, 28 percent of the tests had come back positive, compared with 13 percent a year earlier.
Mount Carmel Health System is managing a significant shortage of flu tests, said Amy Bland, director of lab operations at St. Ann's hospital in Westerville.
She said the lab is recommending that tests be reserved for patients who are being considered for hospital admission. Other patients are being treated based on their symptoms.
At Mount Carmel's East and St. Ann's locations, the 2,169 flu tests run in January were more than three times the 672 in January 2017. Twenty-nine percent returned positive at each location. At St. Ann's, that compares with 14 percent a year ago; last year's rate at East was unavailable.
Mount Carmel West hospital already has run 1,247 flu tests this season, compared with 1,451 during the entire previous season. Twenty-five percent have returned positive, compared with 15 percent a year ago.
At Ohio State University Wexner Medical Center, labs have not had to move to a prioritization strategy, but they have had to look to additional vendors for supplies. They've also limited the number of tests being sent to outside hospitals in need, said Dr. JoAnna Williams, medical director of the clinical laboratories.
She said the number of tests in the system is 180 percent higher than last year at this time. That includes tests sent to outpatient sites; some of those tests are not processed in the central lab.
The central lab, handling inpatient and emergency department tests plus a limited number of outpatient requests, has run about 6,000 this season, compared with about 4,000 a year ago. There has been an almost five-fold increase in the number of tests returning positive this flu season.
For outpatient sites running out of tests, Williams said, she advises doctors to treat based on symptoms. She said priority should be placed on higher-risk patients, including the elderly, the young, people with compromised immune systems and those who are otherwise unhealthy.
Health officials continue to recommend the flu shot to prevent the flu. Although this year's vaccine is a mismatch with the H3N2 strain that has been the most widely detected virus, Gastaldo said that flu patients who have had the shot have experienced less-severe symptoms. He said different strains also might begin circulating in the weeks to come.
Gastaldo noted that the flu can lead to an increased risk of a heart attack or stroke, so the vaccine is especially important for smokers, diabetics and people who have had a heart attack or stroke or have lung disease. He also encourages pregnant women to get the shot, which will lead to their babies being born with protective antibodies.
Other ways to prevent the flu include washing hands, using hand sanitizer, covering sneezes and staying home if sick.