Seasonal Cold or Swine Flu? Moms Face Tough Calls

Lack of fever doesn't mean lack of H1N1 infection. In fact, there's no way to tell without testing.


I sent my 11-year-old son to school today with a stuffy nose and mild cough, as I've done countless times in the past. Now, though, I'm wondering whether I should have kept him home. How do I know it's really a garden-variety cold and not the swine flu?

"That's a great question," says Richard Wenzel, a swine flu expert and former president of the Infectious Diseases Society of America. "You really have no way of knowing if it's the flu or just a cold." Given that we're in the middle of an H1N1 epidemic, he estimates that my son's chances of having this flu are considerable, since some of his friends have had confirmed cases—maybe even as high as 50/50. Even though he doesn't have fever? I press. "At the beginning of the outbreak in Mexico, only 30 percent of patients hospitalized with the infection had fever initially," he tells me, "and 15 percent of patients never developed a fever at all." What usually sent them to the hospital was shortness of breath or chest pain. In Chile, he adds, about half of those with confirmed H1N1 had no fever; many just had a headache and runny nose.

To truly contain the spread of this virus, he says, it would have been smart for me to keep my son home from school. While I can work effectively from home, many working parents can't. I wonder if this is why the government isn't recommending that we keep ourselves or our kids home at the first sign of a sniffle. The Centers for Disease Control and Prevention says: "Those with flulike illness should stay home for at least 24 hours after they no longer have a fever, or signs of a fever, without the use of fever-reducing medicines." That implies that hacking coughs and runny noses shouldn't keep us away from others.

"The CDC is stuck. They've defined flu as having a fever, which means they're going to miss a lot of cases," Wenzel says. To be fair, the CDC does list the following as symptoms of H1N1: cough, sore throat, runny or stuffy nose, body aches, headache, chills, fatigue, and, in some people, diarrhea and vomiting. But fever seems to be the determining factor in whether we should isolate ourselves.

Since most doctors aren't testing for H1N1, we must use our own judgment to decide if that mild cold warrants taking sick days and keeping our kids home from school for up to a week. We might be helping prevent the spread of a potentially deadly virus. Then again, it might be pointless if others are going about their usual day coughing and sneezing around others. (Hopefully, they're washing their hands frequently and coughing into their elbows.) After speaking with Wenzel, I might keep my son home tomorrow—especially if his symptoms get worse.

"This flu seems to spread more easily than a cold virus or seasonal flu," says Wenzel, "most likely because so few people have been exposed to it in the past." Kids are slated to be among the first to get the H1N1 vaccine when it becomes available in early October—a nasal spray vaccine called FluMist will the first on the market. But many will probably already have been infected before they can get immunized; Wenzel predicts the outbreak will last another four to eight weeks before tapering off. Unfortunately, that's just around the time when the vaccine will be available in large quantities. It seems that despite the government's best efforts to get the vaccine out quickly, it missed the boat on this one.

Yes, the CDC will still stick with its recommendation to get any children over the age of 6 months vaccinated—and pregnant women too—unless a previous infection was confirmed via a lab test. But Wenzel says parents may decide on their own to pass up the immunization if their child recently had a respiratory infection that appeared to be swine flu. "These kids probably don't need the vaccine," he adds, "but there's a level of uncertainty, and parents may still be wise to choose immunization just to be on the safe side."

While most cases of H1N1 are mild, this virus has the potential to cause severe complications, including death. The CDC says warning signs in children that warrant immediate medical attention include fast breathing or trouble breathing; bluish or gray skin color; not drinking enough fluids; severe or persistent vomiting; not waking up or interacting; a child so irritable that he does not want to be held; and flulike symptoms that improve but then return with fever and a worse cough. Warning signs in adults include difficulty breathing or chest pain, purple or blue discoloration of the lips, vomiting and inability to keep liquids down, and signs of dehydration, such as feeling dizzy when standing or being unable to urinate.