Take Anti-Flu Drugs Only After Diagnosis, Military Doc Says

By Fred W. Baker III
American Forces Press Service

May 1, 2009 - Senior military health officials are warning against taking antiviral medicines to fight the H1N1 flu virus until a doctor has confirmed the diagnosis. Most patients treated at military medical treatment facilities for flu-like symptoms don't actually have the H1N1 or any other kind of flu virus, officials said.

"Everything that looks like flu is not flu. Most of the cases where people think they have the flu, they actually have some other respiratory disease," said Army Lt. Col. (Dr.) Wayne Hachey, director of preventive medicine for the Defense Department's health affairs office.

Taking the flu medicine without having the virus causes several problems, Hachey said. First, the medicine will have no effect on what actually ails the patient, so the symptoms may only get worse.

The antiviral medicine does not act like a flu vaccine to prevent the flu. Taking the antiviral medicine before diagnosis negates the drug's ability to later fight the virus if the patient is infected, Hachey explained, and it simply depletes the national stockpile available to those actually diagnosed with the H1N1 virus.

Finally, Hachey warned that all drugs have potential side effects. "Taking a medication that you don't need subjects you to increased risks," he said.

Military treatment facilities are not prescribing antiviral drugs such as Tamiflu unless they suspect the H1N1 virus. Tests done locally cannot determine conclusively that a patient has the virus, but Hachey said they are fairly accurate at pinpointing it.

Military doctors send their suspected samples to the Centers for Disease Control and Prevention in Atlanta to confirm the diagnosis. In the meantime, if doctors suspect the virus based on local tests, they take the necessary precautions with the patient and prescribe treatment, Hachey said.

In the next few weeks, military doctors should be able to conduct the tests locally, Hachey said. In the meantime, the Defense Department has a robust system of detection across the globe to protect its servicemembers and families, he added.

Defense Department health officials are "pretty familiar with being able to control and limit the impact of those kinds of diseases, especially influenza," he said. The department has been preparing for a pandemic for the past decade, and has been ramping up its abilities to detect and provide services for the past five years, he noted. A robust surveillance system of 200 sites in 100 countries is tied into a network that reports on patients' symptoms. If several patients in the same region report similar symptoms, the system shows a spike in that area.

Doctors are tied into the system locally, and senior commanders at the Pentagon can view the results globally in near-real time.

"We really do have a nice global perspective using a multitude of different surveillance assets across the [Defense Department] community that all channel into one site," Hachey said. "That way we can shift resources, we can do further investigations, and ... we can also tell someone in a particular area [they may] have a problem."

All the information is shared with the CDC and other state and federal agencies, he said.

The Defense Department is not an island, the doctor noted. "We're part of the national community, so what happens on one part of the fence really impacts what happens on the other side of the fence," he said. "So the more we share information, the better off both of us are."

But for now, military doctors are reporting that the H1N1 virus is relatively mild and is not having much of an impact on the young, healthy troops who make up most of the military. They are, however, urging caution for those who feel they are showing symptoms, and pushing preventive measures to prevent the disease.

"The most important thing right now ... is if you're sick, stay home," Hachey said. "Right now it's a mild disease, so staying at home is a very effective treatment."

The most critical preventive measures include washing hands and covering your mouth when you cough, the same as with any flu, said U.S. Public Health Service Rear Adm. Thomas J. McGinnis, chief of pharmaceutical operations for the Tricare Management Activity.

"From what we see right now, it's not much different than the regular seasonal flu," McGinnis said. "It has a possibility of becoming a pandemic, or it may mediate. We don't know yet."

Most will know the difference between the symptoms of the common cold and the flu, McGinnis said.

"The flu really debilitates you. It knocks you down. And only at that point do we recommend you go to the doctor and seek treatment for the flu," he said. "When you have aches and pains all over, fever, chills, cough, that's when you need to be seen by a provider."