A cancer nurse at Mercy San Juan Medical Center in Carmichael has died of the H1N1 flu, becoming the first reported health care worker in California killed by the new variant of swine flu.
"We’re very concerned that a nurse died," said Jill Furillo of the California Nurses Association, adding that the death underscores the need for strong infection controls to protect nurses and patients.
Mercy San Juan does not know whether the nurse caught the flu on the job or elsewhere, but it has notified all patients who came in contact with her when she might have been infectious, said hospital spokesman Bryan Gardner.
Karen Ann Hays died July 17 of a severe respiratory infection, pneumonia and H1N1, according to her death certificate. She also had methicillin-resistant Staphylococcus aureus, a staph infection that is resistant to many antibiotics.
Hays, 51, was a triathlete, skydiver and marathon runner – and a mom who could listen for hours to minute details of video games that any other adult would tune out, said her 19-year-old son Ian Hays.
"She’d listen to everything," he said. "She basically spent her whole life giving to other people."
Her partner, Dorel Borlovan, believes she probably caught the flu on the job, partly because she was there so much and partly because he was with her the rest of the time, but never became ill.
"Everybody thinks she got it from work," he said.
He described Hays as fit and athletic and said they went regularly to the Sierra to run, cycle and fish. She usually outran him, he said.
It’s not surprising for an otherwise healthy person to die of H1N1, said Dr. Glennah Trochet, Sacramento County’s public health officer.
"Nationwide all along there have been people who have died who did not have underlying medical conditions" such as obesity or pregnancy, she said. "When a disease is common enough and circulates enough, you will see all kinds of deaths."
Since the state began keeping track, the H1N1 flu has killed 80 Californians and hospitalized 699, according to figures updated Thursday on the state Department of Public Health Web site.
The state collects data on health care workers with H1N1, and this is the first reported death, said department spokesman Ken August.
Doctors are still watching and waiting to learn whether the new flu, which combines elements of viruses that infect pigs, birds and humans, will be more dangerous than common seasonal flu infections that kill about 36,000 Americans a year.
"Influenza, when combined with pneumonia, is the fifth or sixth most common cause of death in the United States every year," said Dr. Stuart Cohen, an infectious disease expert at UC Davis School of Medicine. "You don’t want to make this into a panic situation."
At the same time, he said, this flu has a disturbing twist. Even though most people with H1N1 don’t get very sick, the three deaths he has seen were troubling, progressing rapidly from minor symptoms to "total respiratory compromise" within a day.
"I have a healthy respect for this virus," Cohen said. "I graduated from medical school 30 years ago, I’m not a rookie, and these people looked a lot different from the standard flu patients we see who have died."
In Sacramento County, which like the state updates swine flu numbers every Thursday on its Web site, 50 people have been hospitalized with H1N1 so far. Five have died.
In an average year, influenza kills one to three people in Sacramento County, Trochet said.
Because the numbers are so small, and because H1N1 has been tracked more rigorously than standard flu, it’s not clear whether five deaths so far means this flu will be worse, she said.
"It might be normal statistical fluctuation," Trochet said, "and our surveillance for this virus has been much more intense."
Right now, Trochet said, there are no reported clusters of H1N1 in Sacramento County. But the county, like the state and the federal governments, recently abandoned efforts to report all diagnosed cases.
Instead, health agencies have gone back to flu surveillance programs designed to capture a representative sample of cases, along with more extensive reporting of hospitalizations and deaths.
That makes it easier to miss small flurries of illness, such as one that appears to be plaguing the UC Davis Cancer Center.
An unusual number of nurses, nursing aides and clerical staff are out with flulike symptoms, but services have not been curtailed and "to the best of our knowledge, we haven’t had transmission on site," Cohen said.
For nurses, small outbreaks at several hospitals have spurred calls for more masks, more sessions with those trained in how to fit the masks properly, better isolation of contagious patients and better sick leave policies.
"The public should be concerned," said Jan Rodolfo of the California Nurses Association. "When caregivers aren’t protected adequately, they can be a source of infection," and when people do get sick, they need healthy nurses.
While at first hospitals were very worried about containing H1N1, vigilance slacked off as it became obvious most cases of the flu were not severe, said Jill Furillo of the nurses association. That is starting to change, she added.
"In recent weeks there has been a growing concern because nurses are caring for more and more patients who have H1N1," some with "very severe symptoms," she said.
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