How to Know When a Child’s Flu Turns Serious
nytimes.com
nytimes.com
But this statement: "fevers that abate only to flare up again after the child seems to be over the worst of the illness" reminded me of something that happened to my son.
When he was 7, he came down with a flu-like illness that lasted a week, and because it was a bad flu season we were told to stay away from the doctor's surgery. After about 4 days of fever and no eating my wife railed against the advice and took him along, only to be fobbed off by her regular doctor who said there was nothing to worry about, he had an ear infection, and prescribed some antibiotics.
So for the next day or two he seemed to improve. Then, on the Sunday, he suddenly faded away again and seemed to lose all interest in getting better. The only thing he complained about was a perpetual pain in his neck. I took him back to the surgery, and because it was a weekend I saw a visiting doctor rather than our regular one. The guy took one look at him and phoned the hospital, told me to get him there urgently.
It transpired he had a very advanced pneumonia, and had to be transferred to a bigger hospital for an operation to remove 1 litre of fluid from his lung. That was what had been causing the neck pain: the sheer weight of the fluid on one side of his chest. After the op, they managed to treat the infection with about the fourth antibiotic they tried (I think there were only a couple left after that, which was scary). Another week later and he went home, and made a full recovery, thankfully.
When questioned, our family doctor very defensively said she had never come across such an advanced case of pneumonia in "someone who could still stand up", and so she had discounted it. This fact seemed to be borne up by the fact that our son was a prize exhibit at the teaching hospital he'd been transferred to, surrounded on a daily basis by medical students listening through stethoscopes and being told "this is what a pleural empyema sounds like in a child - note the lack of the classic rattling noise you associate with pneumonia" ... so maybe our doctor was correct. Anyway, we were just glad to have our son well again and were not interested in lawsuits.
But every time either of our kids gets a fever or anything that seems like the flu now, we play extra close attention and refused to be fobbed off by over-worked doctors.
Fortunately in the age of the Internet and advanced search engines, you actually can be your own diagnostician.
You have to learn to decide when you must have medical attention, and you must not accept dismissiveness from doctors. Yes, you must also not be a hypochondriac -- that will cost you money and crowd out others who need the care. But this is why you must... become good at being your own diagnostician.
This is very much not what doctors want. It's not what the FDA wants. It's not what anyone should want. But the quality of care is so variable, and so dependent on someone noticing in less than the only five minutes they want to spare you, some detail that you have days to notice... that you just have to be your own diagnostician.
Arm yourself with knowledge before you get to the doctor's office or ER.
The doctors I was working under weren’t bad. They were, however, forced to run ragged all day without a break for a shit, allowed no more than a few minutes per patient. They didn’t like it any: they’d openly say “don’t emulate this,” while running to the next room.
The funny thing is, surgeries and pharmaceuticals and medical equipment are expensive. A doctor’s time? If he’s not a top renowned specialist, not much. But people have gotten so used to insurers playing the middleman retailer (buying healthcare services cheaply and reselling them to patients at a premium...), they’ve forgotten they can just -pay for the doctors time-.
It doesn’t require playing amateur medical sleuth. It just requires admitting that a highly skilled worker that had to train for a decade to do the job costs more than 20$.
You just can't know if you are receiving competent service if you have no level of competence on practicing it.
Solving a problem may be a useful guide. Find someone who can complete some specific task reasonably well, and even if you don't know how to do that task yourself, you may be able to make an assessment amongst various practitioners. This is easier to accomplish for simple tasks than hard ones (say: running a 100m sprint, or deadlifting 250 kg), but is the principle at the heart of, say, Jakob Nielsen's usability testing.
The problem is that there are domains in which tasks are complex, the time to determine successful conclusion is long, etc., etc. In this case, you may need to farm out the evaluation process, or look to evaluate institutions rather than individuals (say, in education, or medicine -- and there are reasons that the collective evaluation approach has validity for each, though also for adjusting for student population / case mix). The general problem of audits or programme assessment exhibits this.
My point isn't that assessments are easy, simple, straightforward, or not prone to their own issues. Only that there does exist a possibility in many cases for making valid assessments of service competence without specific competence in the service being assessed.
Ditto, say, accountancy. You have to have a clue.
My firstborn is 2 months old and I'm always afraid of things like this!
We had extreme lethargy and high fever for a couple days, and our threshold was crossed when the vomiting started. The boy walked into the ER with us, collapsed during chest x-rays, and was diagnosed with pneumonia a few minutes later.
Having had the pleasure of dealing with a (different) child experiencing febrile seizures, I'm not sure I'd want to wait for seizing before getting a diagnosis and supportive care. Seizure protocol involved multiple LPs.
I'd love better criteria than "extreme discomfort" and "clammy skin". Persistent high fever is one (but apparently flu can take a turn within 48 hours, so that's out the window). Relapsing fever is a good one. What else are the clear signs?
Appearance:
“TICLS” Tone – the newborn should have a normal flexed tone; the 6 month old baby who sits up and controls her head; the toddler cruises around the room.
Interactiveness – Does the 2 month old have a social smile? Is the toddler interested in what is going on in the room?
Consolability – A child who cannot be consoled at some point by his mother is experiencing a medical emergency until proven otherwise.
Look/gaze – Does the child track or fix his gaze on you, or is there the “1000-yard stare”?
Speech/cry – A vigorously crying baby can be a good sign, when consolable – when the cry is high-pitched, blood-curling, or even a soft whimper, something is wrong.
If the child fails any of the TICLS, then his appearance is abnormal.
Work of Breathing: Children are respiratory creatures – they are hypermetabolic – we need to key in on any respiratory embarrassment.
Look for nasal flaring. Uncover the chest and abdomen and look for retractions. Listen – even without a stethoscope – for abnormal airway sounds like grunting or stridor. Grunting is the child’s last-ditch effort to produce auto-PEEP.
Stridor is a sign of critical upper airway narrowing.
Look for abnormal positioning, like tripodding, or head bobbing
Circulation to skin:
Infants and children are vasospastic – they can change their vascular tone quickly, depending on their volume status or environment.
Without even having to touch the child, you can see signs of pallor, cyanosis, or mottling. If any of these is present, this is an abnormal circulation to the skin.
Failing any one of these is worth a serious doc visit. And, I’ll add one of my own: any infant that works so hard at sucking down milk that it makes them sweat gets a free trip to the ER.
The ER physician took one look at him and admitted him, shocking us by saying he was within hours of death. He spent a couple days being pumped full of antibiotics, and recovered, but it was a close call. The doctors never did figure out just what it was.
All these years later, and it still distresses me.
How were you supposed to know a tiered guy was at death’s door?
You got lucky, but in the end you did well.
The old Dr's refused to send me anywhere, and immediately got their lawyers when my parents asked questions. The asshats also gave me milk of magnesia at 10pm because "I didn't eat anything for a few days." So that was a great night...
My dad made the call to the other hospital and they arranged an ambulance. I spent a week at the first hospital, and after 3 hours at the new one, I was already under the knife. That was the first time I saw people at a hospital run because of what they were seeing on scans.
The new Dr told my parents (after i was OK) that the only thing he could think about once he initially saw me was that he was "operating on a dead boy."
Scary stuff.
I can't remember exactly what I had, but it was different than what your child had. Very similar experiences though.
I have stomach issues and occasionally use that on a day when I know I can spend the entire next day sat near a toilet, that stuff is absurdly effective as a laxative almost dangerously so.
Kinda makes me want to get back into optics. Imaging like that should be as routine as taking a temperature. Be nice to see stuff like diffuse light and ultrasound get super cheap so it's used routinely.
I've no idea how disruptive technology like cheap ultrasound compares with "traditional" medical equipment. It may be possible to do it cheaply now, but I'd assume the big equipment manufacturers will try to justify their six or seven figure prices for as long as they can, and those in charge of the hospital budgets will probably not be totally unbiased when it comes to making purchasing decisions. It may take some time to filter down into hospitals (like the internet).
Consider a $40k higher end ultrasound machine. Now consider the capital cost of the machine over 10 years. $4000/yr or $10 a day. Yeah the bill you get for an ultrasound is all pork.
It’s funny how popular the Wizard of Schenectady story is on HN when it’s about engineers, but somehow fails to be applied to non-engineers.
Kind of focuses one's attention on the expensive test.
I guess if utilization is low the technicians can end up costing a lot. But say they cost $200,000 a year and do one scan each working day. That's something like $1000 of labor, but it also assumes that they only manage to do 1 thing each day they work.
It was my point was that the 'expensive' isn't due to the capital or maintenance cost of an ultra sound machine.
Although portable units do have the advantage that in a lot of cases the attending physician can bypass the cash cow radiology department completely.
As for the rude tone of your comment, I have a tens of thousands worth of test equipment on my bench and I'd never dream of billing a client an 'oscilloscope fee', a 'logic analyzer fee' or a 'spectrum analyzer fee'. And every other industry works like that, except medicine.
When we had our first kid, my wife had a “fun scan” done. A fancy 3D color ultrasound. It was $120 for a 1/2 hour session. Same diagnostic ultrasound cost $1000 on a much older machine, same person running it.
There was an article on here a couple of years ago about cheap, hand held ultrasound. I was downvoted for saying youl’ll never see it in use.
tingle
Just add if one thinks a bit one can find a lot of industries that depend on renting out expensive capital equipment. Consider a taxi. A taxi might cost $25,000. Smog machines that auto shops have are not cheap. An Boeing 787 costs around $600,000 a seat. Rent a hotel room lately?
But he ended up in surgery pretty quickly after we arrived at the hospital. It took them a day to analyse his X-rays and realise he was not responding to regular antibiotics, and the decision was made to transfer him to the larger hospital for the operation. As for the misdiagnosis made by our family doctor (G.P. or General Practitioner, we call them), I'm not qualified to comment on whether it was a reasonable error or not.
We have the same term and abbreviation in the US for the same people, but I never know how many people who didn't grow up around medical people know it.
> As for the misdiagnosis made by our family doctor (G.P. or General Practitioner, we call them), I'm not qualified to comment on whether it was a reasonable error or not.
Sometimes it is, and it still goes to court. I'm biased towards the US in my knowledge, but a doctor or nurse can be legitimately afraid of, essentially, the precise kind of case your son was the victim of: The extremely rare serious problem masquerading as a very common and not-very-serious problem. That road goes directly into malpractice lawsuit territory, and when you're on that road everyone goes a bit insane.
Everyone in the medical field carries malpractice insurance because, as I've implied, some malpractice lawsuits are inevitable, due to a confluence of reasonable judgement and an unreasonably uncommon malady. Does this mean malpractice law needs to be reformed (read: done away with)? No, because some people out there practicing medicine are really incompetent, or lazy, or just go a bit weird and start cutting their initials onto livers like some deranged Zorro. We need some way to get those people out of the profession.
I guess I'm not really leading anywhere with this. The fact innocent people will have to go to court over reasonable judgment which leads to a bad outcome because of blind chance is just magnifying the unfairness of the whole event, increasing it and spreading it around. Will it make the MD more likely to correctly diagnose next time? It might make them more likely to order a test that's probably not warranted statistically. That's not the same thing. Everyone's human, and humans are sometimes incompetent and malicious, so we need malpractice law, but humans sometimes make honest mistakes and always use limited evidence to reach conclusions which are sometimes wrong, so malpractice suits catch innocents and send them through a wringer.
I agree that it's the right answer in a cold-blooded "improving the practice of medicine" sense, but laws have to take human behavior into account.
Yet that's precisely what the aeronautic industry does.
If, god forbid, our son had not recovered, it would have been a different story, there would have been anger to vent and likely a court case.
This is enforced by all of the HCP registration bodies (GMC for doctors; NMC for registered nurses and midwives; HCPC for allied health professionals). It's also supported by the NHS Litigation authority (the body who'll pay out for negligence claims, or defend those in court), and various medical protection organisations (the legal organisations that represent HCPs in court cases). The MPTS (the tribunal service that holds hearings in fit-to-practice cases) also strongly recommends that HCPs apologise in full.
In England and Wales we have a bit of law ("The Compensation Act") which means an apology outside a court for something that went wrong isn't an admission of liability, which makes it a bit easier for HCPs and their employers to apologise.
I've collected a bit of information here: https://medium.com/@dan.bealecocks/advice-to-doctors-about-s...
Dehydration kills a great deal faster than starvation. Sunken eyes is a sign of serious dehydration in a child. The child either needs to be fed fluids orally by the spoonful until this improves, which can take two hours of devoted care, or they need an IV. I once treated serious dehydration at home with spoons of fluids to prevent my 4 year old from being subjected to an IV. This is a technique taught in developing countries where IV fluids may not be available.
If a child is vomiting but keeps drinking, they are much less likely to dehydrate, even if it does not stay down. When my youngest son had Winter Vomiting, a deadly flu from many years ago, I told him to drink or I would take him to the ER for an IV. He had had an IV once when he had been sick while relatives watched him.* He didn't want another. So he would drink a whole lot of water and eat a few crackers, go projectile vomit it back up and go back to bed.
* That is not a criticism of my relatives. It is just another example of how much of a difference it makes for a child to have a devoted full time caretaker who knows them well. Children are not good at explaining that they have a serious issue. It is vastly better if there is an adult who is in a position to just recognize that their behavior is seriously off and something is just not right. People who don't take full-time care of a child are just less able to recognize that the problem is serious, even when they are otherwise very competent and devoted caregivers.
I knew what I was doing. If a parent doesn't know, sure, get the IV. But if a parent does know and wishes to spare their child some pain, I see no reason that should not be supported. The comfort of my children mattered to me. I cannot imagine that it wouldn't matter to most other parents.
My ex-girlfriend (7years) is a big deal chemist at GILD. So I share some under the covers knowledge here. GILD produces some of the best anti-virals on the market [i] (HIV is now a condition). When GILD discovered the power of Oseltamivir it knew they would not be able to produce the scale needed. They sold their rights to Roche. Roche being a sick pro-profits-first company basically shelved the product. Roche wasn't interested in the 'cure' for the flu they were interested in treating the symptoms. But, as it turns out, china was impacted with bird flu during this period -- and gave no shit about patents and wanted to just save their population. Phone calls were made and china basically was going to produce it at at massive scale. Thus, Roche quickly started producing the product. Oseltamivir is amazing at fighting the flu virus. The original purpose was to take Oseltamivir when you have sick family members or know you might be coming down with symptoms. Recently, I came down with the flu (I had the vaccine), I took 4 pills over 2 days and it was turned into a slight cold. It could save lives. Doctors know this and are reluctant to prescribe it -- since they know it is in short supply and critical populations should get it first. Ironically, doctors reluctance to prescribe it - actually reduces the supply. I say to you, get it, keep it in your refrigerator -- when your 65+ year old dad gets the flu give it to him immediately.
[i] https://www.bizjournals.com/sanfrancisco/news/2018/02/07/gil...
The major Asian bird flu epidemic was ~2005, after it was already brought to market.
Tamiflu isn't a "cure", the effects are pretty limited, but it's used because we have nothing else.
Tamiflu has been wildly successful product for Roche, why would they not develop it and instead try to treat "symptoms"?
Tamiflu is not in short supply by any means, Roche produces huge stockpiles for the US gov't and the shelf life is pretty long. There is plenty to go around.
To summarize, your ex-gf's story sounds like a could-be-true story (for those who don't know better) that plays to the typical stereotypes for "big pharma".
I'll also add that the cost to treat someone with Tamiflu before it went generic was ~$100. Pretty reasonable considering what drug costs are like in general.
https://www.cdc.gov/flu/professionals/antivirals/summary-cli...
Second, in 2003 Roche upped production. So yes they sat on it. SARS was in 2003 - and it takes 12 months to produce. What Roche was producing pre 2002 would prove or disprove the story, but I can't find this information anywhere -- I would gamble not much.
"It's pointless to look at ways for outsiders to produce Tamiflu, Roche's Reddy says. He notes that Roche can meet demand expectations faster than anyone else because it is familiar with the challenging production process. To meet current orders, Roche has quadrupled production capacity since 2003,"
[1] - https://en.wikipedia.org/wiki/Severe_acute_respiratory_syndr...
Production is dependent on demand, which is dependent on how bad the flu season is and how many are treated with Tamiflu. Otherwise a company produces a ton of product that just expires.
Predicting what the next flu season will be like is hard as hell. I haven't seen anyone do a decent job of it. Even Google tried and failed miserably.
I don't see that as "sitting on it". Also, the drug was already approved. Why would Roche not just sell more Tamiflu, it's easy money? What benefit is there to "sitting on it"?
Widespread usage of oseltamivir will almost certainly lead to widespread resistance, and there aren't many other options for future, particularly nasty flus. This is the reason for the US stockpile--even though the data wasn't conclusive on its benefits, oseltamivir was the best plan for pandemic flu.
http://www.bmj.com/content/358/bmj.j3266 http://www.bmj.com/content/348/bmj.g2545 http://www.thelancet.com/journals/lancet/article/PIIS0140-67...
"Tamiflu (the antiviral drug oseltamivir) shortens symptoms of influenza by half a day, but there is no good evidence to support claims that it reduces admissions to hospital or complications of influenza."
https://www.sciencedaily.com/releases/2014/04/140411091937.h...
Or the complete review: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008965...
On my trip to Japan I came down with a flu (Influenza-B). Got 40c fever, full-body muscle pain, the whole shebang. Slept through two whole days, occasionally taking ibuprofen to knock the fever off enough to be able to eat something. Then finally went to a doctor, who without any hesitation prescribed Tamiflu, a stock of which they keep in the office at all times. Two tablets later - the fever is gone, replaced with some dry cough and a bit of a runny nose.
I know my flu. I had plenty of them and if I have one, it lasts for 3-4 weeks before the temp drops below 38c. There is no doubt in my mind that I recovered from the last flu in 2 days exclusively because of Tamiflu and seeing it compared to Paracetamol makes no sense.
From where I'm from there's 36.6c, 37.7c and 39c temperature marks that respectively denote the "ok", "basic cold", "bed regime" and "burning hot" ranges. It does take me several weeks after getting a flu to get back to the "basic cold" level. With this antiviral thing I got there in 2 days flat.
And it is a single anecdote, so, no, it'd be indeed very strange to base the results of a "clinical trial" on it alone. It does however mean that in at least one case the drug worked and it worked very well. As I said above "YMMV".
I too went to the kindergarten and know what statistical significance is. Surprise. So thanks a bunch, but no need for lecturing on the basics of scientific method. I am also a part of a rational part of the society, which you appear to be trying to exclude me from if I'm reading your comment correctly.
> I’d bet that ...
You can bet whatever you want. I had numerous flu's in my lifespan of almost 50 years. All but one were the same, and the exception ended in less than a week. It was lab-tested to confirm that it was in fact a flu virus. It was the only one when I was taking an antiviral med.
You may have learned about statistical significance in kindergarten (props for the kindergarten for great education, I didn’t get there till high school) Still you’re displaying coincidence in a single case as correlation.
Neither did I question whether you had flu or not, you’re attacking a straw man there. I question that tamiflu was a strong factor in your speedy recovery.
"It does however mean that in at least one case the drug worked and it worked very well." - unsubstantiated.
Ironically, you've (again) drawn a conclusion based on only your own experience. Which is why, as pointed out above, "we" don't run single patient clinical trials. Your recovery after using the drug simply cannot be attributed to the drug. In addition, it should be obvious (considering the contents of the comment chain to which you are responding) that it likely was not the drug that accelerated your recovery in this case. Does that makes sense?
Obviously. It was a rhetorical question.
This is getting meta, but as an old Internet adage goes "Try and not speak on behalf of others", meaning that throwing around "we" in a discussion is counter-productive. It automatically pits a person against this implied "we" group, be it actually applicable or not.
The above comment is the perfect example of that - by using "we" the "refurb" person put me and the rational scientific community on the opposite sides of a line, implicitly invalidating whatever it was that I said. This is not an acceptable way to phrase arguments or even to express an opinion. "We" has no place in a public discussion unless there is in fact a group of people that one's qualified to represent.
PS. And don't put words in my mouth - I've drawn no conclusions except for the fact that based on _my_ prior experience with _my_ flu infections, this case was resolved in a very prompt manner and the only difference was the presence and the timing of taking in an antiviral med.
Having said that, his point other point seems to be valid. Tamiflu does not make a claim as to helping someone in your case, afaik.
A much more convincing explanation is that your symptoms were ameliorated by your vaccination, which is a thoroughly-documented effect.
My toddler woke up yesterday with fever and I was starting to feel like I was coming down with something as well (no fever yet), so we went to the clinic. They tested her, flu confirmed, gave us all Tamiflu. I started feeling markedly better about 6-8 hours after first dose. Today, we’re all completely normal except for mild cold symptoms. And this happened basically exactly the same last year. So I find all these studies about how Tamiflu basically does nothing to be pretty hard to take seriously...
EXCEPT that we were all vaccinated, which I didn’t even consider until now. I had assumed that getting the flu was a binary thing, and the vaccination just protected you from coming down with it, but wouldn’t ameliorate the symptoms or cause you to recover faster. That’s a much more compelling story if true.
https://www.cdc.gov/flu/about/qa/vaccineeffect.htm
I guess they don't want to get too far out ahead of the science.
But a vaccine is basically giving your immune system a new toolbox for fighting diseases, so it would make sense to me that even if it didn’t stop you from getting the disease, it still equips your immune system to ease the severity
A couple months ago, I came down with the flu. I, too, had a flu shot. I didn't take antivirals. 18 hours later, I was fine.
Anecdotes aren't terribly useful in medicine.
P.S. If you look up the latest studies and CDC guidance, you may learn that (a) the flu shot seems to cause a decent fraction of people who subsequently get the flu to get over it very quickly and (b) Tamiflu, while probably effective in the "statistically determinable to be better than nothing" sense is only very slightly better than nothing.
However, it's one of the very few options we have, so if the shit does hit the fan with a severe flu, it will save lives.
Yet during the swine flu scare, Roche handed out massive amounts of oseltamivir (Tamiflu) like it was candy to their employees (at least at the SF Genentech campuses). You'd call into a doctor, who would do nothing but verify your identity and issue a prescription. You'd then pick up the drugs on campus. Unfortunately pretty typical for Roche-Genentech, which is prone to fairly disgusting levels of spending on excesses.
What makes you think you had a flu in the first place and not just a cold?
What you find, as you try to dig actual medical results up, is that it maybe knocks as day or two off the course of the flu, has side-effects, and is less effective than the vaccine.
Having some knowledge about both subjects, this is surrealistically close to the difference in how experts vs nonexperts think will keep them safe online (https://www.usenix.org/system/files/conference/soups2015/sou...)
In Aus Tamiflu is often prescribed. In fact, significantly over prescribed. $100+ for a box of tablets, that someone needs to start taking before we even have actual PCR confirmation of flu virus? Does the benefit outweigh the costs? Probably in elderly or in situations with decreased immunity.
For the rest of people, it is probably good to go through a fever cycle once in a while. Your immune system needs something to run at, or else it can end up attacking itself, or missing cancers. The firm evidence base for this is low but my belief (as a biochemistry major and doc with heavy interest in immunology) is that if you are otherwise healthy and you get the flu, then it is probably doing ok for you. We need to stop pathologising all sickness. It’s normal to be sick sometimes, in fact it’s probably necessary for optimum function.
[0] - quick link from google as I am on mobile but well known to me in my professional capacity - http://www.center4research.org/tamiflu-not-tamiflu/
We need to be come robots[2]!
[0] https://www.labroots.com/trending/health-and-medicine/4999/a...
[1] https://www.cbsnews.com/news/flu-tied-to-heart-attack-risk-i...
[2] http://i.dailymail.co.uk/i/pix/2015/12/02/00/2EF55A550000057...
i've just come across [0] which describes roughly what you're talking about.
a bit further digging shows it was available at the hospital I work at according to their press releases. I assume it worked via some sort of compartmentalised ELISA which is pretty awesome.
[0] https://www.nsw.gov.au/your-government/the-premier/media-rel...
This is patently untrue.
Observe the hygiene hypothesis as a starting point
[0] DOI: 10.1126/science.296.5567.490 - Allergy, Parasites, and the Hygiene Hypothesis
Whether the stuff works or not is a different question. I read some of the research and meta-analyses and meta-meta-analyses and it didn't seem cut and dry. I can say I didn't get the flu, but there are many other times I didn't get the flu without taking anything.
Roche is low on this.
There are serious things wrong with our system when the best allocation of capital is to acquire and park IP. "Non practicing" IP should have strong incentives to make it accessible. What are possible policies for that: taxation incentive, compulsory licensing, or others?
Also, it reminds me the allegedly Chinese proverb saying doctors there weren't paid, but would pay if they didn't cure you. Different cultures ...
It's like focusing on making all houses flood proof. Most houses don't need it. If one needs it, relocating the house is probably a better idea that trying to make a new law saying all house should have floaters. The problem is that our society let us build houses on floodable area, not the flood.
https://www.theatlantic.com/health/archive/2013/04/whats-tyl...
Considering her age, the fact that I had a newborn and that rapid testing has a high false negative rate, I was pretty upset that they didn't give her tamiflu as a precaution. Maybe reports that it was in low supply are true
The test having a high false negative rate isn't actually a good enough reason to treat folks, rather a reason to develop a better test.