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We're facing a flu season like no other in recent memory.
It's started far earlier than normal, and there are two strains circulating - the regular seasonal flu and the new H1N1, or swine flu, which surprised authorities when it emerged last April, causing the first pandemic in 40 years.
Health officials are already seeing as much flu now as they usually see in February.
"It's going to be a long and busy season," said Dr. Anne Schuchat of the federal Centers for Disease Control and Prevention.
Charlotte-area hospitals are ready to make room for more patients if needed, and they're planning for how they'll stay in operation if large numbers of their employees call in sick.
Schools have set aside rooms where sick kids are isolated until they can go home. Colleges are telling students to stay in their dorm rooms until they get well.
And doctors' offices have stocked waiting rooms with surgical masks for patients with flu symptoms, so they don't spread the virus.
Despite early fears, the H1N1 virus, first detected in Mexico, appears to be no more deadly than the typical seasonal flu. And the symptoms are the same - aches, fever, coughs.
But because it's a new virus, and it attacks young people in greater numbers than the typical older victims, it has raised fears and confusion.
Here are some other messages to remember:
•If you get the flu, you don't need a test to find out if it's H1N1, unless you're sick enough to be hospitalized. "Right now if we get the flu, it's presumed that we have H1N1," said Dr. Jim Hunter, chief medical officer for Carolinas Medical Center.
•If you're generally healthy and you get the flu, stay home and rest until you've gone 24 hours without a fever.
•Parents of children with chronic medical problems, such as asthma, may want to seek a doctor's care even if their children are just exposed to the flu. It's important to watch them for unusual symptoms, such as persistent vomiting or breathing problems, because these children are at high risk for complications from swine flu. It's not overreacting to take them to the doctor early.
•Otherwise, don't overwhelm doctors' offices and emergency rooms unnecessarily. Most flu doesn't require a doctor's care. Gaston County Health Director Colleen Bridger said 40 people showed on a recent morning at the local ER complaining of flu-like symptoms, but only two had the flu.
•Seasonal flu shots are available now, and H1N1 vaccine should become available in October. The first H1N1 shots will go to those at highest risk - pregnant women, children, young adults, and anyone with chronic medical conditions, such as asthma and diabetes. Senior citizens, who may have immunity to swine flu because of earlier exposure to similar viruses, do not need H1N1 shots, at least initially.
•To prevent the flu, wash your hands often and cover coughs and sneezes. "If those simple steps are taken, the number of those infected will come way down," said CDC director Thomas Frieden.
School-age kids, young adults
After five months of watching the new H1N1 virus, officials expect a lot of school-age kids and college students to get the flu this fall. Most will get well in a few days.
Charlotte physician Obinna Oriaku saw more than a dozen children with flu in a recent two-week period. Most have responded "to just tender loving care and Tylenol and chicken soup," he said.
"That's a very good sign," Oriaku added. "At least they're responding to treatment. They have not needed to be hospitalized."
More than half the deaths from H1N1 flu this year have occurred in children and young adults. About half of those have had other medical conditions that made them less able to fight off the virus.
If flu patients develop breathing problems, pain in the chest, constant vomiting or a fever that keeps rising, they should see a doctor. Also, if symptoms start to get better and then get worse, that's a sign to seek care.
Fifteen-year-old Charlie Bridger had the latter experience this summer. The health director's son contracted Gaston County's first confirmed case of H1N1 flu while attending a camp near Boone.
He came home, got better in three days and returned to camp, his mother said. But a few days later, he became ill again with a bacterial infection, which was treated with antibiotics. Such "secondary" infections can be cause for concern, especially in children with weak immune systems.
Charlie's illness had an up side. When more than 30 percent of the student body at Forest View High School came down with the flu recently, he didn't get sick. He was presumably immune.
"Once you have the true H1N1, you are golden for the rest of the year," said Dr. Jim Lederer, medical director for clinical improvement with Novant Health, the system that owns Presbyterian Healthcare.
Outbreaks also have been reported at several N.C. colleges since students returned for classes. Hundreds of students have been sick at Wake Forest University, Western Carolina University, UNC Wilmington, UNC Chapel Hill and N.C. State University.
"We're nowhere near those numbers yet," said Dr. Robert Jones, medical director for the UNC Charlotte student health center. About 20 students have been seen there for flu. In anticipation of more cases, he said students are being advised to designate a "flu buddy" who would bring food or medicine. That's so sick students don't have to leave their rooms or expose many others to the virus.
At Davidson College, more than 50 students have had the flu in the past month, said spokeswoman Stacey Schmeidel. Sick students are advised to stay in their rooms or move to one of two lounges set up with beds to isolate flu victims from healthy students.
Based on CDC guidelines, students can return to class after they've been free of fever for at least 24 hours.
"The kids who are sick are really isolating themselves," Schmeidel said. "From what I hear...if you're sick, for the most part, you're sleeping."
Vaccines, doctor visits
Vaccine for the seasonal flu is already available in some doctors' offices and pharmacies and at health departments.
But the first shipments of the new H1N1 vaccine are not expected until October. Based on the latest research, adults may get protection from just one H1N1 shot, not two as earlier thought. But the shots will take several weeks to take effect.
Meanwhile, CDC officials advise doctors to use antiviral medicines, such as Tamiflu, judiciously. Antivirals can reduce the severity of swine flu if taken soon after symptoms start. But if the drugs are overused, the virus could become resistant.
Officials at Carolinas HealthCare System and Novant Health say patients with flu symptoms should expect to be asked to wear masks and sit in separate waiting rooms when they show up at the ER or doctors' offices.
"That's for the person who's sick, so they're not spreading the virus," said CMC's Hunter. It's also to protect the staff, who may be wearing masks to keep from picking up or spreading germs.
Both hospital systems say they'll encourage doctors, nurses and other employees to stay home if they're sick. If absenteeism gets too high, healthy employees may be asked to cover other duties.
"Every person standing is a caregiver," Novant's Lederer said. "Even the president of our system has said, 'If I have to empty trash, I'll empty trash.' "
