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Swine flu cases have declined in the Charlotte area after reaching a peak about two weeks ago. But health officials expect another wave when the additional threat of seasonal flu takes hold in winter.
"We're pleased that we seem to be on the back end of a wave of illness," said Dr. Roger Ray, chief medical officer for Carolinas HealthCare System.
"But we don't want to give any sense that the risk is over. ... The typical flu season, January and February, is coming, and that could be rough."
Health officials continue to encourage people to get vaccinated against both H1N1 and the seasonal flu. Limited supplies of swine flu vaccine mean doses are being reserved for people at high risk for becoming seriously ill with the flu.
"We want people to continue getting vaccinated, assuming we have vaccine," said Dr. Stephen Keener, medical director of the Mecklenburg County Health Department.
On Monday, health department nurses will begin holding vaccine clinics for students in Charlotte-Mecklenburg Schools.
The department just finished a week of clinics for pregnant women and young children. Hospitals, doctors' offices, pharmacies and colleges have also offered swine flu vaccine, but no agency has received enough to open clinics to the general public.
This has been an unusually tough year for flu-like illness, starting in April when the new H1N1 influenza appeared in Mexico and the United States. Flu cases continued steadily through the summer and peaked again when children returned to school.
Even with the recent decline in cases, there are still more reported today, in the Carolinas and across the nation, than at the peak of a typical flu season.
Actual flu cases are not counted. North Carolina keeps track of "influenza-like illness" by getting reports from more than 100 "sentinels" in 55 counties. The sites include health departments, doctors' offices, college health centers and hospitals.
At the peak of last year's flu season, in February, 3 percent of patients at those sites reported flu-like illness. By Sept. 12, flu-like illness in North Carolina reached 6 percent. It stayed between 5 percent and 6 percent through Oct. 24. By the end of last week, it had dropped to 3.85 percent.
ER cases still high
North Carolina also counts flu-like illness in hospital emergency rooms. Ten percent of Mecklenburg ER visits were due to flu-like illness in October. That fell to 7percent a week ago.
"That's still very high," Keener said. "Seven percent is still higher than it's been (at the peak of) seasonal influenza."
So far, officials at Carolinas HealthCare and Novant Health, the two large systems in Charlotte, say hospitals and doctors have had no problem caring for patients with the flu.
"We never really got to any significant pressure on the system," said Dr. Jim Lederer of Novant, the Winston-Salem company that owns Presbyterian Healthcare.
At Carolinas HealthCare, doctors are seeing substantially more flu patients than usual for this time of year, Ray said, but they haven't had to hire extra staff. Some offices have expanded hours to evenings and weekends. Employee absenteeism from flu has not been significant, he said.
Death rate high for fall
Nationally, the flu continues to be widespread in 46 states, and doctor visits for flu-like illness declined slightly from last week. But flu-related hospitalizations and deaths continued to increase and are much higher than expected for this time of year.
In the six months since H1N1 was detected, federal health officials estimate that 22 million people have become ill and 3,900 have died, including 540 children.
