Bird Flu? Or not?

Yesterday, I went to the doctor at Kaiser Permanente because I was feeling sick.  After leaving China on the 26th, I noticed an itchy scratchiness to my throat, which I largely attributed to the wonderful and pleasant environment inside the plane.  As I gradually recovered from the jet lag, the symptoms gradually started to appear -- first a sneeze or two after a chill, then a slight headache, then a runny nose,  and yesterday morning a cough.  Normally I wouldn't probably go to a doctor for this kind of illness.

However, after seeing multiple warning's regarding the avian flu H7N9, in the airports both in Hong Kong and Guangzhou, China, I decided to follow the advice I found on the Center for Disease Control website, which says

• See a doctor if you become sick during or after travel to China.
  • See a doctor right away if you become sick with fever, coughing, or shortness of breath.
  • If you get sick while you are still in China, visit the US Department of State website to find a list of local doctors and hospitals. Many foreign hospitals and clinics are accredited by the Joint Commission International. A list of accredited facilities is available at their website (www.jointcommissioninternational.org).
  • According to a message issued by the US Embassy in Beijing, patients with fever and other symptoms of flu will be sent to designated hospitals for evaluation.
  • Delay your travel home until after you have recovered or your doctor says it is okay to travel.
  • If you get sick with fever, coughing, or shortness of breath after you return to the United States, be sure to tell your doctor about your recent travel to China

I did this exactly.  I went to the doctor armed with the advice and told him that I had travelled to China and had visited farms with pigeons, chickens and other animals being bred for pets and for food, and that I went to the Qing Ping pet market.  The doctor said, "well we won't even test for bird flu unless your hospitalized.  There are very few cases.  This flu is not pandemic.  I will give you some cough medication with Codeine."   This seems to completely ignore this advice, from the same document: 

Clinician information:

Clinicians should consider the possibility of avian influenza A (H7N9) virus infection in persons presenting with respiratory illness within 10 days of an appropriate travel or exposure history. Although the majority of H7N9 cases have resulted in severe respiratory illness in adults, infection with this virus may cause mild illness in some and may cause illness in children as well. Influenza diagnostic testing in patients with respiratory illness for whom an etiology has not been confirmed may identify human cases of avian influenza A virus infection or new cases of variant influenza in the United States. If patients are infected with H7N9 virus, reverse-transcription polymerase chain reaction (RT-PCR) testing will be positive for influenza A but will be unsubtypeable. Clinicians suspecting H7N9 infection should obtain appropriate specimens and notify their local or state health department promptly. State health departments should notify CDC of suspected cases within 24 hours. For more information, see the Health Alert Notice issued April 5, 2013.

Because of the potential severity of illness associated with H7N9 virus infection, it is recommended that all confirmed and probable H7N9 case-patients and H7N9 case-patients under investigation receive antiviral treatment with a neuraminidase inhibitor as early as possible. Treatment should be initiated even if it is more than 48 hours after onset of illness. Laboratory testing and initiation of antiviral treatment should occur simultaneously. For more information, see CDC’s interim recommendations on the use of antivirals in treating H7N9 influenza.

So, there are several possibilities, I have the bird version of the flu, which means I am not contagious to other humans, and I will possibly get much sicker, or I have a common cold, am contagious to others and will get better in a few days.  There is a third possibility, that I have the version of the flu that I was vaccinated for.   

Being sick is making me grumpy, and right now it's not getting better.  My illness has been progressive increasing now for 7 days, and there has been no real sign of improvement. After going to visit the doctor at Kaiser, I often feel that the care I receive is quite a bit less then good, and the first effort is always to send you back home and wait. Since I won't take the codeine, I am taking over the counter expectorant.  So the net result of the visit is the reassurance of a doctor who isn't following the advice of the CDC that I don't have the bird flu.   

What I think is the more interesting question though, is whether or not the doctor has a responsibility to report or test on a possible case.  Organizations like the CDC and the World Health Organization are tracking the various flus at they spread around the globe, I am ,pretty sure they would want to know if I appeared in the US with a case.  The statements above claim that all confirmed and probable cases should be reported and receive treatment as soon as possible. 

Clearly, I haven't appeared to have enough of the symptoms to merit further investigation, much less be "confirmed" or "probable".  It's sort of  implied that I will have severe symptoms within ten days, so we'll know in a couple of days.