"Tired, beleaguered and battered" is how Dr. David del Rosario described himself yesterday as he hustled to care for the rising tide of patients streaming into his Patient First clinic in Glen Burnie with symptoms of the flu.
"We started seeing the trickle in mid-January," he said, "and literally by the first week of February, that's when the tsunami hit."
Since then, del Rosario's life has been a blur of 10-hour days in a succession of Patient First sites in suburban Maryland and a parade of patient misery.
"One guy said, 'Doc, if I had hair, my hair would hurt.' "
Public health and hospital officials say that seasonal influenza, with all its aches, fevers and assorted other agonies, is indeed on the increase in Maryland this month, with a peak due in the next three or four weeks.
"You worry most about the very old and the very young," said Leigh Chapman, manager of infection control at St. Joseph Medical Center in Towson. Confirmed cases there have jumped from five during all of January to 18 already this month.
Two patients, ages 83 and 69, have been hospitalized at St. Joseph with severe symptoms. The rest have been treated in the emergency room or other intake centers and released. Many more, probably, are suffering at home.
"We do assume that influenza is underreported. Most people don't come in and get tested," Chapman said.
Melissa Cyr sat in del Rosario's examining room yesterday afternoon, waiting for her flu test. She looked weak, flushed and very unhappy. The 16-year-old from Columbia was brought to the clinic by her father, city paramedic Craig Cyr, after she fell ill over the weekend.
On Sunday, she said, "I woke up, sat up and got really woozy, and the room was spinning. My dad came into my room, and I was really shivering."
She slept from 9 a.m. to 2 p.m., then complained of weakness and trouble breathing. "Every time I try to take a deep breath, I cough," she said. Her appetite had fled.
Del Rosario took samples to test her for influenza and strep throat and planned an X-ray to look for pneumonia.
He estimated that 30 percent of the people he has seen recently with respiratory complaints have turned out to have influenza. And while their symptoms have not been any worse than in past years, patients are coming in with more complications.
"Flu and strep; flu and pneumonia - that's what we're seeing a lot of," he said. One of those patients was a 3-year-old girl in Waldorf who was struggling with all three - flu, strep and pneumonia.
Doctors need tests to sort it all out because, while antibiotics won't work on the flu virus, they might be needed to battle strep and pneumonia, which are caused by bacteria.
Rene Najera, an epidemiologist with the state health department, said the number of laboratory-confirmed flu cases - a sentinel for trends in the community - has been rising statewide for several weeks.
"Three weeks ago, we had 42 confirmed cases statewide," he said. "The following week it was 62, then 78, and now 81" during the week that ended Feb. 7.
"It's the beginning of the seasonal increase in influenza activity. ... We can expect three or four more weeks of increased activity and then a decline."
Johns Hopkins Hospital has reported a similar surge in laboratory-confirmed flu cases. "On Jan. 18, we started seeing a huge increase," said Hopkins epidemiologist Dr. Trish Perl. "We're really in that rapid upswing of the epidemic curve."
Last year's flu season in Maryland surged about the same time but saw more apparent flu cases than are evident this year.
Federal health authorities reported "widespread" flu activity in 16 states, including Delaware, Pennsylvania and Virginia, as February began. "Regional" outbreaks were under way in another 16 states, including Maryland.
If any flu season brings good news, this year's might be that, in contrast to last year, the 2008-09 flu vaccines seem to have anticipated fairly well the viral strains that are circulating this year.
About 80 percent of the flu viruses found nationally have been Type A viruses, all of them related to the two Type A antigens included in this year's flu vaccines, according to the Centers for Disease Control and Prevention.
The rest are Type B viruses, and about a third of those have been related to the Type B antigen in the current vaccines.
Hospital officials say there is no indication that this year's flu is any more severe than in recent seasons. "We haven't been reporting any dramatic complications to the Health Department," Perl said.
Unfortunately, many of the Type A flu viruses have developed a resistance to some of the antiviral medicines that doctors prescribe to reduce the severity of the illness once it has begun. The antivirals can often be effective when the pills are taken within two days of the onset of symptoms.
This year's flu season has been blamed for the deaths of four children in the United States, the CDC said.
For those who have been spared the flu but have not had a flu shot, it is not too late. "We still have plenty of vaccine," Najera said. "It's never too late to get it. You can build immunity in two weeks."
Personal hygiene is just as important, Chapman said. "If you are sick, be sure you're not going to work, so you're not spreading it."
Also, to avoid catching or spreading the flu, wash your hands frequently. Cough or sneeze into your elbow (rather than your hand) or a tissue, then throw the tissue away and wash your hands again.
To enroll in Maryland's influenza online tracking survey, go to tinyurl.com/flu-enroll