H1N1 flu's strength, speed stun mourners

By REID FORGRAVE • rforgrave@dmreg.com • November 14, 2009
http://www.desmoinesregister.com/articl ... n-mourners

Eighty-year-old Lucy McKenzie led her family down Westminster Presbyterian Church's aisle this week, walking past hundreds who gathered at the Des Moines church to remember her son.

The pastor stood at the pulpit and asked the question haunting the minds of many: How could Doug McKenzie, a 54-year-old computer analyst from Clive, with a big belly, a big laugh and a big heart, be gone so soon? How could a man who loved to camp and canoe with his son be healthy one week and dead the next?

"Most of us come here startled," the Rev. Ken Arentson began. "Death seems to have come like the biblical thief in the night, stolen Doug away from all who love him. We wonder at it all, at all the medical explanations about viral pneumonia, and H1N1 and the effect on the body."

The pastor paused. Even doctors struggle to explain why H1N1 influenza strikes a fraction of its victims so hard and so fast.

All the explanations "don't change the fact that death has come crashing in upon us," he said.

Most flu victims recover after a week, but some don't even survive that long. In Iowa, 19 deaths have been confirmed as being caused by H1N1, and more than 500 Iowans have been hospitalized with the virus, according to the state health department.

The thief that stole Lucy McKenzie's son was the virus that has concerned public health officials in Iowa and nationwide. The H1N1 flu has hospitalized nearly 100,000 Americans and killed about 4,000.

For many of us, the virus is just a small worry in our daily lives: Wash your hands, or you'll be stuck in bed for a week with a bad cough and a weak body. We post signs at the workplace, we stand in line for a vaccine, we shrug, we hope for the best.

For Lucy McKenzie, the fast-moving virus took her son before he could say goodbye.

Breathing troubles preceded quick decline

The day before the funeral, McKenzie sat at the Des Moines home where she raised her five sons. She pulled out a photograph of Doug. He was smiling broadly, sipping wine at her surprise birthday party a couple of months ago. He was a man who loved jigsaw puzzles and baking bread, fiddling with computers and writing poetry. He often took his mother to dinner and a movie, and he loved making steak and potatoes for his only son, a 21-year-old Iowa State University student.

"He wasn't afraid of death," Cameron McKenzie said of his father. "He wouldn't have minded having a heart attack over a giant steak. He would have been happy with that."

Ten days ago, Doug McKenzie called his mother. He was having trouble breathing and was heading to the hospital. He asked his mother to call his son. Tell him to take out the dog, Doug McKenzie said.

The next day, a tube was placed in his throat. He was put on sedatives. A machine helped him breathe. Soon, his lungs collapsed, his kidneys failed, his heart gave out.

And one week later, Doug McKenzie was dead.

Lack of immunity lets virus gain foothold

We all know the early signs of the H1N1 virus. They're not much different from the seasonal flu: a fever, a cough, a sore throat, a runny or stuffy nose, an achy body and head, chills and fatigue. Sometimes there is diarrhea and vomiting. For most, it's a week of pure misery.

We all know the best ways to avoid infection. It's not much different from avoiding any seasonal flu: Wash your hands, cover your cough with a tissue or a sleeve, get vaccinated, stay home if you are sick.

But less publicized are instances like Doug McKenzie's. For people like him, the signs are more dire: difficulty breathing, chest pain, lips turning purple or blue, dizziness, an inability to keep down liquids, an inability to urinate.

These patients, the vast majority of whom are between the ages of 18 and 64, are put on a ventilator, some for weeks. Sedatives relax the body and aid the ventilator.

H1N1 was first diagnosed in Mexico in April and quickly spread to more than 70 countries.

One in 14 Americans are estimated to have been infected with the virus, a total of more than 22 million cases since spring, according to the U.S. Centers for Disease Control and Prevention. That's more cases than in any other country, although most infected people have recovered without medical treatment.

"They're just estimates," said Dan Diekema, an epidemiologist and professor of infectious diseases at the University of Iowa. "We have to live with the fact we don't really know how many people have been infected with H1N1 because we don't have the ability to test everybody."

Meanwhile, seasonal flu activity is considered widespread in 46 states, including Iowa, according to the CDC.

That's important, because about 36,000 Americans a year die from seasonal flu and associated infections.

"People say, 'Oh well, it's just the flu,' " said Sandy Peno, a nurse epidemiologist at Iowa Methodist Medical Center. "But it's not just the flu. People can become very, very ill with just flu."

The last pandemic came through 50 years ago. That means people over the age of 65 tend to have an immunity to H1N1, said Daniel Gervich, medical director of infection control at Mercy Medical Center.

The problem isn't that this strain is particularly virulent; it's that the immune systems of people under 65 tend to respond slowly because they don't have an immunity. That lets the virus gain a foothold.

Another wave or two of H1N1 through the winter, combined with the onset of seasonal flu, will likely make this one of the worst flu seasons in 50 years, Gervich said. Most victims will be bedridden a few days. Some will be hospitalized. A few will be like Doug McKenzie.

McKenzie was overweight but had no major health problems. At the end of October, he began struggling to breathe. After that, the virus moved fast.

"The way they look at the end is terrible," said Lucy McKenzie. "All these machines beeping and buzzing, him slowly sedated. It's very hard to think of your son that way."

And if you're Jessica Johnson, the problem is multiplied.

When the 29-year-old Monroe woman was admitted to the hospital on Halloween with a severe shortness of breath, she was 28 weeks pregnant.

Pregnant woman bounces back

Dr. Roger Harvey walked into the eighth-floor room at Iowa Methodist Medical Center earlier this week. When he saw the young woman sitting in the chair, the infectious disease doctor took a double-take.

Jessica Johnson - on a ventilator less than a week ago, on the verge of death because of H1N1 - smiled at him. She pointed at her face: no tubes pumping oxygen into her body.

The doctor couldn't believe it.

"They took it off yesterday," she said, laughing.

"Wow," Harvey exclaimed. "You coughing any at all? Short of breath at all?"

"Not too bad."

"How are you doing with walking?"

"Good," she said. "They told me to slow down."

For the doctor, seeing Johnson's recovery was the best part of his week.

On Halloween, Johnson found herself severely short of breath. Her oxygen level was at about 70 percent of what it should have been. Chest X-rays showed her lungs full of fluid.

By the next morning, Johnson was breathing with an oxygen mask in Methodist's critical-care unit, where the worst H1N1 patients come. Soon she needed a ventilator, a feeding tube, an IV in her neck. Doctors said Johnson's chances at survival were a tossup, and they constantly monitored her baby.

Her husband, Adam Johnson, saw distraught families in the hospital whose loved one died from H1N1. Johnson's family and friends prayed her body would keep fighting.

"All you want to do is go in there, pull those tubes out of her mouth, put her in your arms and carry her out of here," said Johnson's father, Gary Grier.

Then, a week ago, something happened. Her family walked into the room, and she was sitting up in her hospital bed, only two tubes in her nose. The family was shocked at how fast the virus knocked her down, then how fast she improved. So were doctors. By Wednesday she was off oxygen.

Doctors are used to the average flu season. But this year they're seeing younger patients on ventilators who were healthy just days before. They're not used to seeing these young, relatively healthy patients struggling so mightily.

"That's what made Jessica so good," her doctor said, "because we had several patients dying at the same time."

On Friday afternoon, Johnson was discharged. Her baby is due in January. Her doctor told her to stay home a week before returning to her job as a first-grade teacher in Newton. But Johnson wasn't thinking of that. She was thinking of finally going home and seeing her dog, a puggle named Harlie.

Her family tried to think why they were put through this, and why Johnson survived while others in similar situations didn't.

"My biggest thing I see is how easy it is to lose somebody," Johnson's father said.

"You expect when you're sick, you go the doctor, then you're OK. But seeing how helpless she was, how helpless we were, how helpless the doctors were. There's some things you can't do."