As anyone who has seen the news from January 2013 can attest, the flu season is proving more difficult than usual this year. A particularly potent strain of influenza A is spreading around the country and making millions of Americans sick. While this was not an entirely unexpected outcome (the Centers for Disease Control warned that 2012-2013 would be a bad year), many individuals have been caught off guard. This year’s flu season poses a challenge for those patients who may wonder whether they should rush off to an urgent care or emergency department to seek treatment.Emergency departments may be overwhelmed by the influx of patients – some of whom genuinely need care. While the influenza virus generally causes fever, cough, sore throat, body aches, fatigue, and runny or stuffy nose, severe complications do occasionally arise in vulnerable patients. The elderly, those with complicating conditions (diabetes, asthma, and heart disease), and children are all at increased risk for serious complications from the flu. In both susceptible as well as otherwise healthy patients, breathing problems can develop along with secondary infections such as pneumonia, ear infections, sinus infections, and the like. A patient’s body may become so overwhelmed after fighting off the flu that the immune system fails to effectively mount a response to bacteria or other pathogens in the environment. Thus it is not always the flu itself that sends scores of people to the ER, but rather the secondary conditions and breathing problems that it engenders.In general, studies have suggested that patients should avoid the emergency room if at all possible unless they are truly suffering life threatening illness or injury. Some estimates suggest that anywhere between 13.7% and 27.1% of emergency room visits could safely be directed either to urgent care centers or retail clinics . Patients suffering from the flu can both spread the illness to others in the ER or pick up some other bacteria or virus while there. Furthermore, patients without true emergency conditions take away time that would be better spent on truly critical patients (such as those suffering from heart attack or stroke, for example).This advice presents a bit of a conundrum for flu patients for two reasons. First, an adult who has never experienced the real influenza virus before might become alarmed with a fever over 103 F, or with the overwhelming fatigue and malaise brought by the flu. Thus some individuals who just need to wait it out at home and rest head for the ER, fearing their fever is too high or that something is terribly wrong. At the same time, the traditional advice to avoid any emergency or urgent care unless absolutely necessary may also have the opposite effect, where a patient who is genuinely ill delays care until secondary complications have become severe.A good way to handle these two types of patient reactions to the flu is to remember that Influenza symptoms should begin to improve by day 7, and should be gone by day 10. If, at any point during infection with influenza, a patient cannot breathe, begins gasping for air, or has a fever over 105 which does not respond to treatment like Advil or Tylenol, it would be prudent to seek urgent or emergency care. If illness with symptoms such as severe congestion, fever, headache, or malaise lingers for longer than 10 days, it would be wise to visit a family practitioner or other primary care physician. Sometimes, a patient will feel much better for two or three days (at the end of what they think is the flu) and then suddenly become sick again, often with their fever returning. This commonly happens when a bacterial infection has taken hold.Patients should keep themselves informed about the flu and its presence in their area of the country. Helpful information can be found on the Centers for Disease Control (CDC) website available here.References Weinick R, Burns R, and Mehrotra A. Many emergency department visits could be managed at urgent care centers and retail clinics. Health Affairs 2010;29(9): 1630-1636.