ANTHRAX SCARE DOVETAILS WITH ONSET OF FLU SEASON.

Byline: Evan Henerson Staff Writer

Achy muscles, fever and a persistent cough can be symptoms of the potentially lethal disease anthrax. But more likely, say Valley infectious- disease specialists and emergency-room physicians, those feelings of malaise are being caused by that common November visitor: the flu.

In both cases, doctors say, the patient can experience a low-grade fever, a persistent worsening dry cough, sore throat and shortness of breath. However, there are ways to distinguish the two. The biggest difference: None of the cases of inhaled anthrax so far have started with nasal congestion or a runny nose - a common symptom of the flu.

Sufferers of inhaled anthrax will experience a couple of days' letup or ``honeymoon'' before becoming devastatingly ill. Not so with the flu, which will continue unabated until it runs its course - anywhere from one to two weeks.

Still, with the anthrax scare at its peak and the flu season on the way, doctors and patients alike are preparing themselves for questions as well as treatment.

``The symptoms are very similar,'' says Dr. Jon Willen, an infectious- disease specialist affiliated with both Northridge Hospital Medical Center and West Hills Hospital. ``We're seeing a lot of questions from physicians who are getting a lot of questions from their patients.

``The primary-care physicians are looking to us for some kind of guidance as to how to handle all the patient requests.''

A nasal swab test can quickly determine the presence of the influenza A virus. A different kind of nasal test - equally simple to conduct - can also identify anthrax. Willen believes that in the majority of cases, the anthrax screen isn't even necessary.

``The laboratories would become overwhelmed,'' said Willen. ``Doctors are better off doing tests for the flu.''

Willen stresses the need for doctors to take a careful patient history of people who come in complaining of flulike symptoms. Unless someone has good reason to believe he or she has been exposed to anthrax, physicians should be looking for signs of the influenza virus, rather than anthrax.

``People in day-to-day jobs are not going to be the targets for terrorists,'' says Willen. ``If someone comes in and says, 'Myself and three of my co-workers in the mail room at Sony all have the flu,' that should give you pause.''

Emergency-room administrator Dr. Mark Bell says a handful of individuals experiencing ``very minor respiratory symptoms'' have come to the two campuses he oversees at Encino Tarzana Regional Medical Center citing concerns about anthrax and wanting to see their regular internists.

And we're not even in the heavy flu season yet, says Bell, who doesn't expect the ERs to fill up with hacking feverish hordes until mid- to late November.

As for anthrax, Bell expects to see more people who are concerned than those who are actually at risk.

``Quite frankly, it's my hope, and my medical judgment, that I don't believe we're going to be seeing significant cases of anthrax in Los Angeles or in the San Fernando Valley,'' says Bell. ``I think we will all need to have systems in place, whereby should we see it, we treat it effectively and immediately.''

Bell and Willen both said that concerned people of all ages have a resource available to potentially stave off both discomfort and worry: flu shots. This year's influenza vaccine, although somewhat late in delivery, is targeting two strains of influenza A and one of B.

``My office has it, and our hospitals are giving it out right now,'' says Willen. ``The drug chains, because they buy in such large quantities, usually get it before the doctors do.''

The National Immunization Program of the Centers for Disease Control and Prevention expects 87 percent of the 79.6 million doses of flu vaccines to be administered by the end of November.

Tonight at 5, the CDC will rebroadcast its conference ``Anthrax, what every clinician should know'' on the Internet at www.phppo.cdc.gov/phtn/default.asp.

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THE FLU OR ANTHRAX