On the evening of October 30, 2009, previously healthy 7-year-old Trevor Ron Lin developed a cough. A day earlier, his 11-year-old sister, Ashley, had complained about shortness of breath that had stopped her while walking to the bus after school.
Both children’s coughs remained mild that night and improved the next evening while trick-or-treating. Then on that third day, during the early hours of November 1, Trevor developed a seal-like barking cough, along with shortness of breath and fever. His father, a general surgeon, brought him to the bathroom and turned on the shower to allow the steam to resolve his symptoms. But these coughing episodes recurred every hour for the next three hours. On his third recurrent episode, his father, with concern for croup, urgently drove Trevor and his other two children together to the emergency room at the region’s premier hospital.
The ER physicians agreed with the presumptive diagnosis of croup and treated Trevor accordingly with a nebulizer and one dose of intravenous steroids. The diagnosis of novel H1N1 influenza virus, or swine flu, was entertained but the ER physicians interpreted the guidelines from the Centers for Disease Control and Prevention (CDC) to mean that only high risk patients (children with co-morbidities or pregnant women) were eligible for anti-viral therapy such as oseltamivir (Tamiflu). During the ER visit, Trevor developed another episode of shortness of breath and had a fever of 103.7 degrees, with his heart rate increasing to an abnormal rate of more than 120 beats per minute. But his blood oxygen saturation levels remained normal at 97 percent. No chest x-ray or lab tests were performed.
Later during the ER visit, Trevor felt and looked better and wanted to go home along with his sister, Ashley, who had also been evaluated in the ER, but was feeling much better. Their middle brother, Ryan, had no symptoms.
The children went home and Trevor’s symptoms improved. The next morning, he coughed only rarely, and had no problem breathing. However, the next afternoon on November 2, Ashley observed Trevor walking unsteadily at home and fell. Ashley ran over to find his lips and fingers blue. Despite resuscitation efforts and ambulance transportation to the nearest ER, Trevor was pronounced dead within two hours after his collapse.
His father discussed the case with a CDC physician who agreed that Trevor had a swine flu-related death. Trevor had not been vaccinated against H1N1 influenza because at the time the vaccine was not available in his community.
Trevor’s father is currently campaigning for improved criteria for the health care practitioner evaluation of and hospitalization of children with influenza in order to minimize the numbers of previously healthy children who die from influenza after being evaluated recently by a health care practitioner. He plans on establishing a foundation in Trevor’s name to encourage physician groups to provide working guidelines expeditiously despite having incomplete information during medical crises.
- Henry Lin (father)
Place of Residence:
- Bethesda, MD
Date of Child's Death:
- November 2, 2009