The flu has taken at least 20 lives so far this year and several more deaths may soon be confirmed as well.
Dallas County reported nine additional flu-related deaths on Friday - this makes the Dallas County death toll 26 this year from influenza. Denton County on Friday confirmed its third. There is also an unconfirmed flu-related death in Wise County.
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And there may be a flu-related death out of Tarrant County.
On Friday, Fort Worth confirmed one of its employee had passed away Thursday night.
"The City of Fort Worth was saddened to learn of the passing of one of its employees Thursday, Code Officer Diana Ruelas," said Brandon Bennett, Code Compliance Director, in a statement. "Diana was known as a caring and dedicated city employee. We extend our most sincere condolences to her family.”
Ruelas, 42, went home sick several days earlier and members of her extended family at her home tell NBC 5 that they were told she might have had the flu. However, her death has not been confirmed as flu-related.
In fact, Tarrant County has no confirmed flu deaths this season. The flu isn't impacting the county any less.
"What's occurring in Dallas is the same that's occurring here and the rest of the state," said Russell Jones, Tarrant County Public Health chief epidemiologist. "That kind of gives you an indication as to what they're seeing is occurring everywhere else."
The Tarrant County Public Health Department and it's hospital and clinic partners aren't required to report deaths. Only deaths of people 17 and under are required to be reported. Jones says there's only been two of those in the whole state this year. Dallas County and its partners voluntarily report.
"The typical estimate is 36,000 [deaths] a year in the United States [due to flu]," Jones said. "So rather than just look at death surveillance, we look at when flu comes up and down."
In the weekly report set to be published next Monday, Jones says the percentage of patients with flu-like symptoms will be at 9.8 percent for the first week of the year.
For the last week of 2013, the percentage of patients with flu-like symptoms was 10 percent.
Clinics and hospitals aren't required to report exactly how many test positive for flu, although Tarrant County Public Health Department is starting to ask around as it also wants to know the severity of the flu.
The Tarrant County Public Health Department determines severity by looking at how long someone stays in the hospital with the flu and how many are in intensive care. On Friday, Fort Worth's JPS Hospital released those numbers.
JPS' Infection Control Department reports that hospitalized patients are staying longer and that practitioners are "reporting that their flu patients seem sicker this season."
Since flu season began on Oct. 1, 2013, JPS reports 19 people have been hospitalized. The average stay was 5.53 days. One person stayed for 40 days, with the shortest stay at just two days. In the 2012-13 flu seasons the average stay was 3.64 days, with the longest stay being just 10 days.
On Jan.10, 12 people remained at JPS, including three in the ICU - all were there for flu-like symptoms.
"The important thing is that flu is here, there's still flu vaccine available, go out and get your flu shot," Jones said.
And hundreds continue to hear and heed that advice. At public health's La Gran Plaza clinic, nurses had to turn about a dozen people away on Friday afternoon. The staff only has a limited time in which to give shots or nasal mist to patients. They served 80 people on Friday.
"This whole week I've been stressing over and stressing over and okay, 'I'm just gonna come in,'" said Ashley De La Rosa.
De La Rosa brought her seven-year-old son and 9-year-old daughter in to get their very first flu shots, after hearing all the reports on the news.
"This is the first year that we’ve ever had a flu shot in our entire life and I just want to be protected," she said. "It's really scary, I’ve never had one myself, but being 8 months pregnant I think I’m going to go ahead and get one too."
Tarrant County Public Health is asking it's hospital and clinic partners about flu patients and deaths, but Jones says any deaths they pass along to the public do not tell the whole picture. Not all deaths are required to be processed by the medical examiner's office and so some flu-related deaths may not be officially accounted for.
The Tarrant County Public Health Department relies on the medical examiner's office to determine if someone died because of the flu. Death determinations can often take weeks.