Isle residents with flulike symptoms are urged to stay home as swine flu spreads through the state and a fourth death is reported.

“;Basically, we're at a level even higher than we have seen in the last five years during the peak of the regular flu season,”; said Dr. Sarah Park, state epidemiologist and chief of the state Health Department's Disease Outbreak Division.

An adult male in his 50s died Sunday with the infection at a Big Island hospital primarily because of influenza pneumonia, Park said, “;but the patient's underlying medical conditions were a contributing factor.”;

The three previous deaths associated with the novel H1N1 influenza were an adult female in her early 50s who died July 7 at Kona Community Hospital, an Oahu man in his late 40s who died July 10 at the Queen's Medical Center, and an Oahu woman in her late 60s who died June 19 at Tripler Army Medical Center. All were reported to have underlying medical conditions.

State tests show “;the vast majority”; of flu illness statewide now is the pandemic H1N1 influenza, with a small mix of seasonal influenza H1 and H3, Park said.

“;If only I could get people to understand they should stay home when sick,”; she stressed. “;That's all I'm asking now: Please stay home. That would be the best contribution to themselves, their families and everyone else around them. It is a deceptively simple message but a critical message, especially with the upcoming fall season.”;

Many workers who feel ill are still going to work because of the economy, and “;some people are in jobs where it's difficult to take time off,”; she said.

She is asking businesses and organizations to help sick employees stay home as an “;ohana.”;

The U.S. Centers for Disease Control and Prevention listed Hawaii yesterday with 1,424 H1N1 cases and three related deaths, based on state information a week ago. The state Health Department no longer reports numbers of cases, and CDC said its last listing was yesterday.

The CDC and most states are saying “;case counts are not the important focus,”; Park said. Most have prioritized testing, which varies among states based on their capacity for testing, she explained.

Hawaii's State Laboratory is focusing on priority groups: severe cases, people with high-risk conditions or in high-risk jobs such as health care workers, travelers and residents in an outbreak investigation.

“;In terms of public health and epidemiology,”; Park said, “;we're trying to get a snapshot picture of what's circulating in the community and when the virus might change. ... Everything now indicates the virus is the same or similar to what it has been since the beginning of the season. We hope it will stay that way. We just don't know with flu viruses.”;

But whether it is the novel swine flu or seasonal flu, Park emphasized, “;This is a serious disease and can cause deaths.”;

Residents should try to stay healthy and use good hygiene to prevent illness—covering a cough or sneeze, frequently washing hands and not touching eyes, nose or mouth, she said.

Vaccines are not available for H1N1 influenza, but Park encourages people to get shots for seasonal flu. A plentiful supply of seasonal influenza vaccine is expected to be available for doctors at the end of August and beginning of September, she said. The Health Department also is planning a third season of its “;Stop Flu”; school vaccinations for seasonal flu.

With two types of influenza circulating in the community, health care facilities and doctors' offices are crowded with patients, Park said.

“;If we can keep levels of seasonal flu down ... it would help clinicians in managing patients.”;

People have the idea that a rapid H1N1 test can be done in a doctor's office, but that is not true, Park said. Only the State Laboratory is capable of testing for H1N1, “;and it is stretched to capacity,”; she said.

“;We have been running full tilt since the end of April,”; she said.

Hawaii's first three swine flu cases were confirmed May 5.

“;We have to stress that clinicians need to be on alert,”; Park said. “;We don't want to miss other potential respiratory diseases out there. Plenty of other things are going on—the usual respiratory viruses and bacterial infections.”;