ATLANTA (The New York Times News Service) -- So many messages have emerged about swine flu -- it's bad, it's not that bad, it's like the common flu, it's not like the common flu -- that many people are confused about when to seek care or head to an emergency room, doctors say.

When swine flu emerged as a new virus in April, U.S. health officials communicated their alarm about the disease that appeared to be causing severe illness and numerous deaths in Mexico. Schools were shut down and disinfected when a single student was diagnosed with the new flu, which is a mixture of swine, avian and human flu viruses.

But as more information emerged, health officials at the Centers for Disease Control and Prevention softened their alarm and reversed their early advice: Not everyone with a flu needed to be tested for swine flu, and schools should remain open when possible.

Basically, they likened the virus to the seasonal flu.

More recently, however, the message turned again as it became clear that this new virus should not always be treated as the regular flu. Swine flu, or H1N1, was more apt to strike children and young adults than the seasonal flu, and even people with no pre-existing health conditions could quickly sink into illness requiring hospitalization.

The changing messages have left many confused about whether to seek treatment if they or their child are sick, and even health care providers themselves have been challenged to keep up with the emerging research on the best treatment.

"Whenever you change the message, it will create confusion," said Dr. David Propp, a staff physician at the Emory Clinic in Atlanta.

Propp said the clinic has received many calls from people showing symptoms of swine flu but who are unsure whether they should come in for an office visit, go to an emergency room or just curl up with some tea and rest for a few days.

He pointed out that in most cases the swine flu affects a person much the same as the seasonal flu, but there are people who will be hit harder and possibly face a health crisis.

Propp has a general rule: When in doubt about what to do, call your doctor.

Often when people call a doctor's office, they speak to a receptionist or scheduler, but doctors recommend that when you need some medical evaluation over the phone, you ask for a nurse or doctor.

"You don't have to be seriously ill to call a doctor," said Dr. Beth Bell, associate director for science at the CDC's National Center for Immunization and Respiratory Diseases. "I don't think it's a good idea to just stay at home and not ask," she said.

While seasonal flu kills about 36,000 people each year in the U.S. on average, CDC reports the swine flu has killed 1,049 in the U.S. since April.

People with underlying health conditions -- such as pregnant woman, diabetics, asthma sufferers and others with weakened immune systems -- should seriously consider consulting a doctor anytime they have flu symptoms, health professionals said.

Signs of significant trouble can include severe shortness of breath, chest pain and skin taking on a bluish tinge, Bell said. In addition, if a person appears to be getting better and then suddenly gets worse, he should call a doctor, Bell said.

Particularly, labored breathing and a bluish tint to the skin require a trip to the emergency room, Propp said, as these could reflect problems with "vital functions."

Delaying that call to a doctor's office can be costly, health officials say, because the swine flu can escalate quickly into pneumonia.

The World Health Organization has urged doctors to treat swine flu quickly with antiviral drugs.

The antiviral Tamiflu is most effective when taken within 48 hours of the onset of flu symptoms, but can reduce the severity of the flu if given within 72 hours.

Some people may be confused by the changing messages, but CDC officials say they felt obligated to release information as it emerged.

"I think it's important for the CDC to be viewed as credible and transparent. If what we know changes, we need to reflect that," said Dr. Anne Schuchat, the CDC director of immunization and respiratory disease.

Some confusion may be occurring due to faulty test results for swine flu, CDC officials said.

"We are concerned that patients may not be getting diagnosed and treated because some of the tests may be giving incorrect results," said Dr. Dan Jernigan, deputy director of the CDC's influenza division.

Jernigan said, "Clinicians should treat patients who have the significant symptoms of flu regardless of the results of the simple flu tests."

Michelle Freeman, a mother in Newnan, Ga., suspects a faulty test delayed care for her daughter.

About two weeks ago, her 14-year-old daughter, Ashley, showed flulike symptoms and was running a 102.5-degree fever. But a doctor's test came up negative for the flu, she said.

Her daughter's condition has turned into pneumonia.

Freeman suspects she did have swine flu and might have recovered sooner if she had received Tamiflu earlier.

"It's very confusing," Freeman said. "Did she have swine flu?"

Copyright 2009 The New York Times News Service. All rights reserved.