Thursday, 4 June 2009

Swine Flu Tips

The global rise in swine flu has showed few signs of slowing. Now in 11 countries, the H1N1 flu virus was confirmed on Thursday in the Netherlands and Switzerland; in Canada, cases rose to 27 and in the U.S., the caseload increased to 109 in 11 states, with hundreds of school closures that sent some 160,000 students home. Meanwhile, the World Health Organization (WHO) has said that a new flu pandemic is imminent, yet some pharmacies (in New York City at least) are temporarily running short of the antiviral Tamiflu. So, no one would blame you for feeling scared about getting sick.

But when people get scared, they sometimes say or do dumb things. That includes Vice President Joseph Biden, who said Thursday morning on the Today show that the swine flu virus could spread easily on airplanes, and that he has advised his family against traveling anywhere on mass transit. "When one person sneezes, it goes all the way through the aircraft," Biden told Today host Matt Lauer. "I would not be, at this point, if they had another way of transportation, suggesting they ride the subway." (See pictures of thermal scanners hunting for swine flu.)

In fact, as Dr. Richard Besser, the acting director of the Centers for Disease Control and Prevention (CDC), pointed out just a few hours later, there's no real risk for a healthy person in the U.S. to ride mass transit — not with the outbreak as small as it is currently. It's true that crowded trains and subway cars can be a vector for disease transmission if sick people are on board. You can catch the flu if you're within about six feet of a sick person — otherwise known as the "breathing space" — who coughs or sneezes on you, and a small amount of the virus can survive on inanimate surfaces. But with just a tiny number of cases in the U.S. right now, there's little risk that you'll encounter a sick person — certainly not enough to make it worth becoming a shut-in.

(To the Vice President's point about air travel: Aboard a plane, the air flows side to side, with air circulating in from above and traveling across rows — with little front-to-back air movement — before exiting the cabin. Most aircraft also ventilate the cabin with fresh air from outside and use HEPA filters to clean recirculated air.)

But misconceptions spread quickly during the early stages of a new disease outbreak. In Egypt, authorities culled some 300,000 pigs — even though there was no evidence that the H1N1 virus was circulating in these pigs or was actively passing from pigs to people. In France, authorities have said they want to ban flights to and from Mexico, even though WHO officials and other epidemiologists say such extreme measures are likely to hurt far more than they'll help. (The E.U. rejected the French request on Thursday.) "The risk of collateral damage [on top of the flu] is very real," says Michael Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

With that in mind, here are five things not to do in dealing with the swine flu frenzy.

1. Don't Rush to the ER

With the cable news networks reporting nonstop on swine flu, it feels like the disease is lurking everywhere, and that your slightest sniffle is a sign that you've contracted the virus. That would explain why people with no outward symptoms of illness are flooding emergency rooms in swine flu–affected states, afraid that they might be sick. That's a really bad idea.

First of all, having to examine people who aren't really sick only stresses the already strained resources of hospitals that are trying to prepare for a pandemic. Plus, going to an emergency room unnecessarily may even pose a slight risk to you. In past outbreaks, including SARS in 2003, hospitals were actually loci of infections — all those sick people in close proximity — and the same could be true of swine flu.

If you actually have flu-like symptoms — a fever above 100° F, headache, sore throat, body aches, chills or fatigue — and you live in an area where there have been confirmed swine flu cases, by all means report to your doctor. Otherwise, leave the hospital to the sick people.

Read "Battling Swine Flu: The Lessons from SARS."

2. Don't Be Afraid to Eat Pork

On April 29, the CDC announced that swine flu would no longer be referred to as swine flu, but as the "2009 H1N1 flu." It's less catchy, but more accurate. For one thing, there is no evidence that this virus makes pigs really sick. And the H1N1 virus actually contains genes from swine, avian and human flus. The virus also cannot be spread through pork products — you can't contract swine flu by eating bacon, hot dogs or anything else that was once a pig. Nor will culling pigs, as authorities did in Egypt, do anything to stem the spread of the disease. H1N1 has jumped to humans and is passing easily from person to person, so it's now a human flu that needs to be controlled in us, not the pigs.

Read "Don't Blame the Pig."

3. Don't Hoard Antivirals

The H1N1 virus has so far proven vulnerable to the antiviral drugs Tamiflu and Relenza, which is good news. A cornerstone of the government's pandemic preparations was the stockpiling of 50 million doses of those drugs over the past few years, enough to ensure that doctors would be able to respond sufficiently to new outbreaks. But that capacity could be compromised if people begin stockpiling antivirals for their own use. Already there are reports of pharmacies running short of Tamiflu, and many hospitals in the U.S. have begun restricting the power to prescribe antivirals to just a few doctors. Also, the misuse or overuse of Tamiflu or Relenza by patients can promote resistance in the flu virus — effectively removing the only bullets from our gun.

Read "How Fast Could a Swine Flue Vaccine Be Produced?"

4. Don't Leave Home If You Feel Sick

In the absence of a vaccine, the only defenses we have against the spread of H1N1 are simple ones. Cover your mouth when you sneeze or cough (with your arm, not your hands, to avoid spreading the virus through handshakes) and wash your hands frequently. Buy a pocket-sized bottle of hand sanitizer and use it — it's the easiest way to avoid getting sick.

But when it comes to slowing the overall spread of a pandemic flu, the best thing we can do is keep sick people away from everyone else. It's called "social distancing," and studies of the deadly 1918 Spanish flu showed that cities that instituted distancing measures quickly suffered lower death tolls than cities that did nothing or reacted slowly. So if you're feeling sick, don't go to work until you feel better — even though that may not be the most welcome advice for the nearly 50% of private-sector workers in the U.S. who don't get paid sick days.

Read "How to Deal with Swine Flu: Heeding the Mistakes of 1976."

5. Don't Panic

TV anchors can't stop asking the question: "When is it time to start panicking?" How about never? Panic can only lead to stupid actions — on a personal and national level — that would likely make a pandemic worse.

As worrying as the epidemic has been, keep in mind that only one person so far has died of swine flu outside Mexico. Many scientists are beginning to think that even if we do have a full-fledged pandemic on our hands, it may likely be a mild one. A computer model by researchers at Northwestern University estimated that even if nothing were done to slow the spread of the disease from now on, by the end of May the U.S. would have only about 1,700 cases. The good news is that H1N1 is hitting North America at the tail end of its flu season. It's possible that the virus may peter out and re-appear next autumn, but that gives us months to prepare.

As WHO and CDC officials keep reiterating, influenza is an enigma, and H1N1 will keep evolving, keep changing — so we can't predict how the epidemic will progress. But one thing is certain: Panicking will only make the situation worse. "This is a cause for deep concern, but not panic," said President Barack Obama in his April 29 news conference. In the midst of all this anxiety, that's the best advice there is.

Read "To Travel or Not to Travel? A Swine Flu Dilemma."


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