"There's only one hard and fast rule in running: sometimes you have to run one hard and fast."

Wednesday, April 29, 2009

Swine Flu - Caution, not Worry

I've been published in the journal Virology, so I actually have some street cred when it comes to talking about viruses. The first purported case of swine flu has been reported in Minnesota and I thought I'd give my thoughts along with the standard precautionary stuff you can hear anywhere.

There are four different categories of influenza viruses to consider. The first are those endemic to humans, those that make an appearance with the regularity of the seasons and which are not serious unless one has a weakened immune system. I've never had the flu (once, I had symptoms that included muscle aches, but I was training pretty hard at the time and no one else had the flu, so I won't count it)!

The next, somewhat more serious, is swine flu. There are viruses that pass freely among pigs and these occasionally can infect those who work with them. They usually stop there. However, once in a while, someone harbors both a human and a pig virus and they swap genetic material; this leads to swine flu. These new viruses are different enough from the standard human ones that they cause serious illness - it will be the worst flu you've ever had, but you'll survive. Flu viruses mutate rapidly and they almost always become more infectious but less deadly, so the fact that people are dying in Mexico does not mean people here will.

Bird flu is even worse, but fortunately much rarer. Avian viruses are different enough from human ones that people rarely contract them. Again, combining genes from avian and human viruses leads to a new virus, called bird flu. This is usually deadly, but localized. Widespread bird flu is extremely unlikely.

Dozens die from a normal flu outbreak, hundreds from swine flu, thousands from bird flu. It's the nature of the beast. The one that causes epidemiologists to lose sleep is the one that has both genes from bird viruses and pig viruses, like the 1918 Spanish Flu (which actually started in North Carolina). These spread quickly and are very deadly and neither normal prophylaxis or Tamiflu will halt them. The next one will undoubtedly originate in southeast Asia, where migratory waterfowl are raised for food beside swine farms. When it comes, tens of millions to hundreds of millions will die. The best we can do would be to immediately halt international flights and send all U.S. citizens returning to the U.S. to Hawaii, which would be quarantined. We won't do that, at least not in time.

Sorry if that scares you. It scares me. Swine flu is nothing to worry about, though.

What to do, what not to do

The school where the child with swine flu went was closed. That's a big mistake, as it inevitably then sends kids to malls, where they spread it to the general population.

If you think you have the flu, stay home. If you think your child has the flu, have the child stay home. Call your doctor, rather than go to a clinic or hospital and spread it further, and your doctor will tell you what to do. Generally, a fever of 104 for two hours, 102 for two days, 101 for three days or 100 for four days means you need more help than fluids and rest will provide.

Here's the standard info on protecting yourself: wash your hands thoroughly before you touch your face (30 seconds; you can sing "Happy Birthday to You" twice or hum the Jeopardy "think" music for timing) and avoid touching the water faucet afterward. Cover your coughs and sneezes, preferably with your elbow, rather than your hand. Disinfect shared phones and keyboards (also shopping carts and doorknobs, if you can). If there's a public health emergency declared, I'd avoid public transportation. Get adequate sleep, eat healthy, drink lots of fluids and exercise.

But, if you read this blog, you probably are doing that anyway.


wildknits said...

Thanks for the clearheaded comments. As an RN in a clinic I have been getting the Public Health Notices about this since last week. As a school nurse (job #2) I have already had a notice sent home (from the MDH) about what to do. Waiting for the first "worreid well" person to show up on our doorstep with "swine flu".

Interesting note: MDH is does make reference to closing schools with the caveat that parents keep their kids at home!!!! Social isolation works to contain epidemics and kids are notarious (along with adults) for not washing their hands often enough.

I have been listening to news coverage of the probable case in Minnesota and monitoring the CDC website (while working of course). Interesting stuff.

nwgdc said...

Great piece. You've hit it on the head quite well. I've had a bunch of patients asking about this, whether or not to worry...I tried to explain what you just explained a LOT better...with increased spread, the virulence should decrease.
Oh yeah, and Tamiflu is useless.
Best approach? Stay healthy, have a strong immune system (perhaps through occasional breaks from ultramarathons), wash your hands.
Also, avoid the types of hysteria the mass media loves to feed.

Beth said...

Great post. I totally agree about closing the schools. With the high number of households with 2 working parents, closing the schools pushes the kids out into the community. My kid's school just installed hand sanitizing dispensers and are getting the kids to use them before lunch. Should have done that a long time ago.

Jean said...

Steve, thank for bringing some perspective to this situation. Great post.

DCS said...

Good advice. So how come the local newcasts don't feature you giving the skinny on the flu? Rhetorical question, of course. They thrive on drama. Plus the producers and talking heads are not the sharpest knives in the drawer.

SteveQ said...

Welcome to the non-lurkers, DCS! What I said in the post oversimplifies some matters (swine flu genes actually come from birds) and the experts have to be careful not to do that.