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Entries in M.D. (6)

Tuesday
Apr282009

A Swine Flu Primer

Coffee Brown, MD, University of New Mexico, Talk Radio News Service

Is swine flu the pandemic we know is coming? According to federal agencies and a blue-ribbon panel of experts: maybe. The situation is early enough and changing fast enough that we can reasonably hope for the best even as we plan for the worst. This primer is designed to help you do just that. We will continue to post updates. The short answer is that basic hygiene is the most important thing to concentrate on.

The swine flu is a virus, not a bacteria, therefore, antibiotics are not useful against it.
The virus is Influenza A (H1N1), meaning that not all flu is this particular swine flu, and not all respiratory viruses are this virus. This virus has elements of human, avian, and swine flu virus genetics (i.e., not human genes, or bird or pig). There is little or no current human resistance to this strain. Pork is not in any way associated with this virus at this time. raising pigs or eating pork are not thought to carry any risk whatsoever for this infection.

Well then, what can you do? For now, treat this as good practice, not just for the WHO and the CDC, but for each individual: Wash your hands frequently, cover your face when you sneeze or cough, wash your hands after doing so, and demand the same courtesy from those around. Clean doorknobs, faucet handles and similar items that are touched by many other people. Avoid unnecessary travel to Mexico, Avoid work, school, or gatherings if cases have been reported in the immediate area, or if you have any infectious symptoms. Working while ill is not the heroic thing to do.

Should you go to work or school? Yes, with these exceptions: If you have any respiratory symptoms or if swine flu has been identified in your immediate community. These are also the circumstances which would support wearing a mask or avoiding gatherings.

What symptoms should you look for? If your are worried about a contact, symptoms should begin within 7 days. Symptoms should include some combination of the following:
Respiratory symptoms, like sniffles, congestion, cough (typically not productive), or sore throat, are almost always present. Fever, muscle aches, chills, fatigue and malaise are frequent, Occasionally nausea, vomiting, and diarrhea. If you believe you may have the flu, your doctor can test for it.

Currently available antivirals are effective against this strain, and a quarter of government stockpiles, totaling about 11 million doses, have been released from government stockpiles to communities for treatment and prevention. Protection lasts about 10 days. Your has physician has specific guidelines for the use of these medicines, They should NOT be used “just to be sure.”

The current flu vaccine is not effective against this strain. A new vaccine is under consideration, but will not be available over the short term. First steps, distributing a “seed virus” to pharmaceutical companies to create pilot batches of vaccine, have begun. The pilot batches need to be tested for safety and effectiveness before full-scale production is requested. By the time that decision can be made, the pattern of this disease will be much more clear. The whole process takes several months before vaccines are available to consumers, which means it will not be available during this season. The vaccine may still be important, though, because history shows that a second or even third wave may present during fall and/or winter.

Sen. Arlan Specter (D-Penn.) attended today’s hearing briefly to emphasize the need to balance fully informing the public with the need to keep the problem in perspective.

What is the government doing about this? Plans have been long since prepared for just this situation, supplies, like antivirals, masks, and respirators have been distributed by the CDC and FEMA. Daily updates are being distributed to healthcare workers all over the country. The CDC advises a regional containment strategy, varying the level of response to the local pattern of illness. Increased screening of arrivals from out of the country, or travel restrictions within the country, would not be expected to reduce the spread.

We are on Stage 4 alert, per the WHO, how bad is that?
It simply means that there definite cases of human-to-human transmission, Stage 4 does not mean that the disease has become more severe.

All the really sick people are in Mexico. It is not known why the most severe cases appear to be confined to Mexico so far, but the CDC expects some severe cases to occur here as well. How worried should you be? Think of this as similar to an orange level terrorist alert. The emergency designations allow government resources and authorities to be positioned before a disaster occurs.There is a real possibility that the outbreak will worsen, but for now, it’s a matter of being ready. Of the 40 American cases as of last night (04/27/09), one has been hospitalized, none has died, the rest have been mild.

As of 04/28/09, 64 cases had been confirmed, and five Americans hospitalized. These numbers will be outdated by the time you read them. What does that signify? This is an expected event: more cases will be discovered each day for a while, and therefore more hospitalizations. The percent who become severely ill may go up, if this turns out to be highly contagious and virulent, or may go down, as screening picks up more of the milder cases that would normally go un-noticed. The ultimate pattern is not clear this early, but all government agencies are taking the possibility of a true pandemic seriously, and individuals should do the same. States and municipalities should review their infectious disaster plans.

Because of increased attention and the need to report new developments rapidly, expect conflicting information and ongoing reappraisal.

Harkin asked the panel whether funding is adequate for their response. they responded collectively that past funding has made it possible to begin work on a vaccine, and also enabled surveillance that Schuchat said lead to the virus beginning analysis in the U.S. before Mexico sent specimens to Canada for identification. Harkin said that he was disappointed that Mexico considered American bureaucracy a stumbling block, and that he would follow up on that. The panel also told him that reduced funding undermined the states’ ability to operate existing epidemic plans, had cost PHS 12,000 employees.

This Information is from The Centers for Disease Control http://www.cdc.gov/swineflu/ ,the World Health Organization’s http://www.who.int/csr/don/en/ Dr. Richard Besser and the Senate Appropriations Committee Chaired by Sen Tom Harkin (D-Iowa).
Witnesses included: Rear Adm. Anne Schuchat, interim deputy director for Science and Public Health Program at the Centers for Disease Control and Prevention; Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases; and Paul Jarris, executive director of the Assn. of State and Territorial Health Officials.

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