H1N1 Flu – Some Good News, and a Warning There is good news and bad news for the H1N1 “Swine” Flu. The good news is that the World Health Organization has completed testing of flu samples from six countries, and all the samples have been found to be identical. This is great news. Now that scientists are sure there have been no more mutations of the virus, they can begin designing and manufacturing a vaccine. Now some bad news: If this new flu strain acts as those in the past, this is only the first wave of the H1N1 flu and not the end of it. It will probably reappear in the fall, and when strains reappear they often arrive as a more potent strain. We will need a vaccine to protect us when this strain resurfaces for a second, and possibly third wave. Remember, a vaccine helps prevent the flu, while an antiviral drug treats the symptoms of flu. Antivirals like Tamiflu ® have now been distributed to each state. In many states the National Guard is being used to securely transport and store the drug. This is being done to insure the safety of the drugs and to prevent theft and contamination by those who would do us harm. On another positive note, scientists have not found in this flu strain the genetic markers present in the 1918 strain. This is good news, for it means the H1N1 strain will likely be less potent than the 1918 “Spanish” flu. It is too early to let down our guard, though, since in the end nature will have the final say. Public health officials urge communities to have a plan in case schools and workplaces need to close. If you have not already done so, ask your school what their pandemic plan is. You need to know the plan, not only so you have the information for now, but also in the event this flu appears again in the fall. If you have a business, a plan is in order there, too. The Secretary of Education gave some counsel for parents, school districts, teachers and students: What parrents should do:
By Carolyn Nicolaysen
- Keep your children home if they or a family member is ill.
- If your school is closed keep your children at home. School are closed to limit the spread of the flu. If your child is at the mall or a movie the spread will continue. Keep your kids home if their schools are closed!
What school districts should do:
- Close schools if a student of staff member is suspected of having the flu, and plan to keep schools closed for at least two weeks as the virus can be contagious for seven to ten days.
What teachers should do:
- Rework your lesson plans so you can send home handouts and books with your students enabling them to continue their studies at home.
- Know how you can reach your students at home. Get phone numbers and email addresses.
- Design a way to get lessons to students using email.
What can students do? “Keep working hard so you don't fall behind your peers in other schools.”
The lesson for us is again, true for all: "…if ye are prepared ye shall not fear".
Caring for Family During a Pandemic - Part 2 Most experts agree the medical community as we know it will cease to exist during a pandemic. It is critical that we all learn as much as possible now, in preparation to care for ill family and friends ourselves. It is also important to understand that the flu pandemic of 1918 did not begin during the months we normally associate with the flu. We must continue to prepare and understand that when spring arrives we are not "safe for another year". No one knows when a pandemic may occur. Unlike a cold, the flu usually begins suddenly with a fever between 102º to 104º F. During a pandemic we will have little warning that the flu may strike our family. There may be no time to isolate ourselves. It may already be too late if we circulate ourselves in a highly populated environment and are exposed to others who have not yet begun to display symptoms. Someone perfectly well in the morning may be confined to bed by that night. If your family member becomes ill, you should understand the progression of the disease. Day 1- Day 2: Chills, weakness, lack of energy, loss of appetite, headache, back, arms, and legs ache. Day 2- Day 4: Chills, weakness, lack of energy, loss of appetite, headache, back, arms, leg aches begin to decrease and respiratory symptoms begin to increase. Symptoms similar to that of a cold, croup, or pneumonia may appear. Patients may experience a sore throat, headache and a dry, hacking cough. Nasal discharge and sneezing are also common. Fever should disappear. Day 4- Day 7: Symptoms should disappear. Coughs and a feeling of being continually tired may continue for a few weeks. A second wave of fever may occur. This is rare and means the steps will begin over again. Patients should remain at home at least until all symptoms, except a dry cough, disappears. There are times when you should see a physician immediately. If you, or a person in your care, have any one of the following symptoms:
- shortness of breath while resting or doing very little
- difficult or painful breathing
- coughing up bloody sputum
- wheezing
- chest pain
- fever for 3 to 4 days without improvement
- feeling better then suddenly having a high fever or becoming ill again
- extreme drowsiness and difficulty awakening
- disorientation or confusion
- severe earache
- constant vomiting or diarrhea
If your family member has any of the following, go to the hospital immediately:
- Severe trouble breathing and it is not caused by a stuffy nose
- Has blue lips or hands, suddenly becomes pale, or has cold legs up to their knees
- Is limp or unable to move
- Is so sleepy they don't respond when you try to get them up
- Shows signs of a stiff neck, especially if they also have fever, are listless and their eyes are sensitive to light
- Is very confused
- Has a seizure
- Has worsening of chronic medical conditions (such as: heart or lung disease or diabetes)
As with the common flu, time is the healer. Medications to relieve symptoms should be given to patients to help them get the sleep they need for their body to heal. These medications will all become impossible to find once a pandemic has begun. You should be storing them and have a supply in your home at all times.
Medications to relieve symptoms
Muscle pain and fever: Use acetaminophen (like Tylenol). If you take acetaminophen for a long time or in high doses, it can affect the liver and kidneys, so use only when symptoms exist. You may also choose Ibuprofen (such as Advil or Motrin). Ibuprofen can irritate the stomach and thus should only be used when stomach irritation (vomiting and diarrhea) are not present. Never give aspirin to anyone under the age of 18 (i.e., follow manufacturer recommendations).
Cough: Try a medication with Dextromethorphan (DM) for a dry cough that prevents you from sleeping or causes chest discomfort.
Stuffy nose: Use a decongestant. Nasal drops or sprays act quickly and have fewer side effects than medications you take by mouth. However, they should only be used for 2 or 3 days to avoid dependency. If a stuffy nose continues switch to an oral medication such as pseudoephedrine. Decongestants may cause dry mouth, sleep problems, rapid heartbeat or other side effects. People who have long-term health problems or who are on other medications should not take decongestants without talking to their doctor.
Sore throat: Lozenges or throat sprays with Dyclonine works best to numb the throat. Products containing honey or herbs may also soothe the throat. Herbal tea with honey is also very soothing and easy on the stomach.
Diarrhea: This should not be treated with medications. Diarrhea is the way the body rids itself of infection. This is a good thing. Treat cases of diarrhea by keeping the patient on a clear liquid diet (see below) for at least a day. Be sure to continue to monitor the amount of fluids consumed and remember the patient should be drinking more than they normally would to prevent dehydration.
Additionally, a patient should not be allowed to smoke or drink alcoholic beverages. They will make many symptoms worse and slow the healing process.
Diet Recommendations for Flu Patients:
A clear liquid diet should be used to treat intestinal and stomach illnesses. Patients suffering from diarrheal illnesses often experience abdominal cramping if they eat solid foods. In addition, a great deal of water and minerals (sodium, chloride, and potassium) are lost in the watery portion of the stool; if you are not careful this can lead to dehydration. Patients with diarrhea need to drink much more fluid than usual to prevent dehydration. This is especially important if the patient also has a fever, which increases loss of fluid through the skin as perspiration.
When a patient is ill feed them the following:
Step 1: Clear liquid diet: rehydration solution, (see Meridian article: Caring for Family During a Pandemic - Part 1) water, fruit juice, Jell-O™, ginger ale, lemon lime soda, or tea.
Step 2: When a patient tolerates Step 1 well, gradually add: white toast (no butter or margarine), white rice, cream of wheat, soda crackers, or potatoes without the skin. You may also add small servings of banana or applesauce.
Step 3: After a day, add canned fruit and chicken noodle soup.
Step 4: Next add poached eggs and baked chicken breast without skin, canned fish or meat.
Step 5: Finally add milk and other dairy products, margarine or butter, raw fruits and vegetables and high-fiber whole grain products.
A few other tips to keep in mind:
It is a good idea to use a traditional glass thermometer for each person to avoid cross-contaminating patients, or use a digital thermometer with lots of disposable sleeves. It is also important to have a back up just in case of an accident. You don't want to be without a thermometer.
Get plenty of bed rest - you, not the patient. To remain healthy there is nothing better for healthy family members than a good night's sleep. Your body cannot fight an illness if it is exhausted.
Do not smoke. Smoking compromises the immune system of the healthy as well as those who are ill.
Restrict visitors to your home. During a pandemic, plan to have friends and family leave supplies, dinners, or just notes and gifts, on the porch. Wait until they leave and then open the door and retrieve the items.
If you need to leave the house, try to remain at least 3 feet away from others. Also, wear a mask and keep your hands in your pockets. Yes, really. Have you ever just automatically reached out your hand to shake hands when you know someone is ill? Avoid shaking hands with anyone.
Patients should not leave the home during the time when they are most likely to be infectious (at least 5 days after onset of symptoms). When a patient needs medical care and thus must leave home, they should follow cough etiquette (cover the mouth and nose when coughing and sneezing) and wear N95 masks.
Medical facilities will be overwhelmed during a pandemic. You will not want to go to the doctor's office or to the hospital unless it is absolutely necessary. Prepare now to obtain medical advice by other means. Check with your doctor to see if he/she has a plan to answer patient questions during a pandemic. Also, check with your insurance carrier and your state health department to see if they have a help line available. Remember the Internet may be down if the power fails so you will want phone numbers.
A pandemic should not be feared but it should not be ignored either. Now is the time to prepare for the worst and pray for the best.
Carolyn discusses pandemic preparedness every Friday on her blog, where you can find additional information on other emergency preparedness topics.
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