H1N1 is out of control here

[doctorcoug]

We are swamped with sick people. A local high school closed because 1/3 of the students had a fever at school. I've taken care of a bunch of elderly with it, but I now have my first healthy 20 year old that looks miserable. It is really quite unusual.

One of the problems I didn't anticipate is that all of my post-op patients stayed extra days because of high fevers. We were full with no room for patients. Our entire medical floor was spiking fevers.

[DrumNFeather]

Here's a forward I got from my FIL. Pretty straight forward stuff, but I thought I'd post and let the Docs chime in.

H1N1 - SWINE FLU TIPS...

Dr. Vinay Goyal is an MBBS,DRM,DNB (Intensivist and Thyroid specialist) having clinical experience of over 20 years. He has worked in institutions like Hinduja Hospital, Bombay Hospital, Saifee Hospital, Tata Memorial etc.

Presently, he is heading our Nuclear Medicine Department and Thyroid clinic at Riddhivinayak Cardiac and Critical Centre, Malad (W).

The following message given by him, I feel makes a lot of sense and is important for all of you to know

The only portals of entry are the nostrils and mouth/throat. In a global epidemic of this nature, it's almost impossible not coming into contact with H1N1 in spite of all precautions. Contact with H1N1 is not so much of a problem as proliferation is.

While you are still healthy and not showing any symptoms of H1N1 infection, in order to prevent proliferation, aggravation of symptoms and development of secondary infections, some very simple steps, not fully highlighted in most official communications, can be practiced (instead of focusing on how to stock N95 or Tamiflu):

1. Frequent hand-washing (well highlighted in all official communications).
2. "Hands-off-the-face" approach. Resist all temptations to touch any part of face (unless you want to eat, bathe or slap).
3. *Gargle twice a day with warm salt water (use Listerine if you don't trust salt). *H1N1 takes 2-3 days after initial infection in the throat/ nasal cavity to proliferate and show characteristic symptoms. Simple gargling prevents proliferation. In a way, gargling with salt water has the same effect on a healthy individual that Tamiflu has on an infected one. Don't underestimate this simple, inexpensive and powerful preventative method.
4. Similar to 3 above, *clean your nostrils at least once every day with warm salt water. *Not everybody may be good at Jala Neti or Sutra Neti (very good Yoga asanas to clean nasal cavities), but *blowing the nose hard once a day and swabbing both nostrils with cotton buds dipped in warm salt water is very effective in bringing down viral population.*
5. *Boost your natural immunity with foods that are rich in Vitamin C (Amla and other citrus fruits). *If you have to supplement with Vitamin C tablets, make sure that it also has Zinc to boost absorption.
6. * Drink as much of warm liquids as you can. *Drinking warm liquids has the same effect as gargling, but in the reverse direction. They wash off proliferating viruses from the throat into the stomach where they cannot survive, proliferate or do any harm.

[WashingtonCoug]

Half the people in my office (about 20) are out with Swine flu today. I'm thinking about taking the rest off the week off.

[ERCougar]

Here's a forward I got from my FIL. Pretty straight forward stuff, but I thought I'd post and let the Docs chime in.

H1N1 - SWINE FLU TIPS...

Dr. Vinay Goyal is an MBBS,DRM,DNB (Intensivist and Thyroid specialist) having clinical experience of over 20 years. He has worked in institutions like Hinduja Hospital, Bombay Hospital, Saifee Hospital, Tata Memorial etc.

Presently, he is heading our Nuclear Medicine Department and Thyroid clinic at Riddhivinayak Cardiac and Critical Centre, Malad (W).

The following message given by him, I feel makes a lot of sense and is important for all of you to know

The only portals of entry are the nostrils and mouth/throat. In a global epidemic of this nature, it's almost impossible not coming into contact with H1N1 in spite of all precautions. Contact with H1N1 is not so much of a problem as proliferation is.

While you are still healthy and not showing any symptoms of H1N1 infection, in order to prevent proliferation, aggravation of symptoms and development of secondary infections, some very simple steps, not fully highlighted in most official communications, can be practiced (instead of focusing on how to stock N95 or Tamiflu):

1. Frequent hand-washing (well highlighted in all official communications).
2. "Hands-off-the-face" approach. Resist all temptations to touch any part of face (unless you want to eat, bathe or slap).
3. *Gargle twice a day with warm salt water (use Listerine if you don't trust salt). *H1N1 takes 2-3 days after initial infection in the throat/ nasal cavity to proliferate and show characteristic symptoms. Simple gargling prevents proliferation. In a way, gargling with salt water has the same effect on a healthy individual that Tamiflu has on an infected one. Don't underestimate this simple, inexpensive and powerful preventative method.
4. Similar to 3 above, *clean your nostrils at least once every day with warm salt water. *Not everybody may be good at Jala Neti or Sutra Neti (very good Yoga asanas to clean nasal cavities), but *blowing the nose hard once a day and swabbing both nostrils with cotton buds dipped in warm salt water is very effective in bringing down viral population.*
5. *Boost your natural immunity with foods that are rich in Vitamin C (Amla and other citrus fruits). *If you have to supplement with Vitamin C tablets, make sure that it also has Zinc to boost absorption.
6. * Drink as much of warm liquids as you can. *Drinking warm liquids has the same effect as gargling, but in the reverse direction. They wash off proliferating viruses from the throat into the stomach where they cannot survive, proliferate or do any harm.

I'm suspicious how effective these really are (well, except for 1 and 2, which are kind of no-brainers), but they're cheap with little downside, so why not?

It's interesting to see my kids' habits change with their teachers' instructions. They're all coughing into their elbows and catching me every time I don't.

[TripletDaddy]

From today's SL Trib. Some basics, but might be helpful nonetheless.

http://www.sltrib.com/news/ci_13492565

[happyone]

My office had a "swine flu exercise" yesterday. They sent half of the people home and had us work from there. We have had a couple of people with kids that have had it, and they sent them home. The powers that be are really paranoid about this.

[woot]

almost half of my students weren't in class yesterday. It wasn't all H1N1, but I know at least a couple of them have it.

Anybody remember when folks on this board were making fun of researchers/media for making such a big deal about it?

[happyone]

almost half of my students weren't in class yesterday. It wasn't all H1N1, but I know at least a couple of them have it.

Anybody remember when folks on this board were making fun of researchers/media for making such a big deal about it?

Sure, I was one of them.

[Babs]

almost half of my students weren't in class yesterday. It wasn't all H1N1, but I know at least a couple of them have it.

Anybody remember when folks on this board were making fun of researchers/media for making such a big deal about it?

I'm still making fun. It's not a big deal.

[TripletDaddy]

almost half of my students weren't in class yesterday. It wasn't all H1N1, but I know at least a couple of them have it.

Anybody remember when folks on this board were making fun of researchers/media for making such a big deal about it?

I was one of them. Why is swine flu any different than the non-porcine version? I have some bad news for you....many of your students will miss class this cold/flu season, even if the strain of flu is not H1N1.

[Babs]

I was one of them. Why is swine fly any different than the non-porcine version?

The symptoms are milder. The mortality rate is lower. There's no vaccine available yet. That kind of thing.

[Jarid in Cedar]

I was one of them. Why is swine fly any different than the non-porcine version? I have some bad news for you....many of your students will miss class this cold/flu season, even if the strain of flu is not H1N1.

As far as virulence, the h1N1 appears to be less damaging than the routine influenza(based on last springs data, which has some issues). The problem will lie with the number of people who will become infected, due to the lack of baseline immunity in the communities to H1N1 strain.

I think the awareness is important. People need to know what to do if it runs rampant through the country. If it does not, then they were educated on how to help reduce the spread of human based strains of influenza as well.

[Babs]

The problem will lie with the number of people who will become infected, due to the lack of baseline immunity in the communities to H1N1 strain.

Don't patronize TD. I won't stand for it.

Anyway, how is that, in and of itself, a problem? I mean, other than the widespread loss of productivity and so on. People get sick every year. It happens all the time. It still seems much ado about nothing to me.

The only concern for me, is the implications re: a possible avian flu. Now we've seen how fast these things propagate, and there's no guarantee that an avian strain would be as benign as the swine one has been.

[Jarid in Cedar]

Don't patronize TD. I won't stand for it.

Anyway, how is that, in and of itself, a problem? I mean, other than the widespread loss of productivity and so on. People get sick every year. It happens all the time. It still seems much ado about nothing to me.

The only concern for me, is the implications re: a possible avian flu. Now we've seen how fast these things propagate, and there's no guarantee that an avian strain would be as benign as the swine one has been.

Simple logistics.

Routine human influenza strain is introduced into a community of 100,000. There is 65% baseline resistance to that strain in the community.

That means 35,000 could become infected.
Assume a 40% penetrance,
14,000 get infected.

50% assymptomatic spreaders, 30% mild symptoms, 17% moderate to severe symptoms, 3% mortality, So of the 14,000

7000 would not get sick,
4200 get sick enough to miss work,
2380 get sick enough to require medical care, possibly hospitalized
420 people die

Now H1N1 is introduced into a community of 100,000. There is 2% baseline resistance to that strain in the community.

That means 98,000 could become infected.
Assume a 40% penetrance,
39,200 get infected.

50% assymptomatic spreaders, 35% mild symptoms, 14% moderate to severe symptoms, 1% mortality, So of the 39,200

19,100 would not get sick,
13,720 get sick enough to miss work,
5488 get sick enough to require medical care, possibly hospitalized
392 people die

About the same # of people die, but the burden on hospitals and MD offices is much more staggering, altering the ability to deliver care for other illness/disease.

Now the concern about extrapolating April's mortality data is that the outbreak occurred during an unusual time of year for influenza. We do not know whether the current strain will be more virulent when it is colder(the virus can replicate more efficiently, or the host is more susceptible to more severe illness), or will the virus mutate into a much more deadly rendition.

[JohnnyLingo]

Count me in with Babs. Not worried.