2009 Mexican Flu – H1N1 Flu – (Swine Flu) – What to do?

I prefer to name flu by the city where it started and the year. What animal the strain may have started in can be the same in many years so naming it “swine flu” this year seems odd.

Panic is stupid.  Flu happens every year. A person is infectious beginning a day or two BEFORE they come down with symptoms. That is why it CANNOT be contained. It will run its course. Every year about 40,000 Americans die of influenza (often attacking the very old, sick and very young). Some years 100,000 die in the U.S. and some years the numbers are much smaller.

Its actually good to get influenza now and then because you build up partial resistance to many strains. That is why in the 1918 pandemic the middle aged didn’t die much. The young adults with no immunity died. Influenza (“flu”) will spread very rapidly and tens of millions will get sick. Many will have minimal illness and think they have a bad cold if the fever is less than 101 degrees.

In Mexico City there are probably in reality tens of thousands of cases of people who had mild illness and didn’t realize they have the Mexican flu, so I don’t think the death rate is actually unusually high. Many of these people with mild illness, including people who visited Mexico city and were travelers have already spread the illness around the world before they even had symptoms.

Most will have moderate illness consisting of feeling miserable for a few days with fever greater than 101 degrees (usually around 103) in 3 to 4 spikes per day, headache, severe muscle aches, prominent cough, nausea, diarrhea, minimal runny nose, severe weakness and loss of appetite. (“I feel like I was hit by a truck”) Notice that it is not “just a virus” or a “cold” where you have an intensely stuffy and runny nose, maybe a cough and fever of 100 to 101 degrees with mild muscle aches.

The hallmarks of influenza are the high fever (children may have fevers of 105 as they are often 1-2 degrees higher than adults), the severe muscle aches and the headache along with cold like symptoms and cough.

Make sure to push fluids – a good mixture to keep sipping constantly to prevent dehydration is a cup of juice in a quart of water with 1/2 teaspoon of salt added. The goal should be to drink at least a quart every 4-6 hours (for adults). That is at least a cup every hour. Drink it slowly if you are having vomiting – even a teaspoon every 15 minutes. (This is very similar to the children’s solutions known as “Pedialyte” or “Ricelyte” that you can buy at the store to give a sick child so they don’t become dehydrated. This replaces the salt lost with vomiting or diarrhea. Don’t add too much salt! It also gives a little sugar to keep you going.

If you have symptoms stay in bed and drink lots of fluids. If fever doesn’t go away in 3-5 days CALL your doctor and discuss it with him/her. Don’t automatically go to ER or your doctor’s office – you’ll just spread it. If you must go out wear a mask and wash your hands before leaving to minimize spread. If trouble breathing, uncontrolled vomiting or diarrhea making you too dizzy to stand, go to ER, but call before you go and tell them to be prepared. Ask for a mask as soon as you enter or ask for one to be ready when you arrive by calling them.

Those with chronic illness and the very young must be watched carefully. They MUST obtain medication within 24 hours of becoming sick. Help them call their doctor and go to the pharmacy and pick up the medication for them. This is the time to tell your elderly or disabled/handicapped neighbor, if they need your help you are available.

I expect the usual number of deaths this year so even several hundred doesn’t panic me. 

Wherever you go, keep washing your hands – as soon as you get home, after you go to the bathroom and don’t handle doorknobs or faucet handles with you hands if  possible – push them with your elbow or turn them while holding a towel or Kleenex. Anything you touch can spread the illness. Make sure to wash hands before you eat all the time. Wash hands before and after you go to a different location and after you touch common items like doorknobs before you eat. Don’t rub your nose or eyes with your hands. 

Be courteous and don’t go out if you are sick or if your family is sick – wait at least 3 days to see if you will catch it too – remember you are infectious for 2 days before you have symptoms.

Everything will be fine.  Closing borders NEVER works if the illness has spread already across a border.  It is clear that the illness is already global. Therefore, containment IS NOT POSSIBLE AT THIS POINT.  Containment in the modern era with such an illness (short incubation period of days at most, rapid spread by droplets and touching) IS NOT POSSIBLE. STOP even thinking that borders should be closed.  The only thing that should be curtailed is large gatherings of people and gatherings with close contact.

As to the vaccine – there is none right now. It was a new strain that cropped up in Mexico City this spring and it will take 4-10 months to manufacture this vaccine and distribute it. EVERY year a committee looks at what strains are going around the world. The virus changes every year and every year there are new strains, often related to previous strains but not identical. A decision is made in around March or April as to what strains should be included in that year’s vaccine. The Mexican flu (swine flu) was not included in this year’s recommendation, but that is changing and they may still have time to include it or they may have to make a second vaccine batch this year and give two different vaccines – one to the strains going around and one for the Mexican or swine flu.  When it is available at the earliest in around October or November, the elderly, chronically ill, young, and healthcare workers and emergency workers should get it first, then everyone else can get it if they want. For your information I NEVER TAKE the flu vaccine.  About 1 out of every 3 years the vaccine is ineffective as they guessed what strain they should use for the vaccine and their best informed guess was wrong. The vaccine is NOT PERFECT. Also there is some research data that your risk of Alzheimer’s disease goes up slightly with increased numbers of yearly vaccine shots. There is also a small risk of Guillan Barre Syndrome that may result from the vaccine. Every year a few people get very ill from the vaccine but the numbers are VERY small. Everyone needs to decide their risks and benefits from obtaining vaccines based on their own health history, age, and the health history of their family.

Medication is available for most strains, but YOU MUST start it within the first 24 hours of symptoms. Call your doctor the first day if you become sick.  Tamiflu is not recommended to be used prophylactically. It will likely just make the virus resistent to it if too many people use it daily for weeks or months. Don’t do this unless you are chronically ill and your doctor tells you to do this. There are also several other medications available and your doctor will know which strains are resistent to which drugs and how to use them properly.

Listen to the public health experts and don’t use this publicity about what may end up being a normal flu season to discriminate against other people. Let’s just wait and see if this is a bad season or a mild flu seasson. If it starts to get very bad with a higher number of deaths, then that is when we should close schools and businesses for a week or two if there is an outbreak at such a facility.

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