Monday, April 27, 2009

Health Care and Swine Flu

This month, the latest health care scare comes out of Mexico in the form of Swine Flu. Scores of individuals have died there over the past several weeks, and a real fear exists of a pandemic outbreak with devastating effects. So far, the results have been favorable in the U.S. with only 1 fatality to date, and those who have contracted it have suffered with lighter symptoms than those who have it living in Mexico. But the medical community is on high alert, as are major transportation facilities including bus transport and airlines. There have been several thousand reported cases in Mexico and some in other countries. Shortages for face masks and hand sanitizer in Mexico are critical. Very scary stuff!

According to, swine influenza, or “swine flu”, is a highly contagious acute respiratory disease of pigs, caused by one of several swine influenza A viruses. Morbidity tends to be high and mortality low (1-4%). The virus is spread among pigs by aerosols and direct and indirect contact, and asymptomatic carrier pigs exist. Outbreaks in pigs occur year round, with an increased incidence in the fall and winter in temperate zones. Many countries routinely vaccinate swine populations against swine influenza. Swine influenza viruses are most commonly of the H1N1 subtype, but other subtypes are also circulating in pigs (e.g., H1N2, H3N1, H3N2). Pigs can also be infected with avian influenza viruses and human seasonal influenza viruses as well as swine influenza viruses. The H3N2 swine virus was thought to have been originally introduced into pigs by humans. Sometimes pigs can be infected with more than one virus type at a time, which can allow the genes from these viruses to mix. This can result in an influenza virus containing genes from a number of sources, called a “reassortant” virus. Although swine influenza viruses are normally species specific and only infect pigs, they do sometimes cross the species barrier to cause disease in humans.

According to the Washington Post, experts said there are several possibilities: Victims in Mexico may be more vulnerable because of nutritional deficiencies, other infections or some other factor; medical care may be better in the United States and elsewhere; the virus could be weakening as it spreads; or too few cases may have occurred outside Mexico for severe illnesses to emerge. Several experts said they think the most likely reason for the milder illnesses outside Mexico was that there have been too few cases reported elsewhere to see the full spectrum of disease the virus is causing. And, the result so far is that there is small number of people developing complications, some of whom have gone on to have to fatal outcomes.

According to, swine flu symptoms include runny nose, muscle aches, lethargy, lack of appetite, fever over 101 and sudden onset. It is difficult to distinguish from other flu types, and does require a diagnosis. Researchers are not yet sure if antiviral medicines such as Tamiflu or Relenza may remain effective against swine flu, although these antiviral medicines are working against the current strain. The Swine Flu is a combination of four known strains including Avian flu, Human Influenza, and two other viruses.

A toddler who died in Houston, according to the Washington Post, was very ill when brought in from Mexico and died after being airlifted from Brownsville, Texas. Houston health officials said the toddler who died had traveled by plane with his family from Mexico City to a town near the U.S. border on April 4. He then crossed into the United States to visit relatives in the border town of Brownsville, and developed flu symptoms April 8. Several days later, with his condition worsening, the boy was admitted to a Brownsville hospital. He was transported to Houston for additional treatment the next day. It is not known whether the child contracted the virus in Mexico or on the U.S. side of the porous border. The child, who officials said had underlying health problems, died Monday. His relatives are healthy and have not been infected. The toddler's death is a tragic case of a severe lack of health care education by the parents and family.

According to ArcaMax Health online, the Centers for Disease Control and Prevention in Atlanta, said that their study involved the development of news test kits for doctors to swab the mouth of patients and send the results to a laboratory as part of a process to monitor the spread of influenza. The CDC is sending test kits to states so that states will be able to do their own testing, and there is a stockpile of medication and other supplies helpful in managing an outbreak. This is 11 million courses of anti-viral drugs, about 25% of the total stockpile. And according to the Washington Post, U.S. authorities are monitoring the spread of the virus carefully, and urged local authorities to report all suspected cases and close schools where infections are reported to minimize spread of the disease. Private citizens should take care to wash their hands frequently, stay home from work or school if they are sick, and cover their mouths when coughing.

Around the world, governments are closely monitoring the swine flu outbreak. According to the Washington Post, in addition to the U.S. and Mexican cases, at least six have been confirmed in Israel, at least two in Spain, five in Britain and two in New Zealand, according to the World Health Organization. Israeli officials said they had confirmed two more cases, both in men who recently returned from Mexico. German health officials said three citizens who recently returned from Mexico had tested positive for swine flu. The patients were all expected to make a full recovery, officials said, though they warned that the virus was likely to spread and that they were monitoring other suspected cases in Germany. Britain has heightened airport checks of travelers who might have the flu and significantly expanded its stock of anti-viral medicines, and those few infected are responding well to the Tamiflu vaccine. The government had also ordered millions of extra face masks and planned to deliver information leaflets to every household in the country on the swine flu. Cuba and Argentina have banned travel from Mexico, although the WHO has not recommended that option. Several countries, including France, Britain, the Netherlands and Italy, advised residents to avoid unnecessary trips to Mexico. In India, officials were searching for 500 British tourists to check them for swine flu and said they would increase the number of health surveillance booths at nine international airports to screen travelers. And, Chinese officials have reported no confirmed cases on the mainland.

Worldwide, the swine flu outbreak is causing concern that the disease could reach critical mass in a short time frame. But so far, there is no genuine pandemic. According to HealthCare IT News online, both the WHO and the Centers for Disease Control and Prevention are using technology to help track the fast-moving flu and disseminate information and communicate among countries. In the United States, state officials are working with hospitals to ensure they are prepared in the event the number and severity of cases grows. Google maps, RSS feeds and Twitter are among the methods of communication employed by officials, and the public is sharing information at a faster rate than ever before. The CDC and WHO are posting on their Web sites up-to-the-minute information about new cases of the flu. They also offer recommendations on how the public and local and state officials should respond to the threat.

According to, it is likely that most of people, especially those who do not have regular contact with pigs, do not have immunity to swine influenza viruses that can prevent the virus infection. If a swine virus established efficient human-to human transmission, it can cause an influenza pandemic. The impact of a pandemic caused by such a virus is difficult to predict: it depends on virulence of the virus, existing immunity among people, cross protection by antibodies acquired from seasonal influenza infection and host factors. Swine influenza viruses can give a rise to a hybrid virus by mixing with a human influenza virus and can cause a pandemic. Swine influenza has not been shown to be transmissible to people through eating properly handled and prepared pork (pig meat) or other products derived from pigs. The swine influenza virus is killed by cooking temperatures of 160F/70C, corresponding to the general guidance for the preparation of pork and other meat.

The single best way to prevent seasonal flu is to get vaccinated each year, but good health habits like covering your cough and washing your hands often can help stop the spread of germs and prevent respiratory illnesses like the flu. There also are flu antiviral drugs that can be used to treat and prevent the flu. The CDC has several tips to avoid the flu:
1.) Avoid close contact: Avoid close contact with people who are sick. When you are sick, keep your distance from others to protect them from getting sick too.
2.) Stay home when you are sick: If possible, stay home from work, school, and errands when you are sick. You will help prevent others from catching your illness.
3.) Cover your mouth and nose: Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick.
4.) Clean your hands: Washing your hands often will help protect you from germs.
5.) Avoid touching your eyes, nose or mouth: Germs are often spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth.
6.) Practice other good health habits: Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food.

Additional tips to stay healthy and avoid the swine flu are provided by
--Hand Sanitizer: Carry hand sanitizer with you. If you have things others have touched, use your hand sanitizer to avoid swine flu infection. In addition, avoid shaking hands or other hand to hand contact whenever possible. Also avoid kissing on the cheek or other face to face contact as a greeting method.
--Public Facilities: Touch public handles and pens as little as possible. These are loaded with germs that may carry the swine flu virus.
--Air Travel: When you fly, be most diligent about following these guidelines. Transferring any flu, including swine flu, is most likely in close quarters like an airplane.
--Clean Your Produce: The life span of a virus is different for each and can vary from as much as 48 hours to 100 years depending on the hardiness of the virus. Although there have been no known cases of swine flu transmission through fruit and vegetable consumption, there does seem to be some concern about the possibility. The best bet is to buy locally grown fruits and vegetables if possible. Make sure you wash your fruits and vegetables with water, and soak for greater effectiveness. Washes and using chlorinated rinses have not been proven to work. So far there have been no cases of swine flu transmission through fruits and vegetable sources.
--Avoid Crowds: Stay out of crowds as much as possible. Close proximity to other people will heighten your chances of to get swine flu. Wear a surgical mask in areas of high traffic concentration. Try to stay at least 3-6 feet away from people.
--Eating and Drinking: Do not eat or drink after others without complete sanitization of containers or utensils. Swine flu can be transmitted by contact with infected eating utensils.
--Visit Your Doctor: Get to a doctor immediately if you develop symptoms of swine flu including high fever and body aches. Swine flu can be deadly, and it is imperative to get to a physician immediately if you think you have swine flu symptoms and think you might have contracted the swine flu virus. Both Tamiflu and Relenza are antiviral medicines that are currently effective against some strains of Swine Flu. These medicines should be taken within 36 hours of flu infection for maximum effectiveness.

Although swine flu can be highly contagious and very deadly, following the guidelines noted in this post should go far to help you avoid the disease. And like all health care emergencies, given some time, common sense, and effective communication to the public, the disease will pass. Then on to the next epidemic du jour. All kidding aside, stay smart and stay safe, and stay healthy. Don't end up as the next story on the 6 o'clock news.

Until next time. Let me know what you think.

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