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Home > EMS Products > Education
May 04, 2009
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Firemedically
by Mike McEvoy

H1N1 (a.k.a. Swine) Flu: Get Your Facts Straight

By Mike McEvoy

Egypt ordered a mass slaughtering of pigs as a supposed precaution against swine flu. Vice President Joe Biden told "Today" show host Matt Lauer that airplane and subway travel posed high risk for flu virus transmission. An ED doc in the Dallas area purportedly circulated a panicked e-mail claiming the National Stockpile is virtually depleted, local EDs are overrun with flu cases and the media is engaging in a full blown cover up of actual flu cases.

It seems like swine flu idiots are everywhere. Never has a time been more opportune for fire/EMS providers to exercise what they do best: keep people from panicking.

Investigations of the 2009 influenza A (H1N1) virus show it has not been found in swine, although it is genetically linked to pigs. Pigs do not appear to be involved in the ongoing spread of infections. In an effort to leave the poor pigs alone, the World Health Organization asked that we replace the term "swine flu" with H1N1 influenza A.

Hopefully, Egypt got the memo. Joe "shoot from the lips" Biden certainly got a memo from his boss, President Obama, as the White House went into damage control mode. And the Dallas ED doc has no doubt been deluged by calls from his more sensible colleagues. A Harvard School of Public Health study reveals the extent of the panic: Forty-six percent of Americans believe they or someone in their family will get sick from the H1N1 flu within the next 12 months!

Here's what you need to do to step up to the plate and put the smack down on swine flu idiocy. The public wants answers. Fire/EMS providers want information. Information overload and panicked messages abound. First, you need three sources of information: the Centers for Disease Control CDC, the World Health Organization WHO, and your state and local information filtered through your department or service.

The CDC set up a nifty minute-to-minute update site at www.cdc.gov/h1n1flu/whatsnew.htm. Scope it out. Everything you need to know is right there; if you want e-mail updates, RSS feeds, or a Twitter follow, that's there, too. WHO is not so sophisticated, but offers a wealth of information at www.who.int. Local info should be all this and more, but whoa: no need for overload! Your department (pay attention, chiefs) must keep you up to date on your state and local activities and get it to you before the newspaper or CNN.

Local info must be filtered – you don't care how tissue specimens need to be submitted for pathology evaluation, nor do you give a hoot about precautions hospitals are taking when caring for suspected flu patients. Your department must give you manageable, filtered, understandable, and timely information needed to do your job and answer questions from your family and the public.

New York State loves paper, memos and advisories. Its health department wasn't too happy with me when I passed its flu advisories on to my fire/EMS services with commentary that they contained nothing of value to EMS. Guess what? State EMS folks quickly caught on and have themselves started qualifying transmittals with a listing of the salient points specific to EMS. That’s what I need, what you need, and what we all need in a time when our mailboxes are totally overloaded.

Here are some things the public wants to know:

"How do I know if I have the flu?"
Most influenza infections share common characteristics: high fever, chills, myalgias (body aches), headache, non-productive cough, sore throat, and runny nose. The hallmark differentiating flu from other viral illnesses (such as the common cold) is rapid onset.

Common cold virus symptoms begin gradually and tend to worsen over time. Influenza symptoms often begin abruptly, causing a perfectly well person to instantly become extremely ill. Fevers typically exceed 101 F; such body temperatures are quite disabling. Influenza A H1N1 infections have included all these typical flu symptoms and, in a small number of patients, vomiting and diarrhea as well.

"What is the flu and how do I get it?"
All influenza variants are respiratory viruses. They are transmitted through contact with respiratory secretions from an infected person who is coughing or sneezing. The incubation period ranges from one to five days between exposure and onset of symptoms; most average two days.

Viral illnesses are communicable for a maximum of one to two days before symptoms appear and from four to five days afterward. The greatest period of communicability correlates with fever. As a public health tool, seven days is considered the maximum period during which symptoms would appear following an exposure. For reasons not well understood, children can remain communicable for much longer periods of time.

"How close is too close?"
Respiratory secretions are large droplets; they don’t travel very far. The "hot zone" around an infected person is considered to be less than 6 feet. Beyond that, even a forceful cough or sneeze would be highly unlikely to land droplets on another person. Placing a simple surgical mask or oxygen mask over an infected person reduces the "hot zone" to inches.

When a patient is masked and health-care providers also wear N-95 or better respirator masks, human-to-human spread becomes virtually impossible. There is little evidence that wearing surgical masks in the community will reduce spread of infection but, if it makes the public feel safer, the practice should not be discouraged. At the very least, an asymptomatic infected person (who is potentially communicable) wearing a mask in public significantly reduces their likelihood for infecting others.

Airplanes, trains, public transportation, and places of mass assembly are no more dangerous right now than they have been during the past six month flu season. Sure, there is a risk of someone coughing or sneezing on you. The greater risk, however, lies with what or who you touch and whether you remember to wash your hands.

"How long can flu virus live on surfaces?"
Good question. Respiratory droplets can land virtually anywhere. Doorknobs, telephones, computer keyboards, steering wheels, faucets, dishes … the list is endless. Environmental temperature and humidity strongly affect virus survival; in fact, flu season begins and ends when weather conditions change.

As a guideline, influenza viruses will survive on hard non-porous surfaces such as steel and plastic for 24-48 hours, and cloth, paper or tissue for eight to 12 hours. Once picked up on your hands, viruses last for 5 to 15 minutes, although within this time period all it takes is touching your face, mouth, eyes, or nose to transfer the virus into your respiratory tract to produce infection. Two rules are obvious: wash your hands often and keep your hands away from your face.

"What should I do if I think I have the flu?"
It depends on how sick you are. Despite media accounts, the H1N1 influenza has typically produced only mild illness. If illness is severe, or an infected person has other medical problems, antiviral medications may be helpful to reduce the severity and duration of the illness but only if started within 48 hours of when symptoms began.

The best advice is to stay at home so you don't infect others, call your health-care provider, rest, drink plenty of liquids, and use the same cold and fever remedies you ordinarily use. The flu season has not yet ended in the United States; many people worried they had contracted the H1N1 flu have either not had influenza at all or had a seasonal variant of the flu.

Many of these illnesses could have been prevented by seasonal flu vaccination. Take the opportunity to remind friends, family, and the public of this. Influenza is a serious illness. More than 200,000 Americans are hospitalized and 36,000 die each year from the flu. WHO estimates there are more than 500 million cases annually worldwide, killing more 250,000 people. So who are we testing for the H1N1 flu? People who show signs of febrile respiratory illness and have traveled to or had contact in the past seven days with people who have either traveled to Mexico, been infected with the H1N1 flu, or live in a community where there have been cases of H1N1 infection. And is the treatment any different for H1N1 flu versus seasonal flu? Nope, not at all.

"Is there a vaccine?"
Not yet. The CDC announced it had identified the 2009 influenza A (H1N1) virus on Saturday and will begin development of a vaccine. With current technology, this will not be ready for several months, but hopefully in time for next year’s flu season. Keep in mind that a variant of H1N1 is included every year in the seasonal flu vaccine and this may possibly provide some immunity to the new virus.

"Is it safe to eat pork?"
Yes; pigs do not carry the H1N1 influenza A, people do. Don't eat people.

Let's keep this outbreak in perspective. As all-hazard responders to the emergency needs of our communities, we must prepare for the worst. We are not certain what direction the H1N1 flu will take. But the facts are being grossly blown out of proportion. The U.S. city with the largest number of H1N1 cases is New York. Despite 8 million New Yorkers living and working in close quarters, the infection has failed to spread beyond the Queens high school students originally infected in Mexico. New Yorkers ride subways, buses, trains, and crowded elevators every day.

The public looks to firefighters and EMS providers in times of crisis. There are plenty of swine flu idiots out there. Panic serves no one. Let's help calm the hysteria by offering common sense, practical help to each other and our communities. It's what we do best.

About the author

Mike McEvoy, PhD, NRP, RN, CCRN is the EMS Coordinator for Saratoga County, New York and a paramedic supervisor with Clifton Park & Halfmoon Ambulance. He is a nurse clinician in cardiothoracic surgical intensive care at Albany Medical Center where he also Chairs the Resuscitation Committee and teaches critical care medicine. He is a lead author of the “Critical Care Transport” textbook and Informed® Emergency & Critical Care guides published by Jones & Bartlett Learning. Mike is a frequent contributor to EMS1.com and a popular speaker at EMS, Fire, and medical conferences worldwide.Contact Mike at mike.mcevoy@ems1.com.
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