Swine Flu

[Arcan57]

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Just saw a report on NBC regarding swine flu in NYC. Have people been seeing patients show up thinking they have this?

 

[Koko]

Yes. Saw a patient who had family visiting from Mexico City whose neighborhood is now quarantined by police. Supposedly 20 confirmed deaths from H1N1 and 40 other deaths being investigated in Mexico. As with pandemics, the deaths are young and previously healthy patients. Pt from US and two family members from Mexico City with some symtoms. We played the iso game and coordinated PCR testing in house and with Dept. of Health. Now we wait...

 

[Koko]

http://www.cdc.gov/swineflu/recommendations.htm

 

[Koko]

This is an official

CDC Health Advisory



Distributed via Health Alert Network

April 25, 2009, 3:00 EST (03:00 PM EDT)

CDCHAN-000281-2009-04-25-ALT-N



Investigation and Interim Recommendations:

Swine Influenza (H1N1)



CDC, in collaboration with public health officials in California and
Texas, is investigating cases of febrile respiratory illness caused by
swine influenza (H1N1) viruses. As of 11 AM (EDT) April 25, 2009, 8
laboratory confirmed cases of Swine Influenza infection have been
confirmed in the United States. Four cases have been reported in San
Diego County, California. Two cases have been reported in Imperial
County California. Two cases have been reported in Guadalupe County,
Texas. Of the 8 persons with available data, illness onsets occurred
March 28-April 14, 2009. Age range was 7-54 y.o. Cases are 63% male.



The viruses contain a unique combination of gene segments that have not
been reported previously among swine or human influenza viruses in the
U.S. or elsewhere. At this time, CDC recommends the use of oseltamivir
or zanamivir for the treatment of infection with swine influenza
viruses. The H1N1 viruses are resistant to amantadine and rimantadine
but not to oseltamivir or zanamivir. It is not anticipated that the
seasonal influenza vaccine will provide protection against the swine flu
H1N1 viruses.

CDC has also been working closely with public health officials in
Mexico, Canada and the World Health Organization (WHO). Mexican public
health authorities have reported increased levels of respiratory
disease, including reports of severe pneumonia cases and deaths, in
recent weeks. CDC is assisting public health authorities in Mexico by
testing specimens and providing epidemiological support. As of 11:00 AM
(EDT) April 25, 2009, 7 specimens from Mexico at CDC have tested
positive for the same strain of swine influenza A (H1N1) as identified
in U.S. cases. However, no clear data are available to assess the link
between the increased disease reports in Mexico and the confirmation of
swine influenza in a small number of specimens. WHO is monitoring
international cases. Further information on international cases may be
found at: http://www.who.int/csr/don/2009_04_24/en/index.html

Clinicians should consider swine influenza infection in the differential
diagnosis of patients with febrile respiratory illness and who 1) live
in San Diego or Imperial counties, California, or Guadalupe County,
Texas, or traveled to these counties or 2) who traveled recently to
Mexico or were in contact with persons who had febrile respiratory
illness and were in one of the three U.S. counties or Mexico during the
7 days preceding their illness onset.

Patients who meet these criteria should be tested for influenza, and
specimens positive for influenza should be sent to public health
laboratories for further characterization. Clinicians who suspect swine
influenza virus infections in humans should obtain a nasopharyngeal swab
from the patient, place the swab in a viral transport medium,
refrigerate the specimen, and then contact their state or local health
department to facilitate transport and timely diagnosis at a state
public health laboratory. CDC requests that state public health
laboratories promptly send all influenza A specimens that cannot be
subtyped to the CDC, Influenza Division, Virus Surveillance and
Diagnostics Branch Laboratory.

Persons with febrile respiratory illness should stay home from work or
school to avoid spreading infections (including influenza and other
respiratory illnesses) to others in their communities. In addition,
frequent hand washing can lessen the spread of respiratory illness.

CDC has not recommended that people avoid travel to affected areas at
this time. Recommendations found at
http://wwwn.cdc.gov/travel/contentSwineFluUS.aspx will help travelers
reduce risk of infection and stay healthy.

Clinical guidance on laboratory safety, case definitions, infection
control and information for the public are available at:
http://www.cdc.gov/swineflu/investigation.htm.

* Swine Influenza A (H1N1) Virus Biosafety Guidelines for
Laboratory Workers:
http://www.cdc.gov/swineflu/guidelines_labworkers.htm
* Interim Guidance for Infection Control for Care of Patients with
Confirmed or Suspected Swine Influenza A (H1N1) Virus Infection in a
Healthcare Setting:
http://www.cdc.gov/swineflu/guidelines_infection_control.htm
* Interim Guidance on Case Definitions for Swine Influenza A
(H1N1) Human Case Investigations:
http://www.cdc.gov/swineflu/casedef_swineflu.htm

Morbidity and Mortality Weekly Reports Dispatch (April 24) provide
detailed information about the initial cases at
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm58d0424a1.htm



For more information about swine flu: http://www.cdc.gov/swineflu



Additional information is also available by calling 1-800-CDC-INFO
(1-800-232-4636)

 

[12R34Y]

This is going to be sooooo bad before it gets better.

Every freakin' fever, cough and sore throat is going to flood every urgent care and ED across the whole country in the next weeks.

Armageddon!!!!!

Seriously, this could really really suck bad.

thoughts?

later

 

[Rendar5]

This is going to be sooooo bad before it gets better.

Every freakin' fever, cough and sore throat is going to flood every urgent care and ED across the whole country in the next weeks.

Armageddon!!!!!

Seriously, this could really really suck bad.

thoughts?

later

It would be nice if triage nurses at the front could just tell the non-elderly patients to go home if they don't even have a fever...

 

[canjosh]

Have seen several tonight already...none positive for Group A or B. The second 'flu' season has begun...

 

[12R34Y]

The other problem is that the sensitivities for rapid flu test suck. anywhere from 50-70%. so you're going to be missing a ton that ACTUALLY have it and we're telling them " nope, you're flu test was negative." and send them back to the wild to mingle.

later

 

[GeneralVeers]

This will be worse than the Natasha Richardson Brain Bleed Scare!

 

[Jeff698]

This will be worse than the Natasha Richardson Brain Bleed Scare!

First, you say that as though it's over.

Second, the two aren't mutually exclusive. Picture this complaint:

"I have the swine flu which made me weak and dizzy. I past out, fell over and hit my head. I need a CT scan and tamiflu!"

I was in a patient's room the other day when I saw a breathless news reporter talking about the coming flu pandemic on the TV in the room. There should be some sort of filter that keeps stuff like this off of any hospital TV. Sort of like refusing to play Airplane while on an actual airplane.

Take care,
Jeff

 

[Koko]

It would be nice if triage nurses at the front could just tell the non-elderly patients to go home if they don't even have a fever...

One interesting feature of pandemic influenza that distinguishes it from sesaonal influennza is that there is a significant mortality spike amongst the otherwise young and healthy, while the very young and elderly have a more protracted illness and a lower mortality rate.

So while it's early, the initial data from Mexico fit this atypical mortality picture.

 

[diphenyl]

I saw ten flu like sx's last night, 8 of whom specifically brought up the swine flu topic. None of which had fever.over the past 2 days, our amount of flu like sx's has gone up 4 fold over the past 2 days.

 

[kungfufishing]

Colleague actually had a guy from mexico recently who worked with pigs and probably has/had it. Of course, he had no idea the disease even existed, adding irony to the 15 in the WR c/o "get checked for that swine flu"

 

[Kubed]

Reading about the outbreak makes me really excited that I'm about to leave for a week long vacation in mexico 🙄

 

[Jeff698]

Reading about the outbreak makes me really excited that I'm about to leave for a week long vacation in mexico 🙄

If you believe the patients in our US EDs, you'll be less exposed down there.

Enjoy!

Take care,
Jeff

 

[xaelia]

One interesting feature of pandemic influenza that distinguishes it from sesaonal influennza is that there is a significant mortality spike amongst the otherwise young and healthy, while the very young and elderly have a more protracted illness and a lower mortality rate.

http://www.cytokinestorm.com/

 

[badasshairday]

How are ED personnel dealing with this in states that had reported cases? Are the doctors and nurses wearing surgical masks? Any extra precautions taking place?

 

[BADMD]

How are ED personnel dealing with this in states that had reported cases? Are the doctors and nurses wearing surgical masks? Any extra precautions taking place?

http://www.cdc.gov/swineflu/guidelines_infection_control.htm

CDC is recommending respirators for close contact and direct patient care of a suspected case. Patients suspected to have swine influenza should be a single patient room, preferentially with negative pressure.

http://www.cdc.gov/swineflu/recommendations.htm

CDC is also recommending treatment for anyone suspected of having swine influenza (meeting the case definition). As of now, the preferred agent for SUSPECTED swine flu is Zanamivir. For confirmed cases, Zanamivir or Oseltamivir are both options.

 

[badasshairday]

Thanks for the links. Much appreciated.

 

[Arcan57]

We're being told by the state health department that the rapid flu screens are not effective in picking up swine flu. We now are sending samples to the state capital along with an epidemiology case report form, where due to budget constraints only a random sampling of tests will actually be run. I think the combination of excess paperwork and long turn-around times should greatly decrease reports of swine flu in TN.

 

[DrJosephKim]

You may want to sign up for the HCNN (Health Care Notification Network) alert

 

[Kubed]

If you believe the patients in our US EDs, you'll be less exposed down there.

Enjoy!

Take care,
Jeff

Thanks! You bring the grand total of people who think it's a good idea I still go to 1, with several million against (and all of them felt the need to call/text today). I'm banking on a BAC of .25 killing off anything exotic.

 

[leorl]

Yeah, we had quite a few visits for swine flu today (a whole group of young folks who just travelled to mexico and decided to visit the ER together) so we had to make a quarantine room and do not just the flue kits but the viral cultures too. Everyone in ER wearing face masks.

 

[Apollyon]

Actually had a 3 y/o kid with a positive swab for Flu A, and the swab sent to the state lab for typing (per state guidelines). From New Hampshire, and flew through Boston. Dad feeling a bit ill.

The parents are educated, so they understood when I explained about H and N differentiation of flu species, and that it was most likely NOT swine flu, but a more "garden variety" flu.

 

[Jeff698]

Three folks came in last night because of fears of swine flu. Tested two of them, both negative.

The third was for a "bump" on her side (that I couldn't feel) that the patient's mother attributed to swine flu. No test for her.

Take care,
Jeff

 

[DocVirk]

So I'm watching the local news yesterday, and they have a list of bullet point signs and symptoms of swine flu, which include "Runny nose and sore throat, fever, nausea or vomiting, etc etc...".

Then, they proceed to warn the viewing public, "If you have any of these symptoms, you should be seen by a physician."

Needless to say, I live in the third worst allergy area in America. Literally every single person in the county has runny nose and sore throat. Sounds like we all need some nasal swabbage and Tamiflu. Or claritin, one or the other

 

[Jeff698]

I read an article in one of the throw aways awhile back about one shop's approach to dealing with overwhelming numbers from a pandemic (or fear of a pandemic).

They would set up a roadblocked funnel into the ED staffed with RNs, techs and security. They'd do in-car triage with temperature and VS. Flu-like symptoms but no fever, tachycardia or tachypnea? "Here's some information, move along, no need to exit the vehicle, thanks for trusting us with your health care needs".

Fever but no tachycardia/tachypnea? Swab while in-car and move along to another parking lot while we run the test. Positive? Here's your tamiflu. Thanks for playing.

Tachycardic, tachypneic or otherwise sick looking goes into the ED for physician screening, along with belly pains, etc.

As I see where the mounting public fear about this is headed, I've been thinking alot about that article lately.

Take care,
Jeff

 

[txterp98]

In case you guys haven't seen this old PSA about the swine flu vaccine from the 1970's, it's definitely a must see!

http://www.youtube.com/watch?v=9iJLpe1tZl8

Man, commercials like these rocked!

 

[GeneralVeers]

We have one confirmed case at one of our campuses. It's definitely here, but I don't think the hysteria on the TV is warranted. The economy is supposedly improving, so the newsmedia needs something else to wave their hands and scream about.

 

[theCamel]

ugh, my ED is absolutely giving away tamiflu like it's going out of style. only 2 cases in my state, nowhere near my city.

 

[gutonc]

I wonder if mexico vaccinates their citizens with the seasonal flu vaccine? If not, I wonder if our seasonal flu vaccine is giving us "partial" immunity to the current flu strain and people are having milder illnesses in the US compared to mexico (although I know the numbers are unclear from that area).

Unlikely (but, clearly, not impossible). Per the CDC, from this webpage: http://www.cdc.gov/swineflu/key_facts.htm

Is the H1N1 swine flu virus the same as human H1N1 viruses?
No. The H1N1 swine flu viruses are antigenically very different from human H1N1 viruses and, therefore, vaccines for human seasonal flu would not provide protection from H1N1 swine flu viruses.

But the reason for the milder cases in the US is clearly intriguing.

 

[badasshairday]

Could it not be that the virus is mutating?

The 1918 Spanish Flu was virulent as hell, then it calmed down, then became very fatal. If the virus started out in MX as very fatal, then there would be a selection for a less virulent form, since the more virulent form would die out with the host. The mild virus in the US could mutate again to a worse form, like what was seen in 1918.

Just a thought.

 

[ccfccp]

The other option for the significantly different course is the significantly different health evironment. People here are rushing to docs (or the ED) and are getting treated earlier. Also, last I heard, they thought the first recorded cases came from a small town in the Mexican state of Veracruz. Something tells me that area is not crawling with doctors wielding tamiflu (assuming the virus has not yet gained 100% resistance like last years H3N2 strain).

 

[EM_Rebuilder]

Three folks came in last night because of fears of swine flu. Tested two of them, both negative.

The third was for a "bump" on her side (that I couldn't feel) that the patient's mother attributed to swine flu. No test for her.

Take care,
Jeff

I can one up you on that..

I saw about a 7 year old with a ratty old splint on her arm placed over 6 weeks ago (looked like a mummy arm from an Indiana Jones movie) for a wrist sprain, supposed to see someone a week later to most likely have it removed. Instead, she decided to come in yesterday...why?

Afraid the swine flu might get stuck in it and then they might get it!


Now, there was lots of 'stuff' stuck in it, but one of them was probably NOT the swine flu...

 

[ccfccp]

I can one up you on that..

I saw about a 7 year old with a ratty old splint on her arm placed over 6 weeks ago (looked like a mummy arm from an Indiana Jones movie) for a wrist sprain, supposed to see someone a week later to most likely have it removed. Instead, she decided to come in yesterday...why?

Afraid the swine flu might get stuck in it and then they might get it!


Now, there was lots of 'stuff' stuck in it, but one of them was probably NOT the swine flu...

Was she using it to store bacon? Or did it just smell like it?

 

[AmoryBlaine]

Could it not be that the virus is mutating?

The 1918 Spanish Flu was virulent as hell, then it calmed down, then became very fatal. If the virus started out in MX as very fatal, then there would be a selection for a less virulent form, since the more virulent form would die out with the host. The mild virus in the US could mutate again to a worse form, like what was seen in 1918.

Just a thought.

Probably the strangest thing is the # of residents/attendings/nurses/techs who have become overnight experts on influenza virus and who stride around the ER confidently telling people that "this is just the flu."

Uhhh, didn't the WHO just upgrade to "imminent pandemic?"

There's this weird belief that a global flu pandemic would just be like another round of yearly influenza. I don't think anyone who studies flu believes that to be the case...

 

[DaveinDallas]

Probably the strangest thing is the # of residents/attendings/nurses/techs who have become overnight experts on influenza virus and who stride around the ER confidently telling people that "this is just the flu."

Uhhh, didn't the WHO just upgrade to "imminent pandemic?"

There's this weird belief that a global flu pandemic would just be like another round of yearly influenza. I don't think anyone who studies flu believes that to be the case...

I was wondering about that....standard flu season has like 37K fatalities any given year...thus far, we're at 150 some odd (sucks if you or one of your loved ones is one of the 150 or so).....now the CDC/WHO/M.O.U.S.E. issues a "pandemic approaching, get your stuff together" type of warning.....

Ok, so are we saying a pandemic means this is going to do the big nasty and start whacking people or just that it's global as opposed to endemic? If we're using the term to say it's global, well, couldn't it be global and not whack people? Or am I just dazed and confused for so long ....

 

[AmoryBlaine]

I was wondering about that....standard flu season has like 37K fatalities any given year...thus far, we're at 150 some odd (sucks if you or one of your loved ones is one of the 150 or so).....now the CDC/WHO/M.O.U.S.E. issues a "pandemic approaching, get your stuff together" type of warning.....

Ok, so are we saying a pandemic means this is going to do the big nasty and start whacking people or just that it's global as opposed to endemic? If we're using the term to say it's global, well, couldn't it be global and not whack people? Or am I just dazed and confused for so long ....

I look at it like this, this could be a non-starter like bird flu, SARS, hemmorhagic viruses -- although all these things are still out there. But on the other hand it seems like the CDC/WHO are usually fairly cautious about their pronouncements on pandemics. I mean we lose what 30-50k to flu every year and it isn't like WHO scientists are on CNN talking about it.

Now there are alot of smart people saying "it's time to be concerned, not panic but be concerned" and yet many health care providers seem to be saturated in this sense of annoyance at the supposed alarmism.

If this is a non-starter it's probably going to look about like it is now, but if we are on the cusp of global pandemic that will kill millions it might look about like it is now. I sure as heck don't know and I'm not pretending to know.

 

[docB]

Probably the strangest thing is the # of residents/attendings/nurses/techs who have become overnight experts on influenza virus and who stride around the ER confidently telling people that "this is just the flu."

Uhhh, didn't the WHO just upgrade to "imminent pandemic?"

There's this weird belief that a global flu pandemic would just be like another round of yearly influenza. I don't think anyone who studies flu believes that to be the case...

But what can you do about is that's different than the regular flu? We can't just intubate everyone because they might get ARDS. I suppose Tamiflu gives them something to do while they wait to see if it gets better or worse kinda like the azithro for URI.

 

[SoCuteMD]

I was wondering about that....standard flu season has like 37K fatalities any given year...thus far, we're at 150 some odd (sucks if you or one of your loved ones is one of the 150 or so).....now the CDC/WHO/M.O.U.S.E. issues a "pandemic approaching, get your stuff together" type of warning.....

Ok, so are we saying a pandemic means this is going to do the big nasty and start whacking people or just that it's global as opposed to endemic? If we're using the term to say it's global, well, couldn't it be global and not whack people? Or am I just dazed and confused for so long ....

Yearly the US has 37K. Thus far the US is at 1 for swine flu. I've read that worldwide flu fatality estimates are 500K.

 

[Jeff698]

I tested three the night before last.

I tested 10 today. Called in tamiflu for one positive from the night shift (our "rapid" flu is now a send out to the main campus) and wrote one empiric Rx for it for an HIV positive guy.

I wasn't a math major or anything but that looks like a trend in the wrong direction to me.

Take care,
Jeff

BTW, when asked my opinion on whether we're over-reacting or not I give up and tell the truth. I have no idea. It could be the real deal but I'm still getting bumps on the head with Natasha Ritchardson syndrome so I'm a bit skeptical by nature.

 

[Jeff698]

Here's an interesting question for y'all.

As a hypothetical, let's say you start running 101 temp with body aches, cough and nasal congestion.

Do you:

1) try to see anyone about it?

2) want to be tested?

3) want tamiflu?

4) take it if offered?

I think, based on my prior similar experiences:

1) no, I'm pig headed. Perfect for this virus
2) no, since it won't change what I'm going to do but I'd consent for epidemiology purposes
3) no
4) no, unless I'm being admitted for way bad sickness

Take care,
Jeff

 

[EM2BE]

Anyone hear rumor of the pneumonia vaccine getting recommended for health workers? Heard it from person, not written. Just curious if anyone has heard this or if the person was confused.

 

[Koko]

If this is a non-starter it's probably going to look about like it is now, but if we are on the cusp of global pandemic that will kill millions it might look about like it is now. I sure as heck don't know and I'm not pretending to know.

That's the dilemma. Nobody knows, and the definition of an influenza pandemic is telling. The four requirements are:

1) New A subtype
2) Little or no pre-existing immunity
3) Results in significant morbidity/mortality
4) Efficient human to human transmission

The third criterion helps ensure that by the time we label it a pandemic, it will be somewhat retrospective.

Given the facts, I don't see the WHO or CDC as being alarmist. History has shown that pandemics come in waves, and the first wave is typically mild. So this may be the initial mild wave of a significant pandemic or hopefully a mild form of influenza that will flame out. There is no way to know at this point.

 

[xaelia]

Tried to swab an influenza-like illness in a 3 year-old hispanic child last night with multiple contacts in our hispanic community with similar symptoms; state lab is only running tests on folks for whom a direct line of exposure to a known case can be documented.

 

[nlax30]

2 confirmed cases now in Florida. An 11yr old in Lee county and 17yr old in Broward county. Both students but no other details on how they were exposed/infected.

 

[Rendar5]

.

 

[Hard24Get]

Here's an interesting question for y'all.

As a hypothetical, let's say you start running 101 temp with body aches, cough and nasal congestion.

Do you:

1) try to see anyone about it?

2) want to be tested?

3) want tamiflu?

4) take it if offered?

I think, based on my prior similar experiences:

1) no, I'm pig headed. Perfect for this virus
2) no, since it won't change what I'm going to do but I'd consent for epidemiology purposes
3) no
4) no, unless I'm being admitted for way bad sickness

Take care,
Jeff

This happened to me two days ago, and I did submit to testing but it was negative. Wouldn't have taken tamiflu if it was positive. Was finally talked into taking a zpack though, which is doing wonders for the chest pain and pus-laden cough. 🙂

We are using these expensive tests in LA if people have a really convincing story, but so far it has all been regular old Influenza by culture, though we can't know that a priori so the Influenza A's are getting tamiflu within 48hrs. Meanwhile our peds ER is seeing 100-200% more action with panicked parents bringing in their stuffy-nosed kids. It's quite painful.

I think we docs have a right to be at least a bit irritated. Probably any given year where we end up with a strain of flu we have no vaccine for puts us at risk for a pandemic, and the initial reports from Mexico were concerning. But so far, we have yet to see evidence of this flu being any more fatal than regular flu. By all means, if people are ill-appearing we should check them out, but not everyone with a runny nose. Please?

If the media would even just advertise no fever=no swine flu, that would help us out!

 

[Snelgrave]

This is a forwarded email my Mom received 3 days ago, written on 4/29/09 by an FP/EM doc in Texas that he sent to all of his patients I wanted to know if you guys think this doc is causing more panic than is warranted. I’m especially dubious about his recs for N-Acetyl-Cysteine or Oscillococinum – unless the patient has a Tylenol overdose along with swine flu (maybe he owns a health food store). Identifying info has been edited out.

--------

After I returned from a public health meeting yesterday with community leaders and school officials in xxxx County , xxxx suggested I send an update to my patients in the area, because what we are hearing privately from the CDC and Health Department is different from what you are hearing in the media. Some of you know some of this, but I will just list what facts I know.
- The virus is infectious for about 2 days prior to symptom onset

- Virus spreads more than 7 days after symptom onset (possibly as long as 9 days) (this is more unusualthan ordinary flu)

- Since it is such a novel (new) virus, there is no "herd immunity," so the "attack rate" is very high. This is the percentage of people who come down with a virus if exposed. Almost everyone who is exposed to this virus will become infected, though not all will be symptomatic. That is much higher than seasonal flu, which averages 10-15%. The "clinical attack rate" estimation from CDC and WHO may be around 40-50%. This is the number of people who show symptoms. This is a huge number. It is hard to convey the seriousness of thisto those outside of the medical fields.

- The virulence (deadliness) of this virus is as bad here as in Mexico , and there are folks on ventilators here in the US , right now. This has not been in the media, but a 23 month old in Houston is fighting for his life, and a pregnant woman just south of San Antonio is fighting for her life. In Mexico , these folks might have died already, but here in the US , folks are getting Tamiflu or Relenza quickly, and we have ready access to ventilators. What this means is that within a couple of weeks, regional hospitals will likely become overwhelmed.

- Some of the kids with positive cases in xxxx County have had more than 70 contacts before diagnosisas a minimum figure.

- There are 10-25 times more actual cases (not "possible" cases -- actual), than what is being reported in the media. The way they fudge on reporting this is that it takes 3 days to get the confirmatory nod from the CDC on a given viral culture, but based on epidemiological grounds, we know that there are more than 10 cases for each "confirmed" case right now.

- During the night, we crossed the threshold for the definition of a WHO, Phase 6 global pandemic. This has not happened in any of our lifetimes so far. We are in uncharted territory.

- They are advising President Obama to declare an emergency sometime in the next 72-96 hours. This may not happen, but if it doesn't, I will be surprised. When this happens, all public gathering will be cancelled for 10 days minimum.

- I suggest all of us avoid public gatherings. Outdoor activities are not as likely to lead to infection. It is contained areas and close contact that are the biggest risk.

- Tamiflu is running out. There is a national stockpile, but it will have to be carefully managed for law enforcement and first responders as it is not enough to treat the likely number of infections when this is full-blown. I don't think there is a big supply of Relenza, but I do not know those numbers. If I had to choose, I would take Relenza, as I think it gets more drug to the affected tissue than Tamiflu.

- You should avoid going to the ER if you think you have been exposed or are symptomatic. ER's south of here are becoming overwhelmed today-- and I mean that -- already. It is coming in waves, but the waves are getting bigger.

- It appears that this flu produces a distinctive "hoarseness" in many victims. The symptoms, in general, match other flu's; namely, sore throat, body aches, headache, cough, and fever. What is not too common in regular flu cycles is vomiting and diarrhea which seems to be associated with this, further dehydrating victims. Some have all these symptoms, while others may have only one or two.

- N-Acetyl-Cysteine -- a nutritional supplement available at the health food store or xxxx Pharmacy, has been shown to prevent or lessen the severity of influenza. I suggest 1200mg, twice a day for adults, and 600mg twice a day in kids over 12. It would be hard to get kids under 12 to take it, but you could try opening the capsules and putting it on yogurt. For 40 pounds and up, 300-600 mg twice a day, for less than 40 pounds, half that.

- Oscillococinum, a homeopathic remedy, has been vindicated as quite effective in a large clinical trial in Europe , with an H1N1 variant. You can buy this at xxxx Natural Foods, or the xxxx Pharmacy.

I will try to keep everyone posted if I have any new information. Meanwhile, don't be afraid, stay informed and try to avoid infection. The fewer people infected the easier it will be for our public officials to manage it.
If any of my patients become ill, or suspect infection, call the office, do not come without calling and DO NOT go to the ER. If one member in a family is identified all would be given the Tamiflu or Relenza (that is normal course of action) if there is enough distributed to fill prescriptions. Public health stated that one family member identified or suspected to have contracted the flu it will require the whole family to be ‘quarantined’ in their own home until enough time has passed for the remaining household to have contracted it or be considered infection free ( 7 to 10 days per person). As another suggestion, if any member of the family is on routine medication- fill those prescriptions now. Have plenty fluids, Motrin, soups, etc available and make contingency plans in case your family is affected.

 

[Jeff698]

- You should avoid going to the ER if you think you have been exposed or are symptomatic. ER's south of here are becoming overwhelmed today-- and I mean that -- already. It is coming in waves, but the waves are getting bigger.

This part I like. A lot. I'm heading in to work tomorrow and hope the hysteria is dying down.

- N-Acetyl-Cysteine --

<snip>

- Oscillococinum, a homeopathic remedy,

Quack. Quack. Quack.

Anyone else hear something?

Quack.

If any of my patients become ill, or suspect infection, call the office, do not come without calling and DO NOT go to the ER.

I'm sure his receptionist is standing by, 24/7, to field these calls and get them to come in and see him at all hours.

As another suggestion, if any member of the family is on routine medication- fill those prescriptions now. Have plenty fluids, Motrin, soups, etc available and make contingency plans in case your family is affected.

And don't forget to stock up on beef jerky, guns and ammunition.

Take care,
Jeff