The past 2 weeks have been frightening ones for all of us who respect the power of influenza. As three previous pandemics (worldwide spread of an epidemic) have taught us, influenza (“flu”) is devious and potentially deadly. The strains of flu virus that have caused pandemics represent major shifts from the makeup of typical, or seasonal, flu – that’s the devious part. For extensive discussions about influenza, past pandemics, and the infamous 1976 swine flu scare, see Chapters 2,3,6, and 7 of Germ Proof Your Kids – The Complete Guide to Protecting (without Overprotecting) Your Family from Infections (ASM Press, Washington, D.C., 2008).
By way of brief review of the past weeks’ flu findings:
The outbreak appears to have begun, and remains centered in Mexico. Nearly a dozen countries have now reported proven or suspected cases of swine flu, including New Zealand, Canada, and several European nations. The U.S. now has approximately 50 proven cases, most of whom (as is true in other countries as well), recently visited Mexico or had close contact with someone who did. The swine flu strain causing this outbreak is susceptible to both of our best flu-fighting medicines, tamiflu and relenza. In Mexico, there have now been more than 100 fatalities among the estimated 2,000 cases identified so far; that is a death rate of 5%, but it is still too early to know if that rate will increase or decrease as more cases are identified. No cases outside of Mexico have died yet, but the numbers may be too small to take comfort – among the 50 cases in the U.S. so far, a 5% death rate would mean 2 or 3 deaths, and it’s possible that we just haven’t seen enough cases to begin seeing fatalities. Today, the U.S. has taken steps to begin restricting travel to Mexico, something that the European Union did yesterday (when they also recommended against travel to the U.S. where the second largest number of cases worldwide have occurred).
If there’s any good news in all of this, the swine flu strain of influenza spreads by exactly the same routes (respiratory droplet and direct contact) as the familiar seasonal flu – by direct contact and respiratory droplet (see Chapter 2 in Germ Proof Your Kids – The Complete Guide to Protecting (without Overprotecting) Your Family from Infections. As a result, strategies for prevention are also exactly the same as for seasonal flu. Here are the most important 5 swine flu prevention strategies:
1. Careful handwashing – vigorous scrubbing with soap and water for at least 20 seconds, fingertips to wrists; alcohol hand sanitizers are effective when soap and water are not available.
2. Timely handwashing – after contact with anyone sick; after contact with large groups of people (e.g. the “high five” line at the end of the soccer game or the receiving line at a wedding); after being in places where sick people might have concentrated (e.g. the doctor’s office!); after contact with lots of surfaces in public places (e.g. supermarkets); before eating and before bedtime.
3. Cough and sneeze etiquette – cough and sneeze into your elbow, and teach your kids to do the same. This is a very considerate gesture to protect others from catching the germs from your hands or sprayed into the air.
4. Surface disinfection – the surfaces in your homes, your workplace, and your kids’ school (or day care) should regularly be disinfected – cleaning is not enough. The best disinfectants contain bleach, which has not only bacteria-killing power, but also virus-killing power (flu, of course, is a virus).
5. Boost your immunity, and your kids’ immunity – the following scientifically proven methods (well known to moms and grandmothers for generations) will make you less likely to develop severe infections, including swine flu: regular, moderate exercise; bundle up in the cold weather; get adequate sleep (8 hours each night); and eat a healthy, vitamin C-rich diet. If you don’t believe these “old wives tales” about infection prevention, read the real science behind these recommendations in Chapter 11 of Germ Proof Your Kids – The Complete Guide to Protecting (without Overprotecting) Your Family from Infections.
As this strain of swine flu spreads, it is likely that there will be additional restrictions on travel as well as possible emergency use of medicines like Tamiflu and Relenza. A vaccine is less likely in the near term because of the time lag in developing an effective vaccine, and the painful memories of the vaccine complications associated with the last swine flu vaccine given during the scare of 1976 (Chapter 3, Germ Proof Your Kids – The Complete Guide to Protecting (without Overprotecting) Your Family from Infections.)
Another public health measure that may well become necessary is school closures. Influenza pandemics of the past were greatly amplified by the spread of infections in schools. It is not surprising that schools in Mexico City, from day care through university, have been closed in an effort to contain the epidemic in that country. Twenty-eight of the U.S. cases so far have occurred in a single NY school – if other school outbreaks occur in this country, closures are high on the list of recommended interventions.
Should you avoid large crowds of people or public events? Not yet in this country, although those measures are being recommended in Mexico City. If the numbers increase here and elsewhere, we may anticipate similar restrictions. Ditto air travel – other than to Mexico, it isn’t yet time to restrict airplane travel, but we may get there is the epidemic accelerates.
Stay tuned to Dr. Rotbart’sGERMBlog for timely updates as we learn more about this latest challenge to your health.