HELADA Learns about H1N1

Presentation by John Lewis, 14 Sept, 2009

 

What a fun meeting to start the new season! John Lewis gave an informative but amusing presentation on protocols he's developed for his company should 'swine flu' become a problem in Greece.

John's company works with food additives and a few other chemical products with one common factor: They all affect the senses of smell and taste. His workers are accustomed to high standards of hygiene on the job and to wearing masks to filter out air-borne particulate matter (those miniscule globs of bio-dynamic particles that our sense organs respond to.)

Consequently, when he read that in some countries doctors are already being advised to wear P-1 rated surgical masks, he started researching. These masks do a poor job on very fine particles, such as viruses, and they don't fit securely to the face. They prevent particles from the wearer's coughs and sneezes being broadcast widely, much as coughing into the sleeve or into a tissue does. But they don't really prevent viruses already in the air from entering or sneaking around the edges. Ergo, P-1 masks are mainly to protect others, not the wearer, and especially not in an area crowded with flu patients. Doctors might want to rethink this one! So may travellers hoping to stay uninfected in a packed airplane cabin.

However, P-1 masks cost about 10 cents and so can be used and discarded immediately. (Hmm, bad for the environment, those disposables?)  

P-2 masks at about 1 each provide more protection, can be stored in a personal container when not in use, and even reused a few times. P-3 masks cost about 3 each and are even better.  

But the piece de resistance, short of a full 'chem suit', is the 'half mask'. As John pulled this model out to don and demonstrate, the room broke into laughter at the WWIII look of the dual breathing snouts. At about 5, the half-mask offers the highest protection and can be sterilized in a chlorox solution and reused. The refill filters for the two snouts cost pennies and are disposable. 

Protocols in Extremity

John also described other protocols, such as might be needed to receive materials from outside, i.e. that may have passed through contaminated hands. Good examples of this are documents (mail and courier) and money/checks. John's plant gets at least 20 courier deliveries a day.

The choice is either quarantine the mail (up to 2 weeks if recent studies prove true) or disinfect. Noting that you might not want to wait 2 weeks for important papers and more important money, John set his staff checking out disinfection procedures. If need arises, couriers will be met at the door by a gloved and masked employee. The incoming mail will be dropped into a large envelope and sealed, taken inside and disinfected.

How do you disinfect money and other printed matter? Well, in the case of euros, do NOT microwave it! The embedded metal authentication strips fizzle and spark in the microwave. John said this phase of the research was rather costly for him. However, money can be disinfected with a simple spray of 100% (wood/rubbing) alcohol. It kills the virus and evaporates before dissolving the ink. This would probably hold true for most printing ink and check signatures.

Items that won't melt also respond to being heated to 80C for 30 minutes. Do not use this method on plastics!  

Sensible Hygiene

Apart from these protocols, John noted that the simple hygiene procedures now being disseminated are pretty effective. Frequent hand washing helps, either with soap and water or with alcohol gels now being sold in handy purse-size bottles. This should be done after touching surfaces that others, possibly infected, have touched. Hard, non-porous surfaces are the best environments for viruses to survive on. Porous surfaces, including fabrics, permit better air passage and quicker drying/disintegration of the active virus.

(At this point in the talk, everyone raised their elbows from the glass-topped tables in the Athens Centre conference room, giggling nervously.)

Flu viruses enter the body through any oriface, especially the nose, mouth and eyes. Viruses airborne from another's cough can be breathed in, and, obviously, the closer you are to an infected person, the greater the likelihood of contracting it. So, crowded buses and classrooms become higher risk areas during an outbreak. If an infected person has, e.g., coughed into their hand, then grabbed the handhold in the bus, shortly before you do, you could transfer the virus to yourself. However, the risk arises from touching it and then your nose or eyes. Rubbing one's eyes after touching an infected surface should be avoided.

All of these suggestions are simply common sense ways of breaking a virus's trip from source to you. (For more info on minimizing risk, check these suggestions from a friendly RN.)

Be Prepared!

What if you or a member of your household becomes ill? John suggests stockpiling enough food and supplies for two weeks, approximately the time needed to ride out the illness and make sure you're well over it. That's called quarantine, and basically you should stay indoors away from others. So, not having to go to the shops is a good idea. You can rotate the supplies, using and replacing the oldest, as long as the threat exists.

Someone also noted that this is the same good advice for earthquake and storm preparedness ... having what you need on hand is just good practice. And if you have to go out for supplies, send the least vulnerable member of the household.

John also noted that flu epidemics have a curve. They start, grow as more ill people increase the likelihood of contracting it, peak, and then begin to drop off as survivors (now sporting immunity to this strain) grow in number. The curve can be steep and shorter in duration, or shallow spanning a longer time period. In both cases, eventually, the virus finds fewer available hosts and begins to die out. What happens in the interim is the question.

To Panic or Not to Panic

So ... IS this flu a 'pandemic'? Even WHO has noted many cases seem to be no more severe than seasonal flu. So, why all the fuss? And what if you make all these preparations and the flu never comes? Won't you look as silly as the guy that warned all his friends about the Y2K computer virus?

There are several reasons to be informed and prepared.

(This is a rough summary of the post-presentation discussion touching on the political side of the matter):

1. This time round, instead of the elderly, it appears the high-risk groups for H1N1 are the young and firm. That means it could spread more rapidly among school children.

2. IF young adults (parents of young children) become ill or stay home to care for sick kids, that could have a major impact on economy. They're the workers. If workers can't work, businesses will suffer. And some essential services, for example, grocery stores and their supply chain, might be affected.

3. The alternative to John Lewis's protocols (preparation) may be to take the flu vaccine, a source of concern to many. Alerts have been raised about the lack of sufficient testing of this vaccine. This is of particular concern if the vulnerable population is the children. It's one thing to vaccinate the elderly; it's quite another to 'experiment' on the young. There seems to be a fairly widespread antithesis here in Greece to vaccination. NB that in previous years, seasonal flu vaccines also came on the market in quick succession after the identification of the viral culprit. What's different this time? It's a matter of some controversy, which will not likely be resolved until after the crisis passes (or fails to materialize).

4. Another aspect of the vaccine issue is the question of whether enough doses can be produced fast enough. Why is it such a problem with, as John pointed out, thousands of labs around the world that could be temporarily switched over to concentrated production?

Vaccine is currently produced by private pharmaceutical firms, with some limited licensing of production to other labs. To take it from for-profit concerns might require nationalization of production through government action. Governments are slow to take these steps, and even slower when the 'pandemic' has yet to materialize. NB that in the US, nationalization is next best thing to 'socialism' that catch-word that's been thrown up to prevent health system reform, i.e. highly unlikely to happen. So vaccine production will continue to be subject to market forces: limited supply, high price.

5. The profit motive, so often a driving force behind 'nefarious schemes,' paves the way for further speculation on the source of this new virus. Has it, as is suspected with computer viruses, been developed by the 'solution' companies to promote sales? Again, this will take some time to sort out.

6. Yet another concern raised by the anti-vaccination voices is the possibility of mandatory vaccination programs. Intent is difficult to prove, although some laws are in place in the US and coming in the EU, that might make mandating possible. It is a concern that has been raised. The problem for authorities may be: What if we don't vaccinate and it breaks out? Maybe it's better to vaccinate all the kids. But what if the vaccine really isn't safe?

7. This comes full circle to the lack of confidence in numbers. The WHO kept count of reported/test-confirmed cases worldwide until about mid summer. At that point, the Level 6 Pandemic threat was declared -- based on incidence, not on severity of cases -- and counting ceased. Some sources suggest this is because there are so many cases, counting no longer makes any difference. Other writers have claimed that the 'lag time' between possible and test-confirmed H1N1 is long enough that by the time the count is confirmed, the stats have moved on.

So, at this point, it's very hard to say how many flu cases are seasonal and how many are H1N1. It's also hard to pinpoint the severity of this flu: if you aren't sure it's H1N1, how do you compare it to seasonal flu? Likewise, you don't know how many have died from H1N1, nor how many of those deaths involved 'healthy' people as compared to those with pre-existing complicating conditions. Ergo, it seems the Level 6 rating is based on number of cases in the early appearance of the disease, not severity or lethality.

What's a Person To Do?

The choices are fairly straight forward: 
   
You can get vaccinated, though most of us won't. 
   
You can try to avoid getting sick by avoiding crowds and using best sanitary practices. 
   
You can be prepared in case you're incapicated by the illness. 
   
You might, like some in the UK, have a 'flu party' and intentionally get infected so as to get it out of the way. 
   
Or you might carry on business as usual.

The choice, at this writing, is still yours. -- KL

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