Family Flublog

Tuesday, March 28, 2006

Preparation for Pandemic Flu



Thanks for the good question about what to stock up on at home and for how long if the pandemic gets out of the box. The answer is far from simple!

To figure it out, you need to imagine what the impact of a pandemic would be on the community as well as what the impact would be in your household if someone brought pandemic flu home to share.

Once you look at both pieces you can begin to tailor your personal planning depending on whether you're a worry wart, a fatalist, a pragmatist, or simply invincible, like Nathan.

In 1918, once the pandemic swept into town it caused significant illness for the next six to eight weeks. Significant means that at about a third of the people in the community were sick in bed, some desperately ill. It took a person a month or more to fully recover from that flu, and that was only if the person was lucky enough to avoid secondary pneumonia or other common complications during convalescence.

Assuming a similar attack rate for our unknown new pandemic threat, what could we expect? Picture the scenario if a third or more of the work force were absent for a period of several weeks:

--Public services would limp along. Delayed repairs of power or water problems, slower police and fire response.
--Schools and daycare would likely be closed during the peak of the invasion.
--Public transportation of all types would be limited or banned.
--Commercial goods and services you take for granted would likely be scarce or missing.
--Medical services, including emergency response, hospital beds, and pharmacy services would be badly overwhelmed and understaffed.
--Social services for the frail elderly and other individuals would be harder to access.
--I'm sure there are a bunch more that I've missed, but you get the picture.

How long might that all continue? Variable: Given the interlinked economy, goods might be scarce a lot longer than the people in your own community are sick.

How much stocking up you decide on is so much a function of where you live and your family's particular needs that it's impossible to say definitively. Use your best guess given the scenario above.

I've read one recommendation that you should plan for at least a week without a trip to the market. That seems a bit optimistic to me! There is a general overview of the things you should consider stocking up on at

http://www.pandemicflu.gov/planguide/checklist.html

My own personal plan is:

1. Make a list now of the non-perishables I think our household would need for at least two weeks, three weeks for really critical items like diapers and routine prescription and over-the-counter drugs.

2. Begin now to buy extra of just those critical things to avoid a last minute panic.

3. When the pandemic is official anywhere in the world, stock up on the rest.

But that's still only half the answer. What is really critical is to know what to have on hand if, God forbid, you had to take care of a pandemic flu victim at home. Given the attack rate, this is a distinct possibility that we must be ready for. More on that later.

Saturday, March 25, 2006

Pandemic flu, Salad Bars and Buffets

Picture this: You go through the food line behind twenty others, picking up tongs or spoons to get each item you want. Then you put them back into the food, thereby contaminating the food as well as the tongs so that the person behind you has two chances to catch a virus per item. At the end of the line you pay, take your tray to your seat, perhaps go get some bread or soup, and start to eat.

What's wrong with this picture? Probably nothing, right now. I do it all the time and I'm reasonably healthy. Thank heavens for good immune systems. They take a lot of abuse.

But if pandemic flu gets out of the box anywhere in the world, you bet I am going to change my habits! Maybe buffets will require patrons to put on disposable gloves, like their own employees wear, before they start through the line. That's easy enough, and I would gladly do it. But until they do, I will stick a squirt bottle of alcohol-based cleanser in my purse and do a quick ablute before I pick up my bread.

What about a restaurant? The food preparers generally wear gloves, but what about the server who adds the toast or salad to your order at the last minute? Not only do they not wear gloves but they also handle money. Hmm. Any ideas about that one?

Monday, March 20, 2006

What Gyms Should Do about Pandemic Flu

At the gym, the entry point for flu virus is likely to be more HANDS than LUNGS, since most of the machines are at least three feet apart.

The fix is pretty simple: I think that starting now gyms should have containers of alcohol-based cleanser in key spots, so that people can have clean hands going to the machines and can certainly clean them after they have gripped all the grips for that session. A good place to start would be to put containers on the counter at the entrance, the locker room of course, and also on top of the cubby holes where people store their stuff if they don't use a locker. These spots are more obvious than a dispenser on a wall somewhere, and will remind people to use them. A little publicity wouldn't hurt either. Make a squirt part of the sign in/sign out process.

I assume that each gym has a regular cleaning schedule for the machines. For the grips they should be using a disinfectant cleaner, if they aren't already. Might be a good thing for you to check with your gym to see what they use and how often they use it.

Saturday, March 11, 2006

Schools and Pandemic Flu

Let's switch gears and talk about pandemic, not avian flu. Remember, pandemic flu will be potentially deadly and can pass quickly from one person to another, no birds required. The World Health Organization assures us that some form of pandemic flu is coming, they're just not sure when or what.

By the time the pandemic flu variety is clearly understood by epidemiologists in terms of what organs it affects and how deadly it is, it will be way too late for your community to act appropriately. But looking at the flu virus that caused the 1918 pandemic, we can certainly take some educated guesses about how the next one will behave, and act accordingly.

Check this site for more information on the 1918 pandemic: http://www.pandemicflu.gov/general/#history

Children catch flu easily and are a potent source for infecting the whole community by bringing pandemic flu home to their families. A child coming down with pandemic flu will spread it for up to two days before he feels sick. What can schools do to minimize this risk?

CLEAN HANDS
Alcohol-based cleansers are quick and easy to use and better than soap and water for killing flu virus, given the way most people wash their hands. (Squirt a small pool of cleanser into one palm and continue rubbing it over both fronts and backs and between fingers until the hands are dry. Takes about thirty seconds.)

Each child should get a squirt of this cleanser each time she enters the class room. An easy way to do this is for the teacher to give each child a squirt as the line goes past her coming in each morning and coming back from recess and lunch.

Each child should learn to get a squirt coming back from the bathroom. Doors should be opened with shoulders rather than hands if they have push plates instead of handles.

Children in line to go to lunch should get a squirt as they leave the class room.

Teachers are probably not going to be able to get a child not to touch his face, but cleaning the hands at the identified times will reduce the child's chances of infecting himself and others with virus from the playground equipment or other commonly touched items around the school.
Have the cleanser available for children to use if they know their hands are contaminated and prompt them to use it when you see that they need to (for example, picking up a used tissue off the floor to throw it away).

CLEAN LUNGS--it's all about spacing

A cough, sneeze or laugh spreads droplets into the air in a three-foot arc around your face. When the pandemic flu is a reality, it's time to rethink desk placement temporarily. Once the pandemic arrives, it will go through your community for six to eight weeks. For this length of time, desks will need to be far enough apart so that middle school and high school kids cannot touch their neighbors' noses, at the minimum. That's about three feet.

Younger children need this space, too. Two first graders touching knuckles at arm's length is a space of about three feet. Probably at their desks they have this space, but not standing in line and not sitting on the rug. Teachers will need to teach the children spacing for both lining up and rug work.

If a child in the class is coughing, she should be separated from the others as far as possible in a "coughing corner." In crowded classrooms that may not be possible, unless the teacher gets creative with the desks of students who are absent that day. At the very least, a cougher should have tissues and a sack to throw used ones in, with alcohol based cleanser available to clean the hands. Perhaps when pandemic flu is a reality in your community, any cougher should be immediately sent to the nurse's office.

GROUND-UP PLANNING

These simple ideas are an example of "ground up" planning rather than top down. Prevention of a flu disaster in your community depends on teaching the people of the community what they need to do, rather than waiting for definitive word from on high.

However, there is already word from on high that gives at least some guidance for schools:

http://www.pandemicflu.gov/plan/schoolchecklist.html


All classrooms need to take these precautions if they are going to work, so it's not enough for each teacher to implement changes in his own room, although that's certainly a place to start. We, as parents and teachers, need to be sure our school district is beginning to plan for the pandemic now, and certainly implementing these simple classroom changes now. By doing so we are not only helping to keep our children safe but protecting our families as well.

Thursday, March 09, 2006

Personal habits to keep from catching the flu

Sounds like it will be North America's turn for avian flu within the year:

From CBS News this morning:
"Dr. David Nabarro said Wednesday that wild birds will likely carry the virus from West Africa across the North Atlantic into the Arctic this spring.

"Migratory birds flying south for the winter will then spread the virus into the rest of North America and eventually South America, Nabarro told a briefing in New York.

"Frankly, there will be a pandemic, sooner or later," he said. "It might be due to H5N1 or to some other influenza virus and it could start any time."

And you should be keeping your cat inside if your country already has avian flu:

From Bloomburg.com today:

"A beech marten from the Baltic Sea island of Ruegen, where Germany's first cases of bird flu were detected last month, has tested positive for the H5N1 virus, the Federal Research Institute for Animal Health said. It's the second type of mammal after three cats to be infected with bird flu in Germany, where a total of six states have now detected the virus in wild birds.

"It is noteworthy that the spectrum of the H5N1 infected mammals has spread,'' the institute said in a statement. It's the first time a marten, a weasel-like creature, is known to have bird flu."

The last post dealt with not spreading the flu virus. Now let's look at personal habits that may keep us from catching it.

Remember, there are two ways virus gets into your body: your lungs and your hands.

LUNGS: KEEP YOUR DISTANCE

Flu virus is sprayed into the air for up to three feet when you cough, sneeze, or even laugh.
Move at least arm's length away from coughers. Change your seat, step back, slide your chair away, get off and take the next elevator, hold your breath?

Your child's school should move a cougher to a seat apart from the other children.

When I fly, I will take a mask along to wear if I can't get away from a cougher. A regular surgical mask will block droplets if it is worn snugly. It may draw attention, but also may prevent your vacation from being spoiled, like mine was on a trip to Rome a couple of years ago.

Here are some more tips for flying from the Pall Corporation (filter manufacturer):

"Advice to the Flying Public... even state-of–the-art cabin air filters cannot prevent the possibility of direct person-to-person transmission within the aircraft cabin. Direct contact, such as touching common surfaces, sneezing, coughing and talking with an infected individual on an airplane can transmit infections. Proximity to an infected individual increases risk more than the duration of a flight. [my bolds]

"Infection disease specialists recommend that air travelers should wash their hands frequently. Lundquist also recommends that opening the overhead gasper nozzles available on most airplanes to provide a steady flow of filtered air can help reduce the direct transmission of microbes from neighboring passengers. http://www.pall.com/news_articles_36290.asp

I guess that means you open the nozzle and blow it at the cougher and away from you!
I truly think that airlines should provide masks for coughers and insist that they wear them.

HANDS: DON'T TRUST THEM

I don't consider myself a germ freak, but as this virus keeps spreading, we better have new habits in place. We should be teaching our families now how to avoid getting the virus.

Always consider your hands contaminated, unless you have touched NOTHING since you've washed them. Think of them as your own personal fly feet. Yuck!

The advice to "wash your hands frequently" is too vague. Sounds random, and it shouldn't be. Consider the following:

NEVER touch your fingers to your face. Now that will be a hard habit for me to break!

A tissue should be between your fingers and your face any time you need to touch it (rubbing eyes, itching nose, etc). A notorious entry point for the flu virus is your eyes, believe it or not.

If you don't have time to find a tissue, then use a knuckle or the back of your wrist to scratch that itch.

If you bite your nails, invest in a good pair of cuticle scissors to carry instead. They do a much better job, anyway.

When you know you've touched something you shouldn't, carry alcohol-based hand sanitizer in your brief case, purse or backpack to use to clean your hands, before you touch anything else.

The ultimate in things you shouldn't touch is the door knob out of a public restroom.
So you washed your hands. You are in the minority. Those who breeze through and don't wash make the door knob or push plate out a nirvana for viruses. Likewise the faucets at the sink, which are turned on by very dirty hands.

Always use a paper towel between your hands and the faucets and your hands and the door handle, once your hands are washed. If the trash can is too far from the door to reach, so be it. As trash piles up in the corner near the door, the establishment will get the picture.

Wash your hands before you eat, particularly finger foods like sandwiches. Do your children have an opportunity to do this at school? I bet not. That's were the waterless cleanser in the backpack comes in.

Teach your kids not to share bites or sips or even pencils. This seems so paranoid, but will become more and more important as pandemic flu becomes a reality.

Sorry for the long post. It just seems so important to start thinking about these things seriously.

Tuesday, March 07, 2006

What should I teach my family?

You already know about how to avoid bird or avian flu. But you also know that avian flu is not the biggest threat facing us. That would be pandemic flu, not here yet but odds getting better. (Did you read that now some cats have been infected with bird flu?)

So I think it's time we started teaching our families some new habits that will keep them from both SPREADING and GETTING all types of flu.

The key is your fingers: your own personal fly feet. They can bring you the flu as well as share it with others. So we need to practice using our hands in a new way.

SPREADING THE FLU

You spread the flu by coughing and sneezing. We all know that: we drill into our kids to cover their coughs with their hands to avoid it. We do that ourselves as a reflex we've all been taught. But if you've ever watched a four-year old cover a cough, you can see that all it does is contaminate the hand in front of her mouth as well as the air she's coughing into, without blocking anything,

Even if you are a careful cough coverer, that just postpones infecting someone. Because now the hands that covered the cough are on the loose. And your hands are as big a problem as the droplets you just coughed into the air. Just think of all the neat new places they can touch before you get around to washing them.

Some experts say that hands only carry the virus for five minutes, but even if true, that's a long time to not touch anything. Maybe the only time you wouldn't touch something in that period of time is if you're asleep.

The pandemic flu virus of 1918 that killed millions of people could live on a doorknob for 2 days!

Okay, so what do we do?

Of course, cough or sneeze into a tissue and then throw it away, not back in your purse or pocket.

And here's the new trick: if you don't have time to find a tissue? USE YOUR ELBOW to smother your cough or sneeze. Obviously, your inner elbow cannot get into near the mischief afterwards that your fingers can, and that's the point.

Some schools are already teaching their students this habit, which is wonderful. Teach it at home as well. If your very young child carries a stuffed toy around, perhaps you could teach the child to cough into the toy instead of the air.

More on how to keep from getting the flu tomorrow.

Monday, March 06, 2006

What you should do now about avian flu

You've got all the information you need now to protect yourself: You know what materials are contaminated with the virus, how it gets into your body, and how to kill it.

BEFORE avian flu comes to town, learn as much as you can from sites like this one. It's not too early to tighten up your control over your personal fly feet (your hands) and to teach your family about this as well, even though you still can't catch avian flu virus from another person. More on family teaching tomorrow.

AFTER the avian flu virus has already reached your country, you need to be in prevention mode. Remember, to catch avian flu you have to be in direct contact with infected birds, their saliva or droppings. If you are not, then you shouldn't have to change your habits, other than to use careful hand washing and the other techniques we will discuss tomorrow.

Areas of concern if you live in a country with avian flu:

POULTRY

Handle raw poultry and raw eggs carefully: keep them separated from any other foods that you don't intend to cook, such as salad greens or bread, and wash your hands before and immediately after handling them. This is the same precaution that you should already be using to prevent salmonella.

All knives, cutting boards and dishes touching the raw poultry or raw eggs should be washed in hot, soapy water, preferably in a dishwasher. Wooden cutting boards should be disinfected with a bleach solution.

Cook all poultry to an internal temperature of 165 degrees; convert the family to scrambled eggs rather than serving them over easy.

SHOES

Maybe it is time for your house to adopt the practice of removing shoes before you enter your home. Velcro shoe fastenings can make this easy for even young children to do by themselves. Invest in garden clogs that slip off easily before you come in.

I would stop feeding the ducks or pigeons in my neighborhood, or taking my children to play in parks where wild birds congregate. Wild bird droppings in the grass can hitch a ride in the grooves of their sneakers. Ducks in particular are carriers that don't get sick and die but still can have the disease. Avian flu virus can live a month in moist manure.

If you golf, handle your spikes with care. I would clean them outside the house, wearing sturdy rubber gloves, and store them outside the living area. Be sure to wash your gloves while wearing them and then wash your hands when you take the gloves off. Use the same technique if any other shoes get droppings in the grooves of the soles.

BIRD FEEDERS

Take down any outside wild bird feeders and clean up the area around them of all bird droppings, using a scrub brush on a long handle (to keep from splashing droplets on your face or skin) and antiseptic solution. Throw away the used scrub brush, or soak it in a bleach solution (1/4 cup bleach to a gallon of water).

Personally, I would throw away the bird feeder, if possible, or at least cover it in a plastic bag. Remember, once the wild birds in your country have avian influenza, it can take several years before it dies out among them. Why keep the thing around that long?

Wear old clothes and sturdy rubber gloves for the cleanup. Wash the gloves in soap and water before you take them off, so you won't be handling contaminated gloves with clean hands.

Change your shoes before you come back into the house. Wash your work clothes in very warm to hot water and dry on high.

After you take off your work clothes and they are in the washer, wash your hands thoroughly, either with plain soap and water or alcohol-based sanitizer
.
Until the wild bird droppings are completely cleaned up and the area has dried off, wipe your pet's paws with alcohol-based sanitizer before you let it into the house.

Keep your pet bird in its cage for at least two days after you have done your cleanup, just in case some virus has snuck in on Fido's feet.