Life as a Spectator Sport

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Tuesday, June 09, 2009

Not too much panic, please . . .

Once again, the word is out that WHO (World Health Organization) is about to declare pandemic level 6, an "official pandemic." With soaring levels of infection, they may actually do it this time, though their greatest concern still seems to be managing panic, not managing illness.

Swine flu is not only becoming more prevalent, it is apparently becoming more deadly. It was already the predominant type of ILI (influenza-like illness) in the US (seasonal flu has mostly died down). But in the last four days, the official mortality rate has increased from .57% to .94% (figures from today's WHO News Briefing). I suspect this abrupt change is due more to delayed reporting than to an actual large increase in the mortality rate. Even so, it suggests that the mortality rate has been higher all along than reported.

Oops -- Near the end of the News Briefing, Dr. Fukuda took back his statement of 249 deaths. He said, "First let me clarify the number that came up earlier. The number I gave you on the number of deaths was erroneous. The number of deaths is 140 so rather than the 249 – if you can make that correction – that is the number of reported deaths from this virus to WHO is 140. In terms of examples of adverse reaction that we would like to either see not occur or have them be reduced." With that correction, the mortality rate is still roughly .57%. There are many reports, however, of doctors being told to put the victim's underlying health problem on the death certificate as the cause of death, rather than the swine flu the person was diagnosed with. So I personally do not believe the published mortality rate is anywhere near correct.

Part of the reason for the misleading low rate is that the field tests for swine flu are seriously unreliable. In several cases, swine flu wasn't diagnosed until an autopsy was performed on the victim. Earlier tests had been negative. So some of the recent increase in mortality may result from the addition of people who died days or even weeks ago.

If WHO does move to the highest pandemic level, swine flu will once again be back in the news. And once again we'll see two other phenomena: first, the naysayers will flood back out of their closets to pooh-pooh everything they hear. Second, emergency rooms will again be overwhelmed with the worried well, many of whom are likely to go home with infections picked up right there in the ER. A reasoned, well-thought-out, moderate response seems to be simply beyond the capacity of most people.

I'll throw out my recommendations again, for what they're worth, starting with the suggestion to have at least a couple of weeks worth of stored food, water and medications. If your children's day care or summer camp closes and you have to stay home with them, you can eat from your reserves, not your most recent paycheck. If so many people become ill that public services are threatened, you won't be fighting the crowds for that last gallon of water on the supermarket shelves.

Make sure you have a wind-up or battery-powered radio capable of receiving emergency broadcasts. Add a couple of wind-up flashlights and a can opener (amazing how often that gets overlooked). Think about how you would prepare your family's meals without electricity, how you would wash the dishes (and the people and the clothing), where you would go to the bathroom. There are thousands of useful sites on the internet with answers, but they're no use to anyone who hasn't considered the questions.

You can forget the sites that tell you how to track down your food and kill it, how to squat on someone else's land without them knowing it, how to evade the authorities and how to field strip a Sig Sauer. All that information may well be useful in some circumstances. But it doesn't come close to knowing how to prepare food, clean up after yourself, go to the bathroom and care for sick family members. Short of the total breakdown of society, those are the skills you'll need the most.

What about masks, hand sanitizers, gloves, etc.? It's probably too late to procure masks from anywhere but your local hardware store, where N95 respirators are sold in the paint and drywall departments. Alcohol-based hand sanitizers probably do some good, but they're not recommended for children, because a small amount of alcohol is absorbed through the skin each time they're used. It's not enough to adversely affect an adult, but children could be at risk. Some other sanitizers contain triclosan, a toxic poison that is accumulating in our sources of drinking water from being flushed down so many drains. And the FDA has issued a warning about one company's products:
Consumers should not use any Clarcon products and should throw these products away in household refuse. Analyses of several samples of over-the-counter topical antimicrobial skin sanitizer and skin protectant products revealed high levels of various bacteria, including some associated with unsanitary conditions. Some of these bacteria can cause opportunistic infections of the skin and underlying tissues. Such infections may need medical or surgical attention, and may result in permanent damage. Examples of products that should be discarded include:

- Citrushield Lotion
- Dermasentials DermaBarrier
- Dermassentials by Clarcon Antimicrobial Hand Sanitizer
- Iron Fist Barrier Hand Treatment
- Skin Shield Restaurant
- Skin Shield Industrial
- Skin Shield Beauty Salon Lotion
- Total Skin Care Beauty
- Total Skin Care Work

Findings from the FDA's recent inspection of the Clarcon facility are particularly concerning because the products are promoted as antimicrobial agents that claim to treat open wounds, damaged skin, and protect against various infectious diseases. The inspection uncovered serious deviations from FDA's current Good Manufacturing Practice requirements.
Good old soap, hot water and effective hand-washing technique is still the best way to clean your hands (count from A to Z while vigorously rubbing your hands with soap, then rinse thoroughly with water). In public restrooms, open the door with a paper towel or tissue after you wash your hands. Don't touch your face. Sneeze or cough into a tissue or your elbow. Stay home if you're sick, and keep your kids home if they're sick. You'll hear these things over and over, and they all work.

Finally, monitor the more responsible public health sites, such as FluTrackers and Effect Measure. FluTrackers is non-political (and strongly moderated to keep it that way), non-sensational, and many of the members are professionals working in virology and epidemiology. The writers at Effect Measure are public health professionals.
posted by Liz @ 5:42 PM     |


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