2009-06-19 / Columnists

SJEH Wellness Corner

A Pandemic: What You Need to Know
Commentary By Sheldon Gleich, MD, Chief, Infectious Diseases and Saundra Chisolm, NP, Emergency Preparedness Coordinator, SJEH

In light of the recent swine influenza A (H1N1) outbreak and the rise in the World Health Organization's (WHO) pandemic alert phase on June 11, 2009, to level 6 (designating that a global pandemic is underway), many are concerned about the possibility of exposure to this novel virus.

Three major influenza pandemics swept across the globe during the 20th century causing millions of deaths. The first influenza pandemic of the 21st century has begun and no one knows yet how this pandemic will impact the human race in terms of severity.

Every year in the United States there is a seasonal epidemic of influenza (flu). A disease epidemic occurs when there are more cases of that disease than normal within a country or part of a country.

In the case of influenza, seasonal outbreaks (epidemics) are generally caused by subtypes (strains) of a virus that are already circulating among people.

Usually people have some immunity that has developed from previous exposures. A vaccine is typically available based on known flu strains, antiviral supplies are adequate and the health care system can usually meet public and patient needs. Approximately 30,000-50,000 persons die and over 200,000 are hospitalized as a result of influenza virus infections in the United States during a typical year. We usually accept this outcome as part of the cycle of life.

According to the WHO, a pandemic is a worldwide epidemic of a disease. A pandemic may occur when a novel virus appears for which the overall human population has no immunity and there is initially no vaccine. It can result in serious widespread illness that is easily transmissible from person to person by coughing and sneezing and via contamination of environmental surfaces in the same manner as seasonal flu.

Due to an increase in global transportation, spread of disease is enhanced. Healthy young adults, including pregnant women, are often particularly susceptible during a pandemic and multiple waves of disease are characteristically noted.

At present at least 76 countries throughout the world have officially reported more than 35,000 cases of swine influenza A (H1N1).

Fortunately, the mortality rate remains less than 1% of infected persons. Ensuing waves of pandemic illness, though, may be associated with increased viral virulence and more severe disease.

During an influenza pandemic our own behavior will be as important as anything the health care system can do for us. It will likely take at least six months to develop an effective vaccine. Simple measures, such as reducing close contact and covering your mouth and nose when you cough or sneeze and disinfecting the environment, will be keys to limiting the pandemic. Use a tissue to cover coughs and sneezes and throw away tissues immediately after using them. Frequently wash your hands and avoid touching your face with unwashed hands. Generally you should stay home when you are sick and do not send ill children to daycare or school. Keep your distance from others when you are sick and avoid close contact with people who are sick.

Eric Nazziola, MD, Chairman of Emergency Medicine at St. John's Episcopal Hospital, has said, "If you have a mild case of influenza-like symptoms, the Department of Health has asked that you stay at home to prevent transmission of the flu.

If you have flu-like symptoms and a serious underlying condition - such as cardiopulmonary disease, COPD, as- thma, or an immunodeficiency - or are very old or have a very young child with flu-like symptoms, you should come to the Emergency Department. And if you have flulike symptoms, shortness of breath, have trouble keeping fluids down, confusion, or difficulty breathing you should also come into the Emergency Department. If your child has flu-like symptoms and is seriously ill and has trouble drinking enough fluids, you should bring him or her to see the doctor.

If you do come to the Emergency Department with flu-like symptoms, please notify the triage nurse immediately of your condition."

An international approach to providing important epidemiologic information is in place.

Physicians, nurses and scientists as well as government agencies are working in a concerted effort to care for and protect our population. We must all contribute in any way we can to be prepared for such an event.

To follow the most up-to-date information surrounding the swine influenza A (H1N1) outbreak online, access the New York City Department of Health website at http://www.nyc.gov/html/doh/html/h

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