The New Swine Flu Review

Sharon April 27th, 2009

I was all psyched to tell you what I learned about water pumping in the North Country, but when I got back, my in box was filled with swine flu news and requests for what to do.  So I thought it was a good time to post a short review of what to do if swine flu does become a pandemic – you’ll find that a surprising amount of it is precisely the stuff we all have been doing anyway.

As I understand it, swine flu is nothing to get complacent about, but generally less virulent than avian varieties, because we’re better adapted to it.  So far, all the US cases have been very mild – the outbreak in Queens involved everyone being sent home.

My own personal response is to watch and wait.  Both Eli and Eric are going to school today.  I’m still planning on travelling by public transportation to Maine next weekend for a talk, although this could change if events do.  A few years ago I wrote a piece about the potential intersections of pandemic flu planning (and actual outbreaks) with peak oil and other potential crises.  I think most of what I wrote is potentially true, particularly the fact that a not-terribly severe flu epidemic could be used easily for political purposes – we tend only to be able to deal with one crisis at a time, and so one concern is simply that while the news is focusing on flu, they won’t be reporting on what is happening in the economy.  This may not happen – it is merely speculation, but while we should be concerned about a major flu outbreak, we should also continue to look at the world critically, rather than simply getting scared.

So the first thing to say is DONT PANIC – so far, the swine flu, while potentially very widespread, doesn’t necessarily seem to be that serious.  Yes, 160-odd people in Mexico have died.  But lots of people die here of the flu every year – it is actually a very common cause of death among the elderly. So there’s no reason immediately to assume that this is a particularly virulent or unusually serious version. 

The second thing you should do is WASH YOUR HANDS and stay a step back from people.  You obviously should be particularly careful about this if you have elderly or medically fragile people in your home, or are elderly or medically fragile.  Wash your hands *a lot* and wash your kids hands.  If you have appropriate N-95 masks, you can wear them if you have to be out, if that makes you feel better.  They are tough to keep on children and they aren’t a perfect solution, so I tend to think of them as of largely psychological value for many people, but it can’t hurt.

Ok, what’s next on the agenda.  Well, the first thing is to avoid getting swine flu if possible.   That is, you probably don’t want to spend a lot of time hanging out in large public venues, if you are concerned about it (of course, our family just spent the weekend at synagogue, the greenmarket, the public library, but what can you do).  The best possible strategy for controlling the spread of illness is for people to mostly stay home.  Mexico City has already closed its schools, universities and public venues, and I won’t be surprised to see this happening over other regions as well.   

You don’t have to wait until they close your school – you can take your kids out earlier if you are concerned.  Jobs are tougher (trust me, my husband teaches at a large state University) – you may or may not have the option of staying home.  At this point, I wouldn’t lose a job based on what we know.  You are going to have to balance this one.  But the best possible strategy is to stay at home as much as possible – at least give up Bingo night.  Don’t fly if you can avoid it, and I’d wear a mask if I did – airplanes are particularly likely venues of transmission.

If you think you might have Swine flu, you should probably be checked – call your county or state public health office to find out where.  Otherwise, this would be a good time to stay away from hospitals and doctors offices, where people with viruses that might or might not be swine flu may be found.  So you might want to cancel routine checkups, minor surgeries and anything else that can wait – note the emphasis on *can wait* – don’t skip essential medical care. 

 This is also a good time to update your prescriptions – pharmacies are also a place where sick people congregate.  If you can, get your doctor to call in an extra refill, telling them you are concerned that if there is a quarantine, you may run out.  Also a good time to pick up elderberry syrup, rehydration liquids, tylenol, etc…  Don’t forget whatever you might need for children, the elderly, etc…

If you are going to be in Quarantine, you will need a supply of food.  How much?  Well, if you wish to give your paranoia free reign, probably at least 2-3 months.  Why?  Because the CDC has suggested that in a real pandemic situation flu would come in waves – and that extended quarantines might have to last as long as 2 months – and that there might be more than one of them.

Now I’m sure a lot of you have plenty of food, and the odds are very good that this time you won’t need it.  But I’m not sure I would want to bet real cash on that – I’m risk averse.  If this turns into a major issue the *stated policy of our government* (and Australia and Britain’s as well, and New Zealand has already begun to implement quarantines) is quarantine, and it could last at least 8 weeks. I wrote about this in my essay about why FEMA’s 2 weeks of stored food is not enough here.  You might want to do as little shopping in public venues as possible for even longer than that.

What if you don’t have 8 weeks worth of food supplies?  Well, you’d best go shopping.  This is one of the reasons that I wrote this essay on crisis shopping a while back.  I knew that some of you would wait until the last minute ;-) .  Note, while there is no reason whatsoever to run around screaming “the sky is falling, buy spam!” it would be nice if you were to ask an elderly neighbor or a busy young Mom if you can pick up any supplies for them.  And if this motivates you to get to work on food storage, so much the better – as I always mention, this is *not* the ideal way to go about food storage.

In addition, you want to pick up items that will allow you to treat minor injuries and mild cases of illness at home – think about what your family needs when you are sick.  Ideally, you already have a first aid kit, a store of meds, and these things.  Don’t forget to make some chicken soup or miso soup and freeze or can it.

On the home front, it is worth remembering that you may be stuck at home for a while – jobs may be closed down, schools shuttered, and people’s travel restricted.  What are you all going to do together?  Well, assuming no one is sick, now’s a great time to work on the garden and your food producing infrastructure.  Make sure you’ve got seeds and the things you need to grow food, feed for animals and pets, and a plan.  If your kids are used to being at school all day and in front of the computer or tv all afternoon, and you don’t usually all stay home together, you will rapidly find that you get on each other’s nerves.  Now is a good time to think “what will we all do” when we are actually forced to find out how much we like being together.

So now’s a good time to pick up that raised bed building materials, or the new tile for the bathroom.  Now is a good time to think about something you’ve been wanting to do or learn together.  Make sure the kids bring their books home from school at night if you think the schools might be closed.  Plan a family project.  Plan a visit to a local state park or other place not likely to be filled with other people.  Make the change as enjoyable as you can – think of this as a home-based vacation.  And if you don’t know how to have a good time for a few weeks at home, this is your next project – getting to like staying home with your family.

Finally, talk to your neighbors if it seems like this will turn into something significant.  First of all, if by some chance you have to stay home for a month or two, you will be desperate for a little local company, so you might as well hang out now.  Second of all, they may need your help – or you theirs.

Also, you might talk to family – some family may leave population centers to come to a safer location, or you may not want your elderly father to endure quarantine alone. If you are going to consolidate for the emergency, plan ahead – you want to do it early, and ideally, without passing infection back and forth.  If you may need to leave your location, get organized now, and figure out your plan. 

Again, this is not meant to be a “Zombies, run” kind of post – it is simply a reminder that the same basic mechanisms that serve us when preparing for one potential crisis serve us in almost all of them.  That is, sooner or later most of us will have something happen to them – whether a natural disaster, a political crisis, an extended job loss, a pandemic, an extended illness, etc… and the very basic things – take care of yourself, connect with your community, help others, have a plan – will help you no matter what.

 Sharon

42 Responses to “The New Swine Flu Review”

  1. MEA says:

    Welcome home!

    I knew you’d work zombies into this. I am reading Price and Prejuce and Zombies, which is very, very funny, though a bit after your period.

    I’ve alway wonder exactly how isolated we need to be. You mention working in the garden, so I assume we can go outside — but how far can we roam — over to the neighbors to help chop down a tree? 10 minutes walk to see a friend?

    And if we are checking on nighbors and someone doesn’t answer the door, who do we call? Or do we try to nurse them ourselves?

    Thanks,

    MEA

  2. Michelle says:

    Sage, level headed advice. Thanks!

  3. Sharon says:

    Hi MEA – Well, Influenza is airborne, so if you get into easy chatting distance, you have some risk of contagion. Depending on how quarantined your neighbors are, and how paranoid you personally, and what the risk factors are in your family (ie, if you have health compromised folks around), you may want to stay a bit away from each other, and just yell, or you may say “well, they are also in quarantine and haven’t shown any signs, so we’re going to let the neighbor kids over to play, but not anyone else.”

    As for the “nurse them yourself” or call thing – in the early stages of something really serious, I would call an ambulance. If the hospitals are overwhelmed, someone might have to be deputized (and quarantined with them) to care for a sick person or people – ideally this would be done mostly by people who have passed the “my kids depend on me”stage – this historically has been the province of middleaged women, but obviously, it shouldn’t just be.

    Sharon

  4. MEA says:

    Phew — no bed pans for me — unless, of course, I’m one of the sick one.

    It sounds almost as if going into quarantine with a few close neighbors might be the thing to do. Set boundries beyond which on one might ventures.

    Some time ago I read on ROE a suggestion that several household band together, put all the men (by which them meant working out of the home type stiff) in one house, and have there other people not stick their noses out for 3 month, or until the bodies had been cleared away. I could see several problems with that idea…but there might be a workable germ (so to speak) of a plan there.

  5. Kate says:

    Good to see such good common sense advice.

    Just a quick comment about handwashing – which is the single-most effective method of preventing the spread of most common communicable diseases. Antibacterial soaps are typically not a necessary requirement for people (and only provide marginal antiviral effectiveness, no matter what the labels purport). Unless you are or have someone in your care with either a compromised immune system or a contagious bacterial infection (such as MRSA), regular soap with warm water is really just as effective.

    Where most people’s efforts at handwashing fall short lies in two areas – duration of handwashing and amount of friction. Lathering should really be done for at least 30 seconds and should include the nails. Long and false nails have been clinically shown to harbor bacteria for long time and special measures should be taken to clean them. This should be regular everyday practice when preparing/handling food and eating in public facilities to prevent the transmission of such things as hepatitis A and norovirus. Friction does not necessarily mean heavy scrubbing. Unless you are removing lots of gunk, regular lathering and rubbing together is sufficient. The important thing is to get to all exposed surfaces rather than simply running your hands quickly under the faucet.

  6. MEA says:

    Kate, I remember reading somewhere that people tend to miss a particular bit of their thumbs. Do you recall anything like that?

  7. ctdaffodil says:

    Well, in addition to reminding our kids to wash hands – especailly at school – I sent mine off to school with hand sanitizer in a little pump…they both know when and how to use it – its not soap and warm water but better than nothing….Heres hoping they will remember to use it. I’m totally ready to HS if need be though – there is lots they could learn being outside in the fresh breezes…

  8. Mira's Desk says:

    As with everyting in life it is best to be prepared. Here is a link to the CDC for information on the Swine Flu. http://pfx.me/NR

  9. Sharon says:

    Kate, thanks for pointing out (as it needs reiteration) that there’s really no role for anti-bacterial soaps. If you use hand sanitizer, you should choose an alcohol based one.

    If you have kids, you could teach them to soap and rub to a tune – we use “twinkle twinkle” but any short kids song could be a good reminder of appropriate length.

    Sharon

  10. Nettle says:

    In regards to the elderly – the thing that has the public health people in a tizzy about this flu is that it seems to be more lethal in people with strong healthy immune systems. This is similar to what happened with the Spanish flu and the Hong Kong flu – a robust immune response is actually what killed people with those strains. So protecting the immunocompromised or taking steps to boost up the immune system, while a good idea in general, might not be the most useful response to this particular outbreak. If it’s anything like Spanish flu, then older people will be fine and it’s the young and healthy – people in their 20′s and 30′s – who will be the most affected. This is totally the opposite of normal seasonal human influenza.

    Being prepared with food supplies and doing lots of handwashing is great advice – probably the best possible advice under the circumstances – but the elderly aren’t the ones the most at risk here.

  11. EM says:

    Why waste space and effort freeze or canning miso soup? Just add miso to hot water and eat.

  12. Sarah says:

    EM — technically, miso soup also has kombu and bonito in it, though it’s still so quick to make that it seems faster just to keep the three ingredients on hand, since the kombu and bonito are usually sold dried and thus aren’t really perishable.

    I’m glad I finally got back on a 3-months-supply of my meds and have at least 2 and a half months’ worth left…

  13. Theresa says:

    Well, I just emailed my family members and encouraged them to pick up a few extra staples and canned goods this week. They may dismiss it, but at least I tried.

    Thanks for this very practical and realistic post Sharon, and welcome home.

  14. Levi says:

    “In the long run, we’re all dead” – Keynes

  15. Chile says:

    I’m glad this hasn’t spread too far yet. We listened to the news each day during the trip, wondering if we needed to bag it and head home quickly to our own place. Turns out we came home early anyway. We’re set for supplies although I do need to do more for water storage. Because of our firm belief this move was going to work out, I got rid of 150 pounds of great compost (argh!) and my rain barrels. *sigh* Oh well. No rain here until July anyway so we can decide if we need to replace them.

    We took the precaution on our trip home of using lots of the alcohol gel for our hands anytime we touched common items (gas pumps, doors, cash, etc.) at any stops on the road.

  16. Heather says:

    Another vote for alcohol-based sanitizer, if you’re going to use that stuff.

    This new flu strain is of special interest because it has different types of flus in it:

    “CDC officials described the virus as having a unique combination of gene segments not seen in people or pigs before. The bug contains human virus, avian virus from North America and pig viruses from North America, Europe and Asia.”

    Full article at: http://www.msnbc.msn.com/id/30386163/

    ***
    The good news is that this flu is responding to existing medications, Tamiflu and Relenza.

  17. ctdaffodil says:

    I said I wasn’t going to put on the news today and I did – while I cleaned the living room -
    Totally going to the store tonite when kids are in bed…
    Not comfortable with a few things I have let slip in all my stockup prep. Water I’m not too worried we have a private well and its a deep one (also can get the water up thanks to a generator) but I’m concerned about a few other things – mostly dried beans and oatmeal – I wasn’t watching my stock and my kids have been on an oatmeal kick – so we are down to 2 large boxes – And we ate down the HUGE bag of rice – probably have 2 dinners left of that. I want to make up some bread packets (all the dry ingredients into a zipper bag) then all that has to be done is add water and oil/butter into the machine – and get those into the freezer – my oldest son likes to make the bread that way.

  18. Noel says:

    Hi Sharon,
    I’m wondering if you read the article in Energy Bulletin (well really from Pattern Literacy) by Toby Hemenway today. He talks about the food system being, in his opinion, the last to crash. Any thoughts on that? Thanks as always for keeping us informed, entertained, and challenged!

    Noel

  19. Sharon, why aren’t your columns being syndicated and run in 100s of media outlets?

    The quality is there. And the potential audience is growing fast.

    Your common sense is appreciated.

    Bart / EB

  20. jerah says:

    It was really nice to panic at first and then realize, oh hey, I’ve got most of everything I need in my apartment already. I mean, not everything. We did go out and get tons of sugar and salt for rehydration fluid, some extra dried beans and whatnot (canned soup, canned veggies, frozen veggies, condiments), and a bunch of acetometaphin (sp?), immodium, and robitussin.

    Things we already had: all of the above, but not quite enough for months. But enough couscous for, um, MONTHS. In bulk: toilet paper, hard red wheat berries, oatmeal, lentils, popcorn, oatmeal. And lots of water. If the water goes out, we’ve got a fifty gallon barrel we can fill up, and a bathtub. We’ve got candles, flashlights, stuff for making a solar oven, a clothesline, hand-cranked radio/flashlight, a small solar panel and battery for the laptop…

    Why am I telling the internets this? The zombies will be coming to MY house! :)

    But seriously. We had friends over on Saturday night, we hung out in the backyard and drank beer and talked and everyone poo-pooed my doomerism, as usual. But not as much as usual. Some even asked for advice. And we made sure our two closest (unmarried) friends, who have no relatives in the city, know that they’re welcome at our place, worst comes to worst.

    I might start riding my bike to work. Although, the way traffic is on that route, I might have a better chance at survival just taking the subway and getting the flu.

    Sharon: this is the thanking-you-for-your-foresight-and-advice part. Thank you so much. we wouldn’t be nearly as prepared, and neither would several of my close friends, and I wouldn’t be sleeping nearly as well, if you didn’t have this blog. Thank you so much.

  21. jerah says:

    By the way, on the subject of flu prevention/treatment, here’s an interesting idea: get a tan. :)

    http://www.medicalnewstoday.com/articles/51913.php

    Apparently we’re all pretty vitamin-D deficient, and we get more so in the winter time…

  22. Kate says:

    MEA – they didn’t mention that to us in nursing school but I think I will start to pay extra attention to my thumbs now.

  23. Ray says:

    Excellent article and lots of good ideas from contributors. Keep in mind that a genuine pandemic would have major impacts well beyond the medical. At this particular time it could well be the log that breaks the economic camel’s back. A major downturn in consumer spending, international trade, employment, etc. could easily kick the crutches out from an already ailing economy. With that in mind I recommend taking Sharon’s advice re: having a personal store of emergency supplies adequate for two months on hand. This includes the necessities for heating and lighting not dependent on the “grid.”

  24. John says:

    um there have only been about 40 cases reported out of 300 million people….really is everyone panicking over this?????

  25. history says:

    Great, my dh has just been sent over to Texas for the week. He wrote to say that his group was warned about the Swine flu and possible tornado.He has a terrible cold at the moment, I can just see what Canada Customs will say when he has to clear immigration at the airport on Friday.

    hmmm, maybe I should get some shopping done this week….

    Amanda

  26. Well I made some 4 Thieves vinegar yesterday, even though it won’t be ready for weeks, and who knows if it really “works.”

    I’ve been taking Vitamin D for some time now, on orders of my normally skeptical doctor (and calcium). Boosts the immune system and there’s strong data that it fights cancer. I also make sure I get sun exposure whenever I can. Kids get D too.

    In 1998 as an extremely vigorous and healthy 35-year-old, I contracted the Sydney flu and almost bought the farm. After 7 days of high fever, vomiting, diarrhea and unbelievable coughing, and three visits to the doctor, I was hospitalized with pneumonia and extreme dehydration. I’d never been sick with more than a cold before so this was a stunner. I do have more respect for the flu and its power since then.

    But I still dont’ get the flu shot. Don’t believe in it. Not even when I was in chemo. And you know what? Even with a suppressed immune system, I did not get the flu. (and I didn’t use anti-bacterial soap either – regular soap only).

    I really think this is nothing to get too worked up about. It’s good to be cautious and be prepared (I’ve been checking my supplies – how about some Chinese herbs for diarrhea and dysentery?) and it’s also good to relax and don’t get too stressed out. Things would have to get a whole heck of a lot worse before you need to take major evasive action.

  27. Lori Scott says:

    My mother had little children during the polio epidemics of the late ’50s. She stayed home with the children. Dad went out and did everything that required leaving the home including working. They rigged up a shower out on the back porch.

    When he got home, he would shower and change clothes. Mum would pick up the outside clothes, towels and anything he had used and boil them.

    She would wipe down the outside of food packages and shopping bags with weak disinfectant. I don’t think she went out at all for 18 months and they were very conservative about outings for a long time after that, especially as the diptheria came after that.

    This might be a hint for other families who chose to keep their children home. Many epidemics were handled like this before vaccines.

  28. bryan says:

    I noticed the Mexicans are reported to be avoiding church and you in passing mentioned Synagogues. Now, I would think that those of Faith would accept that G-d will protect them in a house of worship, so what does this tell me?

    Hey, Just Asking…

    ***disclaimer***
    note no mention was made of any perceived or real lack of faith past, present or future in any person or persons representing any Islamic Sect, modern or historical. And if some sleight has been accidentally made against any prophet or prophets I’m three more houses down farther on the left.

  29. Fern says:

    John, no one here is panicking or suggesting panicking. HOWEVER – whatever the next pandemic is, it’s not going to come full blown over night with 10,000 deaths a day from day one. It’s going to start small.

    So an unusual influenza, at an unusual time of year for an influenza, ABSOLUTELY makes folks sit up and take notice.

    Fern

  30. Sharon says:

    Bryan, it is a common belief that religious belief requires you to be an idiot ;-) – mostly by people who don’t have any. Most people don’t experience their faith as “I am invulnerable.” That’s what happens when you go through a cosmic ray storm in your space vehicle and become a superhero, not when you pray ;-) .

    Sharon

  31. kathirynne says:

    Not to mention, G*d helps those who help themselves…

  32. hugh says:

    Good post Sharon. I am a doctor heading to mexico soon. Because I am leaving soon I have been following websites in the US and Mx for some wks and saw the early case reports which exploded into an outbreak in the last few days. One of the best sites is the Mexican Salud site but you need to know spanish to read it:http://www.salud.df.gob.mx/ssdf/

    Of course the CDC and who sites are good but be prepared for some variance in recommendations eg is vaccine protective, which antivirals are effective etc. Swine flu has not been much of a lethal variety for humans compared to the human and avian varieties but this strain has elements of all three and keep in mind that this virus reassorts(mutates) readily and rapidly. There may be many varieties already even in Mexico City. One variety is clearly very dangerous and has a mortality profile eerily similar to the 1918 pandemic virus and when you see young and middle age deaths you need to pay attention. When I was in medical school I sat in an ICU and held the hand of a dear friend as she expired from influenza. Young healthy people can die from flu very quickly, so do not be cavalier. If nothing else, Use this as an exercise to prepare and educate the family and friends for the next pandemic in case it becomes a flash in the pan outbreak. When we travel in Mexico we will avoid crowds, wear masks(the best N95 american made 3M varieties), use gloves as needed and use alcohol handwash gels as well as taking Tamiflu or Relenza with us. It is possible to contract flu from skin contact if you move your hand to your mouth but normally it is by aerosol from someone coughing on you.In a real pandemic it is essential to hunker down in place until it blows over. In a real pandemic it is essential to avoid public transportation, crowds of all types.

  33. Sharon says:

    My great neice (2), my neice where ill with vomiting and diarehea on friday and monday, my two sons 21 and 19 have been sick with vomiting, and diarehea for the last 5 hours, my husband has a terrible cough. Could this be swine flu

  34. Texicali says:

    Interesting connection with farming: the swine part of swine flu is likely the result of a factory farm operated by Smithfield foods in the state of Veracruz in Mexico. The farm moved there to avoid U.S. regulation.

  35. Sharon says:

    Sharon, I’d bet not – swine flu seems to start with a sore throat and fever. There’s been a stomach bug going around in a lot of areas – a college in Boston was closed, my sister and aunt both had it. So this may simply be the latest version of the creeping crud, odds are ;-) . Hope you feel better!

    The other Sharon

  36. Shamba says:

    we’ve had an elementary school closed for seven dalendar days in North Central Phoenix as a result of a confirmed “swine” flu in a student there. Students were sent home at midday and sstate health officials had a press conference to talk about it and explain other flue preparations they’ve made. This seems to be developing very quickly. We certainly should be better prepared than previous possible epidemics or pandemic than in the past.

    Peace to All,
    shamba

  37. andoe says:

    Has anyone been tracking the spread of swine flu on this website http://www.swine-flu-tracker.com/? It seems every time I check it the swine flu spreads.

  38. rheather says:

    My favorite flu blog is here http://scienceblogs.com/effectmeasure/.

    More technical info than I can handle sometimes but a very reasoned discussion or the current flu pandemic.

    (I got hooked on them during the avian flu outbraks in south Asia.)

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