Common sense about swine flu

Surely by now you’ve been inundated with scary info about the swine flu. My purpose for this week’s article is not to bore you or add yet another doctor’s opinion about what’s true or not. To be honest, I decided to write about the topic, because I was confused myself!

ay in the Tribune about the one confirmed case here in North Carolina (Onslow County) over the weekend. Another case, the relative of the confirmed patient, is pending confirmatory testing. You wouldn’t believe the timeliness of it all as I also tested my first patient today to rule out swine flu. So, let’s review the details together.

First of all, there are the most common types of flu, or influenza A or B, which are the types we know most. Influenza A has caused pandemics in the United States, creating the need to make the vaccine we have and use annually today. In 1918, 1957, and 1968, worldwide outbreaks occurred in America. Pandemics, defined by Webster’s as “occurring over a wide geographic area,” with influenza seem to occur when new strains and types of the same infection arise. With the above named pandemic years, influenza A occurred in three different genotypes (HINI, H2N2, and H1N3 respectively). I say all this to say, even as we come up with vaccines and medications to treat this virus, it is capable of becoming a new entity as years go on.

However, to avoid getting bogged down with medical terms, the swine flu is different from the influenza A and B we commonly have in that it is different genotype. The genotype of swine flu is the H1N1, the same one associated with problems in 1918. What’s the difference this time? This time, instead of transmission by humans, the transmission was by pigs in Mexico. Unfortunately, the flu vaccine given to our patients this past winter and spring does not protect us from the swine flu. The natural question following is what will protect us?

What we know is this—do what you would usually do to prevent disease: (from the Center for Disease*Wash your hands often with soap & water (or alcohol-based cleansers), and cover your mouths when you cough or sneeze.*If you’re sick, especially with a fever, stay home and keep kids home from school.*Avoid touching your eyes, nose or mouth. Infections spread this way.

The patient I saw today was an elderly, Mexican woman with 1 day of a very high fever to 103 degrees. She also complained of muscle and joint pain all over and a bad cough. This was very worrisome, indeed, particularly because she lived and had come in contact with many relatives, one who also had a high fever. Most importantly is the next question that I asked her and her family that deserves special attention—had anyone in her environment recently traveled to or from Mexico, Texas, Kansas, New York, or California. The answer, thankfully, was no. However, because she is elderly, has diabetes, and was dehydrated, I thought she had severe enough symptoms to send a nasal swab to rule out the flu, and fortunately it was negative (meaning normal). She instead had pneumonia on chest x-ray, and we started antibiotics.

The 2 most important clinical and social history questions to remember in my opinion are “Is there a fever?” and “Has there been travel or an exposure worrisome for swine flu?” Because both swab tests and antiviral medications (Tamiflu and Relenza) are currently in limited supply, we all have to be smart and proactive and not order a swab on every patient with cold symptoms. All of us need to practice prevention, common sense, and doctors need to use their best judgment to decide intelligently who to test and who to treat.

Be healthy and be blessed,Dr. Price

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