Wrin Chikaya (wrin) wrote,
Wrin Chikaya

Respiratory's Guide to Not Getting Swine Flu, You Morons

There's entirely too much panic going on around here. I'm going to set things a smidge straight.

Cred: 1) I work with people with breathing problems for a living. 2) I run a high likelihood of being exposed to this pathogen at work and this is the upper-echelons-of-everywhere's recommendations for how I can avoid getting sick from being exposed at work. 3) All this information is verifiable, though I won't be citing in-line. Some of it is from notes I took from news releases passed around at work and thusly may not be in the public domain in print verbatim, however, is all based in verifiable fact.

My plan: to spread my strategy for staying safe, so that you can too.

Step one: Arm yourself with knowledge. The best knowledge we have right now comes from the Center for Disease Control's website, at CDC.Gov. That link is their most currently-updated list of recommendations for everyone involved. All of the knowledge I'm posting is subject to change if the CDC happens to have, say, a scientific breakthrough or something. If you want facts without panic or hype, this is your website.

Step two: could arguably be step one, according to most infection control experts. There is NO SUBSTITUTE in infection control practice for CLEANING YOUR HANDS to avoid spreading diseases or becoming ill. Alcohol-based hand-sanitizer with at least 70% alcohol is as effective as hand-washing, if not more-effective due to the lack of opportunities to re-contaminate your hands that hand-washing presents (towel, towel dispenser, doorknob, etc.) With alcohol hand sanitizer, as soon as your hands are dry, they are clean. If you are preparing food, be sure to rinse off any residues the sanitizer leaves behind with potable water.

Step three: Be polite about your cough. Influenza is a respiratory illness, which, by the WHO's definition, means a cough. Don't cough into your hands! Your hands touch everything around you. Influenza viruses can contaminate surfaces through contaminated hands, presenting a handy batch of germs to pick up and infect yourself with later. Cough into your shoulder/armpit/upper arm/elbow region, a region that will still keep you from spreading your droplets all over hither and yon, but which will not touch so many surfaces as your dirty mitts.

Step four: Are you sick? Do you have flu-like symptoms? What are flu-like symptoms, you ask? The criteria the World Health Organization is recommending our triage desks use to rapidly identify people who are considered to have "influenza-like illness" are the following: 1) a fever 2) a cough 3) and one of the following: aches/pains, lethargy, or shortness of breath. If you have shortness of breath, you are considered significantly ill and should be evaluated by a health professional.

If you are experiencing the symptoms above, the CDC is asking people to self-isolate by staying home, not going to work and not exposing yourself to other people, except for medical care. You will likely be contagious for a day before and up to seven days after you became sick. People are being asked to isolate themselves in this way for seven days, or 24 hours after their symptoms have disappeared, whichever is longer. Take your doctor's advice about your child, as they may potentially be contagious for longer.

If you must go out into the community while ill, it is recommended that you wear a mask or cover your face with a tissue to catch any droplets you may accidentally mist into your environment. Droplets are not airborne, they are heavier and so only tend to travel ~1m (~3 feet) in room air before settling to the ground due to gravity. As such, the CDC is not recommending the use of high-efficiency filters except during special medical procedures that are likely to generate the very fine particles which float in the air for long periods of time. This is when that alcohol-based hand-sanitizer comes in handy, so you can clean your hands after you cough while you are out and touching everybody else's environment with your germy paws.

There's specific protocols for who gets antiviral medication, because of the likelihood of developing resistance as well as of depleting stockpiles before there's a major outbreak with some critically ill people who may die without it. As a result, if you go to the doctor and your doctor won't give you any Tamiflu, please do not threaten anything particularly stupid, as this will only get you quarantined in your local police station's cells for the night.

Step five: If you are seriously ill, especially if you are short of breath, go see your doctor. Take precautions like wearing a surgical mask to avoid contaminating the doctor's office or the doctor, but get seen anyway. If you need medication it can be prescribed at this time, with some stern advice on the appropriate use of antimicrobial therapy. (I'll shorten it for you: TAKE EXACTLY AS DIRECTED. FINISH THE WHOLE COURSE OF ANTIVIRALS.)

If you have to take care of an ill person and are healthy yourself, follow the CDC's instructions. Avoid large crowds of people clustered in spaces less than a meter apart, and respect school and daycare closures. Avoid touching your eyes, mouth and nose, since how did you think your fingers got covered in germs in the first place? And if you're extra paranoid and want to build a flu bunker as a fun zombie-hunting exercise, they've even prepped you a handy list of starter items.

You'll notice there's not been a mention of Mexico yet. That's because swine flu is indistinguishable from the regular flu, and so means that aside from the Mexico component, you still have a viral respiratory illness that is particularly contagious and not easily treated with anything besides rest and fluids. If we get people all focused on looking for the Mexico link, they stop thinking about the cough-germy-hands-microwave keypad-lunch table-telephone-keyboard-clean hands-mouth-lungs link. Fever? Yes? Cough? Yes? Otherwise not feeling so hot in the aforementioned (achy runny nose sore throat nausea vomiting diarrhea lack of appetite really tired can't breathe) sort of ways? Act like you have something you wouldn't want to give to anybody you care about.

You health care dudes have it backwards: you have to treat those people like they've got something you DO NOT WANT. Those of you in the medical profession should contact your local OH&S office for specific instructions on the policy in your area. Be the most informed. Ask the pertinent questions. And be draconian about making everyone with a cough+fever+not feeling so hot wear a surgical mask or somesuch until they can have a rapid sputum test for influenza A and are determined to be negative.

If you medical peeps out there are involved in any of the following activities, the rules change slightly: suctioning, intubation, resuscitation, bronchoscopy, or patients who are unable to wear a mask (like trach patients.) These are all associated with the generation of aerosolized particles which are small enough (~4μm) to float suspended in the air and which are not effectively filtered by gross barrier filters like surgical masks and handkerchiefs. These particles require the use of a high efficiency NIOSH rated N95 mask which has been FIT TESTED and which fits to your face. Follow their guidelines on when to have your mask re-fit-tested (gain/lose 15 pounds, greater than two years, pregnancy, etc) and use them religiously if you feel it's warranted. They can't be re-used, that's their only downside -- you use it once, you take it off, you throw it out. In putting that mask back on, if that mask is contaminated, you WILL contaminate your nose and mouth with pathogens.

Not only do you have to wear your N95 mask, you have to wear eye protection, gloves, and a gown to cover your clothes. Paramedical types? Feel free to do a mask, scoop'n dash, rather than being the Big Hero who got the tube in on the scene (and all his coworkers sick.)

Questions? Type away. As for me, I've got to go suction a trach.
Tags: health
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