Swine Flu

Arthur Kennedy, the writer

The swine flu bug that is sweeping across the globe is causing a lot of panic and confusion--- amongst Doctors, Administrators and the lay public.

On July 31st, the World Health Organization announced that there were 162,380 cases with 1,154 deaths reported from 168 countries. In panic, a lot of authorities have released conflicting recommendations and announced measures that have no bearing on the spread of the disease.

Over the last few weeks, I have tried to clarify the flu epidemic and how to confront it. To do so, I have reviewed the information put out by the US Centers for Disease Control, as well as other bodies and had extensive conversations with physician colleagues on their approaches to the pandemic. Throughout all these, I have kept in mind the peculiar circumstances of Ghana.

While the pandemic is very serious, we must step back and calmly examine our options. We must remind ourselves that not every fever or cough at this time is due to swine flu. There are still other diseases that will continue to make us sick and “Taflatse” kill some of us. Amongst these are the common cold, malaria and many others, including seasonal flu.

We must debunk some of the myths, mis-information and impractical recommendations that have come out. One obvious one is the linking of the spread of the disease to eating pork. The truth is that eating pork has nothing to do with the spread of swine flu.

Our approach to the swine flu must be hinged on three pillars:

- Vaccination
- Treatment
- Public Health/ Commonsense precautions

The ideal way to fight this scourge of mankind would be to immunize everyone but that is not possible. It is estimated that nearly 3 billion people around the world will be unable to afford the vaccine. While the World Health Organization is doing its best to get as many doses of the vaccine to those who need and want it, it is obvious that there will not be enough doses to reach all the poor. The challenge will be heightened by the fact that in many countries, vaccination for the seasonal flu is happening around this time as well. For most people, ideally, this will mean getting one shot for the seasonal flu and two shots for swine flu.

Since the government and/or the WHO cannot afford to get the needed doses for everyone, the authorities must strategize and prioritize while educating the public on who needs to be in the front of the queue for vaccination. In July, the US Advisory Committee on Immunization Practices recommended that vaccination efforts should focus on 5 key populations in decreasing order of priority:

Pregnant women
People who live with or care for children under 6 months of age
Healthcare and Emergency Service Personnel
Individuals between the ages of 6 months and 24 years

Individuals 25 to 64 years of age with chronic conditions or weakened immune systems. Chronic conditions include Diabetes, Asthma and Cancer

An interesting wrinkle is whether or not to require certain categories of people to get the vaccine. For instance, New York State has just announced that it would require healthcare workers to either take the vaccine or wear masks throughout the flu season.

The next key issue is treatment.
How does one know he/she has the flu? It is characterized by fever, headache, tiredness, cough, sore throat, runny or stuffy nose, body aches and diarrhea/vomiting. Obviously not all those with these symptoms have the flu and not all those with the flu have all of these symptoms. Indeed, the CDC reported that only about 28% of those meeting clinical criteria tested positive for the disease.

Amongst Doctors, one o the key issues is when to test patients for the disease. It appears that in this area too, commonsense is the best guide. For instance, I would treat a mother whose six-year old has already tested positive for the virus and who herself has symptoms, without testing her.

Now here is the controversial part. The experts recommend that those who are sick but do not require hospitalization stay home. The recommendation is that such people stay home for one week after the start of symptoms or for 24 hours after they no longer have fever, whichever is longer. It is recommended that if they must seek care, they do so after calling ahead to the place of care. Actually, this recommendation, for our situation, is a blessing in disguise. I have nightmares imagining thousands of people flocking to our over-crowded hospitals to be tested for the disease. Such hospitals will be prime spreading points for the disease. For those diagnosed with the disease in the first 48 hours, antiviral medications like Tamiflu must be considered. Since there is developing resistance to this and other medicines, Physicians must exercise care in prescribing these medications. While on Tamiflu, the recommendation from certain quarters to give anybody who comes into contact with an infected person Tamiflu for prophylaxis is probably not practical ad will lead to a lot of unnecessary medicating.

In addition, those who develop complications like Pneumonia or Respiratory distress will need additional treatment or sometimes, hospitalization. It appears that in contrast to the seasonal flu, Swine flu affects younger people and those who are hospitalized are more likely to need Intensive care treatment. While at home, those sick are advised to wear masks or to cough into handkerchiefs at all times. It is recommended that family members minimize contact with the sick person and if possible designate a particular person as caregiver to minimize the spread of the disease.

It is recommended that organizations protect themselves by encouraging sick employees to stay at home and where possible, assisting them to work from home.

Perhaps, the most crucial part of keeping this disease under control is in the area of Public health or commonsense precautions.

First, as individuals, we must wash our hands frequently with soap and water and avoid coughing onto others or being coughed onto.

Next, if we suspect that we are sick, we must stay at home.

Third, we must minimize our presence at public gatherings. Examples of places to avoid are funerals, soccer games and hospitals because the sick tend to congregate there.

Hospitals must get public access numbers through which they can be reached by those with questions so that they can disseminate information and cut down on unnecessary visits.

Furthermore, they must look at triage procedures that will quickly separate those who may have the flu from other patients and minimize the chances of the disease being spread. This may be assisted by separate waiting rooms for suspected cases as is being done in many clinics and hospitals in the United States.

One institution that can play an invaluable role in this is the media. I urge media houses to dedicate more time to give opportunities to health professionals to educate the public on the swine flu and how we can protect ourselves. While I am sure that some media houses are already doing this, they can and should do more.

Of course, the government has a very crucial role to play in all of this.

First, it should develop and publicize a National Strategy to deal with this epidemic. This strategy must be updated periodically as more information becomes available.

Second, as part of this strategy, they must develop guidelines that will help institutions to deal with particular circumstances. For instance, if students in a certain hall of residence in one of our Universities begin to get ill from swine flu, what should the authorities do?

If a certain district starts reporting large numbers of sick people, what should the health authorities do?

Third, they should procure as much of the Vaccine as possible, and educate the public on who will get the vaccine first, where and how.

Government must find resources and organize a major educational campaign for our healthcare professionals so that they can treat those who become sick speedily and competently.

Fourth, the government must team up with the media to launch a major campaign to educate the public on how to minimize the chances of getting infected.

Fifth, the government's approach must be well-coordinated so that public officials with large microphones and little knowledge do not confuse the public with falsehoods and half-truths.

Together, let us minimize the impact of swine flu and move forward.

May God protect all of us and give our leaders wisdom to do what is needed.

Written by Arthur Kobina Kennedy, MD
Email: [email protected]