What is the flu?  There are a lot of misconceptions about what is and is not influenza.  The number one criteria is that it is a respiratory illness.  There may be other symptoms associated with it such as nausea, vomiting, or diarrhea, but if there are no respiratory symptoms, it's not the flu.  There's no such creature as "stomach flu".  Influenza is always caused by a virus.  The nasty thing about viruses is that they live and reproduce inside our body cells, then break out of the cell to go infect the next door neighbor.  It is difficult to develop effective medications for viruses because if you kill the cells, you may also kill the individual.  There are many varieties of influenza virus and a peculiar characteristic of viruses is that they are able to "change their stripes" quickly.  When you get your flu shot in the fall it is made up of killed viruses.  The viruses that are used in the vaccine are ones that have been tracked by public health officials and determined to be responsible for outbreaks of influenza around the world.  But, those particular strains most likely will be different by the next year because of the ability of the virus to mutate rapidly and go on to create mischief elsewhere.  That's why you have to get a new immunization every year so that, by and large, you'll be protected when those viruses start making the rounds in your neighborhood.  If your neighborhood happens to be a facility such as an apartment building for seniors, assisted living or nursing home complex, you will face more challenges than someone who lives in the community in a private home.  Or, if you are a regular visitor to a congregate housing facility such as those I just mentioned, you will need to be especially careful that you are neither a donor nor a recipient of flu and other viruses that are always around.  Once viruses get a toehold in a congregate living environment they can spread like wildfire because of close contact with others and because of the many common surfaces on which viruses can live.  Even if you don't see outbreaks of influenza in congregate settings, it's not because the viruses aren't around; it's because most people have been immunized and do not become ill even though they come in contact with specific viruses.  

Now to the newest threat on the world scene, "swine flu", or officially an A/H1N1 virus.  The designation has to do with the type of influenza - Type A - and the appearance and structure of the virus itself.  The specific virus responsible for this illness is normally found only in swine and typically would not pass from pig to person.  And, if it did pass from pig to person it would not pass from person to person.  This virus is passing from person to person without direct contact with pigs.  You may recall that there was a swine flu scare back when Gerald Ford was President.  A vaccine was developed very quickly and there was a massive immunization campaign.  However, it became apparent fairly soon after the campaign got underway that the vaccine was causing some cases of a condition called Gullian-Barre Syndrome leaving some individuals completely paralyzed.  The immunization campaign was stopped and, as it turned out, the swine flu virus of that era didn't develop into the massive public health threat that officials had feared.  There were some epidemics but no pandemic.  Epidemics are present when there are a larger than expected number of cases in a geographic area.  Pandemic means the spread is worldwide.  A Pandemic is what Public Health officials are fearful of with the new "Swine Flu" because they know that the world is overdue for one.  Pandemics will tend to be caused by highly lethal strains of viruses to which people have not developed immunity and for which there is no vaccine.

By now, I'm sure you've heard enough on TV, radio and the print media to know that respiratory viruses are spread by respiratory secretions from persons who are in close contact: sneezes, coughs and nasal mucous.  The exact means of transmission other than person to person is still being debated in the scientific community but it is apparent the virus can live on some surfaces outside the body for an unspecified period of time (probably no more than 48 hours).  But stop and think of all the common surfaces in congregate living settings; doorknobs, telephones, computer keyboards, wheelchairs, countertops, medication carts, toilet handles, sink faucets, etc.  Even in the world outside of facilities, the grocery cart handle has been found to be one of the most highly contaminated surfaces around.   So there is ample opportunity to pick up the swine flu or any other virus where people congregate. 

What can you do as an individual to protect yourself?  And, what can we do as a society to protect vulnerable populations?  Older adults, particularly those with multiple, chronic illnesses are going to be more vulnerable than healthy younger adults. This is true because, in general, the immune system of older adults is compromised somewhat by the aging process and in particular by the onset of chronic illnesses that further impair one's ability to fight off acute illness.   Here are some tips for individuals.  Fortunately, because of recent Public Health campaigns, people are learning to cough and sneeze into their elbow instead of their hands.  That's a good start, because even if the virus is present on your skin or clothing in the region of your elbow, you are a lot less likely to spread it to others than if it were on your hands.  Next, frequent hand washing or sanitizing with a gel or wipe is equally important.  Our hands come in contact with thousands of objects daily and some of them are bound to carry the possibility of contagion.  So, having the habit of thorough hand washing after toileting, before eating or after personal contact in gatherings is important.  When I say thorough I mean you wash with soap and water for about 15 seconds (sing happy birthday to you, happy birthday to you, and happy birthday dear -----, happy birthday to you).  That's about 15 seconds.  Pay particular attention to finger webs and fingernails.  Substitute a disinfecting gel or wipe if you don't have access to soap and water.  Lastly, try with all your might to keep you hands away from your face where the germs on your hands can gain a portal of entry into your respiratory system.  This is a very tall order because touching our faces, cleaning out our noses and rubbing our eyes is just inherent in being a human.  You may not be able to stop the habit altogether, but heighten your awareness of it and if you find yourself doing it, redirect yourself away from it.  If you have respiratory secretions yourself, use disposable tissues, discard them in proper containers meant for that purpose and then wash your hands.  When using public facilities such as toilets, try to touch as few common surfaces as possible directly with your hands.  Grab some paper towels before you go into the stall and use them to work the handle or button to flush, use them to turn the faucets on and off and to work the soap dispenser.  Hang on to them long enough to open the door and then discard them in a safe place.  If you know you've been exposed to someone who has coughed or sneezed on you, wash or sanitize your hands and face as soon as possible. 

How can we protect the vulnerable populations in Assisted Living and Long Term Care Facilities who may not be able to follow some of the guidelines I've just talked about?  They may either be physically or cognitively unable to carry out hygiene measures on their own and must rely on institutional policies and procedures that are designed to protect them from infection.  All facilities have infection control or outbreak control measures they are obliged to follow.  How well they are able to comply with established policies and procedures will at least partially determine whether they are able to control disease outbreaks.  All facility staff are supposed to utilize what are known as "Universal Precautions".  Those are a set of guidelines regarding the handling of bodily fluids and wastes and they're based on the assumption that infectious disease is widely present in the environment.  Hand washing, use of gloves, masks, gowns and other protective gear is specific to particular kinds of situations.  In addition, as part of the quality control measures in facilities, they track trends in infectious symptoms such as fever, nausea, vomiting, cough, etc.   Infection control is part of the everyday life of institutions.  Having said all that, the reality on the ground is that there is always a shortage of staff and staff that are present don't always comply 100% with protocols.  Likewise, any facility can be caught off guard by the unexpected epidemic sweeping through the community and may become overwhelmed with heavier than normal caseloads of ill patients and high absenteeism among staff who are also ill.

If you are a regular visitor to a facility or routinely care for a loved one there, follow these suggestions to help cut down on the possibility of a flu epidemic:

·        Visit with the Director of Nurses or Administrator to find out what their advice is on outside visitors.

·        Inquire as to their protocols for controlling infection within the facility.

·        If you have a fever or other signs of illness, stay home.

·        If you have children at home that you know have been exposed, stay home.

·        Let the care staff know that you support their efforts at infection control and assist with hand washing, not touching or breathing on food served in the facility and other basic hygiene measures.

·        Wear the requested masks and gloves if someone is ill whether patient or visitor.

·        Know the warning signs of influenza - fever, respiratory symptoms such as sneezing, coughing or difficult breathing and possible diarrhea.

·        Avoid contact with someone who has a known case of H1N1 virus, who has been in close contact with a known case of the virus within a 7 day period or who has traveled to an area with known cases of the disease within the past 7 days.

·        Bear in mind that elders may not run a fever even though they may be infected because they are not able to mount an effective immune response.

If you are exposed to the flu or have a confirmed case, there are two medications available; Tamiflu and Relenza.  The family of drugs is known as neuraminidase inhibitors and they prevent replication of the virus.  The emergency use of Tamiflu and Relenza has been approved by the Food and Drug Administration for distribution by non physician providers such as health departments and may be available in your area without a prescription.  These medications need to be started within 48 hours (preferably 36 hours) from the onset of symptoms for maximum effectiveness.  While not tested specifically on this H1N1 virus, they are believed to be helpful.  They do not "cure" the disease like an anti-biotic might cure a bacterial infection, but they do help stop the production of the virus so that the body has a chance to cure itself.  

Currently, the virus is spreading worldwide but has not reached the number and severity of cases to be considered a true pandemic.  There have been some deaths but they have mostly been in people with some immune system problems.  Cases are typically fairly mild and most recover fully.  That doesn’t mean that we don’t need to be concerned however.  Remember that I mentioned that viruses can change and evolve into something slightly different.  That can still happen with this virus and by the time the fall flu season rolls around we might still be looking at a serious health threat.  So, it’s always the right season to follow precautions with respiratory secretions, with hand washing and with the way we relate to our environment.  The flu bug isn’t the only one out there but forming good preventive health habits can help keep us well.