Depth and Breadth of the New Pandemic H1N1 Swine Flu

Pandemics are rare but they do occur. In the last 100 years we have had three. They circle the globe in two or three waves at different times and with varying degree of severity.

By Jimmy Crouch, ENP, EMT – Medic One Technical Advisor
Reviewed by:
• Dr. Ugi Sugiri, Sp. EM – Senior Medical Officer
• Dr. Laurentius Dermawan, Sp. An, KAKV – Senior Medical Control


17 June, 2009
Medic One

The World Health Organization (WHO) has officially declared a pandemic. A pandemic means that a rare new H1N1 Swine Flu is rapidly spreading the globe and if we don’t have it yet in Indonesia, we soon will.

In this update I will answer seven questions about Swine Flu.
1. What is the depth and breadth?
2. What are the symptoms?
3. Should I see my doctor, if I have the symptoms?
4. How is it treated?
5. Is there a vaccine?
6. How do I prevent infection?
7. What can I do?

1. What is the depth and breadth?

In other words how sever and how widespread will the pandemic be once it’s thriving in Southeast Asia? To answer that question we need to put the pandemic in perspective by comparing it with annual flues and past pandemics.

Annual Flues Vs Pandemics
Annual flues infect between 5 to 15% of the world population and kill between 250,000 to 500,000 people per year.

On the other hand pandemics infect and kill more people because of three reasons. First, they are rare new virus strains so we don’t have vaccines for them. Second, they are new strains so people have not built up immunity to them. And third, when they hit countries with limited resources they take a more severe toll.

Pandemic History
The last pandemic occurred 41 years ago, the Hong Kong Flu H3N2, and killed a million people. Before that we had the 1957 Asian Flu H2N2 that killed a couple million people and it was the 1918 Spanish Flu H1N1 that killed 50 to 100 million people.

On a Pandemic Severity Scale of 1 to 5, with 1 being the mildest and 5 being the most severe, the Hong Kong and Asian pandemics were Category 2’s and the Spanish Flu a Category 5.

The Future of the New Pandemic
It is difficult to predict what category this new pandemic will be but scientists currently predict this first wave as a Category 2 where if waves continue at this severity one or two million people will be killed. Severity can change, though, such as with the last H1N1 pandemic where the 1st wave was a Category 1 and the 2nd wave a Category 5 with up to 100 million people killed.

What nobody knows is what the 2nd wave will be like with this new pandemic.

2. What are the symptoms?
Swine flu symptoms are similar to the normal flu where you may have a fever, cough, sneezing, a sore throat, headache, body aches, fatigue and chills. Some people may also have diarrhea and vomiting.

3. Should I see my doctor, if I have the symptoms?
You should see a doctor when symptoms occur but most people develop mild symptoms and will recover quickly without treatment. In the USA 2.5% to 5% of infected people need hospitalization.

If your doctor is suspicious that you have the flu, your doctor might recommend you to a designated general hospital to get an antiviral drug to take. For now, get a medical checkup. The point is that if you want to increase your immunity you need to be in tip top shape.

4. How is swine flu treated?
If your doctor is suspicious that you have the flu you may be given an antiviral drug such as Tamiflu. The key thing is you need to take this drug within 36 to 48 hours of the start of a severe flu infection for the drug to be effective.

With those who die from the infection 50% are high risk patients. High risk patients are people older then 65 or younger then 5 years of age, pregnant woman, have asthma or diabetes, are obese, have a heart disease or a weakened immune system. And 50% of those who die are young and healthy.

5. Is there a swine flu vaccine for people?
No, there isn’t. This is a new flu and it will take months to develop a vaccine.

6. How do I prevent swine flu infection?
The best way to prevent getting the infection is to wash your hands with soap and water frequently. With swine flu, someone near you may have the infection and not even know it because an infected person might not show any symptoms at first.

If they have unclean hands, everything they touch will become contaminated and if you touch that item and then touch your eyes, nose or mouth you then could become infected also. And when you do wash your hands it should be for 20 seconds. That is like singing “Happy Birthday to you” two times.

If you are coughing or sneezing you also should be washing your hands frequently and consider staying at home.

7. What should I do now?
• Stay informed
Things are changing rapidly and the new pandemic could start circulating in Indonesia before we even know it. In Japan, authorities where at first confident that they keep the new flu at bay, but then, in just a period of two days, the flu started to circulate domestically with nearly a hundred new cases.

You should stay informed by checking updates from the World Health Organization's web site and from Medic One by requesting to be added to our News Blasts by phoning +62 21 725 9111.

• Stay home
If you have flu symptoms you should stay home.

• Buy a pandemic flu kit
Are you ready? If the swine flu is circulating in your area you should be protected by wearing a N95 mask when you are in a crowd of people.

• Conduct health screenings
If the swine flu is circulating in your area, your schools, churches and businesses should be conducting temperature scans twice a day and should even consider closing down the facility.

• Seek medical treatment in an emergency
If you think you have an emergency where your child or loved one has a high fever and is not responding to you well, you should seek an emergency assessment through your local Emergency Medical Service system or hospital.

In the USA, I have been on so many ambulance calls where parents were not sure if their child needed to be hospitalized or not. In those cases, we go to their home to do an emergency assessment.

We [emergency health care providers] are more then happy to provide this kind of assessment in order to be safe – rather then sorry. This is because children’s bodies are different then an adult. When an adult is in trouble with an illness or injury we usually observe a gradual decline in their condition. Whereas with children we often do not, their body compensates well for the illness or injury at first and then they rapidly crash.

Here in Indonesia, for peace of mind Medic One provides such emergency assessments for their members.

Under a consultancy arrangement with AREMT, Jimmy Crouch is assigned to work with Medic One in support of ongoing professional training development. He is an Emergency Telecommunications Instructor for the State of Connecticut and a Pediatric First Aid Instructor for the American Academy of Pediatrics.

His career started in the US Army as a telecommunications sergeant, instructor and first responder for acute emergency mental health crisis. Later he became a 9-1-1 center manager, Advanced Emergency Medical Technician (AEMT) team leader, and an Emergency Telecommunicator Instructor. He served in the emergency phase of the 2004 Indian Ocean tsunami disaster.

References:
1. World Health Organization (WHO). http://www.who.int/csr/disease/swineflu/en/
2. Center for Disease Control (CDC) and Prevention. http://www.cdc.gov/h1n1flu/
3. ASEAN Secretary-General says region must not resort to panic measures. Channel News Asia. June 16, 2009. http://www.channelnewsasia.com/stories/southeastasia/view/435609/1/...
4. First Swine Flu death reported in UK. USA Today. June 15, 2009 http://www.usatoday.com/news/world/2009-06-14-swine-flu_N.htm?csp=34
5. 2009 swine flu outbreak. Wikipedia. June 5, 2009. http://en.wikipedia.org/wiki/2009_H1N1_flu_outbreak
6. Statement by Health Minister Khaw Boon Wan at Press Conference On Influenza A (H1N1). May 12, 2009. Singapore Ministry of Health. http://www.news.gov.sg/public/sgpc/en/media_releases/agencies/mica/...
7. DeNoon, Daniel. Swine Flu: Learning from past Pandemics. WebMD Health News. May 8, 2009. http://www.webmd.com/cold-and-flu/news/20090508/swine-flu-learning-...
8. The world response to flu crisis. May 5, 2009. News BBC http://news.bbc.co.uk/2/hi/americas/8022516.stm
9. Climate 'shielding Indonesia from swine flu'. April 29, 2009. ABC.net http://www.abc.net.au/news/stories/2009/04/29/2555500.htm

Stay safe – Stay well

Jimmy
James Crouch, AREMT-Medic One
Technical Advisor/ American Academy of Pediatrics First Aid Instructor
james@medic-one.org

Medic One
Health Information and Training Center
Wisma Medic-One
Jl.Prapanca Raya 6A
Jakarta 12160
t. (62-21) 725 9111 ext. 122
f. (62-21) 739 9303

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