Extreme H1N1 Prevention

In the previous article we armed ourselves with the H1N1 facts.  Now let’s engage in a morbid but healthy psychological exercise.  Visualize yourself grieving at the funeral of a loved one; it could be one of your children or your spouse.  Ever since the person died from H1N1 you have been second guessing yourself.  What could you have done to have prevented it?  It relentlessly plays in your head over and over again.  Now hit your mind’s reverse button and let’s go back to the point a week before the person got infected.  You are now ready and motivated to be a little paranoid and consider an extreme plan of action to prevent that fateful infection.  Here are ways to prevent infection.

The First Thing Is to Avoid Infected People

Since H1N1 is spread person to person via droplets through speaking, coughing and sneezing; we will strive to prevent infection by practicing the following:

  1. Get over what people think about your strange new hygiene habits.  A pandemic is not the time to be concerned about the approval of others.
  2. Avoid anyone with the symptoms of fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue.  If this means that we become antisocial for a season then so be it.  We can always make new friends with the remaining pandemic survivors.
  3. Avoid close contact with those who may be infected by maintaining a minimum clearance of 3-6 feet.  This is the distance droplets can travel in the air through coughing and sneezing.  H1N1 is not considered an airborne virus in the traditional sense like anthrax spores which can remain suspended in the air for longer periods.  
  4. We must minimize our time in crowded settings.  This will be tough if you are a baseball fan like me.
  5. Avoid kissing, shaking hands and hugging.  Show affection verbally.  This could be a hard habit to break for you touchy-feely types.
  6. Never spend very long waiting in a hospital emergency room.  It could be a cesspool of those who are H1N1 hosts.  After registering at the front desk, advise the person to call you on your mobile phone when it is your turn to see the nurse.  Then go wait outside or in your car.  Maybe they can use the kind of pagers that restaurants use but only if they are disinfected after each use
  7. Carry a small bottle of alcohol-based hand cleaner, antiseptic wipes and latex gloves to use in public places.  Use the disinfectants after opening doors and touching escalator rails.
  8. Avoid if possible touching doorknobs and handrails and other surfaces that infected people contact after sneezing and coughing into their hands.
  9. Stock up on food and other supplies which is always good advice even without a pandemic.  My wife has prepared meals in advance and stored them in the freezer.
  10. Use a thermal image scanner to screen home visitors to detect people with a fever.  I’m just kidding although this would be a great idea if it wasn’t so expensive.  I would absolutely do this if I was the other billionaire Larry Ellison.  I would be the Fever Nazi (Seinfeld humor like the Soup Nazi).  For those who are unemployed consider getting trained as a Level-1 Certified Thermographer to work at airports and other mass transit points.

Next Disinfect and Clean Everything

Since the influenza virus can survive on environmental surfaces and can infect a person for 2 to 8 hours after being deposited; we will strive to prevent infection by practicing the following:

  1. Obtain an EPA approved antimicrobial disinfectant for Influenza A on hard surfaces.  The product should advertise 99.99% effectiveness.  Note that cleaning a surface removes viruses but disinfecting kills them.
  2. Clean and disinfect tabletops, counters, faucets, sinks, bathtubs, toilets, doorknobs, appliance handles, refrigerator shelves, light switches, toothbrush holders, hand soap dispensers, trash cans, scissors, toys, etc.
  3. Use the sanitize cycle on your dishwasher to clean dishes, pots and pans, eating utensils and kitchen sponges.  Replace sponges more frequently.
  4. If you don’t have a sanitize cycle on your dishwasher, soak sponges in a mild chlorine bleach solution daily.  Follow the directions on the container.
  5. A good way to disinfect sinks and bathtubs is to fill them with cold water and pour in small amount chlorine bleach.  It doesn’t take much.  Follow the directions on the label.  Be careful not to fill to overflowing unless you want bleach spots on your clothes and towels.
  6. Wash clothes, sheets, pillow cases, towels more frequently.  Avoid hugging the laundry before washing it to prevent contaminating yourself.  Consider washing laundry every day.

Practice Good Personnel Hygiene

Since routes of H1N1 infection are the mouth, nose and eyes; we will strive to prevent infection by practicing the following:

  1. I’m not convinced about the need to wear a face mask or respirator in public.  These should certainly be worn by the person who is sick when a person is caring for them.  I don’t think you need to wear them in public as long as you don’t let someone cough or sneeze directly into your face.  Maintain a 3-6 foot safety zone.
  2. Purchase a good supply of latex or nitrile gloves, masks or respirators early while they are still available.  I buy the 100 count box of gloves at Costco which is my favorite store.
  3. Don’t drink out of the same glass, can or bottle as others.  Become selfish like an only child and don’t share.
  4. Don’t chug out of the milk jug or other drink containers in the refrigerator.  Also don’t let others do it.  I was a big offender of this in my teenage years.
  5. Don’t drink directly out of a faucet with your mouth.  Preferably use a disposable paper cup.
  6. Wash your hands for 20 seconds under running water.  This is hard for me to do since I am very impatient.  My average is about 5 seconds and it always seems like I’m wasting water if I go longer.  Being impatient was a good trait as a firefighter but not in this case for preventing flu.
  7. Wash your hands after using a kitchen or bathroom sponge.
  8. Use the bathroom sink for washing hands and brushing your teeth and not the kitchen sink.  Let’s try to separate personnel hygiene from food preparation.
  9. Use paper towels instead of linen ones for drying hands.  This will cost us more but it will be well worth it during a looming pandemic.  Visualize the funeral again and you will get over the cost factor.
  10. Use approved alcohol based hand cleaners as an alternative to soap and water.  Rub your hands together until the alcohol gel evaporates.  One particular skin sanitizer was recently recalled because it contained harmful bacteria.  How is that even possible with a product that is advertised as microbial?
  11. Use sterile technique for removing gloves, face masks and respirators.  This is where you remove the mask first and then each glove by turning inside out without touching any outer part with a bare hand or finger.  It just takes a little practice.
  12. Don’t reuse gloves, face masks and respirators.  You penny pinchers will have a hard time with this one.
  13. After removing gloves, face masks and respirators, clean your hands.  You may initially have trouble with the perfect sterile technique above and will need to disinfect your hands.
  14. Don’t prepare food in the kitchen sink unless it is in a colander or other container.  Talk about an easy avenue for the virus.
  15. Disinfect trash cans once a week.  Take out the trash while wearing gloves.  Use plastic bags for trash can liners.  I always put 3-4 extra bags in the bottom of the can before I line it with a new one which is a trick I learned from a janitor.  It saves time the next change out.
  16. Don’t wipe children’s faces with a sponge or dishrag.  I struggled to get my wife to abandon this disgusting habit when our kids were very young.  Can you imagine what germs are in an old dirty sponge?  Yuk!
  17. Dispose of used antiseptic wipes, gloves, face masks and respirators in the garbage.
  18. Devise a system so that someone else’s toothbrush is not mistakenly used.  I once accidentally grabbed my wife’s toothbrush while grouping around in the dark because I didn’t want to turn on the light and wake her up.  Let’s see … was my toothbrush at 90 degrees or 270 in the holder?  I didn’t mind but she sure did and promptly threw hers out and opened a new one.
  19. Keep family toothbrushes separated and replace them more frequently.  Wash the toothbrush holder occasionally in the dishwasher.  Have you ever looked at the culture growing in the bottom of one of these?  It would make a good science fair project for your kid.
  20. Don’t trust eating out since sanitation during food preparation may be lax.  I recall a project in which a high school student did a study on the ice dispensed in soda machines.  Many had germs in them from not being cleaned regularly.  This is just one example of things not to trust during a pandemic.
  21. Get every family member their own tube of toothpaste and toothbrush holder.  I just noticed that I touch my toothbrush to the tube when squeezing out toothpaste.
  22. Study your family’s own unique hygiene habits to add this to this list.  I have a habit of inhaling warm water from the shower into my nose to clear out my sinuses and then exhaling forcefully covering the walls with buggers.  It only seems disgusting because you didn’t think of it first.  I’m interested in expanding my list but let’s not turn this into a gross habit contest.

Care for the Sick and Others

Since few people have immunity to H1N1 because it is a new strain and humans by nature are gregarious; we will strive to prevent and treat infection by practicing the following:

  1. Get the H1N1 immunization shot as early as possible.  Full immunity is not reached until two weeks after the vaccination.  This could be a big problem since the vaccine won’t be ready until mid-October and a pandemic could be in full swing by September.  All the more critical to practice these preventive steps.
  2. Try to isolate family members who become infected.  This is a very difficult one to implement but essential to prevent the virus from spreading to others.
  3. Segregate items like toothbrushes that are used by those who are infected.  If possible have them use their own bathroom.
  4. Wear protective gloves when caring for the sick.  If they can tolerate it have them wear a mask while the caregiver is near them.
  5. For the sick use disposable cups, bowls, plates and eating utensils.  This is not a bad idea for the healthy also.
  6. Maintain a strong immune system by eating right, exercising and getting plenty of rest.
  7. Increase airflow in living spaces.
  8. If you become sick stay at home for at least 24-hours after your fever is gone.  This one might prove difficult for workaholics.  Make sure those who are sick get sent home from work.
  9. Infants should not be cared for by sick family members.  Therefore mothers should be especially protected from infection since their family nurturing role is so essential.  This is harder to do as a single parent.
  10. Use a non-contact infrared thermometer to check for fever.  This avoids having to disinfect the classic model.  This is another item to purchase in advance.

If we try to make this into a game with our kids and family then we have a better chance of succeeding.  Explain the importance of what you are trying to accomplish to get everyone on board.  I remember how often my kids reminded me to put on my seat belt while driving.  I and my wife trained them well.  Just like wearing a seat belt this routine can save a life during a pandemic.

Facts about H1N1

Microscopic Flu Virus

Microscopic Flu Virus

Why all the pandemonium about swine flu?  A pandemic was declared in 2009 and by July only 302 people had died in the US from novel H1N1 flu.  In a normal year 250,000 to 500,000 die globally and 36,000 perish in the United States.  This year’s H1N1 numbers are not earth shaking in comparison.

Mutations are the Problem

The reason that health organizations are afraid that a pandemic is lurking below the surface involves virus mutations.  In 1918 the Spanish flu pandemic killed 50-100 million people on the planet.  Like the current swine flu virus it to was the H1N1 type of influenza.  Scientists this year have reported that certain strains of H1N1 have evolved to be resistant to antiviral drugs like Tamiflu.  H1N1 is a very dangerous microorganism that is very adaptive at surviving and evolving.

Impractical Solution

There is a universal solution though.  The first step would be for everyone in the world to stay home and isolate themselves. The exception would be those who are hospitalized with the flu. Second they would need to follow the extreme hygiene steps in my next article to prevent infection and to treat those who are infected. If these steps were taken then H1N1 would die out in humans in one week.  Problem solved, case closed.  But not so fast!  This strain of H1N1 was passed from swine to humans so it would still be secretly incubating in them.  So completely eradicating this virus is not a realistic possibility.

Research and Plan

The first thing we will do as students of science is to carefully research the facts about novel H1N1 influenza.  Secondly we will plan a course of action to survive a possible pandemic.  If the CDC and WHO predictions are wrong about this threat then we have wasted a little time and money.  But if they are right then a lot of people could get sick and die.

Chicken Little and Howard Hughes

Health organizations in this case are not Chicken Little crowing irresponsibly about our health falling.  It is a risk that we need to take seriously.  However we don’t need to be paralyzed by the fear of infection like the billionaire Howard Hughes was in real life.  His bizarre obsession with avoiding all contact with germs was well documented in the movie about his life (The Aviator, 2004).

NCI Pretend

Let’ get ready to look at the facts about H1N1.  We will pretend for a moment that we are a forensic microbiologist working at NCI.   We want to review everything that is known about this virus. Then we will be able to methodically analyze a flu patient crime scene.  We will mark the H1N1 virus with a special dye. Then we will use a portable black light to methodically track how it spreads from person to person via droplets.  (If you are reading this and are really a forensic whatever, then please feel free to correct any junk science in this article.  I don’t want to be like Gary Larson and create cartoons with polar bears and penguins floating together on the same iceberg).

H1N1 Facts

  1. The 2009 flu pandemic is swine-origin Influenza A virus subtype H1N1 to be precise.
  2. Influenza A virus strains are assigned an H number and a N number based on which forms of the two proteins the strain contains.
  3. All influenza A viruses contain hemagglutinin (H) and neuraminidase (N) proteins on the surface of its coat.
  4. There are 16 H and 9 N subtypes known in birds, but only H 1, 2 and 3, and N 1 and 2 are commonly found in humans.
  5. The H1N1 virus form appears hideous under the microscope.  (It could easily be a miniature bad guy in a future “Monsters, Inc.” movie.)

H1N1 Infection

  1. H1N1 is spread person to person via droplets through speaking, coughing and sneezing.  It not considered a classic airborne disease like anthrax that can remain suspended for long periods.
  2. Routes of H1N1 infection are the mouth, nose and eyes.
  3. People may become infected by touching anything with flu viruses on it and then touching their mouth, nose or eyes.
  4. Studies have shown that influenza virus can survive on environmental surfaces and can infect a person for 2 to 8 hours after being deposited.
  5. Common flu symptoms include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue.

H1N1 Immunity

  1. Few people have immunity to H1N1 since it is a new strain.
  2. H1N1 immunity is obtained through two vaccinations administered three weeks apart. (Update: after initial human trials it has been determined that only one shot is required in the US)
  3. Full immunity doesn’t occur until two weeks after the vaccination.
  4. High-risk individuals for H1N1 are children, young adults and those with certain medical conditions.
  5. The vaccine campaign scheduled for mid-October could miss the peak of the epidemic.
  6. Most of the deaths from the virus are from pneumonia and lung failure.
  7. Tamiflu (Oseltamivir) is the only effective oral anti-microbial drug used to treat H1N1 infection. The patent to Gilead Sciences is licensed to Roche.
  8. The normal incubation period for influenza is 2-4 days.

H1N1 Evolution

  1. H1N1 can mutate through viral evolution in a short time frame.
  2. Some strains of H1N1 have evolved producing the H274Y NA enzyme mutation which is Tamiflu resistant.
  3. Because of virus mutations new booster shots are required annually for influenza.

H1N1 Predictions

  1. The World Health Organization (WHO) declared an H1N1 pandemic on June 11, 2009 and moved the alert level to phase 6 which is the highest possible.
  2. The last phase 6 alert was in 1968 for the Hong Kong Flu.
  3. WHO predicts 2 billion people could be infected with N1H1 in the next two years.
  4. The President’s Council of Advisors on Science and Technology (PCAST) predicts 1.8M could be hospitalized in the US during an H1N1 epidemic.  (This means that someone you know will most likely contract the virus.)
  5. PCAST predicts that H1N1 could cause 30,000 – 90,000 deaths in the US.

We are now equipped with the primary facts about H1N1.  Next in the series we will examine detail steps to preventing infection.  Today about 7,000 people will die in the US.  Remember that survival is an option, so choose to survive with me.

What is Survival?

Survival Definition

Merriam-Webster OnLine defines survival as “the act or fact of living or continuing longer than another person or thing; the continuation of life or existence”. So then death is the opposite of survival.  If we don’t die from a life threatening situation then we survived it.

In this first article I want to try to explain the scope of survival since it involves many things.  It certainly covers issues of disaster and wilderness preparedness.  I believe it also extends beyond the traditional concept and includes other disciplines as well.

Business Survival

Recovery Managers deal with business survival every day.  As a former member of BRMA (Business Recovery Manager’s Association) in the San Francisco bay area, I was privileged to rub shoulders with the best minds in the recovery business.  These corporate managers are responsible to ensure that their organizations survive major calamities of all types. They regularly conduct tabletop exercises and mass casualty drills to prepare their companies to work with emergency response agencies. It was fascinating sitting in on the Hurricane Katrina debriefings from four large companies.  The lessons learned were invaluable.

Centenarians

Seniors that have survived to a hundred years old are the ultimate survivalists. The majority of them arrived at the century mark because their bodies produce an abundance of the good HDL cholesterol. They can eat whatever they want and not worry about it.  My mother-in-law has been concerned about her high cholesterol for the past thirty years. She is now 93 and has outlived all her friends.  I told her to quit worrying about high cholesterol since she is obviously immune to it. It’s hard to change old habits.

Health Survival

Survival also deals with issues of personal health. In the past year I survived the discovery that one of my arteries was 80% blocked.  I felt the helplessness of not being able to walk a short distance without my heart feeling like it was going to explode.

Thanks to medical marvels I was back to normal in a week after diagnosis.  After an inconclusive stress test, my cardiologist performed an angiogram through an incision in the femoral artery in my groin. He then injected a special dye and quickly discovered a blocked artery. While he was inside my heart he installed a stint to keep the artery open. This procedure took about an hour and a half and I was home the next day.  Luckily I didn’t experience a heart attack.

The key for me was being in tune with my body through regular vigorous exercise. I knew something was wrong when I had to sit down on the curb after walking two miles. I felt nauseated and had to rest for thirty minutes before going home. Then later I had sushi for lunch and the salt in the soy sauce sent my blood pressure up over 200 systolic. What a terrible feeling. I’m determined to never let that happen again if I could help it.

Survival Psychology

Survival also delves into human psychology as we try to understand how the mind adapts to horrific situations in order to cope. I’m disgusted as I read about the recent discovery of the 11-year old girl in California that was kidnapped and held for 18 years in a couple’s backyard. How did she and her family members manage to survive this ordeal?  Is there any hope now for a normal life?  They will certainly need professional help for a long time.

Risk Taking

Survival for many means not taking any risks and just staying at home to become a couch potato.  As an extreme risk taker I can’t embrace their lifestyle.  They would say I’m lucky to be alive by living on the edge. I’m sure they would be partially correct.

Survival Thinking

Survival requires being able to think clearly in life threatening situations. It doesn’t do us any good to know what to do in an emergency if you don’t apply it in time.  It’s hard not to panic and freeze up when facing death.  Hopefully we can practice in less threatening situations to gain experience.  I have a habit of daydreaming about what I would do in emergency situations. This helps me act with muscle memory if something similar comes up.

Why Do People Survive?

Survival sometimes involves examining the reasons for survival.  Understanding how a person survived a life threatening event is important to future survival training. Did the person apply a survival skill; was it fate or divine intervention or was it just dumb luck?

Survival Priorities

Survival is looking at the threats we face and prioritizing them based on the likelihood of encountering each one. If a person lives in Hawaii then they probably don’t need to be concerned about whiteout conditions from a blizzard. On the other hand everyone should be concerned about a swine flu pandemic and should prepare now to prevent exposure. My next series of articles will present the facts about novel H1N1 influenza with suggested extreme prevention methods.

Quality of Life

Survival also touches on quality of life issues. At what point is it no longer practical to survive? I don’t think any of us wants to survive in a vegetative state with no chance of recovery. I have given my wife Lorrie permission to assist in my departure if I become terminally ill. I instructed her to put me in my kayak and launch me down a class-VI rapid without a life jacket and helmet. The rapid should then be renamed Lorrie’s Revenge.

Summary

As we have seen survival touches on many areas. I hope you will join me as I dive into the specifics of daily survival. Today about 7,000 people will die in the US. Remember that survival is an option, so choose to survive with me.