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You’ve got the flu or want to avoid getting it:

Here’s what you do – HIV Positive people, especially, need to take extra precautions

When U.S. Vice President Joe Biden said that people should avoid subways and other confined spaces because of the swine flu sweeping the nation, the country recorded its first swine flu death – a toddler in Houston, TX – which led to the decision by state and federal health officials to ratchet up their alert level, and which prompted the Word Health Organization (WHO) to up their grade to Phase 5, a status just below declaring a full pandemic, has come as a jolt to everyone. This drastic and seemingly draconian action by national and internationally health related agencies should come as no surprise, since many of them were severely criticized for their lack of preparedness and response to two major flu outbreaks in recent memory, Sars and the Avian Flu, both which emphasized the global nature of the spread of any infection and threatened to overwhelm countries’ health infrastructure, revealing how unprepared many were.

But while there are numerous suggestions on what to do, to protect against contracting or passing the virus on, many of those tips in the local media have not included enough detail for adequate protection.

A person could be infected and spread the flu up to a full day before he or she feels symptoms and up to seven days after they are sick.

Many HIV positive people, especially, need to take extra precautions, as someone once said, the general perception is that most people are afraid of contracting HIV from an HIV-positive person, but really, it is the HIV positive person, who with a compromised immune system, is most vulnerable and at risk from the general population. Consequently, a HIV-positive person needs to observe the rules for the general population and take additional precautions, such as staying away from crowded or heavily populated areas, like night clubs, sex clubs, parties, public transport conveyances, and should contact their doctor to enquire as to the best medication. Those with the HIV virus should be aware of the signs of an illness coming on, the beginning scratchiness or dryness in the throat, the feeling of lethargy or extreme tiredness, or headaches. HIV positive people should make it their duty to pay attention to their bodies, as with a compromised immune system, assumption should not be entertained and nothing taken for granted.

According to William Shay, M.D., a Chelsea-based general internist who specializes in HIV treatment, an HIV-positive person who has a fever of 101-degrees or higher and has a cough with any other symptoms, should see their doctor.

So, while waiting for a vaccine, which the U.S. Centers for Disease Control and Prevention (CDC) optimistically suggest could take six months to be produced and some reports state that even if there is a vaccine there won’t be enough for everyone, and it would be ineffective, because this flu strain is likely to have mutated or people would develop a resistance to it.  These five critical tips, widely agreed upon by the WHO, the CDC, and other health experts, are what a person could do to avoid getting sick and, importantly, avoid infecting others.

  • Washing hands:
    The best thing anyone could do right now to avoid swine flu, experts say, is to wash their hands. It sounds like a stupidly simple response to an overwhelming situation, but almost compulsive hand-washing helps prevent the spread of this respiratory infection. It’s the droplets from coughing and sneezing, which coat surfaces and which people touch that spread the infection. The virus gets on hands, and then everything touched is infected.

    While washing the hands seems simple, how it is done is important:

  • Use warm or hot water if you can;
  • Lather up with soap and rub not just your fingers and palms but also under the fingernails, around the wrists and between the fingers for as long as it takes to sing the “Happy Birthday” song twice; and
  • Rinse well.

While it is important to wash hands thoroughly with soap and water before eating and after using the bathroom, for whatever the bodily function, it is also important after using a tissue or covering the mouth as with a sneeze or a cough, sick or not, or as with seasonal allergies, which could present similar symptoms to the flu.

A person should think of how often he or she would wash their hands if they worked in a hospital’s emergency or operating room; hands should be washed that often and that thoroughly.

2. Covering the mouth when coughing or sneezing.

“The way you spread influenza is with droplets that come out of your mouth or nose,” said Dr. George T. DiFerdinando Jr., a physician, epidemiologist and professor at the University of Medicine and Dentistry of New Jersey-School of Public Health. He recommends the classic shoulder or crook-of-the elbow sneeze.

“It’s a whole lot better for those [droplets] to be on blouse or sleeve than spraying onto surfaces or other people,” he said, after which, wash the hands.

While wearing surgical face masks are an option for containing the droplets, they don’t keep a person’s hands clean and there is no consensus in the healthcare community on whether or not face masks are advisable for everyday use.

“If the swine flu virus is spreading throughout the community, it would not surprise me if people use face masks to good effect,” DiFerdinando said.

  1. Staying home.

Someone who is sick should stay home, DiFerdinando said. Try to muster the energy to wash the hands after every tissue use so as not to avoid re-infecting everything touched afterward. This helps to reduce the presence of the virus in the immediate environment, with recovery, and protects household and loved ones.

  1. Not touching the face.

While very few people succeed at restraint and control, more people are urged to try to keep their hands away from their face and areas where there are mucous membranes, such as around or close to the eyes, inside the nostrils and mouth, which are direct routes to the bloodstream and which allows the virus to bypass the protective barrier of the skin.

“That’s just human nature,” DiFerdinando said. “It’s not something to moan about. In this circumstance you’ve got a very strong motivator to keep your hands clean. If you keep washing your hands, you decrease the dose [of flu virus] that you get when you put your hands in your mouth.”

5. Avoid sick people

It’s a good idea to avoid close contact with other people who are sick, DiFerdinando said, adding: “We won’t even see air kisses.” The flu virus tends not to float in the air. Instead, once dispersed, the liquid droplets tend to settle on objects that doctors call fomites – things that people touch that can pick up a virus. Examples include coins, hand rails, door knobs, common household and office objects. Smooth objects transmit microbes more than rough or porous ones. So, for instance, coins would allow one to pick up more virus than paper money.

Not surprising to Dr. James Koopman, professor of epidemiology at the University of Michigan’s School of Public Health, is the number of cases concentrated in one geographic area.

“There is a lot of direct contact and touching of common things when children are in school,” Koopman said. “They are in general more susceptible to these things.”

Koopman and his colleagues are trying to pin down the relative importance of different routes of transmission, whether by the air or by hand touching, fomite.

“Our work is indicating there can be big differences between something like airborne virus – you may take a small amount in with every breath, but when you get a big goober of someone’s cough on your finger and it touches your mucosal membrane – your eye, nose, mouth or somewhere where it can gain access – that could be a much higher dose,” Koopman said.

It takes time for a new virus – and the swine flu outbreak is based on a new strain of an H1N1 virus – to adapt to a human’s immune system and survive there long enough to find another organism to infect, Koopman said.

At first, the immune system can handle small doses of virus, such as with airborne transmission, he said. In that case, “maybe the hand-fomite touching spread would be more important than the airborne,” he said.

Maybe later, the virus evolves to survive and transmit successfully in smaller doses, or via different routes, he said.

“I personally think this virus has been circulating a bit longer than is recognized at this time,” Koopman said.

The CDC photograph, below, captured a sneeze in progress, revealing the plume of salivary droplets as they are expelled in a large cone-shaped array from this man’s open mouth. The flu virus can spread in this manner and survive long enough on a doorknob or countertop to infect another person. It dramatically illustrates the reason you should cover your mouth when sneezing or coughing to protect others from germ exposure, health officials say. It’s also why you need to wash your hands a lot, on the assumptions others don’t always cover their sneezes.

Photo of man's sneeze - droplet plume

Photo of man's sneeze - droplet plume


April 30, 2009 - Posted by | community, Health, LGBT community, Male Health, Public Health, Uncategorized, Washington Heights Community | , , , , , ,

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