The Origin of Swine Flu?

May 13, 2009

swine flu origin

I need to contact the CDC to track down this kid for isolation.

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Surgical Masks – The Swine Flu Placebo?

May 3, 2009
The Insanity Continues

The Insanity Continues

Arriving to my destination country yesterday, I was greeted with two guys wearing medical masks and holding some kind of alcohol spray in their hands. They were interviewing people – mostly attractive looking women for some strange reason – and asking them where they had come from and if they were feeling “OK”. They had their masks on pretty loosely which just looked stupid.

Of course, Swine Flu is all the rage on the global stage these days. There has been a sudden interest in wearing surgical masks at many airports (I was thinking of marketing medical masks in pastel colors – let’s at least be fashionable right?). Mexico has become a black stamp with other nations canceling flights to Mexico, cruise ships avoiding Mexican ports like the plague and Mexicans traveling to other countries being subjected to extra questioning and possible quarantine. Some countries are even lumping Americans into this group as well because of the rising number of cases in the US.

Which brings me to the main question – do these masks people have chosen to wear really do anything? One US Public Health official was recorded as saying that they “give people something to do”. Hey, it may not prevent you getting sick, but at least you will trick your mind into thinking you are ok. Nice placebo.

For the general public, and those medical personnel who were sleeping during their infectious disease seminars, there are two types of masks used in medicine. The loose fitting “surgical” mask type and then a respirator type of mask.  These pictures will illustrate the various types:

Tie-on Surgical Mask

Tie-on Surgical Mask

N95 Respirator

N95 Respirator

The important difference between these two is their usage. The surgical type of mask is usually loosely fitting and PROTECTS OTHERS from your germs. It also protects the wearer from droplets like blood.

The respirator on the other hand PROTECTS YOU from other people’s germs. We wear them in the hospital when we are dealing with people that have tuberculosis and we have the person with the potential tuberculosis wear the surgical type of mask so they don’t infect others. Respirators are  specially fitted so as not to leave gaps for air-borne germs.

What type do most people wear in crisis moments like these though – they wear the surgical type of mask, and they often wear it incorrectly, like leaving the bottom ties untied, or covering only the mouth and not the nose. These masks would be great if YOU have the swine flu and want to be considerate enough not to spread it to others, but do nothing more than give you the warm fuzzies, fogged up glasses and a sweaty face if you are trying to avoid getting it.

To learn more about the properties of each type of mask and when they should be used, click here for an excellent summary in medical speak.

In the meantime, you can always use a mask to help pick up unwitting foreign girls or to express your thoughts on the continued insanity of  Swine Flu.


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No, We Don’t Need to Land in Scotland!

May 2, 2009
Fish or chicken? Should've had the pasta.

Fish or chicken? Should've had the pasta.

As I had mentioned before, I am on vacation for the next couple of weeks. I thought I would be getting away from the stupidity of swine flu (now called H1N1 flu to protect pork sales), but it looks like I landed right in the middle of stoopid yesterday.

I’m on an international flight and heading towards Europe. Mid-way through the flight I see a crowd gather near one of the galleys and then a frantic sounding flight attendant gets on the mic and calls for one of her associates. I figured it was likely a medical emergency of some sort and followed the hurried attendant.

At the galley, I find a young man laying on the floor breathing O2 through a mask with two disoriented looking passengers fiddling with him. I tell them that I am an ER doc and they tell me that they are paramedics from Europe. The story is that this guy got up to go to the bathroom and became presyncopal (almost fainted) and called for help. I ask the scared looking flight attendant for the medical kit so I can assess this guy.

Now of course, everyone is worried about one thing – SWINE FLU. I can read their scared minds … “Oh no! We’re all gonna get swine flu and die horrible deaths!”. But when I assess the patient, after pushing the very eager, overly wound up paramedics away, my first question is, “How much have you had to drink?” Previous experience with airline medical emergencies has taught me that, just like on the ground, alcohol factors into a lot of emergencies.

After establishing the fact that he didn’t have half a cart of Jack Daniels, my next set of questions focuses on flu symptoms (fever, nausea/vomiting, body aches, fatigue, cough, runny nose, etc.). He was only nauseated, likely from the near fainting. No medical history, on no medications.  Then I hear one of the paramedics talking with the flight attendant about an emergency landing in Scotland and I get really peeved.

Dealing with the totally awesome EMS personnel in the States, I get used to them understanding chain of command and knowing when to defer. I imagine that many EMS personnel in Europe are also the same, so not sure what was up with these jackers. I tell the flight purser that I am the medical doctor in charge and that an emergency landing is not necessary at this point in time and that everyone should chill. Too many cooks in the kitchen.

Getting back to the sick person, I observe another flight attendant trying to put the leads from the automatic defibrillator (AED) on the patient – one on the stomach and the other near the right shoulder. It was like doing a code on the floor – total cluster. I was totally expecting to see the “paramedics” preparing to inject this poor guy with some epinephrine or something.

So, what was the sick guy’s story? He was majorly sleep deprived (typical for many people preparing for international travel), been staying awake on lots of caffeine and probably not having enough fluids to replace all the ones he was urinating out. Add to that, the chicken meal he ate on board.

The AED shows a very temporary sinus bradycardia (slow heart beat) at about 40. While I was checking his blood pressure, it went back up to normal between 65-72. I think it was because he was overhearing the “paramedics” from Hell discussing totally inappropriate interventions. His blood pressure turned out to be 110/70. My team of boners tried to get a blood sugar and failed. But by this time, the guy was saying he was feeling better and wanting to sit up. His “fight or flight” response was probably in high gear overhearing the things being said.

Catastrophe averted for the moment. I told the sick guy to contact me directly if he started to feel woozy again and to avoid the “paramedics” at all costs. The flight attendants were thankful for the man’s quick recovery and for services provided.

In the last hour of the flight though, I was heading up near the sick guy’s seat and see his wife standing and looking concerned. He was feeling woozy again and luckily I arrived at the right time (read – before Beavis and Butthead). I had him lie down and put his feet up. Checked his pulse and it was regular at about 65. He was very nauseated again. To avert another medical emergency landing, I went to the head purser and told her that the guy was stable and not to be worried. I would stay with him until we landed and inform her of any changes.

Within minutes, the guy was feeling and looking back to normal – a good sign that he was likely dehydrated and getting vasovagal. A few nice passengers near-by offered to move so that he could lay down across four seats. Beavis and Butthead arrived soon enough with an O2 tank (incorrectly set-up). Once again, they by-passed me to tell the captain to land ASAP. I think one of them was trying to impress one of the attendants or something.

Just before we landed, sick guy vomited up his chicken. I was sitting right in front of him and immediately after I asked him if after vomiting he felt better or worse. Although it’s not so evidence-based, I have found over the years that with food-borne illnesses (commonly called “food poisoning”) that people generally feel better immediately after vomiting – likely because of the reduced toxin load in their stomach. On the other hand, vomiting from flu syndromes usually results in a person feeling even worse and more fatigued. Maybe it was the chicken after all?

We arrived to our destination after a hurried landing and had to wait on board until this country’s EMS came on board to load up the patient and take him to the airport medical facility. I gave report to the ER doctor that accompanied the team and gave my new friend (sick guy) some farewell advice and a good-bye. My advice was get some IV fluids and some rest. After he was gone, I had to reassure several passengers that there was no flu threat and that they should all be ok.

That is, unless they had the chicken. Glad I ate the pasta.

Swine Flu: Epidemic on Our Hands?

April 26, 2009
Duct Tape. Save Yourselves! The End is Near!

Duct Tape. Save Yourselves! The End is Near!

I’m almost glad that I will be having some time off in the coming days because with all of the insanity regarding the swine flu racing through Mexico City, and now in certain parts of the US. News reports thus far have done what they have become exceedingly good at in recent years – scaring people. Remember duct taping your windows in case of a nuclear strike? Probably about as effective as hiding under your desk (what they officially taught the last generation to do in case of a nuclear strike). So what do I expect will happen?

Starting soon – in a city near you – ER’s will start getting loads of visits from people suspecting they have swine flu (had our first one already today). What are the symptoms you might ask? Same as any other kind of flu – fever, cough, fatigue, body aches, nausea/vomiting, lack of appetite, etc.  Pretty vague right? But there must be a way to get tested right?

Yes, there is a test. Whew, you must be thinking! But, the test needs to be done at a public health lab. So, in other words, it might take a while to get results. But there must be something I can do right?

Sure, if you notice these vague symptoms and get to your doctor within 48 hours of the onset of your symptoms, then you can get antivirals. “What are antivirals?”, you may ask. They are very expensive medications produced in very limited quantities that have totally variable rates of success. What does that mean? It means good luck.  Beyond that, only two out of the four available class of antivirals “seem to be effective” per the CDC. So what happens then if you get to your pharmacy and they’re out of Tamiflu or Relenza (the two that “seem” to work)? If you can’t get it within the first 48 hours then its not worth taking. But you’re not dead yet.

The CDC recommends routine precautions to prevent the spread of infectious diseases: “wash your hands often, cover your nose and mouth when you cough or sneeze, avoid close contact with sick people. If you are sick, stay at home and limit contact with others”.  So, I’m following their advice and staying away from sick people by not working until this fear campaign takes a rest.

The thing that really bothers me though is scaring people over something when there aren’t reasonable options for reassurance.  The last thing I want to see is a run on ER’s and people who are minimally ill, but maximally worried, depleting whatever supplies of antiviral are available (even if doesn’t work so effictively) so that later waves of possibly sicker people will not be able to get treatment.

I also hate seeing people get worried over something which in many cases is no different than getting Influenza. Influenze kills lots of people every year – approximately 36,000 deaths and more than 200,000 hospitalizations are directly associated with influenza every year in America according to the Journal of the American Medical Association. I’m not sure about you, but I don’t change my lifestyle or schedule because of Influenza. Do we really need to change our lives because of the Swine Flu?