Idea #311 for December 26th, 2009: Take No Chances or Pregnant Women Should Seek Aggressive Flu Treatment

Influenza is especially dangerous among pregnant women because of the possible effects it can have on unborn children. Now health officials in California are telling women not to take any chances and begin aggressive treatment if any flu-like symptoms arise. This goes for women who test negative for the flu also. Apparently, the flu diagnostic test is not very accurate and may give false negatives. In fact in one study, 40% of women who were hospitalized with H1N1 initially tested negative for the flu in preliminary tests. So pregnant women who suspect they are ill and demonstrate symptoms consistent with the flu, anti-viral drugs should be administered without delay.

Read more about this story here.

Idea #246 for October 22nd, 2009: Party’s Over or Knowingly Infecting Kids With Swine Flu = Bad Idea

With the threat of H1N1 looming, some parents are considering organizing swine flu “parties” where kids would be intentionally exposed to the virus, along the lines of chicken pox parties. The thinking is that infecting the kids now will give them immunity to swine flu before it mutates into something more harmful. However, this mindset is wrong and potentially dangerous. Healthcare professionals are urging parents not to be involved with swine flu parties.

For one, there’s no evidence to support the claim that the virus will mutate into anything much more virulent than it is today. More importantly, willingly subjecting people — especially young people — to swine flu is dangerous. Whereas seasonal flu deaths occur mostly among elderly populations, swine flu is hitting younger people hard. About a quarter of the deaths so far from H1N1 in the US have been people under 25 years old.

Also, there are complications that can arise from swine flu. Acquiring swine flu might mean getting pneumonia or other conditions down the line that will make things even more dangerous. Further, intentionally giving your child swine flu means that child is contagious and capable of spreading the virus to many other non-willing participants, and exposing them to the risks of complications. In all, swine flu parties are a terrible idea and could pose a serious public health threat.

Read more about this issue here.

Idea #232 for October 8th, 2009: iFlu or Assessing Flu Symtoms Online

Given the large amount of media attention surrounding a possible H1N1 flu outbreak, public panic is a real possibility in the coming months. In an effort to keep people away from unnecessary emergency room visits, Microsoft has unveiled a website to help people make a quick assessment on whether their symptoms are indicative of H1N1 infection.

Microsoft’s licensed their tool from Emory University, who developed it using risk factors identified by the CDC for H1N1. The site asks users some basic questions about their condition to determine if they have H1N1, and if so, whether a visit to a doctor is in order. It can tell you that you likely have swine flu, but that seeing a doctor is not necessary. Or it may determine your symptoms are severe enough that you do have to go to the emergency room. The questions asked are similar to ones used during the triage process at Emory.

Some might expect a tool like this to be wildly inaccurate and steer gravely ill people away from treatment they need. However, a test of the tool against 2500 patient records in Colorado proved quite successful. Only two people that the tool identified as non-serious flu cases were hospitalized in that study. This flu season, a web tool like this holds great promise, if utilized correctly. It’s a quick way of finding out if you’re symptoms are consistent with swine flu symptoms — without the hassle of getting to an emergency room.

Read more about this from the AP.

Idea #221 for September 27th, 2009: Influenza 101 or School Nurse Shortage

This flu season, H1N1 flu could potentially spread rapidly through schools. Normally, school nurses are the first line of defense against the spread of illness in schools. But a huge number of schools in the US do not have a nurse on duty. Only 45% of public schools have a full-time nurse on staff, while 25% have no nurse at all — full- or part-time. Further, the CDC recommends that there is at least one school nurse for every 750 students, yet only 12 states meet that ratio on average. In fact, 14 states have one nurse per 2,000+ students.

Budget cuts partly explain the shortages. In California, about half of the school districts have no nurses whatsoever. A school district near Salt Lake City, Utah has only 10 nurses for its 68,000 students. While the CDC has recommendations about nurse to student ratios, only 19 states actually have rules that ensure certain ratios are met. With the nation facing a possible epidemic of swine flu, it would be wise for more schools to hire nurses, if only temporarily for this flu season. Nurses can help school systems recognize burgeoning outbreaks of flu and take steps to prevent its spread.

Read about the nurse shortage in this news story.

Idea #202 for September 8th, 2009: Riding It Out or Antivirals Unnecessary for Majority of Swine Flu Patients

In the next few months, H1N1 flu is expected to pick up steam in the US. Amid non-stop media attention, there’s the potential the public will overreact or panic about the situation. For that reason, the CDC is urging that two antivirals (Tamiflu and Relenza) be reserved for people either hospitalized with H1N1, or people who are at high risk for complications.

In the majority of cases, swine flu is mild and does not require antiviral medication. For elderly or young patients, and for patients with other health conditions that would make them susceptible to flu, Tamiflu can be used to treat H1N1. But overusing the antivirals can lead to resistance, which would make H1N1 even more difficult to treat. It’s also important that, for patients who do receive antivirals, they begin treatment as soon as possible to effectively treat the flu. But for the majority of us, H1N1 will not have to be treated with antivirals.

Read more about this in the Washington Post.

Idea #198 for September 4th, 2009: Viruses on the iPhone or An App to Track Infectious Disease

Want to know about swine flu in your region? There’s an app for that, thanks to researchers at MIT and Children’s Hospital in Boston. Their application for the iPhone shows outbreaks of diseases in your area, and is called “Outbreaks Near Me.” It builds on information from HealthMap, which in turn gleans its data from Google searches, news items, blogs, and other media. In the Outbreaks Near Me app, users can see a map view of their location with pinpoints showing recent infectious disease cases in their area. They can also search for more information by disease or location.

Aside from viewing data, users can submit their own data — even photos — to the team responsible for the application. The hope is that with enough participation, the app can become a powerful surveillance tool in the fight against infection diseases. Considering the popularity of iPhones, it makes sense to employ them for public health uses. It wouldn’t hurt if they expanded this app to phones on Android too. It’s useful for tracking a number of infectious diseases, but its real test may come in the next few months when H1N1 is expected to spread rapidly in the US.

Read more about this app from this Reuters story.

Idea #189 for August 26th: Anti-Virus Applications or Utilizing Social Networking Sites to Fight Swine Flu

If you want to reach huge numbers of people in an inexpensive way, taking advantage of social networking sites may be the best option. The CDC has realized that, and are utilizing twitter, Youtube, Facebook and other sites to spread message about the H1N1 flu. Their Facebook page has over 20,000 fans and on Twitter, the CDC has over 300,000 followers. Tips for prevention, such as getting vaccinated, hand-washing, and staying home when sick, are offered by the CDC, as well as updates on the number of cases of flu.

Additionally, they are reaching out to “mommy-bloggers” who hold great influence online. The CDC hopes reaching out to the public in this manner will inform people flu prevention, while at the same time trying to deter them from making a lot of unnecessary emergency room visits. Updates can spread virally through twitter, so it’s an ideal way to reach millions of people quickly. One concern with this methodology is that it is reaching out disproportionally to a younger demographic. Elderly people, who are less likely to be online, will not be informed to the same extent. Nonetheless, it’s certainly a smart move on the CDC to take advantage of social networking sites to help contain the H1N1 flu, considering the potential consequences if it spreads unchecked.

For more on this, see an article about it here.

Idea #170 for August 7th, 2009: “Open Your Window and Say Ahhh” or Drive-Through Emergency Departments

We have drive-through restaurants, banks, and pharmacies, so why not drive-through emergency rooms? Stanford Hospital has begun tackling that question with test trials this year. In June, the hospital set up a simulated drive-through emergency department in a parking garage, complete with cars and fictional patients. The goal: to test if this method of seeing patients during a pandemic or bioterror attack would be feasible.

The impetus for the experiment was the overburdening of emergency rooms that commonly occurs during flu outbreaks, when people without insurance or primary care providers have no other recourse. During the test, the fake patients were assigned different symptoms and levels of sickness, so that the triage efforts of the staff could be tested. First, as cars entered the facility, patients were registered. Then the cars stopped at a station where patients’ vitals and medical history were taken. After that, doctors at the next station made a diagnosis and either admitted them to the hospital or routed them somewhere else.

The results of the experiment showed that patients experienced wait times 1.5 hours shorter than similar ones would have experienced in a traditional emergency room. Additionally, keeping patients in their cars isolates them so that illnesses are less likely to spread among potential patients. The trial went smoothly enough that the Stanford doctors are planning to roll this out in the event of an actual swine flu outbreak at this location. In an actual emergency, I wonder if dozens of panicked individuals in the drivers’ seats would result in some kind of traffic accident in the drive-through facility. Still, this is promising enough that it makes sense for other hospitals to implement, after doing some dry-runs of their own.

Read more about this in the Wall St Journal and in the Mercury News.

Idea #89 for May 18th, 2009: A Healthier Workplace or Paid Sick Days

For about half Americans, taking a sick day means taking a cut in their paycheck. Unlike other developed countries, there is no law in the US requiring employers to pay workers for time off due to illness. A new bill introduced by Democrats is aiming to change that by making employers offer up to seven paid sick days per year.

Many Americans who are not given paid sick days find themselves continuing to work during an illness rather than forgoing a day’s earnings. Not only does this affect their own health, it may endanger the health of others too. A restaurant worker, for instance, is capable of spreading disease to a sizable number of diners. Even workers who don’t deal with customers can just as easily infect their coworkers. A study in California in 2008, for example, concluded that paid sick days in that state could potentially help all residents of the state, as cases of the flu and other contagious diseases would decrease.

There is likely to be resistance to the Congressional bill by business organizations who are concerned that the new law would hurt their bottom lines. Those costs should be considered, especially in this economy. But opponents of the legislation have to realize that businesses are hurt by employees who don’t take time to get well, and that paid sick days can help stop the spread of disease, which will lower the healthcare costs of everyone.

For more, see the NY Times and this opinion piece in the San Francisco Chronicle.

Idea #76 for May 5th, 2009: Pandemic Panic or Taking Tamiflu Unnecessarily

Another day, another swine flu news story…

This time, some experts are expressing concern over inappropriate use of antiviral drugs Tamiflu and Relenza. Used correctly, those two drugs are are an important tool in prevention and treatment of influenza viruses. The federal government keeps a sizable stockpile of Tamiflu and Relenza for dispersal in the event of a flu pandemic. Misusing those drugs, though, can result in resistant viruses.

Similar to one of the ways antibiotic resistance can develop, antiviral resistance can occur if Tamiflu is not taken for the full course of treatment. Some panicked people are buying Tamiflu (which normally requires a prescription) off the internet, and if they take incorrect dosages, they could contribute to the problem. The same goes for people who’ve previously been prescribed Tamiflu and have some of the it left over: don’t take it unless under the supervision of a doctor. Aside from resistance issues, there is the possibility of side effects from the drug, especially in young children. Misusing Tamiflu now can put the public at greater risk if and when there is an actual pandemic.

See more about the issue in the LA Times and CBS News.