It is difficult to know how to respond to H1N1. Last spring schools were closing with the first whiff of a possible infection. Now, kids who are sick are segregated until they can be sent home. Schools are unlikely to be closed unless the numbers of absentees are large enough to prevent normal function or vulnerable populations are put at risk.
Based on research, plain surgical masks were felt to afford insufficient protection compared to the more expensive, fitted, N95 mask. This week, the result of an important N95 vs plain mask study is being questioned because of the methodology used. Still, this is a big deal, especially for at risk populations like young kids, pregnant women and people over 65. Underlying conditions like asthma and other chronic illnesses can increase a person’s risk for a more severe illness.
Influenza virus can be broadcast about 3 feet from droplets generated by coughing and sneezing. The virus laden droplets gain access and infect through eye and nose mucous membranes. This initial contact is either direct or indirect. The later occurs when the droplets land on a surface and then are spread to the mucous membranes by hand contact. It is often difficult to get more 3 feet away from someone in a tent, on-board ship or in a classroom. Keeping surfaces clean under these kinds of circumstances can be a challenge.
Here is what I think:
- Most people with influenza are sick. Cough, sore throat, headache or muscle aches with a fever should get your attention.
- Hand washing regularly both before but particularly after contact is very important.
- Coughing into a disposable tissue that is immediately thrown out or, lacking one, into one’s elbow crease will minimize spread potential.
- If you are running a program, isolating people with some symptoms will help. In the middle of the ocean you cannot send the person home but you can use a mask and good hygiene. If conditions permit, on deck, some distance from others would be better than being trapped below deck. Think of this principle for other settings.
- Some kind of a mask is better than none and one mask for someone ill is cheaper and easier than one mask for everyone else. It is hard to believe, if lacking a mask, that even a bandana wouldn’t offer at least some protection.
- Canceling or postponing a trip for the person with symptoms makes sense.
- When you think about hygiene don’t forget about things that you touch – e.g., flash lights, binoculars, GPS. An outbreak of conjunctivitis at a college, reported in the NEJM in 2003, was felt to be related to ubiquitous public computer terminals. Placing hand cleaner near them accompanied by instructions to use before and after was credited in part for getting things under control.
- Most of these steps make some sense to help minimize or contain many infectious illnesses.
The vast majority of people who contract H1N1 will survive just fine. But, when you are not at home, little problems have a way of getting worse (magnifier effect), ultimately affecting everyone’s health and safety. Expeditions or other remote missions are always easier and more fun when people are well.