An ounce of prevention

As summer draws to an end and the influenza season draws ever closer, 'In Jerusalem' takes a look at how the city is preparing for a possible major outbreak of swine flu.

By SUSAN HERSH SACHS
Assaf Harofeh swine flu 248.88 (photo credit: Ariel Jerozolimksi [file])
Assaf Harofeh swine flu 248.88
(photo credit: Ariel Jerozolimksi [file])
While so far only a few Jerusalemites with swine flu are hospitalized, Prof. Allon Moses, the head of the infectious diseases department at Hadassah-University Medical Center, says the figure could rise dramatically come winter. "Today we have only five or six cases at Hadassah Ein Kerem and Mount Scopus combined," he says. But with a caveat that it "is impossible to predict," he warns that the number could rise tenfold or a hundredfold. How prepared is Hadassah? "We are discussing this constantly - the possibility of putting patients in one ward or closing a department or sending patients home. There are plans," says Moses. He draws reassurance from the fact that "Israel is a country that is always prepared for disaster, and this virus is another potential disaster. We hope it won't come to that. We don't think it will come to that," he says. Like Moses, Dr. Yechiel Schlesinger, the head of Shaare Zedek Medical Center's pediatric infectious disease unit, is confident that the vaccine currently being tested against H1N1 swine flu could help as a preventative and thinks the World Health Organization (WHO) is taking great responsibility. "I have no tools to question the WHO on this. They know what they're doing." Although no immunization is totally without risk, the alternative - i.e., the risk of a pandemic with greater impact than we have seen until now - is of greater concern. Therefore, Schlesinger supports the H1N1 flu vaccine, saying, "I would go with it." There are three aspects of this novel H1N1 swine flu that makes it different from seasonal flu: it affects mostly younger people; it is spread very easily; and it is occurring out of season. Schlesinger adds that it is affecting pregnant women more than others. In all these ways it resembles some aspects of the virus responsible for the great pandemic of 1918. However, in its general mildness it is thankfully very different from the pandemic of 91 years ago. Spanish flu, as it was called in 1918, was 25 times more lethal than today's version. Normally healthy people who have caught today's novel flu recover quickly. Only a very small percentage need to be hospitalized. Therefore Dr. Hagai Levine, public health adviser on pandemic influenza preparedness and response for the Health Ministry and Ben-Gurion University of the Negev, makes a strong case for people who have symptoms of flu not to go to the emergency room unless they are suffering a severe reaction, such as loss of consciousness or having breathing problems. People who are more vulnerable - who have heart or lung conditions or chronic illness, or are pregnant - should go to the doctor at the first sign of the flu to receive Tamiflu. But Levine suggests that patients in good general health with relatively normal flu symptoms should not even visit the doctor or a health fund clinic. The average patient should just stay home: (1) to prevent the further spread of the disease and (2) to prevent overburdening the health care system. These instructions are similar to those found elsewhere, including directives issued by Shaare Zedek to its staff. Nobody should take Tamiflu if they don't have flu - it is not a preventive. The normal symptoms are high fever, coughing, sore throat, headache and muscle aches. People with those symptoms should just get plenty of rest, drink plenty of fluids and bring down the fever. They do not need medical treatment. Regarding older adults, a noticeable characteristic of this flu is that it does not strike them at the rate that seasonal flu does, and not at the same rate as it strikes much younger people. The reason for this could be because a "descendant" of the H1N1 of 1918 continued to be present and spread across the globe until 1957, when it seemed to have largely disappeared from human-to-human transmission. Therefore, today's senior citizens who had flu when they were young could have a natural immunity to this one. It's not yet clear, however, whether an older person who does catch this flu will become more ill with it. In general, there is still much to observe and to learn about this novel flu. Meetings at various levels are being held, and more and more information will be relayed to the general public in the coming weeks. But this flu is being well tracked, and the findings are quickly shared around the world and within Israel. Levine, who spoke to In Jerusalem as he was heading to Copenhagen for an international conference on this influenza, stressed the high esteem in which Israel's medical system and laboratories are held. In other words, we are as protected as anywhere. The major precaution that all sources advise is to be careful about personal hygiene. One should cough or sneeze into a tissue that should be immediately discarded. Hands should be washed frequently with soap and water - after coughing or sneezing and before eating or drinking. Nobody should share drinking cups (not even the Kiddush cup) or eating utensils. And all cups and utensils should be washed thoroughly. Should everyone carry a hand sanitizer? These bottles of alcohol gel can go anywhere. And since the gel is simply rubbed into your hands, you don't need to be on the lookout for soap or paper towels or even a water tap. The gel prevents hands from chapping, which is especially important for people who must wash more often than most (nurses and caregivers of babies or of the incontinent, etc.) With a projected rate of one-fourth of the population liable to contract this virus in the fall or winter, we can presume that there will be a large absentee rate in our businesses and public services. The Centers for Disease Control in the US (CDC) advise that substitutes be in place for essential employees. One governor has said, "Make sure you have a substitute for the person who handles your payroll!" The CDC advises families to have a two-week supply of non-perishable foods and paper and sanitary supplies, not only in case family members may be too ill to go shopping, but also because suppliers might be short staffed, so basic items might not get delivered to your local grocery shelves. Have supplies of bottled water and check your flashlights and batteries in case utility services are disrupted as the result of illness among the workers. These suggestions have not yet been posted (as of this writing) by the Health Ministry on its Web site, but they are familiar to Jerusalemites from past preparations for other potentially difficult situations here. What about our schools? Levine says the Education Ministry is working closely with the Health Ministry. Schools are expected to open on time and to stay open unless the absentee rate becomes truly excessive. Although many more pupils may become ill this year compared to other academic years, they are also expected to recover quickly. The Education Ministry guidelines currently being issued are still from May 3, but new ones are promised within the week. If one is ill with the flu, when can the patient return to school or work? The advice as of this writing is 24 hours after the patient's temperature returns to normal. (It is no longer being said that one needs to stay home a full week; it depends on the symptoms.) All those interviewed by IJ stressed that there would be another meeting in their department or facility or nationally or internationally in the next week or two, that updated guidelines would be distributed following that, and that the public should stay tuned. Meanwhile, we can be prepared according to the instructions of the moment - and pray for the best. We do have advantages that the generation of 1918 did not have - aside from Tamiflu and the expectation of the vaccine that is touted to be effective and relatively safe. We have a closer grip on current events, there is coordination of the relevant organizations and, most of all, we have a facility of communication that previously could not have been imagined. For updates on the current situation in Jerusalem, in Israel and overseas, with suggested preparations and instructions, follow the announcements on these Web sites: Ministry of Health: www.health.gov.il/h1n1/ (Hebrew only) CDC: www.cdc.gov/h1n1flu/ (English and Spanish) WHO: www.who.int/csr/disease/swineflu/ (English, French, Russian and Spanish)