H1N1

H1N1 has struck the Miedema household, and I've been getting lots of questions, since I now have first-hand experience. I don't claim to be an expert, but I do sit on the Mercy Medical Center H1N1 Emergency Task Force, so I get pretty up to date information from the Polk Co. Public Health Dept. I also spent time talking with our chair of Infectious Disease, Dr. Dan Gervich, the other day and he is undoubtedly an expert in all things infectious. Here are the most common questions I'm hearing:

What are the symptoms?
Well, for David and I the first symptom was a dry, ticklish cough that got more frequent over a couple of days before a low-grade fever started. For David, he ran a fever between 101 and 103 for about two days. It looks like my fever will be more low-grade - around 100. There are, of course, the general aches and pains; headache; sore throat (from the coughing.) For us, there hasn't been any nausea or vomiting, in fact I'm thirsty all the time which is a good thing.

How do you know it's H1N1?
Good question. At this point the diagnosis is pretty much according to symptoms. The rapid tests you can get at your doctor's office have between 10 and 70% inaccuracy. So some are showing Influenza A, a few are showing Influenza B, and in about 50% of the cases where the rapid test is negative for anything the person actually has H1N1 (assuming they have the symptoms above.) In 99.9% of all cases nationwide, more sofisticated cultures of those that are positive in the clinic are coming up H1N1. So, as Dr. Gervich said, "If it looks like a duck and quacks like a duck...."

When is the vaccine going to be available?
A trickle of nasal (live virus) doses came to Polk County this week. Another small shipment will come in next week. Truth is, there will probably not be enough vaccine to ward this off. In other words, the horse is out of the barn, at least in Central Iowa. If you are patient enough to stand in line at the Polk County Health Department, you might be able to get the vaccine. Right now the vaccine is not available anywhere else in Polk County.

Who can get the vaccine?
Right now the vaccine is being offered to:people between the ages of 2 and 24, pregnant women, and healthcare providers 49 years old or less.

Why is it being limited to those groups?
Because those are the groups of people who seem to be hardest hit. 70% of the deaths nationwide are in people under age 24. Pregnant women have had some nasty complications. Healthcare workers have the potential to spread it like wildfire. Interestingly, as of the October 8 public health update, there had been no reported deaths related to H1N1 in people over age 65.

Does the seasonal flu vaccine help at all?
Theoretically, no. But some very early evidence suggests that people who have had the seasonal flu vaccine are getting milder cases of H1N1. This is very early, so the behavior of this virus remains to be seen.

Is the vaccine safe?
I'm biased on this one. I work in a hospital, so I see worst case scenarios. I encourage everyone to take the flu vaccine, but you have to decide for yourself. All I will say is please decide based on science, not fear.

If I get H1N1 will I die?
Gee, I certainly hope not or I wouldn't be spending this precious time blogging! The vast majority of people will be mildly to moderately miserable for about a week and then will be fine. David is on the upswing - after having 103 fever on Wednesday, he is now out mowing the lawn. The reported deaths are in people who have other medical conditions, such as asthma or diabetes. There is some evidence that morbid obesity is correlated with an increased death rate - that is probably because very obese people have a higher incidence complications associated with sleep apnea. This is primarily a virus that moves into your lower respiratory tract, so if you have lung issues, it is a good idea to see your doctor. He or she may prescribe an anti-viral medication that can lessen the duration and severity of H1N1.

Will taking vitamins, echinacea, or Zicam help?
Can't hurt.

If I get the the symptoms, should I see my doctor?
If you are basically healthy, the answer is probably not. Stay home, drink lots of fluid, take ibuprofen or acetaminaphen (you can alternate the two if you have a really high fever) and sleep. I know it's nearly impossible, but try to stay away from others. Cough into your elbow or a tissue, and wash your hands FREQUENTLY. Label a cup as your own, and do not share utensils. You know, the common sense stuff. If you run into trouble breathing, cannot get a child's fever down, are listless or lethargic more than is normal for being crappy sick, or if you have vomiting associated with the fever, we are recommending that you CALL your doctor and ask for instructions. Clinics are trying to minimize the exposure of other patients and staff, so they may take you right in or ask you to come in an alternate entrance. Or maybe not...pretty much everyone there probably has it also. Unless you really get into an emergency situation, please do NOT go to the Emergency Room. Believe me, the ERs are packed and unless it's a true emergency, you will not enjoy the wait!