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Sunday, May 3, 2009

Swine Flu peeks through windows, scares the children

At work on Thursday we had a nursing meeting regarding the plans for when H1N1 starts showing up in Boston.

"If one of our guys gets it," the DON quoted the medical director, "a hundred of them will."

It's true. The current recommendation for people who think they have the flu is to stay home. Not to go the doc or to the ER where they may infect other people, but to isolate in their home with plenty of fluids and rest. If symptoms get very severe, people should then call the ER, where they would be triaged immediately.

So when it comes to homeless people there's a problem. They have nowhere to isolate themselves. Most of them sleep in shelters, mere inches away from other people. Many of them are substance abusers or mentally ill and unable to take care of themselves. Many of them are compromised by other diseases, including HIV and AIDs. How do we stop the spread of the flu through this community?

At church Saturday night a well meaning priest recommended that we not shake hands during the Peace Offering "due to recent, er, events." The Peace Offering is the part of a Catholic Mass where we "offer one another a sign of Christ's peace." Hand shaking is the status quo (oh, New England), but kissing cheeks, hugs* and hand gestures are also accepted in some folds. The priest laughed when he said it, and we laughed too, but no one touched during the Peace Offering. I rolled my eyes heavenward. There are several probable cases in Boston, but none confirmed yet. No one in the church had so much as sneezed during the entire service and here we were, offering peaceful eyebrow raises and head nods at each other.
Like the people in the Bible who don't allow lepers to walk on the same side of the street. You know, the people we swear we aren't.

"To be fair," said a coworker as I relayed my frustrations Sunday at work, "you know that people can be contagious during the prodromal phase. You're contagious for twenty four hours before symptoms. And we don't know a whole lot about why this kills healthy people off."

I think that the public paying more attention to personal hygiene is never a bad thing. If this teaches people to cover their mouths with their elbows when they sneeze, I'll be thrilled. If it means more parents will immunize their kids, I will do dance. But I'm afraid that instead it's just teaching people to distrust one another. (Here's an inconclusive article from CNN on social distancing.)

But let's go back to where I started. Although I would discourage hysteria, I have my concerns. But my concerns are based on knowing that it will spread faster through the homeless than it will through other patient groups, and that a lot of them just won't be able to handle it.
Although incidence is on the decline, anyone who reads a newspaper can tell you exactly what we learned in nursing school: "pandemics trend in waves." Now is when we start to plan for a viral resurgence in August or September.

We're talking daily about emergency preparedness, and while I don't know that we will ever have to execute any of the planning, I don't mind it. It's not a bad exercise for any of us. And it's sort of inspiring to see it all kick in. I hadn't thought about half the things we're thinking about. Like, how to get a homeless person over to McInnis if he or she is infected. An ambulance is a real waste of resources, but will cab drivers agree to take sick people? Can they legally refuse? It raises a ton of interesting questions, and I think people thrive when they're asking questions.

Part of my job as a nurse, as I was reminded by the DON, is to stay as educated as possible, and to make educated and objective decisions on a day to day basis. This obligation then extends to a responsibility to educate other people so they too may make unbiased, informed choices. Think you should pull your kid out of school? Great. I'm here to tell you the statistics of confirmed cases at your child's school. Thinking about listening to Biden telling people they shouldn't get on a plane? I will be happy to sit with you and explain how droplet transmission differs from airborne transmission** so you can go ahead and buy that ticket. Want to go to work even though you have a fever, aches, and a productive cough? I'll call your boss for you - you're staying home and drinking juice. But that's what I would tell you about any virus, any time.

And if you don't want me to hug you at church I won't. But I think as long as we all wash our hands, we can at least shake on it.

* I like hugs. It's not as disarming as a kiss to most new englanders, but it gets the point across.
** Jeepers, Biden, it's not TB!

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