Health experts: Prepare for spread of swine flu, but don't panic

Wash, wash, wash your hands. Don't panic about the swine flu.

And don't rub your eyes.

A host of health officials, from federal to county, are repeating those messages, reacting to a growing number of swine influenza cases. Of the 82 documented cases confirmed Monday, 48 are in the U.S., 28 of them in New York City. None have been reported in Missouri. Canada has recorded six cases; Scotland has two and Spain has one.

Many flu cases were linked with travel to Mexico -- a country where the suspected number of deaths rose to 149 and nearly 2,000 people are thought to be infected. The U.S. Centers for Disease Control and Prevention is advising people to skip all non-essential travel to Mexico; European travelers are being told to avoid parts of the United States.

Debbie Pliemling, director of Stoddard County Public Health Center, said she spent most of Monday faxing information to physicians, school nurses, the sheriff's department -- "anyone we could think of who could use the information."

Steve Robertson, spokesman for Cape Girardeau Public Schools, said schools sent flu fact sheets to parents.

Karen Evans, the communicable disease nurse for Scott County Health Center, said callers were asking for a swine flu vaccination, which does not yet exist. The virus, identified in March, is being tested for possible inclusion in next year's immunization. Each year, a vaccine is developed based on the most common forms of the flu -- but every flu virus is constantly mutating. People who received flu shots this season are not necessarily protected from the new swine flu.

Dr. Christina L. Frazier, an epidemiologist who teaches Southeast Missouri State University biology students about infectious diseases, said this swine flu is unusual for a number of reasons, including how quickly it shifted from pigs to humans. The World Health Organization has announced a Phase 4 alert level for the first time. Phase 4 "indicates a significant increase in risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion," according to the WHO website, www.who.int.

Phases 4 or 5 indicate the virus is becoming increasingly adept at spreading among humans. Phase 6 is reserved for a full-blown pandemic, with outbreaks in at least two regions of the world. Russia, Hong Kong and Taiwan officials said they would quarantine visitors showing symptoms of the virus amid global fears of a pandemic, an epidemic spread over a large area, either a region or worldwide.

President Obama said the outbreak was reason for concern, but not yet "a cause for alarm."

Bollinger County Public Health Center administrator Beverly Piepenbrok said that is why she is advising people not to panic.

"If we panic, we've lost our ability to communicate," she said.

'Scary virus'

What makes swine flu worse than human or bird flu, Frazier said, is how it connects to the body.

"For a virus to infect a cell, it has to attach to a molecule on the cell," she said. Infection begins the moment the virus connects to cell receptors.

This connection can be compared to putting a plug into a socket, with the top outlet representing the upper part of the lungs and the bottom outlet standing in for the lungs' lower area. A human flu virus would plug into an upper socket. An upper respiratory virus passes more easily from person to person. A bird flu would plug into the lower socket and damage the lungs. Swine flu, she said, can plug into either or both sockets -- and it affects people of all ages, not just the young and old.

Kit Wagar, spokesman for Missouri Department of Health and Human Services, said what makes swine flu a "scary virus" is its genetic code, which includes parts of four separate flu strains: North American swine and bird influenzas, human influenza and Asian swine flu.

Some mutation allowed it to leap from pigs to people; another helped it jump from person to person.

Though there has "not been a single case reported in Missouri, that we know of, we're not expecting to dodge this bullet," Wagar said. "We live in a very mobile society. It would be a miracle of sorts to say people around Missouri would get it, but we're not. We expect to battle this."

Dr. Richard Besser, acting director of the CDC, told reporters Monday that individuals have a responsibility to protect themselves and respond appropriately if they become ill.

Besser said late-season flu outbreaks can return aggressively in the fall.

Fighting back

One quarter of the nation's strategic medical stockpile for treating flu cases is being shipped to states. Missouri has stockpiled enough medication to treat 600,000. Among those monitoring the situation and working with public health officials are Southeast Missouri Hospital and Saint Francis Medical Center health-care professionals.

"The symptoms of swine flu in people are similar to the symptoms of seasonal human flu and include fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and vomiting associated with swine flu," said Carol Jordan, Southeast Missouri Hospital's infection prevention and control coordinator.

Gayla Tripp, infection control coordinator at Saint Francis Medical Center, said the news comes even as some cases of seasonal flu are still being detected. Eighty-four percent of those diagnosed at Saint Francis have been people younger than 24 years old, she said, a group that typically does not get seasonal flu vaccinations.

Tripp said swine flu tests are only being given to people with symptoms who have traveled to an affected area or had contact with ill people from affected areas.

Flu specimens are tested by the Missouri State Public Health Lab before being sent to the Centers for Disease Control for confirmation.

Frazier said people should skip handshakes when swine flu arrives, reduce or eliminate kissing and, if they are sick, stay out of public contact or wear a mask.

"In Japan, it's an absolute, if you have a respiratory problem, you wear a mask," she said. "It's a concept we've never gotten used to."

Until then, there's no point in healthy people hiding at home, she said.

Jane Wernsman, assistant director of Cape Girardeau Public Health Center, said the county's infectious disease task force has been meeting quarterly for three years but since the swine flu alert have been meeting more frequently. On Monday the group reviewed the latest state and federal swine flu bulletins.

"The message we want to get out is that we are aware of what is going on," Wernsman said.

"Anytime someone thinks they need medical testing, they should consult with their medical professional," she said.

The Associated Press contributed to this report.

pmcnichol@semissourian.com

388-3646

Reducing the chance of a flu outbreak

• Wash your hands frequently, especially before and after eating, using the restroom or caring for someone who is ill. Use soap and warm water or an alcohol-based cleaner.
• Cover your mouth and nose when you cough or sneeze using the inside of your elbow or a tissue.
• If you use a tissue to block a sneeze, dispose of it immediately and wash your hands.
• Clean surfaces that may hold droplets from a sneeze or cough.
• If you are sick, stay home as much as possible (Swine flu lasts about seven days; officials say to wait one extra day after symptoms stop.)
• Have a plan in case your child is sick or school is closed.
• Business owners should review plans to handling worker shortages.