Donya Currie is the editor of The Free Lance-Star's Healthy Life section and Healthy Life Virginia newsletter.

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Expert advice on swine flu

You may recognize Dr. Christopher Lillis’ name from his monthly column in Healthy Living. What you may not know is that Dr. Lillis, along with being a doctor at Chancellor Internal Medicine, is a biological expert on the National Medical Response Team (which is the proper name for the D.C. area’s "When really bad things happen" mass casualty team). Lillis wrote a swine flu briefing for his team Sunday afternoon, and I’m posting much of it below for people who want to know more about it.

Perhaps the juiciest part, from a "how worried should I be?" perspective, is near the end, so skip ahead to the part I’ve italicized if you really want to know if it’s time to panic; the more clinical stuff is at the beginning. See for yourself:

 The “swine flu” is a H1N1 strain of influenza A virus that is a new subtype not previously detected in humans.  At this early stage of investigation, it appears to have mutated from its endemic swine form into a virus that is spread from human to human.  The virus is spread through respiratory droplets, therefore wearing a respiratory mask can prevent transmission as well as thorough hand washing.  Individuals with possible exposures are encouraged to stay home from work and avoid close contact with others.  It is not yet known how easily transmissible this new H1N1 strain is.

Clinicians need to consider H1N1 influenza when seeing a patient with a febrile upper respiratory illness who live in an area where other cases have been identified, or have travelled to an area where human cases have been identified.  In Virginia, local Health Departments are tasked with arranging specimen testing through DCLS (Department of Consolidated Laboratory Services).   Individual clinicians can collect respiratory swabs for refrigeration.  Contact your local Virginia health department by calling 866-531-3068.

Influenza basics:  The H refers to the hemagglutanin protein while the N refers to the neuraminidase protein.   The hemagglutanin protein allows for the influenza virus entry into red blood cells, while the neuraminidase protein stimulates the production of more mucous in the human host.  To prevent infection, a human must be immune to the specific hemagglutanin protein on the virus surface.  The influenza virus mutates quickly, even after human infection, thus leaving the influenza vaccines only incompletely effective.  The H1N1 has mutated into various strains, can be endemic in swine and birds, but once the virus mutates to cause infections in humans it can be quite devastating.  The Spanish Flu pandemic of 1918-1919 that killed between 50-100 million people worldwide was an H1N1 influenza A virus.   A strain that has recently mutated is the most dangerous, as the human host will have little immunity to a yet unseen strain of virus.


In my best estimation, given the information at hand thusfar, the H1N1 influenza A virus has little potential to cause a mass casualty event, while it will likely cause an influx of patients into emergency rooms, clinics and private practices.  Encourage calm among worried family, friends and professional contacts while the investigation is ongoing, and emphasize hand washing, avoiding close contact with sick individuals, “self-quarantining” behaviors (staying home from school or work when sick) and testing for individuals who meet the case definition:

·       Fever >100 F + Cough/sore throat

·       Traveled to San Diego, CA; Imperial County, CA; New York City; Guadeloupe County, TX; Mexico City



This is Janet again– thanks to Dr. Lillis for permission to print this. For those who are nervous about this, perhaps the best thing you can do is head to the sink, and give your hands a good scrub.