Saturday, August 22, 2009


After the letter to the STAR editor came out yesterday, this morning, many of my senior patients are asking about the measures that they must take. As you all know, I am a practising cardiologist and all my patients are considered in the " High Risk " group. So, despite the fact that early this morning, I have posted on " Ghost writing ", I thought that I will write a post on A H1N1 prevention.

Basic understanding:
The A H1N1 is a virus that causes this present round of " flu ". " Flu" is a common layman term for influenza. Influenza is an upper respiratory infection due to the flu virus, in this case A H1N1. Upper respiratory tract is that part of our body which includes the nose ( nostrils ), throat, and wind pipe. Should the infection get worse, it may involve also the lower respiratory tract, namely lower bronchus and the lungs ( left, or right or both ). The flu virus is highly contagious and is spread by droplet spread. That means that it is carried in the air, transmitted by persons carrying the virus, upon coughing, sneezing, spitting, ot even breathing. The airdroplets can be so fine that we do not feel it, and yet the virus is there. Anyone within touching distance of the infected host, is at risk of inhaling the droplets with the virus, into our upper respiratory tract, where the virus will fester and multiply. It will reside in the cells of the upper respiratory tract causing the symptoms of fever, sorethroat, cough, running nose, sneezing, etc. Of course, if the host is weak, the virus can overwhelm the host defence mechanisms thereby causing pneumonia and possible death if not treated. The incubation period is about 3-4 days, and once you have recovered, it may take a few days ( a week ) to get rid of all the virus.
It is important to note the presentation of flu can be very varied, depending on the virulence ( strength to cause harm) of the virus and the resistance of the host ( your body's ability to fight infection ). A low viral virulence and a strong host will mean almost no symptoms, or minimal symptoms and a strong virulence and low host body resistance will mean severe flu, which may result in pneumonia and death. The pneumonia ( infection of the lungs ) from flu, in a compromised host, may be viral ( viral pneumonitis ) or secondary bacterial ( means another bacterial has infected the weakened lung, causing the pneumonia ).

How to prevent?:
That's is why, in our strategy, it is important to identify those at risk, or what the minister likes to call the hish risk group. That allows us to try and target our main effort to select out those who need the most attention and management. Of course, every case is imporatnt, but some cases, we must treat early, because they are already weaked by their other condition.
The high risk group will include, anyone with any other chronic condition on drug treatment : example, diabetics, patient with heart disease, patient with strokes, patients with renal failure, patient with chronic lung disease, patients with cancers especially those on chemotherapy, chronic rheumatoid arthritis, etc. The list is probably too long to list down. It would need a textbook. But it is safe to assume that if you have a condition with requires and regular drug therapy, you should consider your self at increase risk.
People in the high risk category, if they have any fever for 48 hrs or more should see a doctor, better their own GP, for assessment. This are the people who may need close monitoring, oseltamivir early or antibiotics early, or they may need to be refered for admission. No harm going early to see your GP. The price to pay for going late is too severe. So go early for consultation. Of course, if you have no fever, don't go simply. At this point in time medical clinics and healthcare facilities, are also sources to pick up A H1N1.

For the general public who are NOT in the high risk category, please observe the following. If you cannot remember all the steps, basically, just keep good personal hygiene. Ok, lets go
1. Know that A H1N1 spread by droplet spread. Close contact of any sort ( within arms length ) with anyone is a danger because, we do not know who is a carrier of the virus. So avoid crowded places, unless you really have to, no choice. This would include all forms of public transport, buses, trains, airplanes, lifts, crowded shops, pasar malams, clinics and hospitals, large scale gatherings and events.
2. Wearing a mask helps but does not guaranteer against picking up the virus. It may reduce the infecting dose and give you a milder infection, but it does not avoid it all together. People wearing mask can still get the infection. It helps a little. There is minimal difference between the various brands of mask, which cost various amounts of cash. It may be wiser to change any mask that is wet, or well used.
3. Change your clothes whenever you come in from public places.
4. Clean your hands and areas of your body in contact which public objects during your visit outside and also upon your return home.
5. Drink plenty of fluids.
6. If you have flu or flu-like symptoms, stay at home, drink plenty of fluids, and rest. If the fever does not improve in 48hours, see a doctor.
7. If your fever also causes you to cough severely, resulting in breathlessness, please see a doctors urgently.
8. All flu at this point in time, should be treated as if it is A H1N1. Swab or no swab, makes little difference. Getting you well is the most important.
9. Do not cough or sneeze in public places, if you can help it. If you cant, cover your mouth and nostrils with a piece of paper or tissue and throw the paper / tissue away, once you are done. Handkies are not so hygienic. Of course, do not spit.
10. Do not panic, if you have fever. 99.98% of patients recover. The fatality rate is 0.01% at the moment.
11. Take care of your body at all times. Do not abuse your body.
12. When in doubt seek medical advice.

Please keep good personal hygiene. Keep yourself healthy so that your body resistance is strong. God help us, and see us through this crisis.

1 comment:

Edward said...

You may be able to stay clean and sober for periods of time, but without a medical detox program and drug addiction treatment, you cannot hope to stay away from drugs and alcohol forever.