H1N1 Fears Reach Close to Home

What is H1N1 and why is it called the “swine flu?”
H1N1 is a newly discovered influenza virus strain first found in people in the United States in April 2009. This virus is also called “swine flu” because initial investigation showed that many of the genes in this virus are similar to influenza viruses that normally occur in pigs (swine) in North America. Subsequent studies have found that H1N1 has two genes from flu viruses that normally circulate in pigs in Europe and Asia. This virus is spreading from person-to-person worldwide, much like the annual seasonal influenza virus. On June 11, 2009, the World Health Organization (WHO) garnered much public attention when it declared that a pandemic of H1N1 flu was underway. A pandemic refers to “an epidemic over a wide geographical area,” so don’t be alarmed; much like the seasonal flu, which makes its way through the population, H1N1 will likely do the same. Physicians will tell you-there is no reason for panic!

How is H1N1 different from the seasonal “flu?”
H1N1 appears to be more easily transmissible from person to person. However, the severity of H1N1 infections appears to be milder than the seasonal flu, especially among individuals aged 25 and older. So far, the number of deaths due to H1N1 in individuals aged 64 and older is actually lower when compared to the seasonal flu. Pregnant women and individuals with high-risk chronic medical conditions (like immunosuppression) may be at an increased risk of complications from H1N1.

REMEMBER: Every year, the seasonal flu kills on average 36,000 people and more than 200,000 are hospitalized. More than 90% of these deaths are in people older than 65.

How does H1N1 Spread?
Much like the seasonal flu, H1N1 is spread person to person by inhaling viral particles from the coughs and sneezes of people infected with influenza. You can also become infected by touching something-such as a handrail or book cover-with flu virus on it and then touching your mouth or nose.

Symptoms of the flu
The symptoms of H1N1 flu virus are identical
to the seasonal flu:
– Fever (temperature>101 degrees F)
– Cough
– Sore throat
– Runny or stuffy nose
– Body aches
– Headache
– Chills
– Fatigue
– Vomiting (in some individuals)
– Diarrhea (in some individuals)

Prevention: What can I do to Lower my Risk?
(1) Limit touching your mouth or eyes to after washing your hands
Since flu virus can remain on table surfaces, handles, doorknobs, and railings,
touch your mouth and eyes only after washing your hands. If you must rub your eyes or wipe your mouth, use the back of your hand or forearm since these do not come into contact with publicly used surfaces.

(2) Eat a well-balanced diet, get enough sleep; consider citrus fruits
Just like your mother always told you, eating a well-balanced diet with fruits and vegetables and getting enough sleep each night helps strengthen your immune system and improves your chances of avoiding the flu. Eating fruits and vegetables not only provides you with essential nutrients and anti-oxidants, but also many fruits (including citrus fruits) have Vitamin C, a potent agent in helping bolster immunity. Having been on the hospital wards at the height of cold and flu season, I swear by a grapefruit a day to help reduce the chance of catching a bug.

(3) Hand washing (the proper technique)
How many times have we heard “wash your hands!” Hand washing during flu season is a must, but make sure you use proper hand washing techniques. Putting your hands under running water for three seconds or rubbing some alcohol-solution on your palms is NOT enough; proper hand-washing includes cleaning in between your fingers, the backs of your hand, and under your nails.

What about antibacterial hand-wash?
Since viruses (like H1N1) are not bacteria and are therefore not living organisms, antibacterial hand sanitizers are of limited value in warding off infection. If you are not able to wash with soap and water and only have hand sanitizer available, make sure you use thorough hand scrubbing techniques. Alcohol-based solutions can have some use depending upon the amount of solution and length of time used. In general, my advice is to use old-fashioned soap and water.

Please see the image on proper hand-washing for more specifics.

(4) Caring for someone with H1N1
Given the ease with which H1N1 is transmitted, close caregivers should consider using an N95-Respirator mask, which is a disposable face mask that is highly effective in trapping small particles. Your local drug store (CVS, Rite Aid, etc) or retail store (Target, Wal-Mart, etc) typically carries these masks. For more information on which masks have been approved by the Centers for Disease Control and Prevention (CDC) please visit: //www.cdc.gov/niosh/npptl/topics/respirators/disp_part/n95list1.html

(5) Vaccines
The seasonal flu vaccine will not protect against H1N1 but you should still get it (to protect yourself against the other flu virus strains that are common during the winter months!). Making vaccine for H1N1 is a multi-step process and will take several months, since the CDC has only recently isolated the new H1N1 strain. The CDC is planning to have an H1N1 vaccine available late this fall.

My advice: get the seasonal flu vaccine NOW-it is foolish to wait for the H1N1 vaccine to be released since flu season has already started. You can always get an additional vaccination for H1N1 when the vaccine comes out.

How can I be exposed to H1N1?
Viral particles can be spread when a person touches a surface that is contaminated (such as a door handle, railing, or tabletop) and then touches his or her eyes, nose, or mouth. Droplets from a cough or sneeze of an infected person move through the air and can be inhaled.

People infected with seasonal and 2009 H1N1 flu shed virus and may be able to infect others from 1 day before getting sick to 5 to 7 days after. This can be longer in some people, especially people with weakened immune systems. Try to keep at least 3 feet in between you and someone who is sneezing/coughing, especially when riding public transportation or in other crowded locations.

Getting H1N1: What should I do if I get infected?
(1) Rest, stay away from others
The most effective treatment for the flu is to stay at home, rest, and drink lots of water and orange juice. If you have the flu, stay away from others; since H1N1 is highly transmissible, do not attend class if you have the flu and try to avoid public places. Cover your sneezes and coughs with the crook of your arm (see picture) to avoid contaminating your hands (and then touching handles and other surfaces).

(2) Antivirals
There are two antivirals that are used for the treatment of influenza (oseltamivir and zanamivir), but these two agents are typically prescribed to those with severe influenza illness or high risk of death from influenza (like elderly, hospitalized patients or patients with severe immunodeficiency). For the rest of us, these antivirals will not “cure” our flu; they will make the illness a bit milder and may alleviate symptoms faster.

(3) Should I see my doctor when I get symptoms of the flu?
This is a difficult question to answer without knowing your medical history and risk for complications from the flu. Assuming you are not in the high-risk category (i.e., have no chronic illnesses, are not pregnant, and are otherwise healthy), most cases of the flu do not require immediate medical attention. However, there are some symptoms that require immediate medical attention:

-Difficulty breathing or shortness of breath
-Pain or pressure in the chest or abdomen
-Sudden dizziness
-Severe or persistent vomiting
-Flu-like symptoms that improve but then return with a fever and worse cough

What is HBS doing?
(1) Flu Vaccine
Get your flu shot! Seasonal flu clinics will be held in the Meredith Room of the Spangler Center on the following days-make sure you bring your Harvard ID!

-Wednesday, 9/30 from 2:00-5:30 p.m.
-Tuesday, 10/13 from 2:00-5:00 p.m.
For more information, visit: //huhs.harvard.edu

(2) Additional Resources
If you have questions related to flu-like symptoms, please contact your physician. If you have questions related to HBS’ actions during flu season, please email hbsfluquestions@hbs.edu or visit //huhs.harvard.edu for more information.

(3) Other Steps
In anticipation of flu season, HBS has already undertaken several actions:

-Added more antibacterial hand sanitizers in high traffic areas of campus
-Propped open doors (to avoid the need to use door handles)
-Increased cleaning efforts in common and high traffic areas
-Made changes in the way food is delivered and served

HBS administrators are asking MBA students who are ill with flu-like symptoms to use the student absence tracking tool and select the “personal illness-flu-like symptoms” code. The tracking tool will help HBS monitor the spread of influenza.

Announcements will be made throughout the flu season; please visit the myHBS platform for additional news.

Wishing you a healthy fall and winter!

Maya is a joint MD/MBA student currently completing medical school rotations at Massachusetts General Hospital. She plans to pursue residency in neurosurgery.