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Life in the Medical Trenches
(H1N1 Pandemic)

By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.

Article printed in the November 21-22, 2009 issue of The Mississauga News
under the feature: Health, Wellness & Beauty, Medicine Matters.
Dr. Peter W Kujtan

Remembrance Day got me thinking. One of my favorite war movies is Patton. It portrays a successful but ostracized U.S. General who was a dogged commander in World War II Europe. His success lay in his courage to visit the front lines under fire to plan and revise strategy first hand. As I sit on the front line trenches of this pandemic, I anxiously await the sight of any health care general. I would settle for a few good privates. No such luck! I thought it may help to share my view of the pandemic from the front lines of this year's influenza battle.

Our approach has not changed in years. It is the same virus with a new disguise as always. The influenza viruses need our lung cells to reproduce themselves, as they always have. In doing so, they create a bit of a mess, much like a teenager's room. Within a few days, its new progeny go on their merry way with a little help from our cough reflex, and the immune cleaning crew takes care of the rest. Viruses are tiny bits of particles that cannot exist on their own. When hosts are harmed, it is unexpected and not pre-planned. Your body is left with the task of cleaning up that messy lung space, and you cough during this time. Your body is really adept at mounting a counter attack by your immune system to eliminate the virus, and to remember what it looks like. The interesting thing is that the virus changes its complexion so that it can be allowed to re-enter next year. Vaccines are designed to recognize surface features in a given year. Their changing nature is what makes eliminating the influenza viruses difficult. Death is rare but tragic when it involves young people.

I work in a small medical building with about 30 primary care physicians, numerous other health providers, and visited by over 1500 people daily. They are all working hard and diligently to offer vaccination and assess the sick. As a group, it is estimated that on some days we are seeing more than a hundred cases of H1N1. It is afflicting mostly the young, and parents are terrified to learn that their children may have it, despite assurances of relative mildness. They have been primed by the media frenzy of unqualified voices spewing fear, and come to seek advice hoping that it is anything but. Surprisingly, it suggests that primary care physicians are seeing more cases than most hospitals and doing a difficult but admirable job. The long hours are taking their toll on all members of the health care team. Large medical buildings, clinics and emergency departments are at the center of many of these battles.

So what have we learned in the trenches so far? This year's influenza is very infectious with sudden onset, especially amongst young people. But, in general, it is milder than other years and the worst is over in a few days. Even though most people do fine, the large number of infected individuals means more people in total with rare side effects will emerge. This virus goes a little deeper in the lungs, and we see a lot of patients with nausea or loose stools. I have guns, but no bullets. I have grenades, but no grenade launchers. 2000 wallet cards showed up, along with some goggles. Still figuring that one out? More vaccine is on its way, but the 10 days it takes for immunity to occur means a lot of people are getting the flu despite the shot. It is not a failure of the vaccine. All the misinformation is frustrating but understandable. Confusion creates fear. There is a ban on testing non-hospitalized patients. Rapid tests which can help diagnose in minutes are nowhere to be found in the trenches. Blood tests for immunity are also discouraged. Some physicians are not willing to make the diagnosis without a laboratory crutch to help them. It is like having radar but being told it's too expensive to use.

TAMIFLU is an anti-viral medication, which does not destroy the virus or prevent infection. It simply helps to impede viral replication, but takes almost 72 hours to do this, which is way after most people's immune systems have already done the job. Yet, many people with mild diseases end up with the medication, purely to avoid legal repercussions. The danger is that we will force the virus to self select resistance to a currently useful medication. Hospitalized patients get TAMIFLU since their illness is ongoing.

As far as precautions go, my advice is to make changes permanent. The fear has sports participants treating each other like lepers. There is nothing wrong with shaking someone's hand, and then washing. The virus can exist on your skin, but cannot infect through it. Avoid watching the news, it focuses on the interesting and unusual since the norm is rather boring. It looks like in the end nature will take its course and may save us from ourselves! See you in the trenches.

Related resources:

Pandemic (H1N1) 2009 from World Health Organization (WHO).

2009 flu pandemic from Wikipedia, the free encyclopedia. The 2009 flu pandemic, or swine flu, is a global outbreak of a new strain of influenza A virus subtype H1N1, a type of swine influenza, that was first detected in March and April 2009. The outbreak began in Veracruz, Mexico ...

TAMIFLU: Flu Treatment and Flu Prevention.

Flu Symptoms.

Flu Tracker. Track the Flu in Your Area. Find out if the flu is in your area, and if so, how severe it is. Requires 5-digit ZIP code.

How to Avoid HINI FLU Pandemic Panic by hazelknows.

Roots of H1N1 swine flu pandemic lie in factory farming by Debra Probert.

CDC: 'Beginning to See Some Declines in Swine Flu'.

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