(September 2009)
Swine Flu - Nothing to fear but fear itself?
Much like a spoilt child, swine flu has been the centre of media attention for the past few months. Its persistent hogging of the spotlight has frightened, bored and irked across the board in equal measure. Supporters of the latter view would see it as detracting from more important issues such as the pharmacy dispute, the dubiousness surrounding the governments attempt to tax us out of the recession and of course the introduction of printing fees for students of University College Cork (yes that’s right, it was sneakily announced during the summer).
Swine flu or the H1N1 influenza strain as it is more formally known, was first detected in humans during April and has since gone on to spread from person to person, prompting the World Health Organisation to declare in June that a global influenza pandemic was underway. As of September the 1st, estimates ranged from 750- 1500 confirmed Irish cases, though, as with most diseases, the true figure is nearly always higher. 80% of these cases were in those under 35 years of age, meaning children and young adults appear to be the most vulnerable. Thankfully only 2 deaths have occurred on these shores at the time of writing. One of these deaths occurred in someone with underlying health problems, and it is unknown whether the second individual had similar problems. The global death toll currently stands at over 2500 deaths with in excess of 250,000 infections detected.
Putting this in perspective, many would be surprised to learn that seasonal flu - a plague we all have become so accustomed to enduring a bout of once a year - actually causes severe illness in 3-5 million per year and kills 250,000-500,000 globally, albeit mostly those over 65 years in first world countries. Yet it rarely raises any eyebrows in the media and by default the general public. Is this because it is seen as a matter of course, an event that happens annually and is therefore devoid of sensationalism and newsworthiness? Swine flu on the other hand - for want of better descriptors – is sexy and unpredictable in news terms. Here is an illness that arrived out of nowhere, that isn’t coy when it comes to courting the young and healthy, and likes to keep us waiting as to whether its eventual path will be our swansong or its own.
The question of course on the tip of everyone’s tongue is where do we hedge our bets? A global audience waits with baited breath as winter approaches, bringing millions into closer contact than normal for a period of three to four months. Of particular concern in Ireland is the return of school children to a new academic year, where some believe the strain will run rampant. There are three main camps it seems. The first argues that the ever increasing hysteria as the colder months approaches is unnecessary hype and simply scare mongering – a ploy to boost newspaper sales and sell-out stocks of Vitamin C. The second camp likens the current strain as following the path of a distant cousin, the Spanish Flu pandemic of 1918, which was estimated to have killed over 50 million and infected 500 million, aided by its genetic lethality and mass troop movement during World War I. As battle weary soldiers returned to grateful families, they brought with them an invisible yet highly potent enemy, one that seemed to mainly attack the young and healthy. The pattern was that it came in waves, starting off relatively mildly, and then dying down for a number of months before coming back with a vengeance as winter approached.
Of course this will draw parallels to the current pandemic and the citizens who vehemently fight this corner range from the pessimistic to downright adamant that swine flu signals our certain doom.
The third camp is one that Dr. Michael Byrne, Head of UCC Student Health Services, falls into, and he is keeping a cool head when others are feverish with negativity. “We must put this threat into perspective. The good news is that people should be reassured that it does appear to be a mild illness for those who contract it. People are recovering at least as quickly as with the normal seasonal flu, and in many cases quicker, so that’s the first thing – keep a sense of perspective and be reassured.”
This is a view echoed by USI Welfare Officer Ciaran Fitzpatrick, who points out that “There is going to be an increased risk when you have people coming from all different parts of the country, and we've set up a protocol between ourselves and all our member unions of what to be prepared for.” While he feels that the situation presents a unique challenge, Mr. Fitzpatrick is encouraged that “colleges are being very proactive rather than reactive which is absolutely fantastic to see - there is not going to be anyone left out who doesn’t know who to deal with it and what advice to give people.” In addition to this, he highlights that “Every college across the country has a pandemic response team and they're going to be responsible for monitoring the situation in each of the colleges.”
Dr. Byrne maintains that the best defence is “make sure you cover a cough with a tissue and dispose of a tissue after single use as quickly as you can (though this does not extend to escaping from your lectures), followed by washing your hands thoroughly. Traditions and etiquette around coughing and sneezing and dare I say even spitting have evolved - we need to develop a concern for others around coughing and sneezing – cough it, dispose it and wash your hands afterwards … Soap and water is at least as effective as and probably marginally more effective than alcohol gels.” He adds that UCC health staff do intend to distribute a limited amount of alcohol gel packs at the entrances to some of the main buildings on campus, in part to raise awareness of hand hygiene – however the most critical advice for the more mobile students (particularly for those who might change lecture hall as much as once an hour) is rigorous hand washing.
It is likely a vaccine will become available by late autumn or early winter, and Dr. Byrne outlines that an immunisation program on campus is planned that will target high-risk groups firstly, which will include both students and staff, including healthcare workers and those who have chronic illnesses. Mr. Fitzpatrick highlights that “vaccination is something (all) college authorities will have to look into. I’ve been speaking to the HSE about this at the moment, who have informed us that when the vaccinations come onboard they’ll have to do tests in each part of the country with small parts of the population to determine the effects they have on them.
Frontline healthcare professionals will be vaccinated first of all. It will be up to the individual colleges then to make a decision.” Staff at UCC’s Health Centre are already working on a system that will allow students and staff who believe they fall under the high-risk category to notify student health services. Students’ family GP is another alternative that will offer the vaccine. Once these groups are covered, it is envisaged that it will be offered on campus to the whole student body in cooperation with the HSE. Whether or not students will decide to take the globally fast-tracked vaccine is a different matter however.
Despite the common misperception that Tamiflu – an antiviral drug that is somewhat effective against various influenza strains – is the best treatment for those infected, Dr. Byrne highlights that “it is only likely to be used when someone is significantly ill, in potentially 5% of cases.” For the overwhelming majority of sufferers, keeping hydrated, along with bed rest, paracetamol and isolation is the only necessary treatment. “This is an illness is in the vast majority of cases that can be and should be self-managed … the fever will be over in 2-3 days … It’s an illness that’s going to be so common its one you’ll be able to diagnose yourself.”
The exceptions to this include those who are pregnant; those over 65 years of age or children; the immunocompromised or those have a chronic illness requiring medication, such as asthma, heart disease or cystic fibrosis. A fever that persists beyond 4 days, or symptoms that return or worsen to coughing up blood, also means you should make contact with the health services. The same can be said for symptoms that don’t respond to paracetamol such as chest pain or headache. For generally healthy students however, you’ll feel ill and quite exhausted but should be able to self-manage your condition with ease.
Mr. Fitzpatrick adds that it mostly comes down to common sense. “Look out for yourself and if you’re in anyway symptomatic do not ignore it, would be the main advice that we’re trying to get across. You’re better to err on the side of caution and contact the HSE who will be able to tell you straight off by listing your symptoms whether you could be potentially at risk. Chances are it could be just a cold but you don’t want to swamp the GP services either, ringing the contact number is the best advice.” Dr. Byrne advises that if you suspect or are confirmed as infected, you should isolate yourself in your own room if possible and, preferably, the family home, so that you can draw on the support of relatives, who should collect you from UCC if possible.
If students are travelling on public transport, then “they need to be mindful of other people on the couch or train and try and sit a metre away from anyone else, and if they are coughing, cover it.” Obviously this will not be suitable advice for all, but will apply to most Munster based students. “The one group of people we advise not to travel are those who have to fly. We’re not saying for international students to fly home, it’s illogical and would put other people at risk.”
We as students have a legitimate right to be concerned. UCC is home to more than 16,000 students and several thousand staff. 70% of those infected so far have been those under 30, the main age profile of students. This in combination with the close proximity we all undergo (the less academic amongst us might say endure) each day makes following the infection control steps outlined above pivotal. Dr. Byrne also rather deftly points out that “As a race, we are given to … enthusiastically embracing each other and it may be just reasonable, particularly if you are coughing or sneezing, to exercise caution!” This may make Freshers' Week less enjoyable but is a necessary evil if you suspect you are infected.
Bizarrely, such is the unease surrounding the disease that it has prompted the emergence of “swine flu parties” in both the US and the UK, whereby friends of an infected person with a mild strain of swine flu keep in close contact with the individual in order to become ill. The hope is that a mild infection will provide protection at a later stage if the strain evolves or mutates, though this of course ignores the fact that the illness will affect everyone differently. Needless to say, no sane medical practitioner recommends this, though that may not be enough to deter the more enterprising (unscrupulous) UCC student from marketing the idea, with the spoils from entrance fees in mind to be gleaned. Be forewarned.
Coming back to the issue of scare mongering, Dr. Byrne comments that the HSE are performing well – “They’ve given a balanced message, the information they have realised has been appropriate and not alarmist. On a whole the Irish media have been balanced – it is a story of major importance and does need to be covered.” In comparison to the more developed situation in the UK (where just under 14,000 cases have been diagnosed along with 66 deaths), he highlights that early media coverage generated panic, but that people gradually became less anxious as they become used to the terminology. It is also however important not to become complacent. Rather a balance is required “like the swan on the water – calm on the surface but paddling furiously underneath.”
Do we fear the flu? It appears we fear the hype more than the flu! If we all follow the above advice, then those infected should be kept at or below 1 in 4, which is vital in order to avoid overburdening the health service. This may seem quite high, but it should be remembered that rather than at any one time, this figure represents the entire length of the pandemic, currently estimated to last 15-20 weeks.
While it is inevitable that Ireland will suffer in this strain of influenza’s wake, the words of the doomsday sayers should be taken with a pinch of salt and a dose of reality.
For further information see:
UCC’s page on swine flu, including a screencast on how to protect yourself and others http://www.ucc.ie/en/flu/
HSE 24 Hour Flu Information Line: (Freephone) 1800 94 11 00
Images: FreeDigitalPhotos.net
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