Line Up for Flu Shots!

All university students who shadow at a clinical site should strongly consider getting immunized for both H1N1 and seasonal flu as soon as the vaccine becomes available, if it is not already mandated for you. In New York State all healthcare workers are being mandated to get both vaccines for seasonal flu and H1N1. This includes physicians, nurses, social workers, laboratory technicians, housekeeping, security/transportation services, construction workers, and even hospital volunteers. Technically, even construction workers and food vendors need to get vaccinated now. Thus far, New York State is the only state to have passed this mandate. Earlier this week, nurse union leaders led demonstrations in Washington D.C., claiming that this mandate is unethical.

The Centers for Disease Control expects half the U.S. population to become infected with H1N1 this flu season. A glimpse in the upcoming flu season can be achieved by looking at our neighbors in the southern hemisphere, who have their flu season during the months of June-August. Sample epidemiological studies in Australia, New Zealand, Brazil and Argentina have reported that more than 90 percent of the influenza cases are now due to H1N1, indicating that there are much more viral copies of H1N1 being transmitted as compared to seasonal flu. A NEJM study, using ferrets as animal models, found that H1N1 is more transmissible than seasonal flu and uses a larger surface area to replicate (using both upper and lower airways) as compared to seasonal flu (which is usually confined to the upper airways). On a positive note, through DNA analysis, viral epidemiologists can tell that the virus has not changed much since last spring, boosting chances that a vaccine against H1N1 will work everywhere. Although the majority of cases will continue to be mild, since there will be more people becoming infected with H1N1 this year there will also be more cases of severe H1N1 infection leading to death. An important difference between seasonal flu and H1N1 is that although the vast majority of H1N1 cases are mild, H1N1 can infect and even cause death in healthy young adults, which is not usually the case in seasonal flu (a leading cause of death in elderly populations). In fact, the healthy elderly population has a lower chance of contracting H1N1 than unprimed younger adults and children. Of these previously healthy young adults who become hospitalized because of H1N1, it is difficult to predict which will go into respiratory arrest. Many of these cases have gone into respiratory arrest within days of being hospitalized and have become unfortunate examples on the importance of taking precautions against H1N1 seriously.

The media did such a good of a job covering H1N1 last spring that some people were preparing for a situation like Stephen King’s The Stand and when that did not become realized many reacted by not taking precautions against H1N1 made by public health officials seriously. Authorities are now working closely with the media to make sure that appropriate messages get out. The basics, which should be reflex for everybody now, should be cover your cough with your elbow (not your hands), sanitize your hands frequently and keep them away from your face especially in public areas. If you develop a fever and cough stay home for at least 24 hours after resolution of your symptoms (some public health officials argue for as long as a week). Physicians are advised to not prescribe Tamiflu unless you have been hospitalized for more than 48 hours or have an underlying medical condition (age greater-than-2 or less-than-65 years, pregnancy, COPD, Emphysema, Cystic Fibrosis, Asthma, Chronic Cardiac Disease, Chronic Renal Disease, Chronic Immunosuppression, Recent Cancer, Diabetes, Sickle Cell Anemia, Neuromuscular Conditions, HIV). Since Tamiflu will not be readily available, I advise people to take preventative measures seriously. Everyone should try to get vaccinated for seasonal flu and if indicated for H1N1 as well, especially you premeders out there who may be shadowing at a clinic or a hospital.

Do not go to the emergency department if you have influenza-like-illness symptoms (fever and cough), go to your outpatient healthcare provider first. You will just overwhelm the emergency department and make it more difficult to treat patients who seriously need medical attention. Last spring, hospitals everywhere became overwhelmed with a surge of patients, most of which were the “worried well,” crowding the Emergency Departments. Emergency Departments were forced to become creative and resort to setting up triage stations and medical screening sites in non-clinical spaces, like waiting rooms and outdoor courtyards. Space within the emergency room needs to be reserved for critically ill patients, who may already be immunocompromised. Also, pregnant patients who present to the ED need to be kept isolated from people with possible H1N1, especially since there is a known increase in mortality in pregnant women. Unless you have a severe case of H1N1 (high fever, impending respiratory compromise), have an underlying medical condition, or are a hospital employee then you have nothing to gain in the ED except for long wait times and spreading your disease to others.

Cynthia Santos is a medical student at Weill Cornell Medical College and the Emergency Preparedness & Disaster Prevention Research Fellow for NewYork-Presbyterian Hospital. What’s Up, Doc?, a column featuring a rotating cast of medical students, appears alternate Fridays this semester. She may be reached at doc2011@med.cornell.edu [5].