My Perspective on the 2009 H1N1 Influenza A Virus

Over the past several months, the federal government has thrown resources into tracking, studying and developing a vaccine for the 2009 H1N1 influenza A virus (H1N1/09). The media has reported a drumbeat of stories about the virus, its spread and deaths worldwide. Here in the U.S., the federal government had announced that a vaccine for this virus would be available en masse early in the flu season. Unfortunately, the development and deployment of the vaccine was delayed--a classic situation of overpromising and underdelivering. In the meantime, the steady stream of scary news about the impending H1N1/09 flu pandemic has filled most Americans with worry. Vaccine supplies remain scarce, implementation plans have been uneven, and now people are more scared than informed.

While it is understandable that people are concerned about the H1N1/09 flu virus, I think many Americans are overreacting based on media reports of illnesses and deaths, and not acting rationally on information. The seasonal flu (yeah, that's the flu we are all exposed to every year), infects between 15 million and 60 million, hospitalizes over 200,000 and kills almost 40,000 Americans every year. The H1N1/09 is forecast to infect up to 150 million, hospitalize up to 2 million and cause between 30,000 to 90,000 deaths in the U.S. Based on these numbers, it's reasonable to conclude that the H1N1 is more contagious but has a lower mortality rate than seasonal flu. It is almost a certainty that more people are going to suffer the flu this season, but even with the higher infection rate, it is also possible that same or even fewer people will die from the flu this season.

Yet, in talking with many friends and coworkers, the perception is that the H1N1/09 is like getting small pox or anthrax. Many people are deathly afraid of this pandemic. When told that my kids had it, they try to avoid me at all costs--in case I am a carrier! Most of these same folks however don't get the seasonal flu vaccine and seem to think that the "regular' flu is just like a bad cold.

From everything I've read, the two main differences with H1N1/09 are: (1) it's far more contagious and (2) it negatively affects primarily the young, pregnant women and people with chronic medical conditions. The seasonal flu more negatively affects seniors and people with chronic medical conditions. The H1N1/09 conversely saves its most serious side effects for the young, who have strong, but virgin (to the flu) immune systems.

Parents with children, pregnant women and other high risk people understandably have real concerns. With the flu season well underway already in the U.S., is the long delayed and still scant supply of the H1N1/09 vaccine too late to do much good? Children under 9 years of age, for example, need two doses of vaccine at least four weeks apart, so they wouldn't have immunity for about a month from the start of their vaccination. With many schools in this country already reporting 10%, 15% or higher absentee rates due to the growing H1N1/09 pandemic, is it already too little, too late to vaccinate many of our most at-risk population? In addition, what about safety concerns and other unknowns about a new and "rushed to market" vaccine?

My own kids had the H1N1/09 flu last week. To be quite frank, it wasn't a big deal at all in our case. Our daughter was lethargic with a fever for several days, and had a mild cough. Except for a short fever, small cough and a sore throat, most people wouldn't even know my son was sick by the way he still ran around the house.

Part of me is glad that our kids are already done with the H1N1/09. One of the biggest concerns with any influenza virus is that it can mutate and become potentially more virulent. This is the reason why scientists are constantly battling and reformulating flu vaccines. H1N1/09 could actually become more virulent and lethal as the season progresses.

The treatment for H1N1/09 is the same as for any other flu: rest, fluids and either acetaminophen or ibuprofen to reduce fever. Anti-virals may be leveraged for certain high-risk individuals. As with any flu, you need to be diligent about secondary infections and should seek emergency medical care if you experience respiratory and other complications.

So the H1N1/09 flu is really just another flu for which there is no need for undue concern or panic. For this season, I conclude:
(1) You are far likely to get the flu--most probably the H1N1/09
(2) For most, the symptoms will be milder than the seasonal flu
(3) More children and young people will die due to H1N1/09
(4) Parents with kids and young people must be extra diligent about secondary infections and respiratory complications
(5) It's probably better to get the flu earlier than later
(6) Get your season flu vaccine!

The Right Way to Treat Scrapes and Abrasions

A few years back, I got several large abrasions as a result of a motor vehicle accident. With plenty of free time laying around on the sofa, I researched the right way to dress abrasions. Note, this post applies only to abrasions (superficial, surface injuries to the skin) and not to lacerations which are deep cuts that may require stiches or other professional medical intervention. Remember the first priority is always to stop the bleeding.

What most people still don't know is that the "state of the art" in wound treatment has moved beyond what our parents taught us. Research has shown that antiseptic rinses and topical anti-bacterial ointments such as hydrogen peroxide and Neosporin (just two examples) actually damage skin tissues and inhibit healing. And Band-Aids do not do very much to help as they do not create an anti-bacterial barrier nor the desired moist healing environment for the wound.

Here's the "right" way to dress an abrasion:

1. Stop the bleeding by apply gentle pressure to the wound. Do not let the wound dry out or scab. If you can't stop the bleeding within 15 minutes or so, you should seek immediate medical assistance.

2. Clean the wound thoroughly using soap and water by removing as much dirt and dead skin as possible.

3. Dress the wound using a semipermeable dressing such as 3M's Tegaderm, J&J Bioclusive or similar product. As long as the dressing does not leak exudate (the "ooze"), it can remain in place for up to a week.

The advantages are:

1. Because the wound is not allowed to scab, the optimum, moist healing environment is created. Remember that our blood clots and creates scabs, because there was an evolutionary necessity to stop the bleeding, but modern man can stop abrasions from bleeding by simply applying pressure. Abrasions heal much faster and better in a moist environment (without the scab). Scarring is also reduced.

2. Unlike Band-Aids, the dressings create an anti-bacterial barrier and thus the risks of infection are greatly reduced.

3. The dressings are waterproof so you shower or bathe with them in-place. Thus the need for dressing change and the amount of overall maintenance is significantly reduced.

4. The dressings are flexible so they are more comfortable than alternative of having a scab and traditional bandage. This is especially important if the injury is in a area that moves regularly such as a knee or elbow.

5. The semi-permeable dressings are clear so you can see how the wound is healing, how much exudate, if it is infected, etc.

The problem today is that these semi-permeable dressings are not commonly available in most grocery stores or pharmacies. They're still relatively expensive (more than $1 or $2 per dressing), and Johnson and Johnson still dominates the bandage market with their "Band-Aid" brand bandages. People have become brainwashed with Band-Aids for 20-30 for two bucks (depending on size and shape). Hospitals and medical professionals already know better but hopefully the word will get out to consumers soon!