Flu Fight: Keep It Simple (The Baltimore Sun)
Sick People Should Stay Home If They Can, Wear A Face Mask If They Can’t
“I guess I’ll take my chances.”
I hear this a lot from patients when I fail to convince them about proper management and prevention of H1N1 flu. Why would someone in this day and age think like that? Why, when we have a rapid test to diagnose the flu; when we have two novel antiviral medications; when the Centers for Disease Control and Prevention are providing more timely information than one can read?
Part of the problem is access to treatment. Most Americans don’t have equal access to our arsenal against influenza, and much of that arsenal is imperfect. The results of a “rapid” test for flu take 24 hours in most community settings, and a five-day course of antiviral medication can cost more than $75.
The way information is communicated is an issue too. The plethora of ever-changing CDC recommendations can leave John Q. Public bewildered. For example, one such recommendation is for “employees with influenza-like illness to remain at home until at least 24 hours after they are free of fever (100 UNKNOWN_HIGHBIT_b0 F or greater), or signs of a fever, without the use of fever-reducing medications.”
Perhaps the biggest impediment – and the one no one is talking about – is the cost of managing a suspected case of H1N1 flu. Telling someone to stay home for three to five days is a tough sell in this economy. Think of an average American who has to determine by symptoms whether it’s one of his or her three annual colds or the beginning of the “real deal.” Or who may belong to that ever-increasing pool of 46 million uninsured Americans who are forced to factor in the price tag of diagnosis and treatment in their health care decisions. Or who may be one of 59 million American workers who don’t have a single paid sick day. Or who has to compute the aftermath of staying home for three to five days – though this is the absolute right thing to do – at a time when the boss might be contemplating layoffs.
When a Harvard School of Public Health study asked more than 1,600 adults about the likelihood of losing their job if they stayed home for seven to 10 days, 27 percent of participants responded in the affirmative (and a whopping 47 percent of minority participants). When asked if they would face financial hardship by missing seven to 10 days of work, one in four said yes.
Our current recommendations are too conservative, and our expectations of the average American too impractical. Expecting everyone with a fever to stay six feet away from household members and not go to work in this economy is like expecting that all youths will practice abstinence as the only mode of protection from HIV. It doesn’t work.
Thanks to grants offered by the CDC, new data suggest that wearing a face mask reduces the spread of influenza in household settings, where the exposure is maximum. While you may have seen coworkers standing beside you hacking away and spreading germs, when was the last time you saw a colleague wearing a face mask to work because he or she had a fever or cough? Studies show that 76 percent of the population used face masks in Hong Kong during the SARS scare in 2003, which helped to reduce the number of respiratory infections.
So how do we keep sending a simple yet effective message to millions who are facing such complicated challenges? How do we stay on a constant campaign against a virus that shifts and drifts? And of immediate practical concern: What can you do if you have a flu-like illness but must report to work?
The solution is simple. People with a flu-like illness should stay home as per current guidelines; that’s still the best option. But if you must go to work while symptomatic, be responsible. Wear a face mask. Wash your hands frequently.
The CDC can help by promoting and supporting this behavior. Don’t bury the information at the end of a six-page document titled “Interim Recommendations for Facemask and Respirator Use to Reduce Novel Influenza A (H1N1) Virus Transmission.” Bring it out in the front. Promote “face masks for the symptomatic” via Facebook. Send tweets or go viral on YouTube. Do whatever it takes to help us remove the stigma of wearing a face mask. Better yet, distribute free face masks to everyone with a flu-like illness.
Cover your cough with a mask. Your friends and coworkers will appreciate it.
Dr. Faheem Younus is medical director for healthcare epidemiology and infection prevention at Upper Chesapeake Health in Bel Air, and a clinical assistant professor at the University of Maryland, School of Medicine. His e-mail is dryounus@comcast.net.
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