Swine Flu: Public Health Emergency

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Richard Wenzel
Professor and Chairman, Dept. of Internal Medicine, Medical College of Virginia
Monday, April 27, 2009; 1:00 PM

The World Health Organization reconvened an emergency meeting of a special 15-member panel of experts to advise the agency whether the outbreak of the swine flu virus warrants elevation of the pandemic threat level, which could trigger international travel restrictions and other measures. The committee had planned to meet again tomorrow, but moved up the meeting to grapple with the rapid developments.

President Obama, meanwhile, said his administration was monitoring the situation closely.

"This is obviously a cause for concern and requires a heightened state of alert," Obama said at an appearance at the National Academy of Science. "But it is not a cause for alarm."

Richard Wenzel, professor and chairman of the Dept. of Internal Medicine at the Medical College of Virginia, was online Monday, April 27, at 1 p.m. ET to discuss the latest information about the swine flu, including its transmission and preparations the medical community is making to combat the virus.

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Richard Wenzel: Welcome, Richard Wenzel here to take your questions today.

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Nashville, Tenn.: How long does a flu pandemic usually last?

Richard Wenzel: In general it is unpredictable, but can last for several months to a year.

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Princeton, N.J.: My husband had fever and sore throat from last Thursday. Now the fever is down after three days, but sore throat and yellow mucous still bothers him. Should we worry about this being swine flu?

Richard Wenzel: This is probably not influenza since there was no cough, or muscle aches. If symptoms persist, please have him see a physician.

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Herndon, Va.: Dear Dr. Wenzel,

How can a mask prevent the virus from entering our body? Can't they sneak through the pores of the mask fabric? Are we just bettering our odds against a infection?

Thanks for your time.

Richard Wenzel: In a study during SARS outbreak in China, masks appeared to be protective, however you are correct, there has to be a tight fit of the mask around the face. Currently, we would recommend N-95 masks if this disease progresses in the US.

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Potomac, Md. : How do I know if my kids have the swine flu or just a cold? They both have sore throats, fevers, coughs.

Richard Wenzel: Children or adults with fever and muscle aches and cough with or without diarrhea and vomiting should today be tested for influenza in light of the growing numbers of swine flu patients being identified in the US.

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Tampa Bay, Fla.: Could you talk a little about recognizing the difference between a cold and a flu. Is fever the key factor? What about runny nose?

Richard Wenzel: Fever and cough are very distinguishing features of influenza. A running nose by itself is more likely a common cold virus, rhinovirus.

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Washington D.C.: Any ideas as to why this disease only appears to be fatal in Mexico?

Richard Wenzel: Interesting question, since the virus seems to be the same in both the US and Mexico. Therefore, we have to look at the host: possibilities include some protective cross reacting antibodies in US patients that are not present in Mexican patients, possible the air pollution in Mexico City that damages the airways, and possibility malnutrition in some patients in Mexico. However, the bottom line is that we do not know.

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Anonymous: North Potomac, Md. We are flying to Albany, N.Y. later this week. Should we wear surgical masks on the plane? Thanks

Richard Wenzel: At this point it is probably not necessary. Large planes such as 758s have laminar airflow (ceiling to floor) which offers additional protection. However, if possible, I would move away from someone with any obvious respiratory infection.

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Richmond, Va.: I have a toddler who sucks her thumb/fingers. How do I keep her "germ free" at a playground -- esp. in light of swine flu. Would a baby wipe be effective until we're able to get to a place to wash her hands?

Richard Wenzel: In general alcohol wipes will kill the influenza virus. However, I know how often you would have to apply this to your toddler's hands.

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Alexandria, Va.: Is there an incubation period? And, if so, are you contagious during this period?

Richard Wenzel: In general, the incubation period is two to five days. Adult patients will excrete the virus for up to a week, but young children can excrete virus for two to three weeks. People who are immune suppressed who are infected with influenza can excrete the virus for over three weeks after infection.

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Rockville, Md.: Any clues as to why this outbreak is occurring so late in the season? Why do flu outbreaks usually only occur in the winter months?

Richard Wenzel: Of interest, the 1918 influenza pandemic began in the Spring and recurred the following Winter. No one knows why the virus usually occurs in the Winter and Spring on an annual basis. There is more crowding indoors in the Winter and Spring and less humidity, and some experts think that these are important in explaining the seasonal nature of influenza.

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San Francisco, Calif.: Does the release of Tamiflu from U.S. stockpiles have any affect for the average citizen here? Is it now easily available?

Richard Wenzel: This is an effective anti-influenza drug, especially in preventing infection among exposed, but not ill people. It also has a modest effect in treatment. The drug is available.

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Pork: Does swine flu have anything to do with eating tainted pork products?

Richard Wenzel: No. There is no risk of swine flu from eating appropriately cooked pork.

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Anonymous: Thanks for taking the question. My family and I recently visited Cancun for spring break. My husband had felt achy, chilled and fatigued after returning home however had no sig cough. He has since improved however remains tired. Everyone else is fine. Any cause for concern?

Richard Wenzel: This is a difficult question. Approximately 20% of people have general fatigue after some infections like mononucleosis of cytomegalovirus and sometimes after influenza. It would be best to have a checkup with your physician.

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Washington, D.C. : I heard that the Swine Flu is suppose to hit the Washington Area hard. Is this true and what can we do to protect ourselves?

Richard Wenzel: No one knows what cities will be hit, or how hard the virus will be. Because Washington, DC is an international city the chances of bringing infections from other countries and other cities is great. At this point, you should be alert to the degree of infections in your own city, report to a physician with respiratory infections and maintain careful hand washing. Despite the custom of handshaking, it is reasonable to avoid that custom for the time being.

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Baltimore, Md.: I've read that this flu has disproportionately hit healthy young adults instead of children and elderly people. Any thoughts on why?

And do you think we will be raised to a WHO Phase 4 or 5 at this point?

Richard Wenzel: It is likely that people over age 60 have some cross reacting antibody from prior infection with a related virus in years past. This remains to be proved. Thus, young adults are disproportionately infected.

I am surprised that WHO did not already call this a level 4.

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D.C.: Is is safe to travel to Central America?

Richard Wenzel: I have not heard of any reports of influenza in Central America, but it is likely that some cases will come to light in the next few weeks. CDC will suggest postponing non-essential travel to Mexico today. So the best advise is to stay alert to their travel advisories.

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Fredericksburg, Va.: What is the possibility of EU countries closing borders to international travel from the United States?

Richard Wenzel: Whenever there are risks of transmission of new infections from one country to another, there is always some risk that travel restrictions will result. We saw that with SARS and could see that with swine flu if the numbers and severity increase in the US.

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Cleveland, Ohio: The case of swine flu in Ohio occurred in Elyria, which is very close to Cleveland. Is it possible that Tamiflu will be made available for people in our area to take now as a precautionary measure? You mentioned that people who have been "exposed" to the virus should take it, but how does one know if one has in fact been exposed?

Thank you.

Richard Wenzel: This is a difficult question. The exposures that qualify for prophylaxis include those within families or those with prolonged exposure such as that of a school. Unless the outbreak is wide spread, general prophylaxis is not indicated.

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State College, Pa.: Why is this virus receiving such rapid, mass attention when there are so many viruses passed around all the time?

Richard Wenzel: This is a new virus not seen before, it may have caused 100 deaths in Mexico, and it has been quickly identified in countries on three continents. Influenza is more than a common cold with respect to its ability to harm patients. These are some of the reasons for the attention given to the new virus.

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washingtonpost.com: How Are You Preparing for Swine Flu? (The Checkup, April 27)

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Washington, D.C.: I'm having a little trouble reconciling the president's "there no immediate danger" comments as well as the Post's Check-up blog that basically says "chill out folks" with your comments suggesting everything from face masks to foregoing handshakes to consternation that the threat level has not been elevated. Which is it?

Richard Wenzel: This is a serious problem and now is the time to prepare for all contingencies. We need to be extra cautious until we know the extent of transmission and of the virulence of the virus. It is also a time for scenario playing, i.e. the what ifs: Communication, drug supply and delivery, infection control recommendations for hospitals, development of hot lines that might be needed etc. In summary, this is the time for special precautions, but not panic or alarm.

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Penn Quarter, D.C.: Is this the same swine flu that was around in the mid 1970s? Will the shot I got then help me now?

Richard Wenzel: Unfortunately this is different virus, and it is unlikely that you are protected, but I have not seen specific antibody analyses yet.

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Virginia Beach, Va.: Are there any special precautions or drugs that my son should take as a patient currently undergoing chemotherapy, hence with a very compromised immune system?

Richard Wenzel: At this point, I would not recommend prophylaxis. However, if the epidemic spreads to your city, it may be prudent to offer prophylaxis for a period of time. You should consult with his oncologist about the timing for such an approach.

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20002: Can this virus be spread through the air? Or does you have to touch something that has the virus on it and then touch your mouth, nose, etc.

Richard Wenzel: Most of the time influenza is spread from person to person by large respiratory droplets. Sometimes, the virus contaminates the environment and hand contact with the environment and subsequent touching of the nose or eye can lead to infection. I also think that uncommonly this virus can be spread by the airborne route: tiny droplets that stay airborne and do not fall to the ground quickly like the large respiratory droplets.

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Richard Wenzel: Thanks very much for the questions.

Richard P. Wenzel, M.D., MSc.

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