Preparing for swine flu

Dr. Tim F. Jones, state epidemiologist (Tennessee Department of Health photo) [Click to enlarge]

No cases of the "novel influenza virus," as Jones called it, had been reported in Tennessee as of Monday afternoon, when Jones held a conference call with reporters. But 40 cases had been reported in five U.S. states. All of the sufferers have recovered, and only one needed to be hospitalized.

But Jones noted that 36,000 people die in the U.S. each year due to the normal seasonal flu, even with the existence of annual flu vaccines. Even a "mild" flu variant must be taken seriously, he said.

"I think people are paying attention," said Jones. "... So far, I don't think people are panicking."

Jones prefers the term "novel influenza virus" to "swine flu" because the latter term ignores the fact that the virus is passed from human to human. In addition, some people who were vaccinated against a different strain, also referred to as "swine flu," during the 1970s might think they're still protected. They're not, because this is a different strain and because it's 35 years later.

Symptoms of the swine flu are pretty much like those of other flu strains -- fever, cough, a bad headache, possibly muscle aches, vomiting and diarrhea.

For the individual otherwise-healthy patient, having the swine flu would likely be "just like the regular seasonal influenza we've been dealing with for the past several months," said Jones.

Treatment

Regular patients should just stay home, get plenty of rest, drink plenty of fluids, and take Tylenol, said Jones. Washing hands frequently and covering one's mouth when coughing or sneezing are important to prevent the spread of the disease.

At-risk patients should contact their health care providers and may wind up being treated with anti-viral medication. Hospitals and pharmacies have plenty of the anti-viral medication, and the state has a stockpile that could be released in a more serious emergency.

The Food and Drug Administration originally approved the use of the antiviral drug Tamiflu for the prevention and treatment of influenza in adults and children age 1 and older. Another antiviral drug, Relenza, was originally approved to treat people 7 and older and to help prevent flu in those 5 and older.

Late Monday, the FDA said it issued emergency guidance to allow Tamiflu to treat and prevent flu in children under 1 and to provide doses other than originally approved in children over 1. The drugs may be distributed to larger segments of the population without complying with the approved label requirements, the FDA said.

The agency also authorized a swine flu diagnostic test for testing samples from people with certain flu infections -- those whose virus subtypes cannot be identified by currently available tests.

Vaccine

Jones said it will be "quite some time" before a vaccine can be developed for the new strain.

"We expect this to go on for a long time," said Jones.

Jones said he expects the number of reported cases to jump rapidly in the next few days -- now that the new strain has become a topic of news and discussion, more actual testing will be done and cases which may already be out there will be specifically identified as part of the new strain.

Pandemic

Most people confirmed with the new swine flu were infected in Mexico, where the number of deaths blamed on the virus has surpassed 150, according to the Associated Press this morning.

Some 50 swine flu infections have been identified so far in the United States: 28 at a private high school in New York City, 13 in California, six in Texas, two in Kansas and one in Ohio. Only one American case has led to a hospitalization, and there have been no deaths.

Jones said Monday the pandemic is quickly being revealed as an international problem and that specific border controls would be of little use.

"That's rapidly becoming moot," said Jones.

The swine flu has already spread to at least six countries besides Mexico, prompting WHO officials to raise its alert level on Monday.

"At this time, containment is not a feasible option," said Keiji Fukuda, assistant director-general of the World Health Organization.

Don't be alarmed

The Obama administration today staunchly defended its "passive surveillance" policy on the emerging swine flu threat, saying that its measured, cautious border monitoring makes sense.

Homeland Security Secretary Janet Napolitano declared that more draconian enforcement steps are not yet necessary, even as she acknowledged that officials "anticipate confirmed cases in more states."

"We anticipate that there will be confirmed cases in more states as we go through the coming days," she said on NBC's "Today" show this morning, reiterating President Barack Obama's stance that people are justifiably concerned but need not be alarmed by it.

Testing and tracking

Testing for swine flu is mainly for the purpose of tracking the spread of the disease, Jones said. The testing makes no difference as far as how the disease is treated, since the test results take time to come back. Some patients are already over the disease before it has been confirmed as swine flu, he said. For tracking purposes, however, hospitals and specially-trained "sentinel physicians" are being asked to submit cultures for testing from patients they believe may have the disease. Jones said only "a couple" of such cultures have been turned in so far.

Jones said the state has had a plan for treating a major disease outbreak for quite some time.

Local plans

Scott Johnson of Bedford County Emergency Management Agency said the local health department has a plan in place for coping with a major flu outbreak, developed during the "bird flu" scare. If an outbreak were to become severe enough, the first step would be to close local schools, because that's a fertile ground for spreading disease.

"You really kill it if you close the schools, quite frankly," said Johnson. Other public gatherings would be discouraged, including church activities.

"That's a tough one in Bedford County," Johnson admitted. He said it's likely that any closures would just be requests rather than government-ordered quarantines.

--The Associated Press contributed to this story.