Swine flu + Japan = Karaoke boom?

Apparently, a lot of students at Japanese high schools that have been shut down due to the H1N1 outbreak haven't been staying home; instead, they've been going out for karaoke. 

As someone who discovered firsthand that karaoke microphones make good fomites (someone shared a nasty cold with me once, by way of a karaoke mic), I'd like to point out that this is a Very Bad Idea.  --All the more so, since a lot of the karaoke venues in Japan include smallish private rooms, where the ratio of students to square feet (and, therefore, the opportunities for large droplet spread) can be quite high.

Is this an argument for not shutting down schools, then?

Probably not.  

Unless a very high percentage of students from these closed schools are crowding into the karaoke joints or other venues where there is a relatively high risk of transmitting the flu, school closings are still likely to be more effective than not in slowing the spread of the virus.

Pandemic Partners - A way to help each other during a pandemic

During a pandemic, we all know a lot of people are going to get sick.  

Whether they get treated in a hospital or recover at home, a lot of those who get sick are going to need some help... and not just with their illness.  Even the seasonal flu can knock you onto your back for a week or more, and a pandemic flu virus is likely to to be worse.  So a lot of people who get sick will also need some help managing their day-to-day lives until they're back on their feet, simple things like:

• Making sure there is food in the house
• Contacting healthcare providers  
• Helping provide care for children or other dependents
• Helping provide care for pets
• Contacting family members
• Picking up medicine from the pharmacy

But in today's society there are many of us who could fall off the map without anyone noticing right away.  In many cases, it's all too possible for a person to be home sick for weeks before anyone thinks to check on them, and this will be even more true during a pandemic.  

Because the same social distancing measures that will help to protect us from the flu (staying away from other people as much as possible, working from home if you can, etc.) will also reduce social interaction to the point that even those who would ordinarily be missed after a very brief illness will be at risk of falling through the cracks.

To help fix this problem, people can pair up with people they trust (friends, neighbors, family members, co-workers, members of their place of worship) to keep track of one another during a pandemic and help each other as needed.

The Reveres over at Effect Measure mentioned one program to do just that, a faith-based initiative called Flu Friends.

A similarly-alliterative initiative called Pandemic Partners is also under development to help people help each other through a pandemic.  Right now, it mostly consists of a set of forms people can use to share the information their "pandemic partners" will need to be able to assist them.

Copies of the form are available as a Word Document: Pandemic Partners.doc 

or PDF: Pandemic Partners.pdf

The forms are a work in progress, so if you have any suggestions for improving them, let me know and I'll pass them along.

Protecting yourself

Although things aren't looking good so far, it's still too early to say for certain whether the swine flu outbreak will mushroom into a pandemic.  But it's a good idea to start giving some thought to how you can protect yourself and your family from infection, if the virus should continue to spread.

Here are some evidence-based protective measures you can take to help prevent infection:

1. Wash your hands

...then wash your hands some more.  In fact, one of the studies examined in the relevant Cochrane Review showed that simply washing your hands at least 5 times a day cuts the risk of coming down with a respiratory infection by almost 50%.  

Handwashing is one of the most important things you can do both to keep from getting the virus and to keep from spreading it, if you happen to be infected.  --And it's important to understand that you may well be contagious for 24 hours before you show any symptoms.  That's one of the reasons why influenza is so much harder to control than the SARS epidemic was.

Most people, even those who have the training to know better, don't wash their hands correctly.  For instance, did you know that every time you wash your hands, it should take you 20-30 seconds to scrub them thoroughly (long enough to sing the alphabet song once or the "happy birthday" song twice)?  For more on how to wash your hands correctly, see the CDC's video "Put Your Hands Together."

2. Stay away from infected people (and stay home if you're infected)

This is called "social distancing" and it sounds pretty obvious, but it's one of the hardest recommendations to stick to.  That's because during a pandemic simply going to work, going out to buy groceries, going to a doctor's appointment or going to school could put you in contact with infected individuals or put others at risk if you're infected.  

And, as I mentioned above, people (yourself included) can be contagious for 24 hours before showing any symptoms.  When it comes to a flu pandemic, the fact that people feel well or look well is not a reliable measure of the risk they pose to others.  

If this does become a pandemic, the safest thing you can do is stay home and avoid contact with others as much as possible.

3. Use personal protective equipment (PPE) when you might come into contact with infected individuals

Masks

There has been a lot of talk over the last few years about the use of N-95 particle respirators as a way of avoiding infection, and they have been shown to work pretty well when used correctly... but the Cochrane Review I mentioned earlier found that there was no statistically significant difference between their performance and that of simple surgical masks.  Another study found that using nylons (AKA pantyhose) to hold the surgical mask tighter against your face improved their performance even further.  This is a more foolproof form of protection than the N-95 mask, which must be correctly fitted and it may be more comfortable, as well, which has implications for compliance.  --Paper masks were not shown to be effective.

Goggles

Eye protection (in combination with masks) was also shown to be effective by the Cochrane Review.  It's not clear whether this is primarily because goggles protected users from airborne droplets or because it prevented them from rubbing their eyes and thus introducing infectious material from their fingers into their eyes, but either way they made a difference.

Gloves

The same Cochrane Review showed that gloves were highly effective in preventing infection. The studies on this topic took place in a hospital setting, where healthcare providers changed their gloves after seeing each patient, so wearing the same pair of gloves all day isn't likely to help.  It's also very important to understand that wearing gloves does not eliminate the need for handwashing.

Gowns

Protective gowns (e.g. surgical gowns) were also shown to significantly reduce infection.  Again, this was in a hospital environment, but it highlights the importance of clothing as a possible fomite (an inanimate object that can transmit infection).  Surgical gowns may not end up seeing much use in day-to-day interactions outside the hospital, but this finding implies that it might be worth changing your clothes after coming into contact with someone who may be infected. 

All of the above, plus handwashing

Not surprisingly, the most effective intervention was a combination of all the forms of personal protective equipment above plus frequent and thorough handwashing.

4. Thoroughly disinfect surfaces where you live and work

Doorknobs, computer keyboards and mice, telephones, tables, kitchen counters and other surfaces can all transmit infection.  Thoroughly cleaning these surfaces with disinfecting agents can help reduce the spread of a flu virus.

5. Use a humidifier

This study (and a few others) suggest that humidifying indoor air may reduce the risk of flu transmission.  The evidence is fairly limited here, but the argument seems sound to me.

6. Practice good cough and sneeze etiquette 

Don't cough or sneeze into your hands.  If you don't have a tissue available, cover your cough or sneeze with the crook of your elbow instead of your hands.  That way, you won't be spreading germs to everything you touch.  If you do have a tissue available, you can cough or sneeze into that, then throw it away and wash your hands as soon as possible.  

7. If you have children, make sure they do all of the above

Children are especially good at transmitting the flu virus, which is why schools are likely to be closed down during a pandemic.  Making sure that your children learn to take the above precautions (especially frequent and thorough handwashing) can help to keep them safe... along with everyone around them.