Tuesday, October 11, 2005

The 'flu ...


Ok, guess I'm a little behind on this awareness week thing. Anyway, ever since I read this excellent, if rather alarming article in The Atlantic Monthly back in 1994 (the article is available only to subscribers. Email me if you'd like a .pdf), I've had an ongoing interest in following this virus. Well the bird flu is in the news, and there's talk about pandemic preparedness, and President Bush outlined his plan last week, and now news that the avian flu is in Romania and in Turkey. So, here's some very useful links (soon to be added to the blogroll on the right):

The Flu Wiki -- a good place to start to learn about the avian flu, what is it, how bad it is, and how it may mutate to cause the next human influenza pandemic. There's a great series of links to Pandemic Preparedness Guides on there, as well as good personal hygiene habits.

A couple of blogs that I am following:
Avian Flu - What we need to know
H5N1

And yes, I'll be blogging about this as well.

How serious is this? Well -- most professionals seem to be of the mind that it's a matter of time before some strain of the influenza virus mutates and leaves the human population without any immunity. It is quite likely the bird flu strain (H5N1), which has reappeared in Southeast Asia, first in 1997-98, and then again since 2001, might do this. So far, bird-to-human transmission has been clearly documented; human-to-human less so. If the virus mutates so that it can pass easily from humans to humans, then we're facing a pandemic. A leader in the Economist a few months back put it this way, "roll dice long enough and you'll eventually get two sixes." (paraphrase, not verbatim)

The last time we had a world-wide pandemic was in 1968. The one that most people are aware of is the 1918 "Spanish Flu" pandemic. Google it if you want to get really scared.

Influenza is a deadly disease. The virus mutuates every year (why do you think we need new flu vaccines every year?)Our colloquialisms mask that ("oh I've got the flu." or "it's just the flu" or "maybe it's a stomach flu"). Most of the time, we're talking about a bad cold, or a GI virus (influenza is a respiratory illness and doesn't affect the GI tract). Those who've had influenza itself know how horrible it is.

So -- educate yourself. Be aware. Follow this story. Start talking to your families, friends and neighbors. Develop good hygiene habits. Think worst-case scenarios (say 30% of the people around you being seriously ill), and make some personal plans. Yes, pray.

An absolute must read: Peter Sandman's risk communication column -- very sane and very helpful.
For those in my local area: we have some public health professionals in the parish, as well as interested laypeople. I'm of the mind that we should do some awareness building and planning at the parish level. Hey, even see if the Diocese can be cajoled to join in (when Floyd hit, and the Bishop got stuck in a traffic jam, he pushed a hurrican preparedness plan to all the parishes. Let's not wait till he gets the flu, to do the same with this!). Let me know if you think that's worthwhile.

7 comments:

St. Elizabeth of Cayce said...

Long post--long response:

The PSandman article gave a good summary of stuff that's been discussed and discovered in planning work over the past few years. Some comments on what he wrote and the issues Gashwin raises:

Psandman writes:
Then there's hand hygiene which isn't really "medical" because you don't need a doctor to do it right. ... Additionally, though without much evidence, they recommend covering your mouth when you cough. (They've got to know that it's hard to cover your mouth without using your hands unless you wear a surgical mask , but for some reason most of the experts aren't enthusiastic about public use of masks. They say they're worried mask-wearers might become complacent, a worry they never seem to have about hand-washers.)

"Cough into your elbow" or "Cough into your shirtsleeve" is the guidance we're expecting to see.

Psandman writes:
Hand hygiene is mostly individual and profoundly low-tech, so it has trouble getting as much attention as it deserves. The U.S. Senate has just proposed to spend $3.9 billion on pandemic preparedness improvements, most of it on vaccines and antivirals. I somehow doubt there's money in the budget to retrofit restroom sinks so you don’t have to touch the faucet when you turn off the water, or restroom doors so you don’t have to touch the doorknob as you leave. (Many restroom faucets and doors at HHS headquarters in Washington and WHO headquarters in Geneva don't meet this elementary hygiene standard.)

Use paper towels for both turning off faucets and opening doors--CDC's been saying that for years.

Psandman writes:
Every organization can rethink its social contact needs. Infectious disease transmission is a function of the number of social contacts -- keeping people home more means keeping more of them alive. What jobs can shift to telecommuting? How can we educate children without making them come to school? How can we distribute food without making people come to the supermarket or the soup kitchen? Should we redefine "delivery person" as an essential job that qualifies for prophylactic antivirals?...Nonprofits can start planning to coordinate volunteers. Like any emergency, a pandemic will yield huge numbers of people who want to do something to help -- including many who contracted pandemic influenza and survived, and are therefore immune. Who is going to sort them out and get them where they're needed most, doing high-risk jobs that don't require special skills (washing linens at the hospital, for example, or making deliveries to people sick at home)?

THIS is what I think is critical in Sandman's article--consideration of the social safety net that relies on mobility. If mobility is limited and every field from healthcare to pizza drivers is affected by illness or death, new networks will be needed. We'll be re-defining persons with specials needs and finding that far more of our previously independent population will need assistance--far more assistance than the public sector will be able to provide.

Churches & other voluntary organizations will need to know far more than they currently do about members in order to provide help. People who appear for Mass and then disappear may still think of themselves as parishioners of this parish. They will be asking for and/or expecting everything from help with getting food to help with paying for medications. They may need money when they cannot work if they work at jobs that don't offer sick time. More help might be needed by any parishioners who might be ordered into isolation or quarantine. We've got no way of tracking those folks--that's one area of planning that could happen now.

Persons in isolation or quarantine miss events; they also need "things" brought top them (food, meds, household products, etc.) They miss contact with others and often have difficulty following the rules of quarantine--even if this endangers their health or the health of family members. They may have trouble paying rent. They may need pet sitters if they are quarantined inside a hospital or other facility

From the CDC (follow-up on persons ordered into I&Q during the SARS outbreak in Toronto:
All respondents described a sense of isolation. The mandated lack of social and, especially, the lack of any physical contact with family members were identified as particularly difficult. Confinement within the home or between work and home, not being able to see friends, not being able to shop for basic necessities of everyday life, and not being able to purchase thermometers and prescribed medications enhanced their feeling of distance from the outside world. Infection control measures imposed not only the physical discomfort of having to wear a mask but also significantly contributed to the sense of isolation...Increased length of time spent in quarantine was associated with increased symptoms of PTSD. This finding might suggest that quarantine itself, independent of acquaintance with or exposure to someone with SARS, may be perceived as a personalized trauma.

Now to the Catholic Issues:

Notes from Toronto's experience with SARS in 2003:
http://www.e11th-hour.org/resources/timelines/sars.04.03.html
"The SARS outbreak forces Roman Catholics to change centuries-old Easter traditions: the practice of sipping sacramental wine from a communal cup is suspended; the traditional communion wafer is to be placed in churchgoers' hands, not on their tongues; confession will take place outside the confessional booth; churchgoers are to bow instead of shaking hands as a sign of peace during services; instead of kissing the crucifix, people are to bow or genuflect."

There's also the issue of using a dwindling supply of priests (many older, infirm and at risk of catching flu) to administer "Last Rites", do sick visitation in hospitals, perform funerals etc. Did the Church make any concessions during the Black Plague for any of this to be delegated, or was there really not a supply problem (i.e., priests died at the same rate as the population, so the ratios didn't change...)?

So, knowing that pandemic Flu is out there means we need to consider:
--knowing who is out there (who is in a particular Parish, who is invisible...)
--finding ways to serve needs (initially/at least within the Parish) of those who may find themselves bereft of resources (illness, lack of mobility, lack of $$, students who are unable to get home to parents on breaks, etc.)
--finding ways to serve the greater community, knowing that we cannot be everywhere at once
--finding ways to serve the spiritual needs of our parish and those who come to us for help.

There's plenty more to think about, but these are the sorts of things we'd need to know how to do if we had an earthquake, huge fire, etc.

Fr. Gaurav Shroff said...

St. Liz, thanks for that thoughtful response. I think the direction you mention seems very appropriate for local parish planning. The question will be, apart from our local community, how does one actually broach this at an area-wide (Deanery say) level, without being thought a nut, or a scaremonger? Or rather, that's the question I'm asking right now ... :)
As to the Black Death -- wow, now that's a scary analogy -- you know, I have no clue, though I might suspect there were sufficient clergy around.

Anonymous said...

St. Liz - good points.

In the Spanish Flu of 1918, many women organizations in community churches provided assistance sending food to the sick. Regretfully I don't know who they helped directly, but I'm sure it was those within their spiritual community. Also during the 1918 Flu, schools were closed and many teens volunteered to provide assistance. I personal noticed accounts in the 1918 newspapers that the Boy Scouts were knocking door-to-door to report of sick individuals in some communities. Studying the history of this event, it was typically organized chaos for the entire community and many local/state governments lacked the necessary planning to react. It was then that people called upon family, friends and their church community.

If a community is going to have a plan it must have some key points:
• Early education;
• Primary point of contact for help (this can be for both spiritual needs and medical needs);
• Recruitment of volunteers
• Protocol for delivering/recruiting assistance (priest and volunteers); and
• Types of assistance to be provided.

Early Education
The community’s leadership must provide early education on prevention and care to its membership. It also should communicate what services it will provide with its staff and volunteers. Clear written steps should be accepted prior to a pandemic in the event that leadership becomes ill and other must fill the role.

Key point of contact.
A primary contact number must be established. A phone number being staffed 24/7 many be required. The community may wish to establish steps for individuals to contact all members within its community to determine their health. Individuals living alone are the most prone and may be too sick to call in for help.

Recruitment of volunteers
Communities must immediately determine who is has the most risk. If the flu afflicts the traditional age groups (the very young and old), then many young adults may be capable of assisting. If a pandemic is similar to the 1918 Flu, then students/young adults may be the most prone. Communities must determine who their primary volunteer base and have alternative plans established if their primary base is sick.

Protocol
Key steps must be implemented on the volunteers’ work and ensure they do not spread the flu to others. If the volunteer group becomes sick, then the service structure falls apart. For those concerned with the well being of the priest/ministers, then clear safety instructions must be implemented to protect the priest/minister and prevent the spread of flu.

Type of assistance
The community must determine what service it will provide. The most demanding need will be food for the sick unable to cook for themselves under the illness. Also the availability of medications will be a concern. Volunteers may need to have access to homes to make routine visits to ensure the health of the sick. Also steps must be implemented if emergency medical attention is needed.

These are just a few random thoughts to help a church community to discuss. A pandemic is going to happen; it’s only a matter of when. If local, state and national governments are not prepared, then it will likely fall upon church communities to serve the needs.

Sincerly, Dogwood

Fr. Gaurav Shroff said...

Well -- many good thoughts here. Let's see what is the best way to go about mobilizing local leadership. I wonder if the University is doing any kind of planning on this? Hey, even the Gamecock today has an article on the 'flu -- however, focusing on the ire of poultry workers in NC. Again, making it seem like this is a poultry workers' issue only :: sigh ::
http://www.dailygamecock.com/media/paper247/news/2005/10/12/News/Concerns.Emerge.As.Flu.Season.Nears-1017825.shtml

assiniboine said...

Yes they did. In England, at least, the laity were instructed to hear confessions and administer the last rites.

Fr. Gaurav Shroff said...

The laity? Any citations or documentations on this? That's quite fascinating.

assiniboine said...

084568 Philip Ziegler
The Black Death
Penguin Harmondsworth 1970