An ongoing dialogue on HIV/AIDS, infectious diseases,
April 26th, 2009
Swine Flu Curbsides: Anthrax, SARS Redux?
In my email in-box yesterday AM from a primary care doc:
A patient of mine, 40 year old woman totally healthy, is going to Cancun on Tuesday for a conference. She’ll be there for 6 days.
I know there are no cases of swine flu in Cancun yet, and the situation is evolving, but here’s my question: what should she do (besides the obvious stuff like handwashing, etc)?? Bring tamiflu?? A mask?? Should she cancel her trip???? [N.B., actual punctuation retained for effect]
Ah, memories of the anthrax attacks and SARS, when an ID threat hits the headlines and people understandably want to know what they can do to protect themselves.
So they turn to their primary care providers, who then turn to us.
And in these situations, there’s the official response to such a question, which as we all know is sometimes different from the practical response — and I define the latter being what would you do for you or your family.
So not only did I say that it would be reasonable to bring some osteltamivir (Tamiflu), I even thought it wouldn’t be crazy to consider a prophylactic strategy — though the fact that she’s totally healthy made me favor the former approach.
And I wonder how many ID docs out there purchased some ciprofloxacin back in 2001, even though we were told not to.
3 Responses to “Swine Flu Curbsides: Anthrax, SARS Redux?”
Paul E. Sax, MD
Contributing Editor
NEJM Journal Watch
Infectious Diseases
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I am here in Cancun now and i have been here for two weeks. Right before this “Swine Flu” came noticeable even in Mexico. My husband lives here while he is working on a job which considers him to shake hands and be in large groups with people from all around the world every day. I totally disapprove of it at the moment but there is nothing i can do. He is a little hard headed but my best advice is to wear a mask at all times which people are already doing here at certain businesses that require it and dont touch anyone. If you get on the buses as stupid as it may look wear gloves if you get in taxis wear gloves. This is our life we are talking about. It is bound to come here knowing this is one place people from all around the world come to. This virus is known to incubate inside of you for 6 days before you even know you have it. It could be in the person next to you and you not not even know it nor them yet. Be cautious.
What happens to americans if there is a hault to travel in and out of Mexico? Do you get stuck there? Does the American embassy put you up?
If you look at the pandemic of 1977, when H1N1 or Swine Flu re-emerged after a 20 year absence, there is no shift in age-related mortality pattern. The 1977 “pandemic” is, of course, not considered a true pandemic by experts today, for reasons that are not entierely consistent. It certainly was an antigenic shift and not an antigenic drift. As far as I have been able to follow the current events, the most significant factor seems to have been that most people, who were severely affected, were people with other medical conditions.