Tuesday, April 28, 2009

Swine Flu Panic...or Prudent Caution?

Here in the valley I live close to four international entry ports...or international bridges from Mexico. FOUR! It is inconceivable that at least a few sick people haven't made it across, especially in the days before the warnings...when the flue was still in it's incubation stage. You can be contagious a day before you actually start showing symptoms.

People cross over all the time, and go to the local hospitals for care. They know that due to federal laws that they cannot be turned away without at least being triaged. It is not common practice for the triage nurses, ER staff, Er physicians, out-patient secretaries or ever the security guards to wear protective masks. It's the time of year when we see a LOT of pneumonia , pneumonitis, acute respiratory disease's, increased allergic responses...because there is a lot of changes in the weather, cool at night - hot and muggy during the day.

Add to that the allergens in the air as the farms plow and plant, and the winds have been blowing 30-40 miles per hour for the past month....every day. It has been theorized that there is more molds in the ground this year due to the excessive moisture and standing water we had during Hurricane Dolly last year. These would have lain dormant until the spring plowing.

I keep hearing the question "Why are so many people dying in Mexico and not in the U.S.". My thoughts are these.

1. In Mexico, if you are sick, you don't need a prescription for antibiotics, you just figure out what you think you need and you go and buy it. People take the antibiotics until they feel better...not until they have taken a full course of medications and eradicated the problem. When they get sick again...the pneumonia, bronchitis, or whatever respiratory illness they are experiencing is more resistant to the antibiotics.

2. Because they can get antibiotics without a physician's order, by the time they actually go to a hospital, they are literally at deaths doorway, nothing is working. Influenza, pneumonia, bronichitis, the common cold, cardiac heart failure, Pulmonary Emboli, Tuberculosis...these all have very similar lung symptoms...with sputum production, infiltrates on Chest X-ray, increased WBC's and/or left shift on bloodwork, cough, fatigue / malaise , and with the exception of CHF, fever may or may not be present.

Every illness that fits this criteria is probably initially treated as pneumonia or bronchitis...a throat swab and sputum cultures are not always ordered. With this Swine Flu ... while there is a frequent cough, there is little sputum production...therefore nothing to culture. Add to that the new resurgence of Adult Whooping Cough...and you have one more thing to add to a differential diagnosis.

What really sends up a red flag is a young previously healthy adult in Acute Respiratory Distress that winds up tubed in the ER. The only problem there is again figuring out the problem. To further muddy the diagnostic scenario is also the fact that there is alot of illegal drugs readily available and used in this area. You can get young healthy adults with Acute Respiratory Distress due to smoking crack, or snorting cocaine. So as you can see, the puzzle can be very complicated for a doctor...or a whole group of specialists to wade through.

Then there is the very real fact that a lot of Tuberculosis crosses over from Mexico, because it is not routinely tested for like it is here in the States. The ICE facilities have isolation beds for this to get illegals well and non-contagious before they are sent back to their native counties, we usually get "over-flows" from them...which means there is a lot of TB out there folks.

Now that there is a Possible Pandemic, something which the hospitals have been training for for the last few years...and we actually know what to be looking for, they can add throat swabs for the flu virus to the battery of tests commonly ordered, they can isolate the patients when they come in the door...except so many are coming in and we only have a few true isolation rooms, which are usually used for TB patients.

CDC may not have reported all the cases as yet, as our local news is reporting "confirmed" cases in Rio Grand City (Starr County), some in Navarro County, and Brownsville ...all which have been reports in school age children, with said schools being placed on mandatory closing until May 5-7 (different stations giving conflicting info). You go to the CDC website...and none of these "confirmed" reported illness are reflected on their "board" as they are still claiming only 3 cases in Texas, one in Dallas and two in San-Antonio. I just listened to a Yahoo video that two students in Cibilo, TX (not sure if that is spelled correctly or where exactly that is) have been confirmed with Swine flu. That brings the number of reported to around 9 cases scattered all over the state ...only three of which are through the official CDC website. Trust me ...there will be more. While I was getting my test done yesterday and issued my medications our ER was jam-packed and a number of the patients were wearing masks...something I HAVE NEVER seen anyone doing in the ER.

So I think this is the tip of the iceberg...and if it does turn out to be like the Spanish Flu of 1918 this could be the first wave. The first wave was mild then the virus mutated and came back with a vengeance 6 months later. Hopefully, if I have a case now, it will give me some immunity later when I may need it. Somebody has to be well enough to take care of the sick.

So folks, stay safe out there, wash your hands often, cover those coughs and sneezes, use the hand sanitizer, disinfect shared telephones, doorknobs, grocery cart handles...all the things you would do in the regular flu season. Be prudent with your own health.

1 comment:

Debbie Y. said...

Why are we not quarantine-ing like other countries when we are right next door. I know I sound paranoid, but give me a break, I am considered an elderly person nowadays and I don't want the flu. With the GBS surgery, I don't thrown up and it is hell having the dry heaves, it hurts. I may be panicky, but I thinks it's a good thing to be prudently cautious.