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Swine Flu Symptoms, What to Do? One ER Doctor's Perspective

Medical Author: Benjamin C. Wedro, MD, FACEP, FAAEM
Medical Editors: Melissa Conrad Stöppler, MD and Charles P. Davis, MD, PhD

As cases of swine (H1N1) flu are being confirmed around the world, governments are ramping up their disease control plans to hopefully minimize the effects of this infection. According to the World Health Organization, "Given the widespread presence of the virus containment of the outbreak is not feasible. The current focus should be on mitigation measures." This means that preventing spread of the virus is not likely, and treating outbreaks will be important in minimizing the numbers of people who might become ill and potentially die.

Swine flu is very similar to any other influenza-like disease when it comes to symptoms:

However, H1N1 swine flu reportedly causes more nausea, vomiting, and diarrhea than the seasonal flu, but not in all patients. Aside from the nausea, vomiting, diarrhea, and chills, these symptoms sound similar to the symptoms of a severe cold. Whether that's all there is or whether a person will become significantly ill is difficult to predict. However, individuals with poor or altered immune systems such as infants, pregnant women, the elderly, those undergoing chemotherapy treatment, or taking medications that impair immunity are at higher risk for more severe illness.

But even healthy people can become sick. The virus spreads by aerosol droplets, meaning that secretions from an infected person can be spread into the air by coughing or sneezing. It's the close contact with an ill person that causes the disease to spread. And a person may be contagious for 24 hours before any symptoms occur.

How a community, a hospital, or an individual deals with the potential for infection will help decide how fast and how far it will spread.

Prevention begins with decreasing contact with other people. For example, at the onset of the H1N1 flu outbreak in the spring of 2009, Mexico had soccer games played in empty stadiums, and public transportation was curtailed. Schools were closed in New York City, San Antonio, and San Diego after children who had traveled to Mexico on vacation returned with the swine flu infection. Travel advisories worldwide were posted to avoid not only Mexico, but also the US and Canada. Currently, limiting contact with those who may be ill and avoiding large crowds where exposure cannot be controlled is recommended.

Most schools, health care centers, and businesses have action plans in place for individuals who may have swine (H1N1) flu. The recommendations include staying home from work or school if you are ill with flu-like symptoms. Do not return to school or work until you have been free of fever (100 F or 37.7C) for 24 hours without taking fever-reducing medication.

Hospitals have plans developed to isolate patients who may present complaining of flu-like illnesses. Patients may be placed in isolated rooms and made to wear surgical masks until they are examined and screened to make certain that influenza is not the cause. This may become a significant burden on hospitals and clinics if too many people show up to be seen. Imagine what would happen if waiting rooms were overwhelmed with coughing people. It would be difficult to isolate each one.

People need to remain calm in the face of a constant barrage of press releases that act as a scoreboard for where and how many swine flu cases have been found. Remember that the large majority of people infected with H1N1 swine flu around the world have done well without medication to date. Nonetheless, it pays to be prepared as follows:

  • According to the CDC, if a person is a high-risk individual, they should be the first to obtain the appropriate H1N1 vaccine when it is available. The H1N1 vaccine recommendations are significantly different than those for the conventional (seasonal) flu. Whereas seasonal flu vaccination programs focus on seniors, adults with chronic conditions, and children, the H1N1 recommendations target these populations:
    • pregnant women,
    • all infants and patients <24 years of age;
    • healthcare workers, and
    • adults taking care of infants <6 months of age
  • Adults ages 24-64 with specific chronic medical conditions [asthma, diabetes, renal (kidney) disease, COPD (chronic obstructive pulmonary disease), angina, immunodepressed, or cancer].
  • If there are cases of swine flu in the area, prevention starts with avoiding crowds of people.
  • Other prevention issues are mostly common sense, such as good hand washing practices, avoid touching the face, mouth, nose, and eyes with your hands,  and getting plenty of rest and fluids to maintain a strong immune system.
  • If symptoms do begin, it is worthwhile contacting your family physician, health department, or local hospital to ask what to do.
  • Staying at home and preventing disease spread to others is the first step.
  • Advice about supportive care such as fluids and fever control measures may be given by phone.
  • Prescription medication for oseltamivir (Tamiflu) or zanamivir (Relenza), anti-viral medications that can treat swine flu, may be also prescribed, but some health care practitioners may want to examine a patient before prescribing these drugs. High-risk individuals, according to the CDC, should have a prescription handy in case they get the H1N1 swine flu.
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