Curbing the Spread of Swine Flu
May 11, 2009 –The H1N1 virus -- widely known as swine flu -- has emerged in almost every state and many countries in the past month. The Centers for Disease Control and Prevention (CDC) predicts the strain will hit every state before the pandemic is over. As cases emerge in more countries, public health officials in the United States and worldwide are working to curb the flu's spread. At Georgetown, Jeanne Matthews uses her joint appointment as assistant professor in the School of Nursing and Health Studies and nurse manager of Arlington County, Va.'s public-health division to help her students understand the implications of swine flu. Matthews spoke with the Blue & Gray about whether U.S. borders should close, crafting a public-health message about the flu and why 'Bohemian Rhapsody' could be the key to stopping swine flu’s spread.
Q. How does the public-health community begin to tackle something like swine flu, especially when it spreads so quickly?
A. There's an incredible amount of planning that goes on in public health all of the time. We started planning for a potential pandemic years ago and put systems in place and developed plans to deal with it. So if we had a big challenge, we'd be able to meet it. It's not just true of Arlington, that's true of the whole country.
There's all of this public-health activity behind the scenes that people never see. We have at least daily briefings since this started, and we moved from plan and preparation mode to implementing public-health communication strategies. For example, messages have to be developed for the public and for various constituencies, such as long-term care facilities or schools.
Q. When you say planning has been ongoing, do you mean for swine flu specifically?
A. Originally the concern was avian flu, and that was the stimulus. But the reality is that whether it's avian or swine flu, a pandemic is a pandemic. There might be some specifics about treatment that change or differences in severity, but the reality of all pandemics is the same. You want to be able to identify who the cases are and control the spread. What we develop around pandemic planning is developed irrespective of the pandemic.
Q. Can you clarify what is meant by the word pandemic?
A. The World Health Organization has six specific levels of pandemics, but the system doesn't address severity at all. It addresses a worldwide spread out of the ordinary -- an epidemic that's worldwide.
Q. What is the public health community's role when something like the swine flu emerges?
A. Public health is pretty transparent unless something goes wrong. When something does go wrong, like a food-borne illness outbreak, suddenly there is a lot of attention paid to monitoring and regulation. I think the same is true of flu. On average, 36,000 people in the U.S. die a year from seasonal flu, and we still have a significant number of people a year who don't get a flu shot.
A flu pandemic or potential pandemic like this one gives us an opportunity to reinforce prevention methods we try to get out all of the time. (Acting CDC director) Richard Besser and others from the CDC talked about the prevention method not being sexy -- wash your hands, cover your cough, stay home when you're sick. And for the seasonal flu, get a flu shot. It seems so intuitive, but there's not enough attention paid to it. If we could get people to wash their hands, we could fix a multitude of problems.
Q. Is stopping the flu spread really as easy as convincing people to wash their hands more often?
A. If people washed their hands, they could decrease disease significantly. It's a real challenge trying to get that message out. Children learn to sing their ABC's while hand washing to make sure they're washing long enough. On National Public Radio, they suggested adults sing the first bars of “Bohemian Rhapsody” because it's the same idea -- wash vigorously for 20 to 25 seconds to make sure you get into all of the cracks and crevices. The friction and running water gets rid of what's on your hands. You don't need the anti-bacterial soap, just regular soap and running and water -- and dry your hands well.
Q. What do you think about calls to close U.S. borders to stop infected people from entering the country?
A. The only point of closing borders would be if it stopped the spread, and it's not going to. It's been likened to closing the barn door after the horse is out. What possible point is there?
There are things we can worry about and things that aren't worth worrying about. We can't possibly monitor the health status of everyone entering the country. What we can do is get the word out so people understand that if they're sick, they need to see a health care provider. And we're lucky so far -- the H1N1 cases we're seeing are very mild.
Q. How does this flu outbreak compare to others in terms of how it spread? It seemed to hit multiple countries very quickly.
A. I would suggest that we're doing pretty well in terms of control because we haven't really seen a lot of community transmission. We hope that's a result of people paying attention to the prevention message. We also know that it's about active surveillance and investigation and putting into place mitigation strategies. Those might be excluding people from the workplace or school if they're sick.
Q. What do you think of the face mask trend? Are they really necessary?
A. One of the things we want to do in our risk communication messages is to be sure to tell people something they can do to prevent the spread. Initially, some people overreact and you see masks everywhere, even in communities where there isn't a significant amount of flu.
There is a place for masks, such as for health workers who are potentially exposed. Or if someone has symptoms and they're not in their own home, they should wear a face mask to try to reduce exposure to others. But other than that, there's no need for masks.
Q. Is there a concern that H1N1 could die down for the summer but re-emerge next fall or winter in a more virulent form, much like the flu outbreak in 1918?
A. We're now at the tail end of seasonal flu in this country, but it will gear up again when colder weather returns. That is a concern with H1N1 flu because thus far it seems to have a pattern of seasonal flu. H1N1 cases do seem to be decreasing in Mexico already.
Q. Given that, how do you keep people engaged in prevention methods and public-health communication?
A. We're being bombarded right now. It's 24-7 swine flu all the time. I think that's a double-edged sword. It gives people the information they need, but can either make them anxious or turn them off. We want to maintain a balance. We don't want to lose the impact, and we want to be able to pick it back up before flu season starts.
One of the things we need to consider for this year in particular is how do we plan the ramp up for the seasonal flu message in the fall. We do it every year, but this year might be different. Do we need to do it sooner? Once this flu dies down, how will that impact people's attention to this?
Q. What opportunities does something like the swine flu present when teaching public-health nursing students?
A. There are often outbreaks of one sort or another -- we recently examined a measles outbreak in the Washington area. On the last day of class this semester, I spent about 40 minutes doing an overview of the H1N1 flu because it's the application of everything we've covered in our public health nursing sessions. We've learned about outbreak investigation, epidemiology, communicable disease, emergency preparedness and communities. I walked them through from the start of when we first heard about it through the collaborative work done by public health communities with business, schools and so on to where we are now. They are great teaching cases for our students.