A recent s
urvey of American adults found that 76% worried about becoming ill
if they had to stay home and take care of the sick during a severe flu pandemic.1
Wash hands for 15 seconds with soap and water
Cover a cough or sneeze with tissue
In the last year we have had over 4500 downloads of the eBook. Visitors have come to the site from all over the world. We have had positive reviews from many professionals in the field. However, we have not been able to secure funding for program operating costs or expansion.
The Pandemic Home Care team will continue to update the website as needed. The eBook will continue to be available for a small fee and for personal use. Thank you for your interest in our work.
On April 12, 2010, the World Health Organization began a review of the global response to Pandemic H1N1, 2009. One objective is to assess "lessons learned." You can read more about the WHO activities at the WHO webpage.
There has been an increase in the number of cases of H1N1 in the US. Please read the CDC press briefing
. Many now hospitalized have severe illness. Vaccine is still available but large quantities will expire in the coming months. As you know, vaccine is the primary prevention activity to protect against influenza illness, including H1N1. Other important measures include covering a cough and handwashing.
According to a survey completed by the Harvard School of Public Health in late January, 2010 a "majority of parents got or intended to get the H1N1 vaccination for their children, but not for themselves."
Again, public health education is sorely needed in order for people to understand the importance of immunization as a primary prevention activity against influenza illness. You can read the press release for the HSPH at http://www.hsph.harvard.edu/news/press-releases/2010-releases/poll-half-of-americans-believe-h1n1-outbreak-over.html
The scheduled web conference "Pandemic Influenza: Public Health Education for Community Resilience" has been cancelled due to a lack of funding.
Ready of Not? 2009: Protecting the Public's Health from Disease, Disasters and Bioterrorism found that "the H1N1 flu outbreak has exposed serious, underlying gaps in the nation's ability to respond to public health emergencies and that the economic crisis is straining an already fragile public health system." Two extremely important areas of the report focus on the need for "accountability and transparency" at the national and state level and "improving community preparedness."
We urge you to download the report for your state. Information about how money is spent and the level of preparation for different states is presented.
Communication of accurate information is an ongoing need that has been raised in various evaluation reports throughout the H1N1 pandemic. See our earlier blog entries for links to those reports. However, national and state organizations continue to use a "risk communication" model to try provide information to the public. Risk Communication is based on a behavioral health, cognitive theory that focuses on managing how people react to difficult situations. It assumes that knowledge is not enough to deal with difficult situations.
We at Pandemic Home Care have advocated for the use of a public health education model to explain complex public health issues to people so they can make the best decisions for themselves and their families in their unique communities. We assume that knowledge is the foundation for a prepared public and the role of health professionals is to explain, in-depth changing situations.
We continue to advocate for in-depth, evidence based benchmarks about home care for the public, written by health care professionals. Our eBook, "Pandemic Flu Home Care: A Detailed Guide for Caring for the Ill at Home" is one example of a public health educational strategy.
The Centers for Disease Control updated their home care information on December 5, 2009. "H1N1 Flu and Seasonal Flu: Caring for the Sick at Home" can be downloaded by going to
Here are resources for finding flu shots (seasonal and H1N1) in your area.
Google Maps Enter information about your location and a partial list of resources will appear
FLU.gov has an interactive maps on the home page "Flu Shot Locator for seasonal and H1N1" that will link you to the specific information for your state.
You can also go to the CDC page http://www.cdc.gov/h1n1flu/vaccination/vaccinesupply.htm "2009 H1N1 Influenza Vaccine Supply Status" for daily updates about the availability of H1N1 vaccines in your area.
The Centers for Disease Control and Prevention (CDC) has a series of educational materials related to the vaccine for H1N1 swine flu.
Please click on the link and read the information. CDC updates the page regularly. The information is practical and easy to read and useful.
Vaccination is the most important primary prevention effort to protect against influenza disease.
You can also read the World Health Organization (WHO) statement on Pandemic Influenza Vacccines: Current Status (including vaccine safety)
WHO describes the H1N1 vaccine testing procedure. WHO also lists common H1N1 vaccination side effects
- soreness, redness and swelling at injection site lasting 1-2 days
- and in some instances fever, headace and muscle aches lasting 1-2 days
- Part of any large vaccination program for millions of people is the constant monitoring of any adverse reactions to the vaccination
In addition, people should also continue to:
- cover a cough
- wash hands
- stay home if you are sick
CDC has a list of free materials that can be downloaded, printed and used in almost any setting for ongoing public education. The materials include:
H1N1 Vaccination Recommendations
Questions and Answers about H1N1
A Guide for Parents
3 Steps to Fight the Flu
Clean Hands Save Lives
Cover your Cough
Please download these free materials, share them and use them.
I continue to watch and read news reports about the current H1N1 flu pandemic. Over and over again, community education efforts present important basic information that includes
Even though recent evaluations of H1N1 flu programs (PCAST, GAO and the Trust for America's Health discussed in earlier blogs) stated more work was needed to help the public understand complex and changing issues, the focus for pandemic planning rests on expanding "surge capacity for hospitals, clinics emergency response systems, "nurse information hotlines" and web based H1N1 information.
Current community education efforts could be expanded to include evidence based, illustrated books, DVDs and other materials. Benchmarks for identifying mild, moderate and severe influenza illness and what to do at each stage including when to contact a health provider and why could be made available to the public now "Pandemic Flu Home Care: A Detailed Guide for Caring for the Ill at Home" is an example of a research based community education resource.
THE President's Council of Advisors in Science and Technology (PCAST) issued a report assessing H1N1 flu preparations. They recommended:
- vaccine production continue as quickly as possible so that "at risk groups" can receive it in a timely manner
- clarify guidelines for the use of antiviral medications
- upgrade the current system for tracking the H1N1 pandemic
- increase the development of communication about H1N1 to the public
See a news release and links to the full report here.
The World Health Organization (WHO) in collaboration with other international organizations issued a document about managing the H1N1 pandemic worldwide. Major points include:
- A review of key principles affecting the H1N1 experience as it spreads around the world
- Measures that can be taken now to reduce the impact of the pandemic
Although a majority of the H1N1 cases experience "mild symptoms" and "recover without medical care" there are high risk groups that should seek medical care including "pregnant women and those with underlying medical conditions."
The document also states the need for the public to have "home care information" to be able to manage "non-severe influenza-like illness including diarrhoea and dehydration, voluntary seperation of the sick and when to seek health care."
To reduce the spread of disease, information should focus on home care of mild illness, "reduced time in crowded settings- especially for high risk groups, cough etiquette (cover a cough or a sneeze with tissue) and hand hygiene (handwashing with soap and water).
Read the entire report at WHO
According to an article by Lauran Neergaard of the Associated Press published today "Flu planners fear ERs flooded with the not so sick" the Centers for Disease Control and Prevention (CDC) is working with "worried doctors" to develop "hotlines" or interactive websites to help people decide when they should go to a hospital and when they should stay home.
The need for practical, detailed community education information remains extremely important.
"CDC Recommendations for the Amount of Time Persons With Influenza-Like Illness Should Stay Away from Others" states:
"people should remain at home until at least 24 hours after they are free of fever (100 degrees F [37.8 degrees C]), or signs of fever without the use of fever reducing medications" The guidance applies to "camps, schools, businesses, mass gatherings and other community settings where the people are not at increased risk for influenza complications." People should continue to practice good handwashing and "cough etiquette" meaning "cover a cough with a tissue."
The World Health Organization (WHO) Pandemic Influenza in Pregnant Women, briefing note 5 identifies pregnant women at a higher risk for "severe or fatal illness" if infected with the H1N1 virus. WHO recommends that any pregnant women who develop symptoms of H1N1 infection should seek medical care immediately. The briefing, posted July 31, 2009 also lists "danger signs in all patients" that include
- shortness of breath while exercising or at rest
- difficulty breathing
- turning blue
- bloody or colored sputum
- chest pain
- altered mental status
- high fever that persists past 3 days
- low blood pressure
You can read the full briefing by clicking on the above link or here
The CDC has issued guidelines for who should receive H1N1 swine flu vaccine when it becomes available. Priorities include:
- pregnant women
- people who live with or care for children less than 6 months of age
- health care and emergency services personnel
- persons between the ages of 6 months and 24 years of age
- persons between the ages of 25 through 64 years of age who have chronic illnesses or immune system problems
These groups are at a higher risk for developing disease and complications from H1N1 swine flu.
CDC also recommends that people obtain the seasonal flu vaccine when it becomes available.
The World Health Organization announced that it will change the reporting requirements for H1N1 virus infections to focusing on new countries where the infection is spreading.
"The increasing number of cases in many countries with sustained community transmission is making it difficult, if not impossible for countries to try and confirm them through laboratory testing."
WHO will continue to provide regular updates "describing the situation in the newly affected countries." All countries including those with widespread community transmission will continue to monitor "unusual events" related to the H1N1 pandemic including "clusters of severe or fatal H1N1 pandemic virus infection, clusters of respiratory illness requiring hospitalization and unusual clinical patterns associated with serious or fatal cases." Read the entire report "Pandemic (H1N1) 2009 briefing note 3 (revised)."
The most recent survey of American adults conducted by the Harvard School of Public Health
found that 6 in 10 adults feel there will be a "widespread cases of influenza A in the fall with people becoming very sick." However, 61% of the adults surveyed also thought that they would NOT become sick. In addition, people felt "capable and willing" to take care of a sick child (78%) or a sick adult (66%) for 7-10 days if necessary. Almost 27% said they did not have anyone to help care for them if they became sick. No specific questions were asked about ability to set up a sick room, take a temperature, monitor fluid intake or cope with the stress of a rapidly changing situation.
The World Health Organization has issued recommendations for Pandemic Influenza H1N1 vaccine use (when a vaccine becomes available). They include
- vaccinating health care workers as a first priority to protect the health care infrastructure
- then focusing on select groups including pregnant women, those older than 6 months with one chronic medical condition
- healthy young adults ages 15-49
- healthy children
- healthy adults 65 years of age and older
Recommendations for vaccine use may change as new information becomes available. Read the entire statement at
See live video streaming from the H1N1 Flu Summit at http://www.flu.gov
The White House will hold an H1N1 Flu Preparedness Summit July 9, 2009
"to further prepare this nation for the possibility of a more severe outbreak of H1N1 flu. The goal
of the summit includes discussing preparedness priorities.
Two priorities that I see include 1: the need for research about what the public does and does not know
about basic home care issues. For example, do people have skills and the resources to take a temperature. How many people have a thermometer, know how to use it and how to interpret the readings? Do people know how to keep a sick person well hydrated and what signs of dehydration look like? 2: Distribution of existing detailed home care information
for the public so that mild influenza illness can be managed at home and people can feel confident that they are contacting a health care provider when they need one. See the press release
for more information.
Last week I was in a major airport where announcements about infection prevention were played. "Cover a cough with tissue; cover a sneeze; wash your hands often." These helpful reminders were unfortunately ignored by many people. I observed adults and children coughing and sneezing, wiping noses with their hands. Were these people unaware of the announcements? Did they forget to follow the basic instructions? I wonder.
The World Health Organizartion declared a pandemic for H1N1 swine flu infections now affecting 74 countries around the world, The illness remains mild in most most countries. Read more from the NY Times
According to a report released by the World Health Organization assessing the "severity" of a pandemic is influenced by:
- characteristics of the virus
- vulnerability of the population
capacity of the population to respond 1
Currently, the pandemic alert phase remains at level 5. WHO will consider severity issues before moving to level 6, "widespread human infection." 2
The Trust for America's Health released a report "Pandemic Flu Preparedness: Lessons from the Front Lines." There are 10 major findings related to the 2009 H1N1 influenza outbreak including:
Read the press release and the entire report.
According to an article published in the NY Times, the World Health Organization is closer to declaring the current H1N1 swine flu a "worldwide pandemic." The disease has occurred in 64 countries and produced mostly "mild illness." According to update 43 from WHO, there have been 19,273 cases of H1N1 influenza around the world and 117 deaths.
Research conducted at the Harvard School of Public Health found that Americans are very interested in information about H1N1 swine flu. Conducted between May 5-6, 2009 the survey found that Americans are also uncertain about the risk this influenza virus poses for themselves and their families. Click on the link to read more about the survey.
This blog will discuss current issues in the news about pandemic home care. We will use some examples from the current public health emergency related to the A/H1N1 situation in the world. In addition, there is a specific page on this website devoted to updated links to the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) information as it is updated.
Recent newspaper articles have repeatedly pointed out that the "worried well" contact health care facilities because they are not confident about how to take care of themselves, even during mild illness. See for example a recent NY Times article, "At the Hospital, the Faces of Fear and Swine Flu"
Why are people so worried, when according to WHO most of the A/H1N1 infections seen around the world have been "mild in nature"? See WHO Influenza A/H1N1 press briefings
Maybe it is because people lack practical, detailed information about basic illness prevention and management issues. Do people know how to take a temperature with a thermometer? Do people know what at "high fever" is? Do people know how to "push fluids" to prevent dehydration?
Current research has focused primarily on the science of the A/H1N1 virus. Current research could also be directed toward identifying what the public knows about home care issues.
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