Since Pandemics are so rare, and so deadly, we will be focusing on Pandemic education for the next few weeks.
Do you recall the pandemic of 2009? Worldwide it is estimated that 579,000 people died. We are again facing the possibility of a pandemic caused by a new strain of virus. According to the World Health Organization:
“Avian influenza A viruses rarely infect humans; however, when human infection and subsequent human-to-human transmission occurs, worldwide outbreaks (pandemics) can result. The recent sporadic infections of humans in China with a previously unrecognized avian influenza A virus of the H7N9 subtype have caused concern owing to the high case fatality rate associated with these infections (more than 25%), potential instances of human-to-human transmission, and the lack of pre-existing immunity among humans to viruses of this subtype… The robust replicative ability in mice, ferrets and nonhuman primates and the limited transmissibility in ferrets suggest that A(H7N9) viruses have pandemic potential.”
Since we rarely hear about pandemics in the media before they occur it is time to do what those who are self reliant always do, we research and prepare ourselves. Pandemics don’t care if it’s summer vacation, Christmas or spring break, they come uninvited. They usually begin in the fall or spring but can begin at any time.
Sadly, in addition to preying on the elderly, pandemics also prey severely on children and young adults, yes, those in their 20s. The lack of immunity in the young is a disadvantage. We cannot assume anyone is safe.
6 Important Decisions to Make Now
There are valuable lessons learned from past pandemics. One thing we know is that they spread very rapidly. This will leave us little or no time to prepare once a pandemic outbreak has been confirmed. Because of this, there are decisions to be made right now.
1. Determine who among you is at greatest risk of illness during a pandemic. These are the people you may need to emphasize in your preparation, as they may not be able to plan for and care for themselves. According to The U.S. Department of Health and Human Services this would include:
- The economically disadvantaged (having little or no money to stockpile food and supplies),
- Those without a social network (many children, the homeless, those geographically separated from family including transient workers and elderly),
- Dependent individuals needing support for daily activities (physically disabled, developmentally disabled, mental illness, substance abuse or addiction, difficulty seeing or hearing, and other medical conditions),
- Those with trouble reading, speaking or understanding English.
2. Determine which room in your home will act as the isolation room, or room where those who are ill will be cared for. Whenever possible this should be a room with its own bathroom facilities. If you have a bedroom which is separated from other bedrooms in the home, this would be a good choice. When possible, this room should also include a TV with DVD player. Those who are ill will need a diversion to keep their minds occupided as they recover. This room should also be large enough to set up an additional bed.
3. Stockpile food and medications. We will talk more about storing for those who are ill in a future article but don’t forget about those who are not ill. We need to have a three month supply of the foods we eat on a regular basis. During a pandemic there will be a great deal of stress in a home where people are ill. Be sure you have comfort foods in your storage as keeping a positive attitude is an important aspect of physical well being and healing, and nothing does that better than a brownie. While you are at it, your storage should include enough for others beyond your normal household, if possible.
It is important to store over-the-counter drugs for fever, muscle ache, nausea, diarrhea, and sore throat pain. Be sure to store both adult and children’s varieties of these medications. Remember, aspirin should not be given to children without consultation with your physician. Be sure to have a supply of all prescription drugs required by every family member. Consult your doctor and/or pharmacy on how to do this. As you help to prepare those in the high risk group, be sure to help them to legally accumulate these supplies as well.
4. Discuss pandemics as a family. Remember the insecurities children and many adults felt after 9/11? Informing your family and others you will care for about pandemics will greatly reduce the fear when it finally hits. There is a great comic book prepared by King County, Washington which can be downloaded and used as an educational tool. Copy this tool and prepare a lesson now and as sson as you hear a declaration that a pandemic has been declared share the information you’re your family. Do www.kingcounty.gov/healthservices
Discuss exactly what your new family routine will include. Walk through your isolation room and talk about how you will care for a patient.
5. Complete a basic medical record for each person in the family, and any others you will care for. Do this now as it is a valuable resource during any emergency and should be in every 72 hour kit. You can find a basic form
6. Designate a primary care giver and a second if the first should become ill. This should be a person who is familiar with patient care, which we will discuss later – hopefully a person who has a strong immune system.
Once a pandemic has been confirmed, it is time to self quarantine (you may want to do so even before local leaders get around to imposing measures, in case they are unprepared to do so). Immediately pick up others you will be caring for and bring them to your home. As we have learned from past pandemics communities and families who self quarantined survived at a much, much, greater rate than those who did not. Now is the time to settle into a new routine. Designate times for watching TV, doing homework, crafts, reading, meal preparation, chores and playing games. If you assume all of this will just happen, then you will watch all the DVDs you own in the first week and discover you still have weeks of self isolation left to fill with activities. If you live on an acre or more, you will want to include time outside for children to play each day, within bounds of course. Exercise will be important to maintaining good health.
Prevent Spreading the Pandemic
How does a pandemic flu spread? Primarily, it is airborne. This can happen when an infected person coughs or sneezes. Coughing and sneezing produces droplets which can pass the illness to others when inhaled.
These droplets may also land on surfaces and, according to the Mayo clinic, can remain active for up to 48 hours.
Droplets from an infected person can make contact with surfaces such as table tops, door knobs, water faucets, shower handles, telephones, toys, remote controls, books and magazines, toilet seats, computer keyboard and mouse, wheelchairs, walkers, baby swings, everything and anything a person who is ill touches or sneezes or coughs on.
Anyone living in a home with an influenza patient is at risk of becoming ill. Good hygiene practices should be implemented throughout self-quarantine, and if illness befalls the household, boundaries and hygiene rituals must be observed.
Remind your family to cover their mouth and nose with a tissue when they cough or sneeze, and then to put the used tissue in a waste basket and wash their hands. Label each box of tissues with a family members name, another way to prevent transferring germs. When a tissue is not available, have family members cover their mouth and nose with their arm (not hands). Practice good hand washing techniques. This is a great exercise for a family home evening. Remain conscious of what and who you have touched. Wash frequently.
When caring for someone who is ill use alcohol-based hand wipes or alcohol-based (60-95% alcohol) gel hand sanitizers – rub these on the hands until the liquid or gel dries. Wash your hands often when you or others are sick, especially before touching your mouth, nose, and eyes. Always wash or sanitize your hands before preparing food or eating.
Cleaning and disinfecting hard surfaces and items in your home often will help to prevent the spread of the flu. When using a commercial product, be sure to follow the directions on the labels carefully.
Pay attention to any hazard warnings and always use gloves when advised to do so. Do not mix disinfectants and cleaners unless the labels indicate it is safe to do so. Combining certain products such as chlorine bleach and ammonia can produce toxic vapors which may result in injury or death.
If disinfectants are not available, use a chlorine bleach solution made by adding 1 tablespoon of bleach to a quart of water or 1/4 C bleach to 1 gallon of water. Using a clean cloth, wipe down surfaces and let stand for 3 – 5 minutes before rinsing with clean water. Wear gloves to protect your hands. Be sure to firmly cap any remaining bleach disinfectant and label it well.
Make waste baskets easily accessible throughout the house. Line them with a plastic bag and empty them at least daily. After emptying, be sure to thoroughly wash your hands.
Wash laundry as you normally would for all of those who are not ill. Remember, the germs which cause the flu are spread through the air so do not shake soiled laundry. Wash your hands after you gather laundry.
When laundering for those who are ill you may want to keep these items separate from the rest of the laundry in the home. This is primarily because you may want to assign someone to do the washing, for those who are not ill, other than the person who is caring for those who are ill. Having chores to do will help each family member feel needed and we all feel more in control and under less stress when we are contributing. There is no reason to expose the person assigned to do laundry to the germs in the sheets and towel of those who are ill. I have purchased white sheets and towels for use by those who are ill. I can then bleach them if someone should vomit on them or as otherwise necessary.
For all the above tasks, gloves and masks should be worn for best protection.
Now to the Isolation Room
Have gloves, masks, a gown and anti bacterial wipes or lotion near the door of your patient room. I would place them directly outside the room so I could put them on before entering and then leave them in a wastebasket in the room before exiting. All masks and gloves should be used only once. The jury is still out on the effectiveness of masks but if they make you feel safer by all means use them. Be sure they are N95 masks. A gown is not a necessity, but if you prefer you can slip it on as you go into the room and remove it before exiting, leaving it in the room for next time. You can use a robe or any other easily removed item of clothing to protect your clothing from germ laden droplets. On the table outside the room place wipes to disinfect the door knob and also to wipe your hands. Also have a bottle of lotion available. All this hand washing is going to dry out your skin quickly, and you don’t want to have chapped and bleeding skin.
Keep a record on every patient. Get a notebook or make a form to complete each time you care for a patient. Make a separate record for each day. Include the time and patient’s temperature, pulse, and blood pressure. This should be done at least four times a day unless the patient is very ill or their condition deteriorates, and then it should be done more often. Blood pressure devices are cheap and widely available these days.
Keep track of the patient’s food and fluid intake. List everything they consume. Also keep track of output. This can be difficult as no one really wants to urinate into a measuring cup when they are ill but at the very least have the patient record every time they use the bathroom and estimate how much their output was, even if they record a little, hardly any, or lots, as their response. If you have chemical in your toilet that turns the water blue, remove them. They will make identifying problems much more difficult. This is extremely important, as the leading cause of death from the flu is dehydration.
One of the first signs of dehydration is weight loss so be sure to keep track of a patient’s weight.
Mild dehydration is very difficult to detect. Often the only sign is thirst. Take it seriously if a family member says they are thirsty and give them fluids such as water, juice and Popsicles. Never give soda or caffeinated drinks when you suspect someone may be dehydrated. It is important to pay attention to family members who are well, as it is easy to become focused on those who are already ill and to forget the others.
Moderate dehydration will result in an infant becoming thirsty, restless or lethargic, irritable and drowsy. An older child or adult will often be thirsty but still alert. The pulse rate of all who are moderately dehydrated will increase. Respiration will become rapid, blood pressure normal or low, week or dizzy when standing, eyes will become sunken and tears reduced or absent. When the skin of the moderately-dehydrated person is pinched it will not retract immediately, but more slowly. Try the test on someone you know is not dehydrated, and compare to the one you suspect may be. The membranes of the mouth and nasal passage will be dry and urine flow will decrease and darken. If you believe someone is moderately dehydrated, force fluids immediately.
A person who is severely dehydrated will be drowsy, cold, sweaty, have wrinkled skin, fingers and toes and an infant may become comatose. Pulse will be rapid and feeble and in some cases impalpable. Breathing will be deep and rapid with blood pressure low and sometimes un-recordable. A pinch will retract very slowly. Eyes will be sunken and tears absent. Mucus membranes will be very dry and the tongue will stick to the mouth. Urination will be minimal, if any. If you notice any of these symptoms, get the patient to the doctor or hospital immediately.
You may store commercial rehydration products for use during a pandemic. Since a self quarantine may last longer than your supply – here are a few homemade rehydration solutions you can make from items already in your food storage.
Solutions which are not recommended for rehydration are: solutions combining water, sugar and salt, cola drinks, soft drinks, chicken broth, salt water and sugar water.
In the pandemic of 1918, perfectly healthy young people could get up feeling normal at breakfast, come down with illness in the afternoon, and be dead by tomorrow morning. It was shocking.
If faced with the same infection today, which could happen (since we know such viruses still exist in laboratories and new ones are created in nature), at least we would have the benefit of clear hindsight, better resources for preparation, the ability to self quarantine, and public health resources to track and warn the public. But only we – you and I – can implement the advantage of self-preparation and voluntary self-quarantine.
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