H1N1 (aka Swine flu) came and went from public consciousness in the late spring. Summer arrived, and people had things on their minds other than a flu pandemic. But the H1N1 flu virus is again in the forefront of the news. Why? First, it's flu season. Second, this novel virus has spread worldwide, resulting in the World Health Organization declaring it a Level 6 pandemic, which is the highest phase on the 1-6 scale. The virus spreads easily, but fortunately the case fatality rate doesn t seem to exceed that of the regular seasonal flu. It does, however, appear to have a greater effect on the younger population in terms of incidence and severity of illness. As of early September, H1N1 has struck hard at the University of Washington, with more than 2,500 students affected. The bad news is that they're ill; the good is that symptoms are mild/moderate, and no deaths have been reported at the university.
On Sept. 9, Donald Williamson, MD, Alabama state health officer, at a joint news conference with State Superintendent of Education, Joe Morton, PhD, said about the acceleration of flu cases in Alabama schools:
We are still in the acceleration phase of H1N1 influenza, and there has been almost logarithmic growth in its incidence. Looking at our schools, three weeks ago 20% of schools had more than 5% absenteeism, and now 54% of schools have absenteeism rates of this level. On a positive note, relatively few schools have more than 20% absenteeism, and this seems to be stabilizing.
Protecting the Population
Early discussion focused on the use of anti-virals, such as Tamiflu and Relenza, to reduce the effect of H1N1. This was the get-sick-first model. But prevention is better than the cure, so the focus shifted to developing a vaccine to prevent the illness.
Creating a vaccine doesn t happen overnight. The seasonal flu vaccine production had to be completed, and the H1N1 strain still had to be identified. As the process began, researchers discovered the flu virus wouldn't grow quickly in the chicken egg yolks that are normally used to produce the seasonal influenza vaccine, and companies still had to safety-test the resulting vaccination. As this article is printed, those tests are going into human trials. So far the results look favorable, and the H1N1 vaccine appears to be safe. But the number of doses available by mid-October is considerably lower than anticipated. The good news: Testing of the vaccine indicates only a single injection, not two as originally believed, will suffice. But the general populace needs to be vaccinated with both the regular flu virus as well as H1N1, because one vaccine doesn t offer protection against the other.
What Does It Mean for Law Enforcement?
Recent response models placed first responders and immediate family members in the first tier of those to be given protective drugs. With H1N1, this won t happen unless the officer or family member falls into the high-risk groups that have been identified by the Centers for Disease Control and Prevention (CDC). They are as follows:
- Pregnant women;
- Household contacts and caregivers for children younger than six months of age;
- Health-care and EMS;
- Children age six months 18 years, because they re in close contact with each other in school and daycare settings, which increases the likelihood of spreading the disease;
- Young adults who are 19-24 years old, because they often live, work and study in close proximity, and they re a frequently mobile population; and
- People who are 25-64 years who have health conditions associated with higher risk of medical complications from influenza (e.g., asthma or weakened immune systems).
Health authorities say it takes the better part of a month to achieve immunity after inoculation. Get the seasonal flu vaccine as soon as possible, then consult with your doctor regarding the H1N1 vaccine.
Testing for H1N1
Most doctors don t test for H1N1. If they do and the test is positive, it s unlikely you ll need or be given Tamiflu or other anti-viral medicine unless you re extremely ill and need to be admitted to the hospital. The bottom line: Eat healthy foods, decontaminate your hands and work areas often, get plenty of sleep and exercise routinely. Stay away from sick people. However, if you need to go near someone who is ill or go to an ER waiting room to do a post-accident interview, consider wearing an N-95 mask. For more tips on how to stay healthy this flu season, visit www.lawofficer.com/swineflu.
The Symptoms
According to a Centers for Disease Control and Prevention (CDC) official, typical symptoms include fever often higher than 101 F headache, body aches, chills, sore throat and a cough. Although some people may have mild symptoms, others may feel like a train has hit them. Treatment includes drinking plenty of fluids and staying home, to avoid infecting anyone else.
Warning Signs Requiring Urgent Medical Attention
Children:
- Fast breathing or trouble breathing
- Bluish or gray skin color
- Not drinking enough fluids
- Severe or persistent vomiting
- Not waking up or not interacting
- Being so irritable that the child doesn t want to be held
- Flu-like symptoms improve but then return with fever and worse cough
Adults:
- Difficulty breathing or shortness of breath
- Pain or pressure in the chest or abdomen
- Sudden dizziness
- Confusion
- Severe or persistent vomiting
- Flu-like symptoms improve but then return with fever and worse cough
Half Your Staff Has H1N1 Now What?
Flu symptoms may last seven days or more. This means that those who are ill should be back to work in a relatively short period of time. Absent a mutation of the virus, those infected will develop immunity, and it s unlikely they will fall ill again with the same flu. However, just because a person has been ill with the flu, it doesn t mean they should stop practicing good hygiene. There are thousands of other viruses and bacteria just waiting to infect someone.
If personnel shortages occur, shared resources may become necessary. To maintain a capable patrol force, you may need to consider hiring police officers from surrounding jurisdictions to work patrol during shortages. Now is the time before widespread infection to develop area maps and communications information.
Consider: What would occur tomorrow morning if half of your department called in sick? Include in the sick call many of the command staff. Are your line officers up to the job of running the shift? Have you trained them and offered them the opportunity to make decisions as OICs? When we bring other officers in, they work under the command of our personnel, which can only work if our officers know what they re doing and have been trained to be in charge. It shouldn t be trial by fire but seamless interaction based on prior training. Combining staff from dispatch centers that have mutual aid agreement and capabilities can keep communications running and emergency calls answered.
Emergency calls may require a triage system. Crimes against people will always take priority over property crimes. The public expects immediate response to a 9-1-1 call, but it may not be feasible.
In Sum
H1N1 is here to stay. Use the above information to set up your personal and workplace wellness programs. There are no guarantees except one: To do nothing is to place yourself and those around you at increased risk. That s not acceptable. Review the U.S. Department of Health & Human Services Law Enforcement Pandemic Influenza Planning Checklist and create a plan.
Resources
Note: The author appreciates the assistance of ER doctors John Wipfler (Ill.) and David Chen (Calif.) in reviewing this article and their unending efforts on behalf of law enforcement.
