As the media coverage of this infection spreads, I have been asked more questions. Here are some of them:

1. Should I cancel my trip to Mexico? The CDC is recommending against unnecessary travel to Mexico. Similarly, many countries have done the same. I recommend canceling all unnecessary travel for the time being to any destination. 

2. Are airplanes safe? Not clear. This was reported earlier today in the NYTimes: “Most of Boeing’s airplanes have air filtration systems with “similar performance to those used to keep the air clean in hospitals, operating rooms and industrial clean rooms,” according to Jim Proulx, a Boeing spokesman. “These filters are very effective at trapping microscopic particles as small as bacteria and viruses,” Mr. Proulx continued. “All Boeing production airplanes have HEPA filters, which are effective at capturing greater than 99 percent of the airborne microbes in the filter air.”- However, if you are sitting next to someone with Swine Flu (or within 6 feet from that person) then filters will not be of much use to you.

3. Should I wear a mask?: Face masks and respirators (see below) are most useful for people who are in crowded settings, such as classrooms, subway or airplanes, where they will protect the mouth and nose from germs and reduce the likelihood of coughing or sneezing on other people.

4. Would any mask do? No! Don’t count on those disposable masks to completely protect you against the swine flu. These are loose-fitting and designed largely to help stop droplets from spreading from the person wearing the mask. They also protect the wearer’s mouth and nose from splashes. They are not created to protect the wearer from breathing in very small particles. Respirators, on the other hand, are made for just that. They are similar in appearance to the relatively inexpensive face masks but are designed specifically to protect the wearer from breathing in such particles. These masks, known as N95 for its filtering ability, fit more snugly on the face than face masks so that most air is breathed through the filter material. They work best if they are fitted specifically to the person wearing the mask. so wear the correct mask (N95) and fit them snugly on your face.

5. Is this it? Am I now protected? No.  Face masks and respirators should be used along with other precautions, such as frequent hand-washing, covering coughs, staying at home if ill and avoiding crowds.

6. Should I panic now? No absolutely not. This is preventable and treatable illness. If you protect yourself and others, use common sense and do not ignore symptoms, then we will all be better.

Many of us are concerned about the Swine flu. As a physician in Medical practice, I received a lot of call from my patients about this. So here I will try to answer some:

1. What is Swine Flu? :Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza viruses that causes regular outbreaks in pigs.

2. Is it contagious? Do I have to go to Mexico to get it? CDC has determined that this swine influenza A (H1N1) virus is contagious and is spreading from human to human. However, at this time, it is not known how easily the virus spreads between people. People who have it can pass it on to others.

3. If I have it what do I feel? The symptoms of swine flu are similar to the symptoms of regular human flu and include fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and vomiting associated with swine flu.  Like seasonal flu, swine flu may cause a worsening of underlying chronic medical conditions.

4. How can I tell if it is Swine Flu from regular flu?: probably the most telling symptom is fever. Swine flu usually brings on fever above 100.5F, which is not common with regular flu.

5. How can I get infected with Swine flu? Spread of this swine influenza A (H1N1) virus is thought to be happening in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing of people with influenza. Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose.

6. How soon can one infect other? Infected people may be able to infect others beginning 1 day before symptoms develop and up to 7 or more days after becoming sick. That means that you may be able to pass on the flu to someone else before you know you are sick, as well as while you are sick.

7. How long would the flu virus stay infectious if it is on a door knob or handle or other hard surfaces? In addition to the droplets from coughing or sneezing, germs can be spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth. the virus will remain contageous probably for 24- hours after dropping on a surface.

8. How can I protect myself  from the flu? First and most important: wash your hands. Try to stay in good general health. Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food. Try not touch surfaces that may be contaminated with the flu virus. Avoid close contact with people who are sick.There is no vaccine available right now to protect against swine flu. 

9. What can I do to protect myself from getting sick? There are everyday actions that can help prevent the spread of germs that cause respiratory illnesses like influenza. Take these everyday steps to protect your health:

   * Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.

    * Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.

    * Avoid touching your eyes, nose or mouth. Germs spread this way.

    * Try to avoid close contact with sick people.

    * If you get sick with influenza, CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.

10. Is there any good news? Swine Flu responds to treatment, and we have two medications that can treat it (Tamiflu, Relenza). These medications must be started within the first 48 hours of symptoms. These medication do not prevent the infection, but rather treat it. Do not take thee medications unless there is high level of suspicion for Swine flu.

In the past several weeks, there has been an outbreak of illness in Mexico and the U.S. caused by a new strain of influenza virus that contains a combination of swine, avian, and human influenza virus genes. The illness has killed many patients, and the outbreak has features that suggest it could become a global pandemic. Federal officials have responded by declaring a public health emergency in the U.S., freeing up new resources for the prevention, diagnosis, and treatment of the disease.

Pigs, birds, and humans are each susceptible to lots of influenza viruses. Typically, these viruses infect only one species. However, sometimes the viruses swap genes, creating new viruses that have the capacity to infect more than one species. Even then, new viruses capable of infecting two species typically are very hard to transmit from human to human. Sometimes, however, further recombinations or mutations of genes create a virus that can spread rapidly among humans — creating a global pandemic. The worst global pandemic in modern times was the pandemic of 1918–19. It affected about a third of the human race, and killed at least 40 million people in roughly a year — more than have been killed by AIDS in three decades.

The World Health Organization and the CDC have confirmed that the new swine flu virus is transmitted between humans. It is not clear yet how transmissible it is, nor how it is transmitted. Almost surely, like other flu viruses, it can be transmitted by aerosol and by skin-to-skin contact with an infected person.

As of this writing, about 100 deaths have been attributed to the virus — all in Mexico. The 20 confirmed cases in the U.S. have all recovered (with only 1 case requiring hospitalization). Ominously, many of the deaths in Mexico seem to have occurred in healthy young adults, a pattern seen in past pandemics — not young children and the frail elderly, as is most often seen with the flu. It remains uncertain what the mortality rate is in Mexico and why the illness appears to be milder so far in the U.S.

The new virus is resistant to amantadine and rimantadine, but sensitive to oseltamivir (Tamiflu) and zanamivir (Relenza). Based on experience with other flu viruses, treatment would be most effective if given within two days of the onset of symptoms. Obviously, there is no vaccine yet for the new virus, and the CDC has expressed doubt that the current flu vaccine will offer protection.

The initial symptoms with this swine flu virus are like those with the annual flu viruses: fever, myalgias, rhinorrhea, and sore throat. Nausea, vomiting, and diarrhea may be more common with this flu than with regular flu. The usual precautions for patients apply:

• Sneeze and cough into tissues and throw the tissues in the trash.
• Wash your hands or use alcohol-based hand cleaners frequently.
• On greeting people, don’t shake hands or exchange kisses.

People should be considered contagious until at least 7 days after the start of symptoms; with children, it may be 10–14 days. Patients can be reassured that they cannot get swine flu from eating pork.If a global pandemic ensues, governments may well close schools and public places, require as many people as possible to work from home, warn any people who develop symptoms to isolate themselves at home, and warn those with symptoms indicating more severe disease (particularly breathlessness) to seek medical attention immediately. Journal Watch will update you regularly as new information is available.Updated information from the CDC is available at   http://www.cdc.gov/swineflu/.Published in Journal Watch General Medicine April 27, 2009.

Comment: This is an excellent summary of where we stand today. Unfortunately we maybe at the brisk of an epidemic_BA