A Consultation with Beijing United Family Hospital

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Dr. William Chickering,
Beijing United Family Hospital

What can families do to avoid catching H1N1 2009?  
Extreme personal measures, such as not leaving home or wearing a face mask, do not seem justified by the risk so far. The virus is mild enough that most people can view getting sick as natural immunization.

For the high-risk, there are some basic measures you can take. Doorknobs, handrails and subway poles are common sources of illness. It’s important to note that the virus on a doorknob cannot infect you unless you bring it to your mouth or nose. Get into the habit of not touching your face while out and about and then washing your hands as soon as you return home. Infectious disease experts advise washing your hands ten times a day. This sounds a bit difficult to me, but every little bit helps.

Will H1N1 2009 mutate into something more serious?
The virus will almost certainly mutate; whether it’s into something more serious, it is difficult to predict. What is worrisome is the possibility that it might pick up drug-resistance from the seasonal flu or lethality from avian flu. The possibility of this, even if very small, is what drives me to want to vaccinate my children rather than a desire to avoid H1N1 flu in its current form.

How can parents tell H1N1 2009 from a normal cold?
You really can’t, given that infection with H1N1 can be mild or even without symptoms. However, we believe that most cases can be distinguished by how bad you feel. High fever, body aches, and headaches play a larger role in the flu than in the common cold. The duration of the symptoms can also be important. If you get markedly better in a day or two, it’s more likely that you had a cold.

Should children be vaccinated?
Yes, if possible. The chance of an ugly mutation, though presumably very small, is far scarier than any risk posed by the vaccine, which is being produced by methods that are identical to those that have been used for seasonal influenza for 40 years, and is being tested as we speak. Adjuvants, used to boost immune response, have also been used for years, and may in fact broaden our immunity in case the virus mutates. However, for expatriates, it is not yet clear how or even if the H1N1 vaccine will be available in China. If you happen to be going on home-leave, get vaccinated at home. If not, at least get vaccinated here against seasonal influenza, as there is some recent evidence of cross-protection.

Should people with H1N1 2009 be quarantined, or is this going too far?
A goal of the Ministry of Health is to spread the epidemic over a longer period of time, so the hospitals are not overwhelmed with lots of cases at once, especially in intensive care.

Quarantine measures are just a brake to help slow an epidemic down. At the moment sick people are required to stay home for seven days, but their family is free to go outside unless they develop symptoms. In the US people are required to stay at home until 24 hours after the fever is gone.

The main reason quarantine cannot stop this epidemic is that there are people who have H1N1 but have few or no symptoms. These people are less contagious, but contagious nonetheless.

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