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Expert Advice on Swine Flu

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Back to school means early mornings, cold showers, and bagged lunches. It can also mean runny noses, coughs, and sore throats. With the recent spread of the H1N1 virus, it can be difficult to sort out the difference between a common cold and a severe flu. Dr. Maldonado, Chief of Infectious Disease at Packard Children’s Hospital, offers advice for parents on how to prevent the spread of the virus, what children can do in school to stay healthy, and the determining symptoms that signify a severe flu.

Parent & Child: What are the expectations for the H1N1 virus in this country in the fall?
Dr. Yvonne Maldonado:
Really, nobody knows. We don’t know what’s going to happen. The reports all over the news follow a worst-case scenario. That way the president and his advisors can know how far to go in preparations. So our expectation, of course, is that there’s likely going to be H1N1 circulating. It’s been at a relatively low level, but it’s at a higher level than we would normally see over the summer. We would expect that it would continue to circulate during the fall and the winter.

P&C: Are certain ages targeted?
Dr. Maldonado:
We know that people under 60 have clearly not been exposed to this virus before, and it turns out that some people over 60 seem to have some immunity to this virus. So, the major impact of this virus has been in young adults and children with the median age in the United States somewhere around 16 years of age, more or less.

P&C: How is the H1N1 flu different from a cold?
Dr. Maldonado:
There’s a major difference. Let me just give you a little anecdote that I heard somewhere. Basically, if you wake up in the morning and you don’t want to go to work, then you have a cold. If you wake up in the morning and you feel like you want to die, then you have the flu. The flu is not just a bad cold. For the general public, the three things we talk about are allergies, colds, and flu. Almost by definition, if you have the flu, you’ll have a fever. Generally, we’re talking about a 100-degree fever or higher, especially in children. It’s very unlikely to have fevers with allergies or colds. General aches and pains are usually pretty severe with the flu, never with allergies and colds. Fatigue and weakness is very severe with the flu. Stuffy or runny nose, sneezing, and a sore throat can be common to all. That’s where we get into the confusion. You can have coughing with all three, but with the flu, it usually becomes severe over time. Chest discomfort is much more common with the flu. In terms of other differences, the onset with the flu can be really sudden. You can sit there, and feel like a truck hit you. The common cold, you might wake up with a sore throat, and by the afternoon, you have the sniffles. That’s usually not the case with the flu. Although, with this flu, it has started off a little slower than we’d expect. But, again we don’t know what’s going to happen in the fall. The duration is usually longer with the flu. Allergies can last forever, but a cold only lasts a few days. You can get red eye with the flu, not all the time, but it’s very uncommon with a cold. The big differences are major fatigue and weakness, aches and pains, and the fever is really a big hallmark.

P&C: Is the flu preventable?
Dr. Maldonado:
Yes, it is. We’re hoping the vaccine can prevent a majority of cases. We’re not sure how many cases the vaccine will prevent because it’s in the process of being tested. The ways to prevent becoming infected are common: covering your nose and your mouth when you cough or sneeze and throwing the tissue in the trash after you use it; washing your hands or even gelling them; if you touch somebody, don’t touch your eyes, nose, or mouth in particular. The virus is spread when somebody sneezes, or has a runny nose, or from the respiratory tract. But it’s not the type of thing that sits in the air in little microdrops for hours and hours. Pretty much, you get infected if you’re 3 to 6 feet from somebody, and they’re coughing or sneezing on you, and those larger droplets get into your eyes, your mouth, or your nose.

P&C: How can parents protect their child from getting the flu in school?
Dr. Maldonado:
One thing is preventing the spread of germs to others. I think what they’re teaching the younger kids is to sneeze or cough into their sleeves. We used to always use our hands, but that’s not a good idea. Avoid coughing into the open air or into someone’s face. If you’re trying to prevent getting sick, you would do the reciprocal of that. If you’re in close contact with someone who’s coughing or sneezing, even if they cough in your face, gel your hands and try to avoid touching your face. Another way is to avoid touching other people’s stuff.

P&C: What are the ways schools can prevent the flu or the spread of it?
Dr. Maldonado:
Besides providing hand sanitizer and tissues, they might want to have cleaning wipes on hand. If you sneeze on your desk, for instance, you may want to wipe your desk.

P&C: Are some children more at risk of contracting the flu than others?
Dr. Maldonado:
Children with underlying conditions, like chronic diseases, asthma, heart problems, other long-term chronic problems are more at risk. For instance, with the heart and lung conditions, their heart and lungs are already at risk for not being able to handle an infection as well as a person who doesn’t have those. Anyone who thinks that they have an underlying condition should talk to their doctor about what they should do. They should do the same things in general as those who don’t have underlying conditions. They just might be more likely to come in for evaluations if they think they have caught the flu.

P&C: What should a parent do if they believe their child has contracted the flu virus?
Dr. Maldonado:
They should at least get some direction from their physician’s office. My children’s health care practice has a separate phone line for information about the flu. If you think your child is sick, she should not go to school. If she has a fever, for sure, she should not be going to school.

P&C: How contagious is the flu for children?
Dr. Maldonado:
It’s not clear yet because we haven’t seen a lot of data on how it transmits around the country. It seems to be as contagious as the regular flu.

P&C: What would you say is the biggest misconception about the H1N1 virus?
Dr. Maldonado:
I think the biggest misconception is to underestimate that your symptoms are the flu. Most people, at least in our study here in the clinic in the hospital, have a child with a cough, a runny nose, and a little bit of a fever, and they don’t think it’s the flu. Kids get that kind of thing all the time. In general, any other time of the year, it probably isn’t the flu. But right now, it could be. So, underestimating your child’s symptoms has probably been the biggest misconception.

P&C: Do you have any other advice?
Dr. Maldonado:
Parents should get their child vaccinated. In terms of going to school, at this time, I think I would really follow the school’s guide in terms of what they should do at the school. The reason is that the school is really in touch with the county, the state, and the federal government. There’s a very nice layer of communication. The schools find out right away if there’s anything that needs to be known, and I think most schools are pretty good about disseminating information pretty quickly.

P&C: Can you give any helpful websites to parents?
Dr. Maldonado:
The school will be very helpful in terms of local information. For general information, symptoms, etc. is a great site, along with

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