Elephant in the room

Let's talk swine flu. 6,000 people in Mexico have it, with 100+ deaths. And the first US death, or a 23-month-old in Texas. And now Germany's reporting it.

Yesterday I missed the school bus and took my older one to school. There was a girl wearing a mask walking into the school.

This morning I asked my older son if he'd heard of it, and he said his teaching said it was "going around the school." I'm sure that's an exaggeration, but it may not be in another few weeks.

I think we all know the best precautions:
1. Wash your hands.
2. Take care of yourself (sleep/good foods/water/laughter/vitamins/exercise).
3. If you feel sick, go to the doctor.

Can we talk about how we talk about it to our kids? And if you want to express fears, go ahead.

Comments

[momgawaga]

I worked in hospitals, and we were instructed to wash our hands with soap & water before touching patients, or hand sanitizer if we were just handing them something, or standing in the room, etc. My understanding was that the soap & water method helped to clean under nails/rings/etc better than the hand sanitizer did.

[the milliner]

@Michelle- Totally get your worry for your stepson (DH is immunosuppressed - heart transplant). It sucks to have that extra layer of worry for a)the increased chance that something will slip by their very weak immune system and b)if something does slip by, the last thing they need is another drug with yet more side effects. No solutions...just commiseration.

And, on another note, FWIW, I've read (can't remember where) that putting hand cream on after washing (soap & H2O or sanitizing gel) helps provide an extra barrier against germs.

[Meika]

I just finished reading a book that began with a woman's parents and husband being essentially filleted in a pogrom. She slipped her two-year-old daughter out the window and told her to hide, and couldn't find her afterwards. A family member told her the baby was dead, then, when she was thousands of miles away, another family member told her that whoops, no, the baby was alive and somewhere in Siberia. (Should've had a surgeon-general-type "Not for mothers of toddlers" warning on the cover.)

My grandmother lost one brother to who-knows-what, and another to whooping cough. My mom lost a brother in a farming accident.

This swine flu business really does freak me out a little bit - not so much with how things are now, but with how bad they could get. But all of this has me wondering if the question we all should be discussing is how we handle our FEAR, because it really does seem like we are afraid of EVERYTHING these days. I mean, what population in the history of the world has a better chance of coming out of a flu pandemic unscathed than most of the readers of this blog? We live in places with vaccines (imperfect as they may be, they exist to avoid an alternative that's worse) and public health, and tamiflu... and we're still completely freaked out by just a few mild cases. What did our grandmothers and great-grandmothers - who ran a very real risk of losing every child they birthed - know about managing fear that we don't?

[L.]

I'm 8+ months pregnant and have a 2-year-old but, honestly, I am surprised to see this level of concern in the comments. Maybe I'm insulated because there aren't any local cases--though we're next door to a couple states that have some--but my feeling is that it's way too early to freak out. (If I lived in an area that was a focus of concern, I'd probably be a little more careful.) I'm glad the state and federal governments are taking steps to protect us in case things turn out to be bad; I want them to be overcautious. But my life's too short to borrow this trouble just yet.

@Meika, there are two things I can think of; 1) information overload makes it easy to freak yourself out--news about this kind of thing was much more delayed in your forebears' days, and they had much less information in general; and 2) maybe fear can be a weird kind of luxury. There's definitely an amping-up response that happens with big-deal incidents, and although I think it is psychologically and physiologically natural, the media hype really exploits this. Sometimes I feel like society is looking for the next big thing to worry about. These events do allow us to unite in response and let mundane or less interesting issues fall by the wayside. It's just too bad human nature seems less built to respond like this to the less obviously urgent issues.

[agnes]

I'm definitely freaked out. Woke up at 6 am and couldn't get back to sleep. It probably doesn't help that I'm an epidemiologist, so I'm very aware of the 1918 flu and what this could become. I also happened to read the statistics about pregnancy and epidemic flu yesterday, and pregnant women aren't much more susceptible to the disease, but they are _much_more susceptible to complications. I'm 3 1/2 months pregnant. Yikes.

Of course, as an epidemiologist, I'm also very interested in it all. I will be interested to see how the mortality in Mexico ends up shaking out - is it more lethal there, did they just have more cases, are the deaths in young people b/c young people are more susceptible or b/c deaths in older people weren't noticed?

I'm seriously debating not going to the big festival in my town this week, but that would probably be craven, so I guess I'll just stick to the handwashing and cut back where it's not too noticeable.

[Nut Mommy]

I'm supposed to go on a work trip to Europe in 2 weeks, which will involve a pretty crazy schedule, 5 countries in 7 days kind of thing. I'm a little bit nervous about doing it and am wondering if I should ask my doctor for Tamiflu or Relenza as a prophlyaxis. I'm just worried about spending that much time on planes with people who have been god knows where. Am I overreacting? Do you guys think my doctor would even give me something? That is, of course, if air traffic from the U.S. hasn't been banned by then!

And I took my almost 2 year old to the doctor with a cough and slight fever today. Two weeks ago I probably would have let it go a couple more days, but today I wanted someone to see him. Seems like he has croup, so I guess I should be thankful.

[Keri]

Honestly, I'm a little freaked. I was doing fine until reports this morning of an outbreak on the north side of the city where we live. Adding to that, we just switched my two-year-old from a nanny to a home day care, so, yeah, my panic buttons have been smooshed.

As for the reports of swine flu being worse for younger, healthier people, last I heard the jury is still out. I've heard the reports are too jumbled and contrary at this point to know for sure. It may be that younger people in Mexico who contracted thought they could fight it on their own and only sought medical care when it was too late. Or it may be be like the Spanish Flu epidemic, in which having a healthier, stronger immune system correlated to dying from the virus.

[ambrosia]

I'm going to pipe up and try to calm some fears. DH is a physician and works in biotech, has a lot of work experience dealing with flu vaccines, and understands a great deal about our immune systems and the influenza virus. We had a conversation about this last night and I am going to try to replicate how he explained it to me, and hope that eases some concerns.

Our immune system is constantly fighting off attack from all kinds of bacteria, viruses and parasites. A healthy person goes about without noticing this constant low-level battle. (But if you leave a steak out uncovered on the counter for four days, you will have a sense of what would happen to our flesh without this vigorous immune system. )

The flu virus mutates constantly, in some part in response to the conditions of its host. This particular flu virus in Mexico mutated over the last few months to be particularly effective in Mexican hosts. Essentially it sort of worked out the weak spots in the community immune response and exploited those. But you and I, and people in New Zealand and Israel and so forth have immune systems that have been primed by a completely different set of pathogens, and this Mexican mutation is not as effective with our immune systems. DH believes this is why the virus seems more virulent in Mexico than elsewhere. (And note that the only death in the US so far is of a Mexican toddler who contracted it in Mexico.) Obviously people with compromised immune systems do have cause for concern, but the rest of us don't. Now, if that Mexican flu virus intermingles with a more effective local flu virus, that could cause more problems here. Then DH points to the calendar and says it is nearly May, the worst of flu season is over, so that is not very likely.

With regard to travel, DH thinks that the speed at which the virus mutates is too slow for today's jet travel. A person goes to Mexico, picks up the virus, and brings it home so quickly the virus has not had the chance to mutate to be effective in its new environment. If you think about the 1918 flu pandemic, people were traveling by train and by ship, more slowly, so the virus had the time to mutate to be more effective within a contained group of people and then arrived at a new destination ready for the new environment.

In a nutshell, DH believes that this is why we will not ever really have another influenza pandemic on the level of 1918. The virus mutates too slowly to adapt to new hosts with differently-primed immune systems. Note he is not saying we will never have another pandemic. It just won't be influenza. If Ebola or Marburg (or another) ever mutate to the point that they don't kill their hosts quite so fast as they do now, and mutate to be airborne-transmissible, then we will have a horrible pandemic and we will lose 10% of the world's population in a week. Eventually that *will* happen. But this Mexican flu is not that and won't ever be.

Hope that helps.

[caramama]

@ambrosia - That helps a lot! Thank you so much for the explanation! That really eases my concerns greatly.

[Luann]

@ambrosia, thank you very much for that, it helps to get perspective and facts.

I've been on a news media blackout since the CIA torture memos came out (not even watching the Daily Show) and just Monday felt like it was safe to look at TV again (other than Turner Classic Movies.) My bad. The fear-mongering really does have an impact. That said, the 1918 pandemic was an awful, awful thing. I watched a great documentary about it when I was pregnant (before I learned my lesson) and have never forgotten it. The reason that flu was harder on younger people was because it was rooted in a flu that had passed around two generations earlier - so the older people already had some immunity to it, and did not catch it or got milder cases of it. Which is a really important argument for the flu vaccine, btw - not that I want to cause a flame up about why or why not to vacc...)

Bonus fear: I'm worried for Mexico because their government is unstable and there have been plenty of other scary things happening there lately that are setting up a really terrible environment for terrorism and exploitation.

My toddler is allergic to eggs, so flu shots are always traumatic (eggs are used in the creation of the vaccine) and closely observed, and my husband has chronic sinus problems. There's a fever going around daycare (no other symptoms) and it just seems like every sneeze has people on edge.

Deep breath - I'm reaching for my Pride and Prejudice DVD right now...

[Mandie]

The more I hear about these new cases in the US, I become more and more concerned. What has really caught my attention is the recent case that resulted in the death of a 23-month old. In the field that i work in, it is very easy for me tobring this vicious thing into my home. As a result, i am more conscious of what I do. I wash my hands often and I try not to wear my work clothes in the house. With two little ones at home, I am PARANOID. I hope this thing goes away soon or that they find a cure for this thing quick!

[Katie B.]

@cloud: definitely Mr Collins.

I haven't watched the news regularly in YEARS to avoid panic and depression, so I hadn't heard anything about this until Monday when it popped up on a local mom's list. My first reaction is not concern for my family's health - we're a pretty healthy bunch, bar my very asthmatic brother - but that this is a shameful indictment of modern food production. Go read people like Michael Pollan if you don't know what I'm talking about.

Healthwise, I'm sure we won't change our habits much... although I may get a flu shot next fall, for a change. I lost a great-grandmother from the flu in 1924 (I believe).

[caramama]

@ambrosia - Okay, I've been thinking about what you said, and although I feel better, I have a question I'm hoping you or someone can answer. Since the swine flu has now traveled into other countries and it is spreading among the population, isn't it possible that it will mutate to affect the population where it is currently spreading? I'm not sure why the traveling slowly would be key if it has already traveled here (and elsewhere).

[caramama]

@Cloud - As for Elmo possibly playing Mr. Darby... Awwwwww!!!! Don't ruin my favorite book and movie by bringing Elmo into it!!!

[hush]

On second thought, it's not actually the swine flu itself that I'm afraid of: it's the potential for xenophobic, civil liberties-ending social changes to begin to occur, like the search for a scapegoat, citizens viciously hoarding resources, resorting to gun violence, etc. Man, I have definitely seen way too many zombie movies that deal in themes of anarchy after a pandemic, where the protagonists are undone not by the zombies, but by their lack of cooperation in the face of a common threat. Gotta love George Romero's zombie movies for their wacky social commentary, even if I have to watch them through the cracks in my fingers.

@Katie B. - I've read Michael Pollan, but I confess I still don't know what you're talking about as it relates to swine flu. Could you please be a bit more specific?

[Cloud]

Sorry, @caramama. I think I may be the only adult on the planet who thinks Elmo is kinda cute. This may be because we limit our exposure, and because Pumpkin is so cute when she sees Elmo. I guess Kermit is a more likely Mr. Darcy, though. But Miss Piggy is no Elizabeth!

As for the mutation of the flu virus to spread better in its new home (read this with the caveat that I'm not a virologist or an immunologist)- it is very likely that it will happen. But that doesn't mean that the mutation will make the virus more deadly. If you think about it, a successful virus doesn't kill its host- the host stays alive and walks around spreading the virus. A mutation that makes a virus kill more quickly generally works to limit the spread of a disease (while making it more horrific for those who get it- think Ebola).

I don't think anyone knows why this virus has only killed in Mexico so far. I am sure that people are working hard to figure it out, though- besides being a question of enormous practical significance, it is a fascinating question scientifically.

@Katie B- while I generally agree that our industrialized food production system has problems and I'd like to see some changes, I'm not sure we can blame this outbreak on that system. These cases where a virus jumps species are usually traced to close contact between humans and animals. This is why most people worry about bird flu coming out of Asia- it is not that birds in other parts of the world don't get bird flu. It is that there are still a lot of people there who share living quarters with their poultry. If there is one thing that our industrialized food production system has done, it is cut down on the contact between us and our farm animals! Of course, this virus could turn out to have taken a different route into humans.

And while I'm pontificating wildly- on the why we worry more now question: I agree with the idea that its due to our increased access to information. I also think we are less likely to trust the authorities than our grandparents were, but that we don't always have the knowledge/expertise to make an accurate risk assessment ourselves. In fact, we generally suck at risk assessment- there have been studies showing this. So we have untrained people assessing risk based on a glut of information, much of it irrelevant. And that information is fed to us by organizations that have an interest in sensationalizing things, because that increases audience, and they make money based on audience size.

[ambrosia]

@caramama,

(totally unscientific analagy ahead) think of the flu virus like the piece of a puzzle that has parts that stick out and parts that open to fit up with the rest of the puzzle. Any flu virus can mutate over time, shifting little bits around to better plug itself into the holes in the host's immune system. Any flu virus can do that, but not overnight. It takes a while for a flu virus to mutate. The Mexican flu virus probably had the bulk of the flu season (this past winter) to fine-tune getting its particular puzzle piece to fit into the immune systems it was encountering in Mexico.

Now pick up that puzzle piece of flu virus and try to stick it into a completely different puzzle (someone in the US with an immune system that is tuned for a different set of microbes.) That flu virus could, over time, mutate to shift its bits around to better exploit that particular immune system, but it takes time, and a reasonably healthy person would fight it off.

Add to that the time of year. This isn't the time of year when people are most prone to influenza. The weather is warm, people are getting fresh air, not cooped up indoors as much. It's certainly *possible* to catch the flu in May, but the conditions aren't the same as in January.

Now, there is one other possibility. To quickly mutate to affect a new population, the Mexican flu virus would have to find a host that *also* had a local flu virus, and have the two viruses swap bits. Flu viruses swap bits all the time, this is one of the reasons why it's so hard to predict what the makeup of the flu virus will be in any given year to formulate that year's vaccine.

It is theoretically possible for this to happen, but much less likely in May than in mid-winter. The flu season here has pretty much run its course. It's a fairly long chain of hypotheticals (IF someone here is exposed to the Mexican flu virus + IF that someone happens to also be fighting a localized flu infection + those viruses swap the right bits + people are uncharacteristically coming down with influenza in the off-season.)

To go back to why slower travel was important: travelers on a ship are often a mix of people (whether passengers or crew) some of them from the point of departure, some of them from the destination, as people travel back and forth. So a flu virus would have, say, one week to travel amongst the passengers on the ship, mutating and swapping bits with other flu viruses, making its "puzzle piece" if you will something that fits people from both the destination and the origin. But it can't change in the hours it would take someone to fly from Mexico City to New York, so it gets to New York essentially unchanged. It isn't as well adapted as it would have been if it had spent a week on a boat with Mexicans and New Yorkers on it. Does that make sense?

I'm sorry I am not a scientist myself, I'm just married to one, so I'm just explaining it as I understand it.

[akeeyu]

I'm going to throw in with the ...eh crowd. Maybe it's because I used to live where people still died of the plague every year. Yes, THAT plague.

If 36,000 people die of straight up flu every year (and they're not ALL the elderly/infirm/babies) and it's still hard to convince people to get a flu shot every year, why is everyone so het up about a vaccine for swine flu?

I feel like somebody's mom. "No, I will not buy you a new swine flu vaccine! You don't get the vaccines I already bought you!"

I already take everyday precautions against disease transmission as it is, because as it turns out, I don't actually enjoy upper respiratory infections. Hand washing is surprisingly effective.

If it comes to a point where we all have to freak out, I will be the first to say "Oooh, hey, my bad!" but I don't think we're there yet.

Wash your hands.
Don't french kiss any pigs with the sniffles.
Use common sense.

I think we'll mostly be okay.

If we're not, hell, I guess I owe you a coke.

[akeeyu]

I don't want to sound flip, but I guess I'd rather see all this press and fervor dedicated to creating better sick leave policies in the US (so parents don't get canned when they have to stay home with sick kids) and free (regular, unflavored) flu vaccines for everyone.

[Jac]

Hands down, best line all day.

"Don't french kiss any pigs with the sniffles."

Bwahahahahah.

[Cloud]

@akeeyu- I get where you're coming from, but see it from my point of view. I am an asthmatic, and flu for me is not a week or two of feeling crappy. Its a week or two of feeling crappy and literally struggling to breathe, followed by several more weeks of not breathing well. I am considered high risk for developing complications if I get the flu. And I have MILD asthma.

I am diligent about hand washing, because upper respiratory infections are a big deal for me. I get my flu shot every year. I even make my needle-phobic husband get his shot. I want us to develop a vaccine for this strain because if it does come back next year, I want my doctor to be able to offer me a chance to try to protect myself.

But I'm with you on a campaign for better sick leave!

[Kimberly]

I'm also not worried, and there are some cases in my area (SF Bay Area---there was just a high school closed in San Jose today because of a student with swine flu). I just can't understand people being this afraid of the possibility of swine flu when they do other, far more dangerous things (like take their kids on car rides) without a second thought. If the thought of swine flu is seriously keeping someone up at night and impeding their ability to live their life normally (unless they're in Mexico City :-p), I would suggest a session or two with a therapist to work on anxiety issues. I have done cognitive-behavioral therapy for an anxiety disorder, and it makes a huge difference in my response to the latest fear-mongering campaign in the media.

Bottom line: I'll worry when the number of deaths approaches anything like the normal number of deaths from the flu every year.

[z]

@ambrosia thanks for relaying your conversation with your husband and the puzzle analogy. they both really helped calm my fears. i think i am coming down with a cold but i was feeling dizzy and achy today and my gut reaction was OMG what if i have swine flu... it helps to read some reassuring comments and yes it would be nice to get some attention to creating better sick leave policies.

[HeatherD]

Thanks for starting this thread Moxie. I am late to post a comment, but it is helpful to have a place to talk about how scary this is - I am with Jen, who said that being a mother has changed how she is responding to the onslaught of reports about a potential pandemic from the media.

And right now, I am really, really worried. They just announced swine flu cases in our state today (Maine) in neighboring counties, and my 18 month old has had a fever and cough since Sunday in the middle of the night. We went to her doctor (a pediatric nurse practitioner) this morning, and she believes my daughter has a mild case of croup. But when the cases in our state were announced after our visit to her office this morning, I have been a wreck ever since.

We are fortunate in that my husband is a SAHD and my daughter can be safely kept at home for as long as we need, but they are typically very active and I can't stop worrying that she may have been exposed at storytime, the park, the grocery store . . .

I'm planning on having her tested just in case and working from home the rest of the week and planning on watching her very, very closely.

It is helpful to read about others' thoughts and have some healthy perspective and humor brought into the mix. I really need it today. The media coverage is too, too much. We don't have a TV and frequently have NPR on in the evenings while getting dinner ready, etc., and we realized today we can't handle the reminders about the flu every twenty minutes. I'm not planning on putting my head in the sand, but the news on the radio is out for now.

[Nutmeg]

I have a little to add about this which is that one problem we need to keep in mind is that while flu season is over here, more or less, it is just starting in other parts of the world to which the virus is spreading and can easily return in the fall when our flu season strikes up again. This is what makes something a pandemic. The same virus circulating in multiple populations over multiple seasons.

So... I think it's pretty clear this WILL be a pandemic (and the WHO said as much today) but that doesn't mean the end of the world is nigh.

As far as the evolution of virulence is concerned, as Cloud was discussing (and I'm not an epidemiologist, but as an ecologist/evolutionary biologist, we do think about these things as well) many viruses DO become less virulent as they begin to be transmitted through a population (eg. The two years after it was introduced into local populations, West Nile virus DEVASTATED crows. They're numbers dropped by a third or more. But, after only a few years local populations became adapted to the virus AND the virulence of the disease diminished, depending on the method of transmission it is better for disease transmission to have a person well enough to be walking around and spreading it, coughing and sneezing... Malaria is better if the person is so sick at night that they can't move and mosquitoes can readily suck their blood.)

Ambrosia's explanation is ONE way things can work, that the virus can't invade our cells in time for it to escape our immune response. The other option is that our immune system isn't capable of accurately recognizing and responding to the threat OR over reacts to the threat which causes it's own problems.

I will say that a simple cold nearly sends my kid to the hospital because of his asthma, so I'm not freaking out, but any flu that doesn't have an effective vaccine out for it is something I'd be afraid of. Two years ago we were afraid because the flu strain that was circulating was only partially covered by the vaccine... and my husband is in the trenches as far as sick contacts.

My son is too young to need to have a discussion, but I can't tell you how hard it is to get a two year old to cover when he coughs. He pretty much always covers his mouth... AFTER he coughs.

[caramama]

@Cloud, ambrosia and Nutmeg - Thanks for the more detailed explanations. I do feel better (and I was never panicked in the first place), but I will still be careful and watchful. If the WHO is raising this to the second highest pandemic alert level, then I don't think it's something to ignore. I so appreciate the facts and science, rather than the scare tactics of the media.

Here's hoping that the strain isn't able to mutate and adapt to new populations and doesn't come around again in the fall.

[Cloud]

@Caramama- I wish I had a better understanding of these things so that I could give a really good explanation. I class my knowledge of this stuff at about the cocktail party level- i.e., I could have a reasonably meaningful discussion about this with someone at a cocktail party. But I am certainly no expert. This always makes me hesitate to post too many details, because I certainly don't want to contribute to the misinformation that is out there.

I will share one thing that I find comforting, from my previous work- I know that the folks charged with responding to this sort of event have been practicing for it. I think most of the relevant agencies, at all levels of government, are probably pretty well prepared. I guess that is one good thing that came out of the bioterrorism funding that was flowing pretty freely after 9/11 and the later focus on the bird flu risk.

[StayingAnonForThisOne]

Maybe I'm buying into the media hype, but I am seriously concerned about this. It's easy to be like, "hey, lots of people die of normal flu so I'm not gonna worry about it" but when you see whole neighborhoods and city blocks of people infected with this nasty flu, I think you're going to see a totally different vibe. I live in the bay area and several cities are now reporting schools closing and it is only a matter of time before this spreads. I'm actually surprised that there aren't more strict quarrantines in place, considering how easily this thing spreads. Personally, I wouldn't have a problem keeping my kids out of school for the next few weeks to see what evolves with this but my husband won't let me. And I know I'm in the minority on this.

But what does annoy me is this idea that everyone will just go about their business and ignore the situation and be all blase about it. I think the situation is much much worse than the "regular flu" because of the implications it has for mutating into something more deadly.

And judging from what is happening in New York (specifically in response to pnuts mama who said families of those sick kids seem to still be going about their business at church and sending their other kids to other schools) it is only a matter of time before this spreads far and wide. I thought families that were affected by the closures were told to stay in, umm... quarrantine themselves. WTF? Why are they still out and about? That to me seems completely irresponsible.

And considering that you're contagious BEFORE you show symptoms, it makes you wonder why they aren't asking anyone who has recently travelled to stay at home for a few days. Seriously, does it HAVE to become a mandatory kind of thing? It's for the greater health of everyone involved. My husband was on his way to an off-site lunch today at a vendor's office, and as he was chatting with another coworker he found out that the vendor hosting the event had literally *just* returned from Mexico a couple days ago and went right back to work. I don't care if it was a bit paranoid, but he turned around and said he remembered something he had to do and he took a pass on the meeting. Frankly, I think anyone who just came back from Mexico 2 days ago might want to seriously stay home for a few days till the incubation period is over, since that is one of the main known vectors for this virus.

All it takes is for that person to go out to church, to the grocery store, take a crowded subway to work, etc. to spread the virus to many more people.

And yes, it's "only the flu." But it's a completely new virus with animal DNA to which we have 0% passive immunity that is also proving to be highly contagious. The more frequently it jumps from person to person, the higher the likelihood that it mutates into something worse, or makes that deadly jump to being a full blow "avian flu" that seems to have a much higher kill ratio.

Call me crazy, but with 2 kids at home with somewhat compromised immune systems (we had pneumonia in our household 3 times in the last 8 months), this stuff keeps me up at night.

[hedra]

We have a potential case at work, at the site I spend a reasonable amount of time at (lab results are not back, but the conditions are appropriate - just came back from Mexico, yadda yadda). That person went home promptly, and is under medical care. The tactical team identified eight people who were in contact with this individual, and sent THEM home to wait out the incubation period in voluntary quarantine. They're taking it very seriously.

My great aunt lived through one of the great flu outbreaks as a kid - 1920? Not sure. She had taken a train trip with her sister to visit relatives. They stopped the trains going back to stop people from carrying the infection to new locations, and she and her sister were stuck in a strange town for I think two weeks. Fortunately stuck in a location that didn't have an outbreak, but they were pretty scared (they were both kids, essentially traveling alone - elder sister - my grandmother - was a teen). She said it was terrifying - reports of towns being halved by the death rate, that kind of thing. She figured *some* of it was overstated to keep people at home, but it was still awful.

Also, it is worth noting that the majority of deaths have been from HEALTHY adults, not the immune-suppressed or weakened individuals. This was true with one of the pandemic flu outbreaks in the past, as well. Essentially it was the healthy immune system over-reacting to the flu infection that was the key factor in the death rate and profile. Immune-suppressed individuals actually have a *better* profile. They may still get sick, but are less likely to have that over-reaction in the immune function that is seen as a factor in the mortality rate in this case.

Also note that it is very likely that there are many cases of much milder version of this flu in Mexico that were not reported, so the profile 'as seen' is not thought to be the actual profile of infection and mortality rate.

I'm taking it seriously, but no panic.

[hedra]

(vague recollection that the train stoppage was local, not regional/national... not clear on that detail, should have taken notes... sigh.)

[Brooke]

I am surprised at the level of panic in the comments here. Seriously. And the assumption that people can just take time off work for weeks? Because they maybe, might have been exposed? What world do you people live in? Because it's not the one I live, that's for damn sure.

I didn't comment yesterday because I had to go pick up my daughter from daycare. Because she had a fever, again, and has to be out for 24 hours. I know people get all het up about keeping sick kids home, but I think you must not have fever-prone kids. My daughter gets low-grade fevers easily. She gets a cold, she gets a fever. She gets some random virus, she gets a fever. She's not even sick today. Seriously, she is running around and being goofy and generally herself, but she can't be in school because her temperature yesterday afternoon was 100.3F. So, yes, I will in fact medicate a fever down to send her in if she is otherwise healthy. It's a lot cheaper and easier than going to the doctor to get a note that says she is healthy enough to be in school even with a low-grade fever.

And what is this emergency back-up care people talk about? We have that here, but it's not for sick kids.

Can you tell I'm just a little bit irritated that I have used up 75% of my sick time for the year and it's not even May?

[StayingAnonForThisOne]

Brooke,
While I feel your pain that you have to use up your sick time to care for your sick child, I'm tired of using my sick time to take care of my kid when I know she caught it at preschool after being with a kid that was sick whose parent decided to hide their cold with some tylenol.

Medicating a child to look healthy so you aren't invoncenienved, I know it's done. But I'm constantly amazed how many people brag and laugh about it like it's totally acceptable.

When a child has a fever, they are fighting off something. They may not have the full blown cold, but they can still carry it into the school. Which is precisely why they say stay home. Medicating to take away the fever doesn't take away the virus. Just masks the symptoms and puts everyone else at risk.

This whole idea of "I can't stop working" for weeks, it may well come to that for whole cities (like Mexico City) if this thing continues to spread. All I'm saying is that people who have been knowingly exposed---at this stage of the outbreak---ought to urge on the side of caution and take a couple days to see what happens.

The stakes are high here, folks. And when it finally creeps up on us, it'll be devastating. We're talking alk about whole cities not being able to go to work, for a week or two, like Mexico City, because they're sick or caring for sick kids. Not pretty.

[L.]

StayingAnonForThisOne, "people who have been knowingly exposed" to swine flu does not equal "people who have been to Mexico" (though I might encourage those people to be cautious, too) does not equal "people with everyday coughs and colds." That's a huge range of variation.

I would certainly prefer people to err on the side of caution with sick children and daycare, but I'm also feeling like there are some very divergent topics that are getting lumped in together here.

[Brooke]

Also, for the record, swine flu does not have "animal DNA" and passive immunity is the opposite of acquired immunity, so if this is, in fact, an entirerly new disease, the only thing we DO have is passive immunity.

[hush]

Whoa! I hadn't realized I'd just inadvertently tuned into an episode of "Judge Judy" here!

Can't we just support and accept each other in this space, fears, warts and all? No one is perfect and I guarantee no one has perfect information about what may or may not transpire. So let's not pretend to know what choices or what line of thinking is "best" for someone else, living somewhere else, who we don't even know. Cool?

[StayingAnonForThisOne]

Brooke, yes, you're right. I misstyped it. It contains DNA strains from animal flus: swine flu and avian flus. It's not the actual animal's dna in the flu. Regardless of how we parse that out, our bodies don't have any immunity---period---to this flu. Passive or active. And in fact, it seems to cause a hyper response in healthy people and the symptoms are so much worse.

Which is why it's so critical to try to contain it.

To L: ["people who have been knowingly exposed" to swine flu does not equal "people who have been to Mexico" (though I might encourage those people to be cautious, too) does not equal "people with everyday coughs and colds." That's a huge range of variation.] For the sake of argument, I tend to think that the lines between these three distinctions is a little blurry where Swine Flu is concerned. Frankly, Mexico is ground zero, and the only known cases here are from people who recently travelled there. So yes, if you recently got back from Mexico or have been in contact with someone who was, I think there's a very very high likelihood you were exposed. Too bad most people are taking the laxe approach. When it's your school that's shut down, or your child in the ER with this thing, let's see how you all feel about it then.

And Moxie asked us for our fears... how we feel about it. I don't entirely think this is terribly "divergent."

It is scary. I'm not living my life terrorized by it. We're still going about our lives and going to work and school. But I'm quite disappinted so far with what seems like a pretty subdued response all around. Just my opinion, but clearly not a popular one.

[Anon]

@Hush is right.

I, for one, don't come here to hear web designers' opinions about science. As for non-judgmental support about parenting in these times? That's what I come here for, and that's why I feel so let down by too many of your comments.

[StayingAnonForThisOne]

I also wanted to explain a little more where I'm coming from and why my hackles are so raised. I have 2 kids with an underlying kidney condition for which their medication seems to make them immunocompromised and more prone to get pneumonia. My 6 year old has had pneumonia 3 times in 10 months. My 3 year old just got over her first bout of pneumonia last month. In the last year, I have also developed developed asthma symptoms (probably because I've caught all my kids colds). So when one of us gets even a simple cold, it poses a huge threat to our family. Hospitals, nebulizers, massively strong antibiotics. And believe me, the ER is not the place I want to be in the middle of an influenza outbreak.

I'm also here in the Bay Area, not too far from a cluster of schools that have been closed with confirmed cases. I'm just hoping and praying those families with the quarrantined kids do everything in their power to isolate themselves. And yes, I'm saying I don't think it's unreasonable to ask them to take a couple days off work, or missing church services, or not going to a crowded party or to a crowded store.

That is specifically why the WHO has raised the threat level, to facilitate an entirely different kind of discussion and response. This is definitely NOT just a typical flu. And I don't think they'd be sounding this kind of alarm if it were. I'm usually quite cynical and a conspiracy theorist (and it annoys me that Rumsfeld will probably profit greatly from this outbreak), but I do think there is serious cause for alarm and the time to act is now, not when thousands of people are sick.

The board of education and our county has said that they won't be closing schools until there are more confirmed cases, but they've also said they expect this thing to spread. Hello, that's just stupid to me. I think the New York example shows that closing the 1 suspected school is not enough. I hope our county has a change of heart, and soon, and reacts more strongly. At least closing all schools in an affected city to start. All it takes is one sibling at another school to go to school, etc. And then it's a full blown countywide problem. But it has to do with money, I suspect. They just don't want to close all the schools because those schools need the funding of each child in school. In fact, our local politicians are actually trying to draft a bill to protect the funding for the schools that have to close, so that perhaps more schools will feel fiscally protected if they do need to close in the coming weeks. Luckily, school is out in a month and a half, so hopefully this won't get too out of hand before then. But we shouldn't *have* to rely on hope. There is another solution (i.e. closing schools) that could probably help control the spread of this, but so far everyone (from the politicians and the state officials all the way down to us regular citizens) seems to have "wait and see" approach, willing to let it spread before reacting strongly. And that I just don't get.

Anyway, just so I'll answer Moxie's main question: how are we handling it with our children?

As soon as I found out about this, I started encouraging even more hand washing with my older child. (My little one is with me all the time.) I've told her that there's a particularly bad flu going around. But I was deliberately avoiding the name "swine flu" or trying to scare her in any way and was only speaking in general terms. We're also not acting alarmed or taking any strange precautions at home. And we're going about our business, school, parks, play dates. We're just being more careful and I am definitely avoiding the super stores and crowded areas.

But it turns out the teachers talked about it very openly yesterday at school. (This is Kindergarten, too.) They gave specific instructions on how to cough and sneeze (into their arms, not hands), and frequent hand washing. I commend the teachers for talking so openly and calmly about it. It also opened up an avenue of discussion, so that when my daughter came home from school and said, mom, what is "Swine Flu" and what is a swine, I could calmly answer her questions in an instructive sort of way. We talked about the usual ways we keep colds away like lots of rest, good eating habits, sunshine, and frequent handwashing being the most important when we're out and about.

So that means no fingers in the nose or mouth without washing hands first. That means no snacking, or eating, without first washing hands. Simple enough for her to follow, too, when she's away from me.

Now if only I could get her to stop shoving her hands in her nose and mouth.... gawd why do all kindergarteners do that? LOL

[Meika]

One thing I appreciate about this community - our vastly different backgrounds. Where else can I come to hear an epidemiologist mama's (and all sorts of other brands of mama) opinion on what's going on. Cool.

[akeeyu]

Cloud,

I have asthma, too. All of my colds end up with secondary crap, frequently involving steroids. I've got two kids who, if they get a cold, will likely require hospitalization and/or surgical intervention. It is full of suck.

And yet, I am STILL not more freaked out about swine flu than I am about regular flu and RSV. I take all possible precautions to avoid ALL upper respiratory contagion because, like I said, I don't really like being sick.

According to the Department of Health, 20 people in my state died of regular flu (in the three largest cities alone, not including rural areas/small towns) last week.

Nationwide, 8 children died of regular flu last week.

I'm not advocating carelessness, I just like perspective.

We've already got plenty of reasons to be freaked out. I consider the swine flu freak out to be akin to that lovely dessert cart that creaks by just as you've finished dinner: I just had a big meal of RSV freak out and flu freak out; I'm full.

[Cloud]

Akeeyu- I'm not freaked out. I know the stats about regular flu, and I think the vast majority of what I've read about the swine flu is incomplete, inaccurate and/or hysterical. (For instance, all the media keep going on about 1918. What about 1976? That swine flu outbreak turned out very differently.)

But I still think a vaccine is worth developing, even if only some of us who should get it bother to do so. Really, the idea that we shouldn't bother developing the vaccine was what I was responding to. On most of the rest of your points, I'm in whole-hearted agreement. Peace?

@StayingAnonforThisOne- I understand your personal situation makes this a bigger threat for you, and can appreciate why you're frustrated. But I also think our public health officials know a heck of a lot more than we do about how to respond to the situation. They certainly know what the WHO risk levels mean. I'm going to trust them a bit here.

Closing schools has a huge impact that I don't think you've thought through. What should the parents who don't have jobs that give them time off do? Just lose their jobs? I'm pretty lucky. I could make it work if I was told my day care had to be closed for two weeks. But that would certainly involve some time off with out pay. I can afford that. Not everyone can. Who should help the people who can't, when our social safety net is already stretched by a recession? Are we going to protect the jobs of parents forced to take time off? Or just count on their employers to do the right thing?

[L.]

@StayingAnon, I'm not judging you; I think we're actually not that far off in thought. I too would surely want to see someone who's been quarantined obey the rules, and if I had immunocompromised children I would be extra careful, and extra concerned, too. On the other hand--"So yes, if you recently got back from Mexico or have been in contact with someone who was, I think there's a very very high likelihood you were exposed."--on Wednesday my husband was at the dentist's. The hygienist was cleaning away and starts talking about how she just got back from Mexico. Hands in his mouth and all. He wasn't thrilled about it, of course, but I think it's highly unlikely he's actually been exposed, or even that she has. (Mexico is a big country!) Honest question here, do you think if the hygienist is feeling absolutely healthy, that she should stay home, or that now my husband should, or should we not have sent our son to daycare this morning? That is the distinction I was trying to draw.

[StayingAnonForThisOne]

@L, ya know, truthfully, yesterday my answer to your question is that I might have been concerned. (I'd certainly be pretty creeped out.) But seriously, I would have probably asked him where in Mexico he was. I might have even asked him how many days ago he came back. If he had said Mexico City, and that he flew in the last 2 days, yeah... I might have seriously considered staying at home today. Or, my husband would have talked me off the ledge (LOL) and forced me to go to work, all the while I sweated bullets for the 48 hour incubation period. LOL But that was yesterday.

I think today, my answer would be one of more calm. The news seems to be shifting and it's clear this virus, though extremely contagious, is also fairly benign. And the spread of it seems to be slowing down, and still limited to pockets of people who either are in Mexico, recently travelled there or through there, or were in touch with someone who did. Here in CA we have only a couple of cases that are in people who haven't had any known contact with other people which are puzzling health officials.

We still need to limit the number of cases so that we can limit the potential of it mutating into a more dangerous strain. But I think we're gaining a better picture of it and I'm easing off the panic button a bit.

One other thing I thought I'd mention because I've been wondering this myself (and might have seen this comment here and on other boards)... a lot of people wondering if maybe this virus has been out in the community previously, and maybe they "just" caught on to it when they tested someone. My entire family was horrendously sick last month... both kids got pneumonia. My husband and I got bronchitis. My parents, who NEVER ever get sick, caught it after only being exposed to me for a couple hours, and it spread like wildfire. I just spoke with my doctor and asked if there was a chance that what we and everyone else here in the bay area had last month might have been this new swine virus.

She said to make no bones about, this swine flu is brand new with ground zero being somewhere near Mexico City. Of that, the CDC is 100% certain. And it is dangerous because of the rare combination of bird/swine/human flus; because of the risk of it mutating. Although it is technically an "influenza" (and you catch it the same way as other influenzas and it seems to follow a similar path as influenza), it is definitely NOT "just like the normal flu". It is flawed logic to say "the normal flu kills xxx number of people so I won't be alarmed until this reaches that number." It is definitely cause for alarm now, before it gets to that number, but of course not panic.

Another thing I wanted to mention is that although everyone I know is going about their business and very publicly saying things like, "hey, I'm not worried", when I've had private conversations with friends and other parents at school, everybody privately admits things like that they've gone and bought more hand sanitizer, and that they've changed their summer travel plans. Privately, people are really worried about this, but openly saying anything about it seems to be socially unacceptable. And I just tend to show my emotions more on my sleeve and tell it like I see it.

Hopefully we can all have a nice weekend and enjoy our children.

[Asics shoes]

Nothing great was ever achieved without enthusiasm.