Saturday, February 16, 2008

The Challenge of Pandemic Home Care - Part II

 

# 1676

 

 

 

 PART 1 of this 3 part series is HERE.

 

 

 

 

Were a pandemic influenza just an ordinary flu virus, home care might not be as great an issue.  

 

After all, millions of people get the flu every year and most manage to recover at home without the intervention of a doctor or the need for hospitalization.

 

 

But pandemics are caused by novel influenza viruses, ones that mankind has little or no immunity to, and so the level of morbidity and mortality is generally much higher.

 

 

The H5N1 bird flu virus, the one we are currently watching,  is one of these novel viruses; one that humans have devastatingly little immunity to. It has thus far exacted a heavy toll on those infected - with most developing pneumonia - while some saw the infection spread to other organs like the liver, kidneys, and brain. Fully 60% of those known to have been infected, have died.

 

Instead of running its course in 5 to 7 days, like a seasonal flu, many H5N1 survivors have required 30 days or more of convalescence.

 

 

Caring for avian flu patients in the home is therefore likely to be more involved, and more intensive, than handing them a bottle of Nyquil, a box of tissues, and the TV remote. 

 

In fact is is likely to be quite a challenge.


 

To date, most H5N1 virus sufferers have been treated aggressively in hospitals with IV’s, Oxygen, antivirals (Tamiflu), antibiotics, and many have been placed on ventilators. While many of these interventions are unlikely to be available in a home setting, trying to keep a severely ill patient hydrated, clean, and comfortable is a full time job.

 

The government is stockpiling antivirals, and hopes to be able to put them in the hands of many of those sickened quickly enough to do some good, but those stockpiles are insufficient to cover everyone, and the distribution plans are untested.

 

Antiviral drugs many not be effective against the next pandemic flu, and in any event, will be in limited supply. A vaccine won't be available until at least 6 months into a pandemic, leaving most of us with basically the same tools our grandparents  had in 1918 when they combated the Spanish Flu.

 

 

 

Complicating matters, influenza viruses are notoriously communicable, and while the H5N1 virus has yet to acquire that trait, by definition - if it becomes a pandemic strain -  it will be highly contagious.

 

 

Which means that every member of a household with an infected patient will be at risk.

 

The argument has been made, and may well have merit, that as a flu victim may be contagious for up to 48 hours before showing symptoms, all family members would already be exposed. If they were going to develop the disease, that die was already cast.

 

There are, however, unanswered questions regarding viral loading, length of exposure, and routes of transmission and we simply don’t know how much contact it will take to convey the virus from one person to another.

 

Initial exposure doesn’t necessarily equate to automatic infection.

 

 


In a hospital setting, Health Care Workers (HCW’s) would understandably demand that they be provided suitable PPE’s (Personal Protective Equipment) such as gloves, N95 masks, gowns, and goggles. The contagiousness of the disease, along with the morbidity and mortality rates, makes treating patients without them an unacceptable risk. Those risks do not diminish simply because one is in a home environment.

 


Obviously, infection control is going to be an issue when treating avian flu patients in the home, and a failure to deal with that will likely spread the disease throughout the entire household. Given the duration of the illness, and the incubation time once exposed, an entire family could be sickened at the same time, with no one available to care for them.

 

While home care may be the only option open to us, even basic nursing care can be lifesaving.  

 

 

First, you need to create a plan as to what you will do if you suspect a family member has contracted the flu.


Some of this plan will be contingent upon what services are available to you and your family during a pandemic, and that will vary depending upon your location, the severity of the crisis, and how early or late in the crisis your needs arise.


 

In some localities there are plans to provide telephone call-centers, other places may provide home delivery of certain meds and supplies, and a few places may even manage some sort of home visits by medical teams. Even so, the burden of round the clock care will fall on families.

 

Early detection of any illness in the family will be important. All family members should be instructed to `fess up’ immediately if they suspect they may be falling ill.

 

Suspected flu patients should be separated from the rest of the family as quickly as possible, to limit cross contamination.

 

Setting up a sick room, and maintaining as good of isolation practices as possible, may help reduce this risk. Having latex gloves on hand, N95 masks, and disposable gowns may help protect the caregiver. Obsessive hand washing, and the use of alcohol gel sanitizers, are both sensible precautions.

 

You obviously want to avoid infecting the caregiver and avoid having them spread the disease throughout the house to others.

 


Proper cleaning and disinfection supplies are a high priority. A 10% Clorox/water solution, or a 3% Lysol spray have both been recommended for infection control. Bagging infected or soiled linens or clothes prior to laundering them is a wise precaution.


 

 

Obviously, having adequate supplies of over-the-counter (OTC) medications such as Tylenol, Ibuprofen, expectorants, and oral rehydration solutions are a must.

 

These, and infection control supplies (bleach, masks, gloves) need to be acquire BEFORE a pandemic begins.  They could all be in short supply once a pandemic starts.

 

 


Dr. Grattan Woodson’s guides to the home care of Avian Flu victims, available for free download from his web site, are as good an overview of home care that I’ve found. If you don’t already have it, get it.

 

 

Read it now, before you need to utilize the knowledge. That way, you’ll know what supplies you will need, and can acquire them before a pandemic starts.


 

As you can see, caring for a pandemic flu patient at home will require planning, organization, and stamina.    Nursing one or more sick patients is hard work, likely to go on for days or perhaps weeks, and will be particularly stressful when you are dealing with loved ones.

 

 

We need to be prepared for the very real possibility that thousands of people could die in their homes while under the care of family members simply because the option to go to a hospital simply won't be available.

 

 

In our society today, we simply aren't used to dealing with illness and death at home.  Particularly when many of these victims will be children.  The psychological stress and pressures, plus exhaustion, will take a terrible toll on the caregivers, some of whom may be battling the virus themselves.

 

 

While the problems of home care during a pandemic are complex, they are not insurmountable.   With proper planning, advance preparation, and a bit of ingenuity many of these can be dealt with successfully.  

 

In Part III of this series, we'll explore a proposal that could make the task of home pandemic care far more manageable.