Friday, August 28, 2009

They Walk Among Us



# 3678


I’m hearing a good deal of consternation on the net, and in my travels in the `real’ world, over the use of `fever’ as the determining factor in whether it is safe for a flu patient to return to work or school.


The CDC originally stated that students and employees with suspected H1N1 should stay home for 7 days, or 24 hours after symptoms disappeared . . which ever was longer.


This recommendation was based, I’m certain, on studies that have shown that adults shed the flu virus for about 7 days.  Children may potentially shed the virus for several days longer.


Recently, the CDC changed their recommendations to staying home until 24 hours after the abatement of (an untreated) fever.  


In other words, stay home until 24 hours after a fever disappears without the use of aspirin, Tylenol, or ibuprofen.


This has immediately raised concerns that flu victims who may still be shedding virus, are being told it is okay to return to work or school. 


Critics also point out that we’ve seen reports that some percentage of H1N1 patients never develop a fever to begin with.


Fever, critics maintain, is an imperfect gauge of infection.


And they are right, of course. 


Using fever as a criteria will, no doubt, allow some infected people to walk among us; at work, at school, at the mall . . .  and these people will probably be shedding some quantity of virus, and may go on to infect others.


Of course, we also know that those infected with the flu virus can begin shedding virus 24 hours before they show symptoms, and that some percentage of infected remain asymptomatic for the full course of the infection.  


They walk among us, too.


Like it or not, there is no easy litmus test for infection (and viral shedding) when it comes to influenza.   The array of symptoms (or lack thereof) displayed by those infected with the H1N1 virus preclude any kind of 100% accurate `checklist for infection’.


Sure, we could lock up everyone who sneezes, coughs, or spikes a fever for 2-weeks.  But even that wouldn’t catch those who are shedding the virus before developing symptoms, or those who remain asymptomatic for the full course of their illness.


So the new guidelines are a compromise, based on the knowledge that there is nothing that can be done to completely stop the spread of the virus. 


The best you can hope for is to slow it down.


The belief is, that those who are the sickest (i.e. coughing, sneezing, fever) are probably shedding the most virus.  And so keeping them home, away from work or school, makes sense.


Fever is an easy enough symptom for most people to check.  It is an objective sign, one that can be measured with a thermometer.  It may not catch all of those who are shedding the virus, but it probably catches the most contagious among them.


With thousands of people walking among us quietly shedding the virus it simply makes little sense to tell those who are probably only shedding very low amounts of the virus – but who feel well enough to work or study - to stay home for a full week. 


Of course, if you are coughing your head off, sneezing every 5 minutes, or running to the bathroom 3 times an hour . . . you might want to give yourself an extra day or two to recover. 


We are allowed to use some common sense here. 


So yes, using fever as a criteria for staying home is a compromise. It balances public safety with economic and societal considerations.  It isn’t perfect, by any means.


But as compromises go, it is a reasonable one.  


Which is why it is so important to remember to wash your hands frequently, clean and disinfect shared objects like phones, keyboards, and door handles, and to try to maintain some space between yourself and others during a pandemic.


All of these steps are basically delaying actions, which will hopefully help keep you and your family virus-free until a vaccine can become available later this fall. 

As imperfect as all this may be, for the next couple of months they are going to be your best defense against this virus.

1 comment:

phytosleuth said...

A few years ago, Montana passed a "prudent and reasonable" speed law on the expressway. That is, they trusted people to make speed limit decisions based on road conditions. Guess what happened? People assumed there was no speed limit at all. It was like to Autobahn in Germany. So the state changed it back and put up signs for 75mph again.

People should be able to make good decisions, but the public needs a measuring tool, apparently. Fever is measurable, how sick you feel is subjective.

I can see why they are using fever as a yardstick. The problem is, some could use it to guilt people into returning to work too early, or parents may use it as an excuse to get their kid back in school before they are really well again.