Monday, June 22, 2009

Swine flue Not the Deadly influenza the media make it to be)

On Saturday, Narace announced that there were 16 cases in Tobago and nine in Trinidad, bringing the total number in the country to 25.

"Out of these total 25 cases, 12 people have recuperated and have resumed their normal activities, as they are not infectious or ill anymore. All cases thus far have shown mild severity of the disease and have responded well to treatment. The most recent cases have been placed in isolation and are currently receiving proper treatment. Those patients are also doing well," Narace said in a release.

Medical director of the adult emergency department at the Eric Williams Medical Sciences Complex in Mt Hope Dr Helmer Hilwig is in charge of screening, testing and treating the suspected and confirmed cases of swine flu in Trinidad.

Well appreciative of T&T culture, he is well-placed to understand the ways and means by which the A (H1N1) influenza virus can be transmitted, and how we can prevent it from spreading.

Q: Should we panic, doctor?

A: The swine flu, luckily, is still a mild to moderate virus. Initially, we were a little bit scared because so much people had died in Mexico, but after that, it started to slow down. ...Now we see that the people who died had morbid conditions, like the girl in Dominican Republic; first case in the Caribbean who died. She was 17, pregnant; she had tuberculosis. If you're like that and you get the virus, it might be the last drop that killed the horse. The other cases are, in principle, quite mild. It is even so that in the United States now, people say if you have mild symptoms, don't even bother to go to the hospital or go to a doctor. Just sit it out at home. And cases that I've treated here in Trinidad, the first day you're sick. The second day, you're kind of sick and within five days, all of them are back on their feet.

Didn't you give them Tamiflu?

Protect your mouth: Dr Helmer Hilwig

I absolutely didn't give them Tamiflu. We are very restricted in our way how we providing Tamiflu. It's only a few doctors in the hospital who are allowed to prescribe Tamiflu. According to research done by the company that sells Tamiflu, it shortens the sickness process by 1.3 days maximum. So instead of being sick for seven days, you're sick for 5.7 days.

Okay, so we shouldn't panic?

No, no, no, no. Not at the moment. I don't want to say when this virus comes back after it has gone to Chile in the flu season, in the southern hemisphere, and it starts to mutate again and again-but you also have to keep in mind...SARS, which was quite deadly-40-50 per cent deaths-stopped in its tracks while Ebola, which is a really nasty virus, is still so contained...The virus that adapts itself nicely to the human environment will have a much better chance to survive and, therefore, when we start getting immune to the virus, it will mutate slightly and it comes back to haunt us. And then it will mutate slightly again and so on.

Trinidad is trying to do the impossible. We are a Caribbean island, so we can still track the trail of the virus a little bit. It comes in by plane-you know that? We have a good surveillance system. There's a case I can track back to a house in New York, and I know in which street that house is. We're small, everybody knows everybody, so we can still keep track of where it came from. But it's here to stay- there's no doubt about that. And there comes a moment when we cannot trace back anymore, it becomes community acquired, and you might wonder if that has happened in Tobago already where a Tobagonian is passing it on to other Tobagonians. The cases that I have dealt with, so far, I can still trace it back to the outside world. It all has to do with the United States.

But there comes a moment when we stop checking. Australia has stopped checking by the airport because there are hundreds of cases over there, and it makes no sense anymore... you cannot trace back anymore-it's just there. So you just deal with it. We were the 69th country to get it-so 68 countries before us. It is amazing that we could still keep it out so long. You have to keep in mind, in the United States, 35,000 people a year are dying from the normal flu virus and, so far, in the US, only 29 cases have died from the swine flu virus. So the normal flu virus is, in principle, worse than the swine flu virus. So that's why I tell the people who I've treated, "Yuh lucky that it is swine flu because you are now immune against swine flu. You don't have to worry about masks because you cannot get it anymore."

So even if it mutates and comes back, they will have immunity?

If it mutates, then, no. But for the present virus, they are the safest persons to talk to in Trinidad or to sleep with or to kiss or to cough with.

Okay, let's deal with the high-risk groups. We have a high number of HIV-positive


Pregnant women, people who have asthma, pre-existing lung diseases, chronic obstructive airway disease, emphysema-you have to be careful because that can push them over the edge. The elderly, children under two years.

From the literature about swine flu, it seems that once we see the

symptoms and we treat it, the person should be okay?

I don't think I will see anybody dying from the swine flu very soon, unless it is an elderly gentleman who already has, say, emphysema, is diabetic or has heart disease, kidney/renal failure- these are people you have to keep an eye on, people on dialysis. But for a healthy person like you, if you get swine flu, I wouldn't worry too much about that. And keep in mind, 98 per cent of the cases could be treated at home. Only two per cent needed hospitalisation. The fact that you test positive doesn't mean that you need to be in the hospital. The best place is to be at home. You sit at home, on your porch, you're fine.

A lifeguard thinks all of them should be outfitted with masks. I said the safest job in the entire world is being a lifeguard on the beach. Especially Mayaro beach because it always has breeze there. What is interesting is the girl [the first confirmed case in T&T] was sitting in the plane talking to the guy next to her for ten hours...The girl goes home, she stays there for about two to three days before she came by us and we could test her. In her home, she has her father, her mother and her sister who is sleeping with her-and she is unable to pass this virus on to any of her family members. They're living in a house with louvres, a door open, a little porch and a standing fan. And I am getting so convinced now that this is why in Africa-it might be that they don't test there properly yet, or they don't have the infrastructure-but you're not seeing many cases because they have an outside life. And it's the best place to be. The one place you cannot get it is on the beach.

Then why has it spread so quickly in

Tobago where you imagine most people are outdoors or on the beach? Maybe the

conditions were different?

Perhaps, they were different. I don't know yet. We still have to find out exactly what happened in Tobago.

What about offices with their air conditioning? Let's deal with the mask hysteria-do people need to wear masks on the street?

No. Because only when somebody coughs straight in your face.... That's why I say they can treat the people at home. I constantly tell them this. [He gets up and walks to the door.] You're in your room. I've confined you in your room. First, I want you to open your windows. And, if anybody comes into the room, you put back on your mask...

This virus is not alien, it's not from Mars. We know everything about it. We know that it takes one to four days to incubate. We know that after seven days, in principle, you cannot share it anymore. We know that it belongs to the Influenza A family. That is why we will have a vaccine in September. HIV when it came around, we didn't know anything. People were dying-from what? Was it a virus? Was it bacteria? We took years to find out.... But at this point, we still don't have a vaccine for HIV, and I'm telling you, in two to three months, some companies are going to make plenty money for a vaccine which gives you five or seven days of the flu. It would have been nice if we had spent all that money and effort in finding a vaccine for malaria or any other tropical disease. But we don't care so much because we don't see it so much in the Western hemisphere. But it's there, somewhere in Africa. Who cares about that?

And you're seeing it already in the newspapers-GlaxoSmithKline is willing to donate 36 million free doses to the Third World. Thirty-six million? We have six billion people in this world, of which five billion live below the poverty line. Novartis says they are willing to give it for a discount. It's the same thing with the anti-retroviral drugs...

So there is no doubt that there are some in the pharmaceutical industry who have an enormous interest in keeping the scare alive as long as possible. That is why everybody was angry with France because they bought up the entire Tamiflu supply. Britain announced that it had 36 million doses or whatever. And all this Tamiflu, I am sure, it will end up in the drains.

There's a misunderstanding that the virus is airborne, in that people can get it because it's in the air, and that's why they're wearing masks.

Yes, and it is not a virus that when I cough, it hangs now on the ceiling, waiting to jump on an innocent passer-by. Am I going to be sick? No. It's a very simple fact: it comes out of your mouth and it goes into your mouth. It doesn't go into your skin. So if you protect this [he covers his mouth and nose] and luckily, in Trinidad, we have a reasonably good cough etiquette already. Very few Trinidadians cough straight in your face cuz all the grannies and the mothers have to get complimented for the fact that Trinidadians have learnt you don't cough in somebody's face. Go and buy your doubles, and look at the man who is handling the money is not handling the paratha [bara], yeah? Because he will not sell one doubles. So in Trinidad, we have already a sense that your hands can be your enemy and your friends. In France, people buy the baguette and the baker gives you the change, and they put the baguette under their arm and go with it. And I never noticed it until I was in Trinidad!... What I hope will be the legacy of this virus is that we re-emphasise what we have already over other countries, which is that we wash our hands.

I want to get the message out: don't panic, it's just a flu.

Yes, correct.

...the only thing, perhaps, we should change is our social interaction. If I see you, I should go for the Indian way (he clasps his hands together and bows). Or you know, like the Japanese [he bows].

Natural ventilation, use it. When I was a young doctor, I worked at a children's hospital, and of course, it had endless amounts of viruses there. And then, you didn't have anybody who was immunised against mumps and rubella and all the viruses from the children. So what you had was a little balcony built on the northeast side because in Europe, you have a lot of northeastern winds, and I was always taught this, you examined the child, you go wash your hands, now, you go to the balcony, stand for two minutes in the wind, and sometimes it could be freezing cold, then you go back to the next child, wash your hands again, go back to the balcony. Because the wind kills the virus.

So in Mt Hope, I have arranged in the emergency department, we have a little area called the hyperbaric [area] where we're trying to keep the traffic away [to assess all respiratory cases]. The staff put on and take off their gowns outside, so you don't spread it. Now, the doctor has to walk via a little corridor on the outside, and the staircase is on the outside back into the emergency department, so you get a complete extra disinfection from just a little breeze in the outside world and in the sunshine. So we can use this advantage that we have over other countries.

What about your eyes? Some of

the literature says they can be

a point of entry for the virus?

Yeah, but it's very low on the list. It goes in here [pointing at his mouth] and here [pointing at his nose]. It can't go via your ears, your bottom, your toes. And 90 per cent of the cases, you did it yourself.

royalblood :I am very weary of vaccination programs


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