CEO Musings

Flu Outbreak

October 1, 2017

It was so lovely to see her!

I hadn’t expected her to be up and around so soon as a respiratory illness had laid her low quite recently.

This marvellous resident (well they all deserve this moniker) had succumbed to an illness which started with a temperature, malaise and a very crook chest (hugely scientific symptoms this last one….)

Of course in this current climate the big “F” word leapt out at us; the draw bridge was raised and the core of Coventry imposed upon her. Thank goodness this had passed…

She had her usual jaunty cap on and smiled with her old bonhomie  but it was clear that illness had left it’s mark; her eyes looked tired, her face drawn.

She hadn’t been F’d but a nasty chest infection had almost been as bad.

For months we’ve been in trepidation about an obscene word. It’s filled us with dread and no little paranoia—anyone with a hint of contamination raised suspicion, sideways glances and a head averted to prevent any infection.

The F word is bad enough but the C word is also appalling. Both were rarely as prominent as they have been in the last few months.

But the C word is a repository of its own terrors as it’s elusive, causes confusion and often needless (but still sensible) caution.

The entity is a chameleon. It can come in a costume as deceiving as any ‘Les Girls’ glamazon.   It’s danger is that its far less drastic consequences can lead to reduced vigilance. This sheep in wolves clothing is no friend but a decoy dangled in front of us like a duplicitous figure in Greek   mythology; a Trojan Horse giving shelter to hubris and often misleading complacency.

For Colds can lay you low but Flu can kill and has killed more of us aussies than any outbreak since the Great Spanish Flu of 1918 in which up to 100 million people died worldwide.

So far we have recorded 370 deaths Nation-wide. A large proportion of these (as we have all been reading) has been in Aged Care where a combination of reduced response to the Flu-Vax (due to less immunological reactivity) and underlying heart and chest problems have been a potent mix too overwhelming for some to defeat.

It is now October and Fairway has not had one resident with the Flu!!

Aaaahh! Those who are superstitious would say I am tempting fate to even breathe this fact. And -yes it could still happen but on the balance of probabilities and according to Professor Peter       Collignon from the Medical School of the A.N.U.  We are well over the peak with little flu activation expected this late in the year.

However, this zero statistic has not held for staff—including moi!

There have been at least 5 confirmed cases of influenza A and B in our staff population. Possibly this could be a greater figure as mild infections can go unrecognized, treated as ..”a bit of a lurgie” and with a few days rest  younger systems bounce back and can carry on.

This begs the question—and it is often difficult to answer—when is the C word really the F word?

On the Monday I took ill (sounds like something out of Jane Austen doesn’t it?) I must admit I dragged myself out of bed and as the day progressed a certain fatigue descended—and it was not just that I had to write my Board Report; there was a scratchiness to the throat (not simply the wifely hoarseness induced by hubby needing a small dose of tongue pie over brekky that morning). Things were brewing…

A new staff member started with us in the afternoon and I barely managed a squeak of welcome where normally I would have been all enthusiasm and introductions (actually this may have created a gentler vibe and contributed to greater staff orientation satisfaction …must check this out…)

At one stage Carolyn looked over at me from her desk. The look was quizzical and concerned “I think I’m getting a cold” I stammered, “…Now it’s not the Flu, Carolyn don’t worry I just know its not the Flu…”  We had all been reading reports in the paper and hearing Health Dept warnings about the Influenza season upon us.  We were alert but not alarmed—well actually I lie—we were alarmed—bloody alarmed as “outbreaks” are the stuff of nightmares for us.  Isolation and Barrier nursing is difficult, demanding, resource heavy (human and financial), awful for the resident and can be very challenging in a confused person who just cannot remember to stay in his or her room and desperately needs to wander amongst the throng coughing, sneezing and the like.

Gastro is similarly as difficult to deal with and we all hear of facilities and hospital wards in “lockdown” due to such infections. Locking down a bewildered human being is another matter.

Driving home that day all I could think of was assuming a horizontal position in that greatest sanctuary of all—beddy-byes.

And here is where I started the questioning….is it C or F?

Damn—I felt freezing and started to shiver but my temp was up (cardinal symptom). I didn’t want to eat at all (usually regarded as a terminal sign in my family).  Off to the doctor and after a swab  inserted up my nose and pulled out at the top of my head (felt like that anyway) I received the official pathology report  “Influenza strain: B”

It’s a funny feeling to be like a pariah —’unclean’ and a risk to others. Family were OK I kept my distance and none of them succumbed but I knew that at work my presence was very definitely not required, and for some time at that.

Colds are perennial, we all have them; the tickle, the sniffle, maybe a cough, feeling off colour. A range of rhinovirus (and others) cause these illnesses which pass soon enough but can definitely     warrant a few days or even a week of rest and nurturance.

When you have Influenza it is usually a more intense illness with fever, shivering headache, muscle and joint aches, tiredness, some respiratory symptoms (nose, chest etc) and even vomiting (more common in children however). But not all of these markers may be present.

With a cold I think you feel as if you have been slapped around the face with a wet fish; with the Flu you feel as if you’ve been head butted by a rhino (and you are not even Tony Abbott). But though these David Attenborough-type descriptions have merit they may not help a GP much as the cross-over in presentation between Cold and Flu can sometimes be tricky. A swab really is the only cincher—either that or just treating every infection as Flu which is the way we have gone this winter putting into isolation anyone with suspicious symptoms.  Only 3 have required this

Touch wood…

Curious to know more about the Spanish Flu I researched it a little. Scientists have been able to sequence the DNA of this strain from the lungs of a deceased Eskimo woman whose remains were well enough preserved in permafrost from 1918.

A very brave virologist injected this DNA into a live cell and actually created a replica of the Spanish Flu virus. It was deadly alright and killed experimental mice. Strangely this Flu affected the young more than the old and fatalities seemed to have had a very dramatic immune response to the virus—including a bleeding tendency.  So different to this current strain 100 years later.

Scientists know that the world has always had influenza and Pandemics may have occurred over thousands of years.  There is documentation of a huge outbreak in the 1500’s with classic Flu symptoms recorded.  Influenza seems to mutate rapidly and contain variants of bird and animal proteins which cross over as it does so.

The problem with vaccines (and there is no doubt that the 2017 mix was a bit of a fizzer) is that they are prepared, refined, and produced in huge amounts several months ahead and by this time the   major strains may have changed—sometimes far more than expected.

It is utterly impossible to produce such a vaccine armoury within a week!

The Scientific Community will have a lot to think about in next year’s brew, and hopefully the comparatively reduced effectiveness of the 2017 mix will not turn people off getting the Flu Jab (almost 100% of our residents were inoculated; 2 could not oblige as are allergic to egg protein in which the vaccine is produced).

All of our staff are offered Fluvax gratis and the take up has been 50%. I had it and still got sick—but mine was quite a mild dose and could have been much worse if I had not been vaccinated.  Who knows?

How long to stay off work if you’ve had the flu? Well once again—it depends.  Most GP’s would say at least a week if you have no ongoing symptoms but if a “wettish” cough and respiratory symptoms remain stay away until these abate enough to feel safe.

The dry cough which can persist for ages once an infection has subsided is more to do with inflammation (and swelling) of the air passages—the bodies immune response—rather than active infection.

Such a cough can be annoying but not a risk to others.

Last week when I greeted our lady with the jaunty cap I said “It’s so lovely to see you up and around after being so unwell”.

“Was I?” she said taken aback   “Well no one told me about that…are you sure?…

I certainly hope I was no bother to anybody….”

Don’t you just love this? – whether it’s a chest infection (as she had) or a dose of the flu, a little amnesia in the mix may be a definite plus!

Cheers to all, wash you hands now!