Flu Epidemic? Think Quarantine

Why not stay at home and avoid exposing others

If you read the newspapers or watch TV at all, you get the idea that doctors’ offices and ERs are swamped with patients who think they might have the “swine” flu. Almost all of them don’t, but they may shortly become ill after being exposed in the healthcare facility. If there were a plan to disseminate contagious disease in our country, this would be it. Scare people, then watch them run to the very place where the disease can be found.

Pardon the reference to ancient history, but this would never happen in the US of, say, 1936. Then, if someone had a contagious illness, a public health nurse would journey to the patient’s home, confirm the diagnosis, and post a contagion sign on the door. The sign would be taken down when the household was again entirely healthy.

With vaccines to prevent the worst of childhood contagious illnesses, and with much publicity about how we Medical Magicians can cure just about everything, there is no longer a push to isolate victims of easily transmissible illnesses. To ameliorate concerns re a flu pandemic, it’s time to rethink current practices and perhaps resurrect some old ones.

Here’s how it could be done.

1. Establish telephone triage centers in all cities. Manned by an infectious disease trained person, many concerns could be stopped at this level. Ease and cost? Compare this to having people go to an ER.

2. Relieve public health personnel of their current non-critical assignments, and, after telephone screening, have them visit possible influenza patients in their homes. This level of triage could screen out illnesses other than flu, assigning those who need timely treatment to get it at a healthcare facility (office, urgent care, etc.). Ease and cost? Would take a week or so to mobilize these teams, and the cost would be in lost time at their previous assignment.

3. Fact: Influenza, like a lot of other bad illnesses starts suddenly, and is purely a respiratory disease, with some sore throat and cough accompanied by fever (sometimes to 103 or 104) and general malaise. It is not a “bad cold” nor is it a GI disease. Ever. Period. Ease and cost? It doesn’t cost a thing to get smart.

4. Avoid risk of missing serious illness (pneumonia, meningitis are examples) by applying rules of evaluating such patients. If he tries, can he eat, drink, and walk around the house? Is he short of breath, or deficient on oxygen? (Accurate oximeters are available and transportable.) Is he mentally alert, and simply miserable, or is his mind not with his body? If the answer(s) to any of these is “yes”, arrangements can be made for evaluation at a higher skill and treatment level. This, too, could be done in homes. Ease and cost? Would take some time to put together a team to evaluate and treat serious illness in homes, but it would cost far less than doing the same in a hospital setting.

We need some leadership in implementing this return to basics. It isn’t brain surgery when all involved work at their individual skill level. This is where we belong; whether we will get there and stay within our limits is a topic for ongoing debate.