From a Doc on the west coast:
If we're in luck, the number of deaths world wide will not skyrocket though the case rates will certainly continue to grow. One point of caution though is as the H1N1 propagates, it tends to mutate rapidly. 2 problems come to mind:
1) H1N1 can continue to change and might grow more aggressive/virulent with time, especially if it begins to take hold in denser/urban locales (ie. Asia) with closely packed populations and poor living conditions/poor healthcare systems. H1N1 will be part of the viral landscape from now on (joining Bird Flu H5N1 and the myriad of other strains), it will not be going away completely.
2) There is often a pattern of a second surge in these Viral Epidemics several months down the line, look for another increase in cases 6 months down the line in Fall or Winter even if things don't get severe with this first surge. The second surge in cases can have a higher kill rate/lethality if the virus changes enough between now and then.
Comments taken from the Surgeon General's release on Tuesday, April 28:
Ongoing surveillance of US Army and military populations in general has not shown any unusual spikes in suspicious upper respiratory cases which might be attributable to this flu. Rest assured that my staff and I are working the swine flu issue closely with the Joint Staff Surgeon, the Assistant Secretary of Defense for Health Affairs, the other military Services, Health and Human Services, and Centers for Disease Control and Preventive Medicine.
Information about Basic Protection for Law Officers w/ regard to Swine Flu:In terms of decreasing your Officer's risk for exposure during contacts, one could approach suspects/contacts with the following 3 tiered approach:
These precautions are predicated on the fact that the transmission of the Viral particles is primarily via aerosolized droplets from coughing or sneezing, and subsequent inhalation of these droplets or contact from where these droplets have deposited (from the contact's coughing/sneezing/touching other items) to one's mucous membranes (eyes, nose, mouth).
2) Barrier Contact/Respiratory Filtering
3) Post contact decontamination
1) Distance - if possible prior to close contact (within 6 feet), perhaps the LE's could just take 30 sec to a minute (while waiting for the warrant checks to come back over the radio) to observe the suspect/contact for obvious symptoms of coughing, sneezing, wiping at their nose/blowing their nose, congestion, red eyes, etc. If such symptoms are observed, the officers could as a pro-active precaution put on their N95 masks and gloves prior to close contact. If the contact becomes distressed at the presence of masks, often just saying
"I see that you're coughing/sneezing, this mask is just a precaution." will often set them at ease. We do this in the ER all the time.
Having contacts come out doors if this is possible/safe (ie. as opposed to talking to them in close confines) will mitigate alot of the potential for concentration/exposure to respiratory droplets in a closed space.
Having traffic stop contacts remain in their vehicles if possible and approaching from the right hand/passenger side and having a conversation through the window keeping your head out of the inside of the car will also create some distance and decrease the possibility of exposure.
When transporting suspects/detainees, to keep front windows open and avoiding use of recirculating in the car's AC system is helpful. If the individual is active coughing, placing a N95 mask is helpful or for severe respiratory cases consider EMS transport to a hospital for clearance (per your medical screening protocols). Wiping down the interior of the vehicles after transports with some of the products mentioned next may also be advisable when possible.
This may not always be possible due to the tactical situation or timing, but the use of the N95 masks and gloves before actual contact would be of help.
2) Issuing N95 masks liberally as well as Gloves (latex free for latex allergic staff) pre-emptively as well as proper training on the use/fitting of the N95 masks would be ideal. If any officers come into the ED requesting Masks and Gloves and surface decontamination (wipes/lotions/sprays) I personally have always gladly give them out. You may want to have some arrangements with your local Hospitals to have these given out to officers that come in requesting the materials if there is a large demand.
3) After contact decontamination is best accomplished through frequent hand washing which is not always possible with your officers in the field. In the Hospital, we use several virus killing types of topical hand lotions/foams, sprays and wipes. These may be more realistic for your officers to use after any high risk contacts (visible coughing or upper respiratory symptoms), or better yet after any and all contacts.
In the Hospital we use a product made by PDI called "Super Sani-Cloth" which kills many bacterial and viral antigens as well as the Influenza A family of viruses. It comes in a large 65 count wipe dispenser (like a diaper wipe dispenser) as well as individually packaged 1 use wipes that are smaller and transportable (flat 2.5"x2.5" packets). These may be used for decontaminating surfaces/equipment as well as skin (not to be used near the eyes or mouth/nose areas).
There are several over the counter products that can be purchased at pharmacies that are virus killing hand sanitizer/foam/lotion preparations. The ones that are alcohol based are not anti-viral. Look for products labeled as being anti-viral. For example: "Gel/Stat" which comes in a convenient hand pump sized dispenser which I found at several pharmacies on line.
One generally good procedure is to have your staff wipe down their comm gear before and at the end of every shift and to advise them to wash their hands and/or use hand sanitizers frequently, especially before touching their faces/mouths and before going home or upon arriving home.
While these measures are not guaranteed to prevent transmission/infection, they are simple enough and easy to institute so as not to be too much of a burden on your staff while providing some protection and reasurance to your staff and their families.