Swine Flu Survival Guide

surgical masks may have almost entirely disappeared from the streets of manhattan, but the h1n1 virus, a.k.a. swine flu, is still on the radar, particular for health and education officials.

since it was classified as a "pandemic" last june, swine flu has been the target of a serious public information campaign, which seems to have gathered steam at the advent of the 2009-2010 school year. when kids entered the city's public and private schools this month, they were greeted with meetings and pamphlets, most of which centered on the basics of disease prevention: wash your hands, sneeze into your arm and stay home from school if you are sick.

schools prepared themselves with hand sanitizer and soap, and shored-up emergency-response procedures and backup plans in case of absences. letters in nine different languages were ready to go home to public school moms, dads and guardians to stave off the expected-and understandable-paranoia.

on sept. 1, a week before school opened, mayor michael bloomberg held a press conference to explain how the city was preparing for a second outbreak of swine flu, introducing a range of experts from the health and education departments who have been coordinating efforts.

"from everything we've seen in recent months, most experts in epidemiology believe that there is a strong possibility that the virus which cropped up in our city in may and june will return sometime this fall or this winter," bloomberg said.

he added later that, "all signs point to an outbreak that will be much more moderate."

that's certainly reassuring, but the bottom line is that swine flu is likely to return. so who should be most concerned about this illness? how is it contracted? what symptoms should you watch out for? and, most importantly, how is it treated?

earlier this year, as swine flu fears swept the city, officials came under fire for not clearly explaining the process for closing schools, adding to the sense of panic and lack of preparedness. this year, officials appear determined to be out in front of the illness.

"as a city, we have been very proactive this summer," said marge feinberg, a spokeswoman for the department of education. "we, along with the department of health, have been meeting regularly to come up with information that's helpful for parents and policies that will be better than it was in the spring. it all came to us as a surprise then."

in april and may, when the number of swine flu cases seemed to be rapidly expanding, particularly among school-age children, more than 16 schools closed their doors. at schools like st. francis preparatory in queens, st. david's in manhattan and horace mann in the bronx, end-of-school rituals like exams were canceled, and even prom and graduation were threatened. this year, the strategy is to avoid this kind of disruption while containing the spread of the disease.

"people really didn't know what the flu was going to look like, if it was going to be a very deadly strain, how quickly it would spread," said myra mcgovern, director of public information at the national association of independent schools. "this year, schools are really aiming to empower children and families to prevent the spread of disease, and also communicating with parents because children's health is such an emotional topic."

now that everyone is more informed, some of that emotion and panic has died down. the disease spreads quickly, but it appears to be no more lethal-in fact, less so-than the seasonal flu, which takes 36,000 lives a year in the united states. as of august, the centers for disease control and prevention reported 477 deaths from swine flu. those who may be more seriously at risk include children under 5, pregnant women and those who have underlying respiratory or immune conditions like asthma, diabetes or cerebral palsy.

"it's a novel strain," said dr. craig van roekens, chief medical officer for manhattan's physician group and a specialist in emergency medicine. "there's no natural immunity, so you're more likely to catch if it someone were to sneeze, cough, not wash their hands or share utensils. as a result, it spreads rapidly. but it's not as virulent as typical flu strains. it causes less illness, death and complications."

van roekens and other experts point out that a vast number of new yorkers-some 80,000 to 100,000-may have already been exposed to the disease when it hit the city last spring, and have therefore developed some immunity.

to prepare for the return of swine flu, health officials recommend that young children, the elderly, health-care workers and those who work with vulnerable populations be vaccinated for both typical influenza and swine flu. the city plans to distribute the new swine flu vaccine, to be made available in october, for free at elementary schools (for students whose parents have granted permission) and for older students at depots throughout the city. most health experts are applauding the city's efforts, but van roekens interjects a note of caution: before his office starts widely offering the vaccine, they are going to make sure they have all the information possible about its benefits and side effects.

stocking up on antivirals like tamiflu, which can help bring a more rapid end to both swine flu and regular flu symptoms, is another weapon against the disease, especially for those who may be more susceptible. tamiflu needs to be taken early on in the course of the illness to be effective. experts recommend stocking up now on other cold and flu medicines that reduce individual symptoms, such as fever reducers (not aspirin), decongestants, cough suppressants and stomach medications. staying hydrated is crucial to recovery.

vaccines and medicine aside, the key to prevention, as health experts frequently point out, is taking some classic "mom" advice when it comes to hygiene. don't stress about masks or avoiding the subway; just make sure to wash your hands thoroughly over and over, keep your sneezes to yourself, get rest, eat properly and stay home from school or work when you're sick.

"workplaces and schools need to understand that it's not helpful to have people who are sick present at work," van roekens said.

swine flu can be hard to identify, particularly since the symptoms of both strains of flu are identical: fever, stuffy nose, cough and sore throat-although swine flu is more associated with nausea and diarrhea. earlier this year, doctor's offices, hospitals and emergency rooms were flooded with people who were not sure if their symptoms warranted treatment.

to combat misinformation and paranoia, the government and schools want to arm public with facts. the department of health and mental hygiene is planning a subway ad campaign encouraging new yorkers to get their shots, and is putting together an informational website, nyc.gov/flu, which will include a map for vaccination spots. the national website flu.gov is also a treasure trove of information. the cdc website has a list of severe systems that warrant medical attention, like difficulty breathing or persistent vomiting.

so that life goes on, even if swine flu strikes, many private and some public schools are working on keeping their web and phone communications up to date, to help home-bound students keep up with work and not feel pressured to come to school.

"internally, we're making sure all our contact info is correct," said father steve katsouros, head of the loyola school on park avenue near east 84th street. "our website is already very interactive, but we're beginning to think about how you would post assignments and lessons for a period of time, should the school have to close or faculty members be out sick."

bloomberg also announced that the city would post a daily report on school absenteeism, which would inform the public about any schools reporting five or more cases of flu-like illness.

meanwhile, city council member gale brewer has introduced a paid sick leave bill that she believes will help contain the flu. the legislation mandates that private employers grant sick leave access to sick employees and parents of sick children, whose ability to stay home will keep the disease from spreading. her bill, introduced last month, has the support of mary pappas, the head nurse of st. francis preparatory in queens, which was the center of media scrutiny when a large number of students contracted swine flu last spring. pappas diagnosed the first case at the school and in the city. the bill, which brewer said she hopes will get a hearing this fall, has 37 co-sponsors, but has attracted opposition from some small business owners and chambers of commerce who say it's too burdensome in an already tough economy.

overall, officials want people to be informed and alert, but there's no need to panic yet. loyola's katsouros said that the school is preparing a three-step approach to disease: prevention, containment and continuation of services in the event of an emergency.

"tomorrow is the first day of classes," he said last week. "we'll meet with kids and go into it: what they should do for prevention, how we would communicate with them if need be. here's hoping the prevention will be where we end up."

-- swine flu at a glance q: what are the symptoms of swine flu, and are they different from regular flu? a: for the most part, they are the same. fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. however, vomiting and diarrhea are more associated with swine flu.

q: is swine flu more or less dangerous than regular flu? a: so far, there have been fewer swine flu fatalities. regular influenza appears to carry a higher risk for elderly patients than swine flu.

q: should i get vaccinated in october? a: if you have an underlying respiratory of immune condition, including diabetes, heart disease, asthma and kidney disease, if you are pregnant, or are in any way particularly vulnerable to the seasonal flu, then it's a good idea to get vaccinated for swine flu. consult your doctor if you are unsure, and check out nyc.gov/flu for updated information on vaccination distribution.

q: how long can an infected person continue to infect others, and how long after being sick should someone stay home from school or work? a: the disease is contagious for up to seven days after a person has been infected, and people with swine flu should stay home from work or school until the fever has been gone for 24 hours.

q: if someone in my house has swine flu, should i stay home? a: it's not necessary to stay home if you use proper hygiene, wash your hands and avoid touching your face.

q: where do i get more information? a: call your doctor and check out the following websites: www.flu.gov, www.nyc.gov/flu and www.cdc.gov/h1n1flu/qa.htm.

-sarah seltzer

source: centers for disease control and prevention