A month ago, I was diagnosing several cases of influenza-like illness (ILI) every day. Then, as suddenly as it began, it disappeared—no ILI, no positive nasal swabs for influenza A (and hence H1N1/swine flu)—just the usual strep throat, poison ivy, ankle sprains, etc. So what happened?
The new influenza A/H1N1 (hereafter called “H1N1″ or “swine” flu) emerged early this year and rapidly became pandemic. It caused a “second” flu season, ramping up just as the usual winter flu epidemic was winding down. This graph shows vividly the two-peak flu season we have this year due to the new flu.
As others have discussed, it is not unusual for a novel, pandemic flu strain to come in waves. As the first wave of H1N1 leaves the northern hemisphere and takes root in the southern hemisphere for their flu season, what may we expect next? Or is the “first wave” even done with us yet?
One possible answer to the sudden absence in swine flu in my daily work may be the end of the school year, the removal of kids from the crowded environments that they inhabit during the rest of the year. And where do these kids go when not in school? Many of them go to summer camps, where H1N1 may find a comfortable place to hang out. It’s still early in the camping season, but in parts of the country where camps start early, they are seeing cases of H1N1 flu.
A brief google search reveals different ways in which summer camps are dealing with influenza-like illnesses. For example, in Ontario, Canada, health officials recommend against testing for flu and base guidelines on clinical circumstances. Some camps have temporarily shut down, others have sent sick children home, and others have implemented screening, control, and isolation programs within the camp, especially those that are geographically isolated. One summer camp sent out this letter:
As has always been the case at this time every summer, four campers have presented themselves to our Health Centre with fevers and/or flu symptoms. And as is always the case, our MASH staff have responded expertly and quickly to provide a comfortable and isolated space for these kids to begin the process of getting better.
Sending kids home to recuperate is one of the options that we have available to us in this sort of situation.
We have decided it to be prudent to send these campers home for a few days until they are cleared by their doctor to return. Our motivation is:
1.To provide the most comfortable space for kids to get well and
2.To protect our overall (and overwhelmingly!) healthy population from acquiring any contagious illnesses.
All four of the families have been contacted and are cooperating with this decision. We are helping with their camper’s transportation to their hometown.
Yes, we are acting particularly cautiously in this summer of 2009 while fears of the spread of H1N1 flu through the cities remain significant.
We also wish to inform you that there are a number of practices that we initiated this year to protect our population:
1.Everyone coming in and out of camp from the “outside world” is screened before being admitted to camp. (This includes staff on days off, canoe trips, field trips, inter-camp, and individual “ins and outs”)
Definition of “screen”: Their temperature is taken, they are asked a series of diagnostic questions, and they are watched while washing their hands.
2.The cabin groups (including staff) of campers with a fever are screened twice in the first day and then periodically over the next week.
3.We are delivering specific, repeated, and targeted education about coughing safely and proper handwashing practices.
The reason for this communication is strictly to keep you informed, to let you know that there are some kids who are sick at camp, and to let you know that we are doing our very best to take reasonable and appropriate steps to protect our campers and staff.
One camp, which news reports did not identify by name, voluntarily shut down after experiencing a large flu outbreak. This does not, however, appear to be the norm. After communicating with several summer camps across North America, it would appear that many are experiencing small outbreaks of ILI which they are containing within the camp environment, and have implemented increased prevention and control programs.
What’s the lesson here?
As has been known for at least a century, crowding helps the spread of influenza. It would also appear that aggressive prevention and control programs can mitigate this spread. During the current pandemic, should we be keeping kids away from schools, camps, and other areas where flu can be spread? Is this pandemic worrisome enough that we should, during this Depression, halt necessary economic and educational activities? Remember, when a kid stays home from school or camp, a parent stays home from work or vacation, both of which are income-generating activities. These sorts of questions were asked during the 1918 flu pandemic, which attacked while the US was preparing for and fighting a war. It was not clear to health officials then what necessary activities should be curtailed to help stop the spread of flu (and of course politics made decisions doubly difficult).
For better or worse, time and science will give us more insight into these questions. If there is to be a “second wave” of H1N1 in the fall/winter flu season, our current experiences may serve as a guide for how to control the next phase of the pandemic, should it arrive. Meanwhile, my kiddo is going to camp, I’m going to work, and life continues on nearly as always.
But I do carry a bottle of hand sanitizer with me wherever I go, and I never touch a doorknob. I’m not so fond of shaking hands, either.