Category: influenza

First Frost

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written initially Sept. 23, 2005/updated Sept. 30, 2009

There needs to be a warning system in place for the first frost. Today caught me completely unaware, as I woke in a bedroom with windows flung open as they’ve been for over 4 months. I sensed immediately that autumn on the calendar meant business. It was freezing, both inside and out. I wanted nothing more than to stay under the covers, hiding my head from the reality outside. The wood floors were cold, the furnace sputtered itself to life as I closed windows and gazed out at frost on the grass and leaves, sparkling in bright morning sunshine. How can this be, a month earlier than typical? I am not ready for this. No one prepared me for summer to be over, literally overnight.

It was, to be entirely fair, a very transient frost. It wasn’t crunchy underfoot and merely put a little glaze on everything. As the sun rose higher, in only a matter of minutes, the frost softened and melted, leaving no trace behind. The only hint of cold air was the puffs of steam from the horses’ nostrils as they raced in the pastures to warm their muscles, as they do not yet have their full winter coats, and they too were startled by this early cold.

Things happen daily in our lives that we feel unprepared for. No matter how much schooling we pursue, how much news and information we absorb, or how many tales of advice we’ve heard from our wise grandparents, there will always be a surprise around the corner, and usually not as harmless as an early frost. Perhaps it is a hurricane that shifts direction picking up speed and ferocity, or a virus that mutates in a way that makes its transmission more deadly, or the “big one” earthquake that has been predicted for years finally lets loose. These threats hang over our collective heads and we cower and hide our heads under the covers, as it can be too overwhelming to contemplate.

I have been taking part in Disaster Planning work preparing for the H1N1 influenza outbreak, as well as participating in “tabletop exercises” that help prepare first responders and health care personnel for a variety of horrible scenarios, and I found that I’m not cut from the same cloth as many emergency workers who seem to enjoy thinking up the worst possible cases. I end up in a state of tabletop anxiety as we walk through the handling of chemical spills, dirty bombs, and deadly pathogen release into the community. No matter what we discuss, a positive outcome was to contain inevitable destruction to a localized area, and prevent spread, not only of the deadly agent, but of the immobilizing and contagious fear that can bring society to its knees. It is hard for me to think in those terms, as even one death in my clinical practice is unthinkable and rare. As I’ve read the stories of the health care professionals who worked days on end to help in the Katrina disaster, I realize they too were unprepared and undoubtedly scared. Yet they were there, doing their best helping people despite overwhelming need and limited supplies, because giving up one’s own comfort in the service of others is the good and right thing to do.  So my long work days seeing many H1N1 influenza-afflicted college students seems very minor in comparison.

We are called to get up and get going even on the “coldest” of mornings, when throwing the covers back over our head and staying warm and comfortable is far more appealing. It is such a small sacrifice, as insignificant as a first frost, compared to the monumental gift, earth shaking and heart rending, that has been given to each of us, unselfishly,  out of Love. In response, we must leap willingly out of our warm beds and stand ready to go wherever and whenever we may be needed most.

Don’t Wanna Hold Your Hand

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Ross MacDonald illustration for the New York Times

Suffice to say, I’m not germ phobic.  If I were, I wouldn’t live on a farm handling manure everyday, and I wouldn’t work as a health care provider in the “culture media” otherwise referred to as a university student health center.  I’ve learned to live in harmony with all the pathogens I come in contact with, and, for the most part, we leave each other alone.

Yet there comes a time (and this is it!) when a little paranoia about viruses is warranted.  This current early influenza season has the potential to be a real humdinger because the virus people are passing between them is unfamiliar to the majority of the younger (under age 50) population, so their immune systems are not readily primed for the antibody fight.  So there may be good reason for social rituals to adapt to protect the unprotected.

There is reasonable evidence that H1N1 influenza really takes hold in environments where people are doing a great deal of “meet and greet” activities, such as sorority and fraternity “rush” week at universities.  That means that hand shakes and hugs, or the seemingly benign cheek kiss, confer more than good will.  They become the vectors of a viral gift, ready to transfer to our mucus membranes with an innocent rub of an itchy eye, or licking of our lips after touching the outside of our mouths, or running the back of our hand across our noses.

In other words, we inadvertently share and receive more than we intend with a simple greeting ritual.  This becomes important during a time when potentially fatal viruses are circulating widely, especially as a certain percentage of the population will tend to be “carriers” without having obvious symptoms,  effectively becoming unwitting transmitters.

So this fall, the time has come to stop greeting with hand shakes, particularly in “high volume” situations like political rallies, wedding and funeral receptions, church lobbies and school orientation activities.  The options to replace the hand shake are plenty, but ideally should minimize physical contact.   I prefer a simple nod, leaning forward, hands behind my back, and actually using my vocal cords to do the work:  “good to see you”  or some other gracious few words.

I’m not being unfriendly, nor am I rebuffing your friendly extended hand.  I just don’t want to share what I may have just been exposed to a few minutes earlier without having had a chance to adequately wash my hands, as I would if I were working in the barn or the clinic.  Just like the classic classroom exercise illustrating how many sexual partners you exponentially end up with when you consider all the partners of the partner’s partners, etc. —when you shake my hand, you are shaking the hand of everyone I’ve touched since the last time I washed my hands.  In certain social situations, that can be an overwhelming number of contacts.  So let’s just take handshaking out of the equation and make it a little tougher for this virus to find its way from me to you.

So it’s good to see you looking so well. And I really want you to stay that way.