Pandemic

(Survival Manual/1. Disaster/Pandemic)

 Humans often tend to forget that they are not the only living species which adapts to and exploits the populations of other living beings.
A virus, such as one of the influenza variety, would have  a field day in our global, highly inter-connected society, especially in the midst of an economic depression (remember, H1N1 killed 50 million people in the early 20th century).

 1.  Overview: Surviving a deadly  pandemic
•  The duration of  a medical crisis  is usually 14-21 days depending on the disease and its method of movement through the country. There may be another 2-3 months before things swing back  to normal, but the worst will be over in 3 weeks.
•  Today we understand that a 30-40 day break in a human borne diseases cycle will stop most from spreading, except in the case where there are vectors such as rates, mice, pigeons that continue to harbor, carry and spread the disease.
•  Successful medical survivors will need to be news junkies, learning all there is to know about any threatening disease. What is it, how is it spread, why is  it here, what hosts are involved, and how long lived outside of human/ animal hosts?
•  Things to watch for: Look for signs that diseases are spreading than the experts normally expect, that the strain if disease is especially difficult to treat, that it is being spread by means not previously observed by those in the medical profession, that there are observed multiple /simultaneous outbreaks, that the disease is strangely affecting plants and /or livestock.

Diseases characterized as being ‘a far more virulent strain’ and/or that ‘are attacking our agricultural production’ are especially cautionary.
•  The basics of survival need not include anything more than provision for food, water, shelter, energy, medical and sanitary and self actualization.
•  Own a full face respirator (HEPA=high efficiency particulate air) with HEPA filters capable of sorting out particle down to about 0.3 microns. That size includes TB and smallpox organisms. Smallpox is one of the largest viruses known. You will need to store 4-6 extra sets of filters for each apparatus per
person. (see Disaster/Biological warfare document)
•  When an outbreak reaches the 30-50% rate victims will be whisked away to a central location if for no other reason to get them out of sight to die.
•  If  the epidemic is raging in your community or the neighbor have contracted it, you may be faced with wearing your mask continuously indoors.  (safety people who currently use masks claim,  “You get use to them”). In any event, city survivors might wish to wear at least a model N95 HEPA disposable filter during any infrequent time they leave the retreat to replenish supplies.
•  Remember that irregardless of the promises and issued statements, government never has done well at medical or any other enterprise. There is no penalty for government workers who fail to produce or who make wrong decisions.
•  The best survival defense is total obscurity. Another iron rule of survival is that you should never, never become a refugee. Worldwide, throughout history, refugees have always been as good as dead.  Refugees are characterized as being hopeless people with absolutely no control over  their lives. All of lives necessities are provided by others—always at their whim. Crime is rampant. In refugee camps, private property ownership is always nonexistent. Any necessity of life comes from the will of an often-disinterested, corrupt, arrogant, bureaucrat. Food, shelter, warmth, family stability, sanitation and personal safety are all in the hands of another person—who usually doesn’t give a damn.
•  Another rule of survival is that as much energy as possible should come from renewable or scrounged sources, ie firewood, burnable scrap, , peat dug out of a nearby bog, etc.
•  Effective shelter absolutely must provide for a place to safely store food supplies, prepare food, provide access to water, answer to one’s need for cleanliness and sanitation, and provide protection and security.
•  The deployment of tents means more than one tent, as there should be one tent for kitchen and food supplies, and another for personal shelter and maybe a 3^rd for sanitation and porta-pottie.

How a pandemic might look (synopsis)
Some effects that a pandemic might have:
First off, people might not go to work, either because they’ve got the disease, they’re  too scared to show up, their workplace has been closed, or they’ve got to stay home because their kids are out of school.

The results of this might include:
•  Utility plants (power, gas, water, sewage) left untended, and maintenance and routine chores neglected until they cease tofunction.
•  Nobody available to fix things that break: powerlines, water mains, etc.
•  Public transit closed, either because there’s no employees around to run said transit (or for quarantine reasons)
•  Farmers who can’t farm, because they’re sick or they can’t get gas, diesel, propane, or supplies.
•  Items stored in warehouses can’t be distributed,including, potentially, food and medication and parts to fix things
•  Gasoline and diesel shortages
•  Retail and grocery stores closed
•  Additionally, local authorities may institute quarantines and closures. Either you may be unable to
travel to get your groceries, or the groceries themselves may be stuck inside or outside of a quarantined area. (One would assume that the authorities will figure out how to safely get supplies delivered; one would also assume that there would be some chaos and bureaucracy involved. I’d rather not go hungry
for a few days while they wrangle out the details.) It’s the rare grocery store that stocks more than enough food for a day or two for a given area. And areas where large groups gather, including schools, retail stores, movie theaters, and nonessential businesses of any kind, may simply be closed to limit spread.
•  Quarantine is a real possibility. Some of the families of the infected patients in the US have already been told to stay home until the authorities are sure they’re not sick. (See above: contagious before symptoms.) I’ll assume that, since there are only a few of them, having food and supplies delivered to the sick and quarantined won’t be a problem. However, if there are tens of thousands of families sick,
and all their friends, family, and the local pizza delivery drivers in the city are sick? Yeah. That could be logistically a little bit more of a challenge.
•  Finally, a pandemic will put a huge stress on the economy. Businesses will go under. It’s kinda hard to keep a cash flow going if you can’t sell anything because both your customers and your employees are unable to buy anything because of illness, quarantine, or unwillingness to leave the house. And if people can’t work because of quarantines and closures, they won’t have money to buy things.  Our economy is already a fragile house of cards. A pandemic would yank a few supporting aces out of the base, in unpredictable and potentially disastrous ways.

So. You need to prep in a hurry. What do you do?
First off, consider the basics. (See topic, Preparing for a Pandemic, below
1)  Water
2)  Food
3)  Shelter
4)  Health care
5)  Personal protection

First, cover your “water supplies” first. This is fairly easy, but also rather important. You  could see either shortages or contaminated water if water treatment plants break down, and if you’re on a well, you’ll need a power source to pump the well.
Get some jugs, fill them up, set them aside somewhere in your house. Figure a couple gallons per person per day. (You’ll need water for cleaning, drinking, and cooking.) How many days worth of water you feel you need to store is very situation dependent, of course. I’m probably going to need have a lot more water stored in Arizona than a guy living on a lake somewhere in the Pacific Northwest where it rains every day.
Also, if you don’t have some in your laundry room, get a couple jugs of chlorine bleach,and set it aside for water purification. For unscented chlorine bleach at 4-6% strength add 8 drops per gallon of water. If water is contaminated (see: water treatment plant breakdown) or you need to resort to natural sources of water such as rainwater or rivers and creeks you’ll have something to purify it with.
If you don’t need to purify water, you can use it for sanitation or for your laundry, and an extra jug of bleach is cheap enough that it shouldn’t be a budget breaker.

Second, figure out what you’re going to do for food. A few weeks, or even a month or two, of supplies is a good idea.
If you buy basic staples, you probably won’t break the bank. Buy food that you’ll actually eat and know how to cook, or can easily learn. Also, buy food with an idea of how you’ll cook it if the power goes out. If you’ve got a large home propane tank that’s been recently topped off or a wood burning stove you may chose to stock different types of food than someone who’s living in an apartment with just an electric range. If the power goes out, cooking a big pot of dry beans is not easy … but you can still eat a cold can of soup.
Go for the most calories for your buck if you’re short on money. Also, do not overstock on items that need to be frozen or refrigerated.  If the power goes out, or your freezer simply breaks down (See:  Murphy’s Law), you’re going to be eating a lot of meat in a hurry if your preps included half a cow.

Severity?
The severity of the next pandemic cannot be predicted, but modeling studies suggest that its effect
in the United States could be severe. In the United States, a pandemic influenza outbreak similar to the 1918 strain, could result in:
•  2.25 million deaths
•  90 million falling ill
•  60% absenteeism in the workplace
•  An economic impact of $310 billion reduction in GDP

Bird flu poses no great threat to humanity. This disease is simply too lethal to its victims and  too fast in killing them to ever pose any significant threat to mankind. With a 50% or so mortality rate  occurring in about 5 to 7 days after infection this disease cannot live long enough to spread. It also assures prompt detection.
Quick effective countermeasures can be applied. It may be a problem, but H5N1, as this virus is known, is not going to be a mass killer.

A pandemic disease of great danger has a unique pattern for its transmission and lethality. A dangerous pandemic disease will only have a moderate mortality rate in the order of 1% or 2%. This
will allow the disease to survive and infect. It will spread slowly and incubate for fairly long periods of time. This provides effective transmission to large numbers of victims. H5N1 simply doesn’t fit the bill. Even in a fairly mutated form this disease has little or no prospect of ever being a serious threat. The high rates of morality for bird flu and its fast transmission will make great headlines. It will not make a great epidemic. This bird flu will die out too fast to amount to anything. This is why the disease after 7 years has only produced a few deaths.

The flu is truly a dangerous disease.
In any given year the USA will lose between 10,000 and 50,000 people to the flu. It will make ill in varied degrees of seriousness between a million and 5 million persons. A truly serious flu epidemic could kill millions and make sick large parts of the population. We definitely need much more effective measures to deal with the flu in whatever form that arrives each year.

Pandemic Self Quarantine (Influenza)
•  10 days for personal infection = 1 incubation period
•  21 days minimum, more likely 8 to 10 with 12 weeks maximum for the community = 3 to 5 incubation periods
•  The disease may have run its course after the initial wave, if not may return in 3,6 or 12 months with a second wave. While the initial wave will most likely occur during the normal flu season, November through March, subsequent waves may arrive for a few individuals in June, but no new community outbreaks occur until August. with a wave peak in October (see below–to get chronology right).

2.  Preparing for a Pandemic
An expert discusses the ‘Must-Haves’ if Bird Flu (or ‘fill in the blank’) cripples the country.

The Red Cross says that if there’s a pandemic, we need to prepare for 10 days of being stuck in our homes, and that we may be without power and water during that time. In the event of a bird flu pandemic, Americans should plan for interruptions or delays in other services: Banks might close, hospitals could be overwhelmed, and postal service could be spotty. Experts also say that people need to begin stocking up on extra food and supplies like protective masks, flashlights, portable radios, batteries and matches.

“When you go to the store and buy three cans of tuna fish, buy a fourth and put it under the bed.
When you go to the store to buy some milk, pick up a box of powdered milk, put it under the bed,” said Health and Human Services Secretary Mike Leavitt. “When you do that for a period of four to six months, you are going to have a couple of weeks of food. And that’s what we’re talking about.”

Previous pandemics occurred in 1918, 1957 and 1968, and the worst waves of illness seem to pass
through communities in a matter of six weeks to eight weeks. Computer models suggest about 30 percent of people could be infected, but not all at the same time.

In the event of a pandemic, people must practice what the health officials call “social distancing,” or keeping away from other people’s germs. Schools and day-care centers could be closed, sporting events and other large gatherings could be canceled, and shaking hands could become socially unacceptable, at least for a while.

Darlene Washington, the director of disease prevention education at the American Red Cross, points
out some of the must-haves in the event of a bird flu pandemic.

Have 3 sources for each of the following necessities
•  Water–(utility, potable water storage, rainwater catchment, local fresh water supply/ treatment).
•  Food–(store, stocked cupboard, food storage program)
•  Shelter–(Home, camper, tent, 2^nd home, relative or friend living away from the area)
•  Energy–(Utilities, Propane and propane appliances, firewood, solar appliances, battery backup/ photovoltaic

Water
“We recommend that each member of your family has a gallon of water for each day, so a family of
four needs to have 40 gallons of water available for a 10 day emergency period, that water needs to be stored because there’s a chance that your water will get cut off if there’s a pandemic,” Washington said. “Workers may not be able to make it, and plants may stop operating. Your family will need to drink water and for hygiene, for brushing their teeth and washing their hands.”

Food
In previous centuries, people had no means of  accumulating and preserving enough food and water to see them through a 3-10 week crisis. Fortunately, this is no longer true today. Modern technology
allows us to store food and water and to separate ourselves from disease  organisms.
You need foods that will not spoil, so you need canned foods like tuna. You also need to get foods that you don’t have to heat, because just like your water, your powers may go out, too. In addition, to things like canned tuna, you should start storing peanut butter, protein, bars, crackers. Again, foods that have a long shelf life and that don’t need to be heated. Make sure you have enough formula and baby food to get through that 10 days. You have to plan for every member of your family and that includes your pets. So get extra dog food or cat food, and make sure you have extra water for your pets. You need a 10-day supply for everyone.”

In spite of the apparent violation of the Rules of Three: Food storage alone is the best single recommendation for epidemic  survivors.

Some common sense:
•  If there is a avian type disease around, don’t  eat pigeons.
•  If yellow fever, malaria or any other mosquito borne disease is pandemic you may not want to wade into the swamp or hang around the lake collecting cattails.
•  If some mutant form of bubonic plague, spread by natural causes or bio-warfare is around, don’t consider rats as an emergency food.

Power Outages
It’s reasonable to believe that the grid will mostly  stay up during an epidemic and that emergency may be short lived.
“Stores are going to run out of what you need, too,” Washington said. “So that’s why you need to stock up now. And we encourage families to have supplies on hand like flashlights and batteries, matches. Hand-cranked or battery-operated radios, and a manual can opener, because you are going to need to open all those cans of food. And this may not seem important, but you must get activities for your children and yourself, games, coloring books, cards.”

Cleaning Supplies
“You have to have all those on hand to keep your home clean and to have receptacles for all your
trash,” she said. “You probably won’t have trash service and you need to account for that. You need to make sure to have paper towels, toilet paper and soap. Everything you need to keep your home clean and practice good hygiene.”

Medication
“You need to get an additional 10 days of all your prescription medications,” Washington said. “You
should also have over-the-counter, fever-reducing medications; medications for upset stomach; and cold and flu medication. You’ll also want to have fluids like Gatorade and Pedialite, which have electrolytes and will help a family member rehydrate if they get sick. Also, keep a few thermometers around in case someone gets sick.”
Taking refuge in a travel trailer or tent is OK for medical survivors, as long as you  don’t become refugees.

 If a Family Member Gets Sick …
“The first thing is  to strengthen your hand washing and to have the infected family member cover
his mouth when he coughs,” she said. “You should also keep that person isolated in a certain part of the house and identify a family member who will help him. You may have to take turns.”

Concepts to consider when preparing for a pandemic & self quarantine
•  Flu spreads in waves of 3-5 months with 3 months in-between.
•  Self-quarantine for 90-120 days per wave.
•  Government efforts to supply food and water are 10% effective at best.
•  Outside dirty, inside clean; Boy in the Bubble concept
•  Maintain household shelter with a good seal.
•  Clear brush and undergrowth 100 feet parameter around the house.
•  Preferable: Heat pump with forced air cooling/heat to filter out virus/microbes.
• Have a water reservoir, i.e., covered, pool, tubs and barrels, then disinfected.
•  Any source of standing water or body of water is a contaminate. Remove birdbaths,  old tires and/or fill puddles. Virus lives in water for days, influenza lives on hands 5 minutes.
•  Don’t have  bird feeders or chicken in your yard
•  Food supply; Have 1year supply per person.
•  Vacuum with bags that filter for allergens.
•  No eating from outside gardens, only preserved food.
•  Indoor sprouts, fluorescent lights for indoor growing plants vegetables.
•  Bleach for water disinfectant (10 drops/gallon) and medicinal wound care (½ sterile water ½ bleach).
•  Hand cleaners- soap and alcohol based.
•  Running water for washing hands, not standing water.
•  Face masks N-95 and goggles for outside.
•  No individual contact less than 8 feet (NO handshakes etc) social distancing.
•  Animals inside space and same social considerations.
•  Dogs and cats immunizations kept up (any stray dog will be shot).
•  Water repellent clothing w/ hood when outside (large garbage bags)
•  Toilet bowl cleaner tablets for inside standing water (tidy-bowl etc).
•  No contact with people within 8 feet, viruses jump 5+ feet.
•  If an exchange is required drop item in spot i.e. porch and leave then the receiver can pick up the item i.e. soup, firewood etc. (This was the practice during the 1918 influenza)
•  Keep dust to minimum, dusters, wet wipes. Sneeze into your elbow.
•  Keep surfaces clean with disinfectant.
•  Bake items coming into house for 20 min at 325F+ degrees (Microwave is best)
•  Good hygiene; Wash hands thoroughly and frequently after contact from outside world.
•  Once one individual leaves and breaks quarantine, they cannot return to re-infect rest of household.
•   No group meetings parties’ weddings, funerals, church, etc.
•  Only burn wood that is stored under protective covering and dry, if wet consider it contaminated.
•  Wallpaper the ceiling, walls and windows with foil in one safe room to insulate and retain heat.
•  UV lighting on surfaces (can cause skin cancer).
•  No washing cars by hand.
•  Flies and mosquitoes out must be kept out, don’t leave windows, doors open, screens are not an option. Bug Zappers are either a really good idea because they kill bugs or a real bad idea because they attract bugs.
•  Handling mail, wear gloves and bake mail before opening it (e-mail best).
•  Analog phone for when power goes out.
•  OTC medicine supply for diarrhea and cold remedies.
•  Homemade ‘Gatorade’: 1 tsp Lite Salt (source of potassium) + 1/3 tsp Baking Soda + 10 tsp sugar + 1 qt water OR 1 tsp salt + 3 tsp sugar + 1 qt water.
•  Turnips, clover and potatoes are good crops for cold weather.
•  0.4 rads / min acceptable after nuclear fall out.
•  Mice- use copper wool stuffed into holes around plumbing to keep them out.
•  Garbage bags to wear punch holes in sides and put arm through, good for warmth and as a disposable barrier from the outdoors.
•  Have a supply of Vitamins.
•  Wash down entryways w/ bleach or cleaner.
•  Keep shoes outside of living quarters (on enclosed pourch).
•  Use a pressure cooker and/or microwave to disinfect food.
•  Food from the outside- root veggies only (microwave and wash).
•  Cage animal, not range free (rabbits)
•  Dishwasher sterilizes
•  Remember your dishcloth is the dirtiest item in household
•  Shopping cart handles are the dirtiest item in public
•  Magazines  are the dirtiest item in doctor’s office
•  Your purse is exposed to everything, same with the morning coffee mug that follows you around at work
•  Do not share pens, combs, etc.
•  Tarp and duct tape corpses, bury deep at home if possible
•  Remove moss from roof as it harbors bacteria and virus.
•  Streams, lakes, ponds, marshes, rivers are sources of contamination.
•  Keep the outside yard dry, no watering lawn.
•  Rain, Snow, Mist, and fog are also carriers for the virus…
•  The Plague never returned to London after London’s Great Fire

3.  Flu Pandemic Mitigation – Social Distancing
 “It’s not like a ‘snow day!”
The so-called social distancing measures they studied would dramatically alter the life of the city for a period of months — long enough, Eubank said, for vaccine makers to develop a vaccine.

Schools and day-care centers would close. Theaters, bars, restaurants and ball parks would be shuttered.
Offices and factories would be open but hobbled as workers stay home to care for children. Infected people and their friends and  families would be confined to their homes.
“We are not talking about simply shutting things down for a day or two like a ‘snow day’. It’s a sustained period for weeks or months,” he said. “You wouldn’t go out to the movies. You wouldn’t
congregate with people. You’d pretty much be staying home with the doors and windows battened down,” he said.

While those measures seem draconian, Eubank said they are steps many people would take on their own in the face of a deadly flu outbreak. “In the context of a very infectious disease that is killing a
large number of the people, I think large fractions of the population won’t have a problem with these recommendations,” Eubank said.

 Two ways of increasing social distance activity restrictions are to 1) cancel events and 2) close buildings or to restrict access to certain sites or buildings. These measures are sometimes called “focused  measures to increase social distance.” Depending on the situation, examples of cancellations and building closures might include: cancellation of public events (concerts, sports events, movies, plays) and closure of recreational facilities (community swimming pools, youth clubs, gymnasiums).

Closure of office buildings, stores, schools, and public transportation systems may be feasible community containment measures during a pandemic. All of these have significant impact on the community and workforce, however, and careful consideration should be focused on their potential
effectiveness, how they can most effectively be implemented, and how to maintain critical supplies and infrastructure while limiting community interaction. For example, when public transportation is cancelled, other modes of transportation must be provided for emergency medical services and medical
evaluation.

In general, providing information to domestic and international travelers (risks to avoid, symptoms to look for, when to seek care) is a better use of health resources than formal screening. Entry  screening of travelers at international borders will incur considerable expense with a disproportionately small impact on international spread, although exit screening would be considered in some situations.

Although data is limited, school closures may be effective in decreasing spread of influenza and reducing the overall magnitude of disease in a community. In addition, the risk of infection and illness among children is likely to be decreased, which would be particularly important if the pandemic strain causes significant morbidity and mortality among children. Children are known to be efficient transmitters of seasonal influenza and other respiratory illnesses. Anecdotal reports suggest that community influenza outbreaks may be limited by closing schools. Results of mathematical modeling also suggest a reduction of overall disease, especially when schools are closed early in the outbreak.
During a Pandemic Period, parents would be encouraged to consider child care arrangements that do not result in large gatherings of children outside the school setting.

There is some evidence that big gatherings of people encourage spread of flu, and measures to flatten the epidemic curve can helpful in easing the most intense pressure on health services. Limiting public gatherings can be an effective preventive measure for diseases that are transmitted through the air [unlike flu] – especially for diseases that are transmitted by individuals with no symptoms [such as flu]. Often, public health experts recommend limiting exposures to others-such as frequently occurs during influenza season. There is a big difference between recommending limited public gatherings and enforcing a more specific and uniform requirement. In making a decision to close gathering places, the impact on economy, education, and access to food / water / other necessities needs to be balanced with the ability to effectively protect the public through such means.

During the 1957-1958 pandemic, a WHO expert panel found that spread within some countries
followed public gatherings, such as conferences and festivals. This panel also observed that in many countries the pandemic broke out first in camps, army units and schools; suggesting that the avoidance of crowding may be important in reducing the peak incidence of an epidemic.

During the first wave of the Asian influenza pandemic of 1957-1958, the highest attack rates were seen in school aged children. This has been attributed to their close contact in crowded settings. A published study found that during an influenza outbreak, school closures were associated with significant decreases in the incidence of viral respiratory diseases and health care utilization among children aged 6-12 years.

Given a pandemic strain causing significant morbidity and mortality in all age groups and the absence of a vaccine, the WHO consultation on priority public health interventions before and during an influenza pandemic concluded that authorities should seriously consider introducing population-wide measures to reduce the number of cases and deaths. These would include population-wide measures to
reduce mixing of adults (furlough non-essential workers, close workplaces, discourage mass gatherings). Decisions can be guided by mathematical and economic modeling.

The Center for Biosecurity of University of Pittsburgh Medical Center [UPMC] argued that idea that the cancellation of public gatherings or the imposition of travel restrictions might limit the spread of disease are scientifically unfounded, and that presenting them has the potential to create false expectations about what can be accomplished by government officials and their proposed containment measures. The UK Government, for instance, has concluded that closing schools and other
educational facilities would have a limited effect on the epidemic. There would be a major reduction in the numbers of students affected. On the other hand, there would be little reduction in the number of cases in the rest of the population. The UK Government concluded that there was little evidence that
cancelling large public events would have any significant impact on the course of the epidemic.

Flu Pandemic Home Care
Home care will be the predominant mode of care for most people infected with influenza. Most patients with pandemic influenza will be able to remain at home during the course of their illness and can be cared for by other family members or others who live in the household.  Anyone residing in a household with an influenza patient during the incubation period and illness is at risk for developing influenza. A key objective in this setting is to limit transmission of pandemic influenza within and outside the home. When care is provided by a household member, basic infection control precautions should be emphasized (e.g., segregating the ill patient, hand hygiene). Infection within the household may be minimized if a primary caregiver is designated, ideally someone who does not have an underlying condition that places them at increased risk of severe influenza disease. Although no studies have assessed the use of masks at home to decrease the spread of infection, use of surgical or procedure masks by the patient and/or caregiver during interactions may be of benefit.

The term “flu” is much used and abused.
Some people use the term “stomach flu” as an informal way of saying “gastroenteritis of unknown etiology.” Sometimes people confuse cold and flu, which share some of the same symptoms and occur at the same time of the year (cold and flu season). However, the two diseases are very different. Most
people get a cold several times each year, and the flu only once every several years. Others think that “flu” is any kind of illness with aches and fever with or without respiratory symptoms. In reality, influenza is none of these things. Influenza is a specific, often severe, respiratory viral infection caused by influenza viruses. The whole body suffers from it.

Typical symptoms include:
•  The flu usually begins abruptly, with a fever between 102 to 106°F (with adults on the lower end of the spectrum). Other common symptoms include a flushed face. Some people have dizziness or vomiting. The fever usually lasts for two or three days, but can last 5 days.
•  Somewhere between day 2 and day 4 of the illness, the “whole body” symptoms — chills, weakness, lack of energy, loss of appetite, and aching of the head, back, arms, legs — begin to subside, and respiratory symptoms begin to increase.
•  The virus can settle anywhere in the respiratory tract, producing symptoms of a cold, croup, sore throat, bronchiolitis, ear infection, or pneumonia. The most prominent of the respiratory symptoms is usually a dry, hacking cough. Most people also develop a sore (red) throat and a headache.
Nasal discharge and sneezing are common. These symptoms (except the cough)
usually disappear within 4-7 days
•  Sometimes there’s a second wave of fever at this time.
•  Often the person continues to feel sick for several days. Cough and tiredness usually last for weeks after the rest of the illness is over.
•  Sometimes the person can have complications, such as dehydration or pneumonia.The disease is characterized by abrupt onset of constitutional and respiratory symptoms, including fever, chills, muscle aches, headache, malaise, nonproductive cough, sore throat, and runny nose. Upper respiratory and constitutional symptoms tend to predominate in the first several days of
illness, but lower respiratory symptoms, particularly cough, are common after the first week. In children, nausea and vomiting and, occasionally, ear infection are also symptoms.
•  Since several other respiratory pathogens (including adenovirus, respiratory syncytial virus, para influenza virus, rhinovirus, corona virus, human metapneumo virus, Mycoplasma pneumoniae and Legionella) can also cause a similar clinical picture, definitive diagnosis of influenza requires laboratory confirmation. However, laboratory testing is not necessary for all patients. In the presence of a community outbreak of respiratory illness, a presumptive diagnosis can be made based on knowledge of the predominant agent causing the outbreak. Uncomplicated influenza gets better with or without treatment, but may cause substantial discomfort and limitation of activity before getting better.
Complications of influenza can include bacterial infections, viral pneumonia, and cardiac and other organ system abnormalities. People with chronic medical conditions may have increased risk of complications when they get influenza.
Many other diseases, including serious infections such as rapidly progressive bacteremias, may start with symptoms that resemble influenza and may need to be considered in treatment decisions. Many people with uncomplicated influenza use over-the-counter medicines to help lessen their symptoms.Here are some tips to keep from spreading your germs to others, and to keep from catching someone else’s germs.

Keep your germs to yourself
•   Cover your nose and mouth with a tissue when sneezing, coughing or blowing your nose.
•   Throw out used tissues in the trash as soon as you can.
•   Always wash your hands after sneezing, blowing your nose, or coughing, or after touching used
tissues or handkerchiefs. Wash hands often if you are sick.
•   Use warm water and soap or alcohol-based hand sanitizers to wash your hands.
•   Try to stay home if you have a cough and fever.
•   See your doctor as soon as you can if you have a cough and fever, and follow their instructions,
including taking medicine as prescribed and getting lots of rest.
•   If asked to, use face masks provided in your doctor’s office or clinic’s waiting room; follow their instructions to help stop the spread of germs.

Keep the germs away
•  Wash your hands before eating, or touching your eyes, nose or mouth.
•  Wash your hands after touching anyone else who is sneezing, coughing, blowing their nose, or whose nose is running.
•  Don’t share things like cigarettes, towels, lipstick, toys, or anything else that might be contaminated with respiratory germs.
•  Don’t share food, utensils or beverage containers with others.
•  Especially during a pandemic or disaster situation you are best served by not visiting the hospital if you can help it, where you are more likely to sit or stand next to a person carrying incurable TB, flu, smallpox, or whatever epidemic disease is ‘going around’. Remember, the doctor’s office and hospital’s
waiting room is where the sick congregate, it’s this infected group that you are trying to avoid! You are much more likely to encounter contagious people in hospitals than anywhere else, even though the facilities are generally much more sanitary. Survivors will try to avoid contact with anyone while outside.

4.   Plan  Ahead
People should plan ahead and think about what they need to have in their house in case someone in their household were to become infected with influenza and need to receive care at home. If you live alone, are a single parent of young children, or are sole caregiver for a frail or disabled adult, it would be a good idea to have some items stored in your home in case of illness:
•  Have enough fluids (e.g. water, juice, soup) available to last for 2 weeks.
•  Have enough basic household items (e.g. tissues) to last for 2 weeks.
•  Have acetaminophen and a thermometer in the medicine cabinet. Do you know how to use/read a thermometer correctly? If not, ask someone to show you how.
•  Think of someone you could call upon for help if you became very ill with the flu and discuss this possibility with him or her.
•  Think of someone you could call upon to care for your children if you were required to work and their school or day care was closed because of the influenza pandemic; discuss the possibility with them.

A.  Infection Control Measures in the Home
•  All persons in the household should carefully follow recommendations for hand hygiene (i.e., hand washing with soap and water or use of an alcohol-based hand rub) after contact with an influenza patient or the environment in which care is provided.
•  Although no studies have assessed the use of masks at home to decrease the spread of infection, use of surgical or procedure masks by the patient and/or caregiver during interactions may be of benefit. The wearing of gloves and gowns is not recommended for household members providing care in the
home.
•  Soiled dishes and eating utensils should be washed either in a dishwasher or by hand with warm water and soap. Separation of eating utensils for use by a patient with influenza is not necessary.
•  Laundry can be washed in a standard washing machine with warm or cold water and detergent. It is not necessary to separate soiled linen and laundry used by a patient with influenza from other household laundry. Care should be used when handling soiled laundry (i.e., avoid “hugging” the laundry) to avoid contamination. Hand hygiene should be performed after handling soiled laundry.
•  Tissues used by the ill patient should be placed in a bag and disposed with other household waste. Consider placing a bag for this purpose at the bedside.
•  Normal cleaning of environmental surfaces in the home should be followed.

B.  Management of Well Persons in the  Home
•  Persons who have not been exposed to pandemic influenza and who are not essential for patient care or support should not enter the home while persons are actively ill with pandemic influenza.
•  If unexposed persons must enter the home, they should avoid close contact with the patient.
•  Persons living in the home with the pandemic influenza patient should limit contact with the patient to the extent possible; consider designating one person as the primary care provider.
•  Household members should monitor closely for the development of influenza symptoms and contact a telephone hotline or medical care provider if symptoms occur.

C.  Management of Influenza Patients
Persons who have a sudden onset of influenza-like symptoms (e.g. headache, fever, chills, cough, chest pain, sore throat, muscle aches, weakness, exhaustion) should do the following:
•  Remain at home at least until all symptoms have resolved (approximately 4-5 days)
•  Take medication as needed to relieve the symptoms of the flu.
•  Decongestants, such as phenylephrine, and pseudoephedrine, produce a narrowing of blood vessels. This leads to clearing of nasal congestion, but it may also cause an increase in blood pressure in patients who have high blood pressure. OTC drugs to relieve stuffy noses often contain more than one ingredient. Some of these products are marketed for allergy relief and others for colds. They usually contain both an antihistamine and a nasal decongestant. The decongestant ingredient unstuffs nasal passages; antihistamines dry up a runny nose. But some of these products may also contain aspirin or acetaminophen, and some contain a decongestant alone. Closely related products with similar names may have different ingredients. There are other medications in the form of nasal drops and sprays sold OTC for this purpose. As with pills, some of these are long acting (up to 12 hours) and some  are shorter acting. And, as with pills, most have some side effects. Many of the products contain a nasal decongestant such as oxymetazoline or phenylephrine. When used for more than three days or more often than directed by the label, these drops or sprays can sometimes cause a “rebound” effect, in which the nose gets more stuffy. Other nose drops and sprays are formulated with a saline (salt) solution and can be used for dry nose or to relieve clogged nasal passages.
• Dextromethorphan, an antitussive, is used to relieve a nonproductive cough caused by a cold, the flu, or other conditions.
Dextromethorphan comes as a liquid or as a lozenge to take by mouth. It is usually taken every 4-8 hours as needed. Do not take more than 120 mg of dextromethorphan in a 24-hour period. Refer to the package or prescription label to determine the amount contained in each dose. The lozenge should
dissolve slowly in your mouth. Drink plenty of water after taking a dose. Follow the directions on the package or prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand.
•  Antipyretics are fever-reducing medications; the term comes from the Greek word pyresis, which means fire. Ibuprofen (Motrin) and acetaminophen (Tylenol) are generally recognized as safe and effective single analgesic-antipyretic active ingredients. These two antipyretics can be taken
together or on an alternating 4 hour schedule. Ibuprofen provides greater temperature decrement and longer duration of antipyresis than acetaminophen when the two drugs are administered in approximately equal doses.
•  Never give aspirin to children or teenagers who have flu-like symptoms (and particularly fever) without first speaking to your doctor. Giving aspirin to children and teenagers who have influenza can cause a rare but serious illness called Reye syndrome. Reading the label becomes especially important when it comes to products containing aspirin (acetylsalicylic acid) or their chemical cousins, other salicylates, which are used to reduce fever or treat headaches and other pain.
•  A person’s fluid needs are greater when that person has fever. Drink lots of fluids (water and other non-alcoholic, non-caffeinated beverages) to avoid becoming dehydrated. Start with sips of any fluid other than caffeinated beverages. Drinking too much fluid at once can bring on more vomiting. Electrolyte solutions available in drugstores are usually best. Sport  drinks contain a lot of sugar and can cause or worsen diarrhea.
•  If you have diarrhea, it’s a good idea to rest, eat only small amounts of food at a time, and drink plenty of fluids to prevent dehydration. Avoid over-the-counter diarrheal medications unless specifically instructed to use one by your doctor. Certain infections can be made worse by these drugs. When you have diarrhea, your body is trying to get rid of whatever food, virus, or other bug is causing it. OTC products marketed to stop diarrhea may contain loperamide (Imodium A-D), or attapulgite (Diasorb, Kaopectate and others), or bismuth subsalicylate (Pepto-Bismol and others).
•  Use either a traditional glass thermometer for each person [don’t cross-contaminate patients], or a digital thermometer with lots of  disposable sleeves. The thermometers are a few dollars. The sleeves are a dollar or so per hundred.

• Get plenty of bed rest
• Do not smoke
• Restrict visitors to their home
• Cover mouth and nose with a tissue when coughing or
  sneezing.
• Keep at least 3 feet away from others.
• Patients should not leave the home during the period when
  they are most likely to be infectious to others (i.e., 5 days after onset of
  symptoms). When movement outside the home is necessary (e.g., for medical
  care), the patient should follow cough etiquette (i.e., cover the mouth and
  nose when coughing and sneezing) and wear procedure or surgical masks if
  available.

To protect the patients infected with influenza, individuals having contact with the patient, and the community in general, certain infection control measures should be practiced:

• Wash hands often with warm soap and water, scrubbing for 15-20 seconds
• Family members should wash hands or use waterless hand sanitizer after contact with the patient
• Do not share eating utensils or drinks
• Do not rub eyes, touch nose or mouth
• Patients should cover their mouths and noses with tissue when coughing or sneezing, dispose of used tissues immediately after use and wash hands after using tissues
• In general, wearing goggles or a face shield for routine contact with patients with pandemic influenza is not necessary. If sprays or splatter of infectious material is likely, goggles or a face shield should be worn as recommended for standard precautions.
• In the absence of visible soiling of hands, approved alcohol-based products for hand disinfection are preferred over antimicrobial or plain soap and water because of their superior microbiocidal activity, reduced drying of the skin, and convenience.
• Physically separate the patient with influenza from non-ill persons living in the home as much as possible.

In a pandemic influenza event, some individuals who are cared for at home may develop complications. Should complications develop, these individuals should seek medical care immediately, either by calling the doctor or going to an emergency room. Upon arrival, the receptionist or nurse should be told about the symptoms so that precautions can be taken (providing a mask and or separate
area for triage and evaluation).

D. Warning Signs to seek urgent medical care
In children, these include:
1.  High or prolonged fever for more than 4-5 days
2. Fast breathing or trouble breathing
3. Bluish skin color
4. Not drinking enough fluids
5. Changes in mental status, somnolence, irritability
6. Seizures, confusion or seizures
7. Influenza-like symptoms improve but then return with fever and worse cough
8. Worsening of underlying chronic medical conditions (for example, heart or lung disease, diabetes)
9. Cough becomes productive of yellow sputum

In adults,  these include:
1. High or prolonged fever for more than 4-5 days
2. Difficulty breathing or shortness of breath
3. Cough becomes productive of yellow sputum
4. Pain or pressure in the chest
5. Near-fainting or fainting
6. Confusion or seizures
7. Severe or persistent vomiting [2 to 3 times in 24 hours] (vomiting is usually present in young children and elderly persons with influenza infection)
8. Skin color changes (lip and hands)
9.  Persons should seek medical attention at their physician’s office, urgent care facility or hospital emergency department if they are at high risk for the development of complications:
•   People age 65 and older, people of any age with chronic medical conditions and very young children are more likely to get complications from influenza.
•  Pregnant women also have an increased risk for pneumonia, lung insufficiency, and death after an influenza infection.