We are in the early stages of an influenza pandemic, the first of the 21st century. Health professionals call it Pandemic (H1N1) 2009, but the rest of us call it Swine Flu. It is timely to review the situation and what we should do about it.
The science
The flu virus is very cunning. No more than a tiny bit of DNA hidden inside a protein coat, when it infects a cell in our nose, throat or lungs, it takes over the cell’s machinery and reproduces countless copies of itself. These infect other cells, making us seriously ill, until we develop immunity. And by making us cough and sneeze, the flu spreads itself from person to person in tiny liquid droplets in the air or on surfaces.
Our bodies are also cunning – our immune system has evolved to protect us from viruses, so that once we recover we can’t catch the same virus again – we become immune. But the flu virus is tricky – from time to time it changes its coat proteins so that our immune defences cannot recognise and eliminate it before it makes us ill.
In this pandemic, scientists believe, the new virus picked up some DNA from a form of pig flu – which is why we call it Swine Flu. Most people in the world have no immunity to it, so Swine Flu has spread rapidly world wide since first detected in Mexico in April – this is what is meant by a ‘pandemic’. Hundreds of thousands have already caught it in North and South America, the Far East, and in parts of Europe, particularly Britain. Now it is spreading in Ireland, with our rate of infection being about four weeks behind that in Britain.
We have had flu pandemics before - there were three in the 20th century: Spanish Flu in 1918, Asian Flu in 1957 and Hong Kong Flu in 1968. Flu is always a serious disease, but some kinds are much more severe than others. Asian Flu and Hong Kong Flu were quite mild, but Spanish Flu probably killed more people than the 1st World War.
Thank God, it seems that Swine Flu is a mild one - at least for the present: some are concerned that the virus could change again to become more lethal later on, as seems to have happened with the Spanish Flu. Most people recover fully at home in a week or so with no special treatment. 1 or 2 percent may develop complications needing hospital care, and a few die. The very old, the very young and those with certain pre-existing conditions are most at risk. As of late August, we have had just three deaths in the island of Ireland. Around three-quarters of Swine Flu cases are in children and young adults under 30 – older age groups who have had flu in previous pandemics may have some immunity.
Unlike previous pandemics, doctors can now treat patients with anti-viral drugs such as Tamiflu and Relenza, but they are ineffective unless given within a couple of days of symptoms appearing. Anti-virals are not a cure but they help recovery by relieving symptoms, they reduce the length of illness by around one day, and they reduce incidence of serious complications such as pneumonia. If used too widely the virus may become resistant to them. Bio-technologists are also working to make Swine Flu vaccines to give recipients immunity. The first supplies may be ready in October and Ireland has ordered enough for the whole population.
Once children go back to school and we spend more time indoors in the colder weather, we will see a big increase in infections. The Department of Health has warned that 1 million people – a quarter of us – are likely to get Swine Flu this year, but I suspect this is no more than a guess and nobody really knows.
How should we respond?
Whatever we do we should keep a sense of proportion – for most people Swine Flu, however nasty, will not be life-threatening. The real issue for all of us is what we ought to do to reduce the impact on those at most risk.
Those of us who have had flu before, as I have, will know the symptoms: fever over 38°C and a cough, often with sore throat, muscle or joint pain, headache, chills, fatigue and runny nose. They come on quite suddenly and are much more severe than the heavy cold which we sometimes colloquially call the flu.
If you think you have Swine Flu, you should do everything you can to avoid passing it to others. If the rate of transmission can be slowed, there will be less strain on health services and fewer people in high risk groups will catch it before they can be protected by the vaccine. Vaccines will be offered first to those at most risk as well as health care and other essential workers, which is as it should be – it would be unchristian to try to jump the queue.
The HSE web site (http://www.hse.ie/eng/swineflu) and information line (1800 94 11 00) provide good advice. In summary, if you contract it:
- Phone your GP – do not visit the surgery or A&E, where you may infect others. Your doctor will advise whether you need any additional treatment or monitoring.
- If your symptoms are severe or if you or household members are in a higher risk group, your doctor may prescribe anti-viral drugs, which are available free of charge. Ireland has stockpiled enough anti-virals to treat 55% of the population. It would be unchristian to demand anti-virals if you don’t need them.
- Stay at home for up to seven days or until well again, take paracetamol or ibuprofen to reduce the symptoms, take plenty of liquids, and discourage visitors.
- Women who are pregnant can take anti-virals safely, and paracetamol, but not ibuprofen.
- Contact your doctor again if you begin to have difficulty breathing or other unexpected symptoms, or you start to relapse after improving – you may need emergency care.
The HSE also advise that whether sick or not we should all follow hygiene and cough etiquette guidelines (see separate box). Face masks may do more harm than good except for health professionals.
Implications for parishes
It is good to see that the house of Bishops have issued interim advice about Swine Flu on the Church of Ireland website, but most parishioners will not see this. I feel clergy should also give clear advice to their congregations.
First, as a matter of common sense, people who feel unwell and may be developing Swine Flu should be discouraged from coming to church until they are better.
Second, there are liturgical implications. The Bishops advise that we can continue to shake hands at the Peace provided hands have been washed, since Swine Flu is transmitted primarily by droplets in the air. The Bishops also suggest that if infection levels rise it may be advisable for communicants to receive the bread only and not the common cup. They discourage intinction except for sick communions, as it is no safer than sharing the cup. And it is always open to those particularly concerned to share the peace with a smile and a wave and to take communion in one kind only.
Third, it is likely that ministers will fall sick at short notice. Parishes should review the availability of lay people to lead services should the need arise, and neighbouring clergy should perhaps discuss arrangements to cover for one another.
Lastly, the Swine Flu pandemic has created a great deal of fear as well as significant sickness among the community, and at this time it is our duty as Christians to remember those who are affected in our prayers.
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