As we return for the 4th quarter, we are launching into our unit on Prevention and Treatment of Diseases, which includes both communicable diseases (common cold, flu, heptatis, ringworm, etc.) and non-communicable diseases (heart disease, diabetes, cancer, etc.)
We will be using the movie Contagion for part of our lesson on communicable diseases, and pandemics--as it relates to influenza.
Seven Types of Symptoms of Influenza
Influenza is a respiratory disease with symptoms that last one to two weeks. Types of influenza symptoms include:
A fever or feeling feverish (although not everyone with the flu has a fever)
A cough and/or sore throat
A runny or stuffy nose
Headaches and/or body aches
Nausea, vomiting, and/or diarrhea (most common in children)
The flu and the common cold have similar symptoms, and it can be difficult to tell them apart. In general, the flu is worse than the common cold. Symptoms such as fever, body aches, tiredness, and cough are more common and intense with the flu. People with colds are more likely to have a runny or stuffy nose. Health care providers have a test that can determine whether a patient is suffering from the flu or a common cold.
For more information, go to Seasonal Flu — Symptoms.
The flu spreads when an infected person coughs, sneezes, or talks and droplets containing the influenza virus are inhaled by another person. The flu can also spread when a person touches an object or a surface which has the virus on it and then touches his or her mouth, eyes or nose.
The best defense against the flu is vaccination. Other preventive measures are to live a healthy life style and particularly get enough sleep and to eat well. Stay away from people who are ill. When exposed, see a physician about getting an antiviral drug. These drugs are more effective the sooner they are taken and can be beneficial to reduce symptoms if they are taken up to two days after a person becomes ill.
The incubation period from first infection until the onset of symptom is 1 - 4 days, averaging two days, in adults who will shed influenza virus beginning one day before they start to have symptoms through the next 5 - 10 days. (These figures are probably the same for otherwise healthy teenagers.) Young children and severely immunocompromised persons can shed virus for longer periods.
For more information, go to Seasonal Flu — Prevention.
Treatment for the flu starts with bed rest, drinking clear fluids such as water, broth, electrolyte beverages (sports drinks) to prevent dehydration, and taking over-the-counter medicines to help with symptoms. A humidifier can also make breathing easier. Salt water gargles (1:1 ratio warm water to salt) will help with sore throats. Fevers and aches can be reduced with over-the-counter pain relievers and wet cool washcloths applied to forehead, arms and legs. For all medications, be sure to read the label and don't take too much. Pharmacists can be helpful if there are any questions. Be especially careful of acetaminophen (Tylenol®) because it is found in many combination preparations and overdosing can cause serious liver damage. Note that antibiotics do not protect against viruses such as the flu. However, they can be helpful if a secondary bacterial infection develops.
The most common complications of the flu are bacterial pneumonia, ear and sinus infections, dehydration, and the worsening of chronic illnesses. Seek medical attention immediately if any of the following symptoms appear:
Fever over 102 degrees or fever lasts longer than three days
Difficulty breathing, wheezing when breathing, or shortness of breath
Purple or blue discoloration of the lips
Pain or pressure in the chest, abdomen or neck; severe head-ache;
Severe or persistent vomiting
flu symptoms that worsen each day;
Flu-like symptoms that improve but then return with fever and worse cough
People who have the following chronic illnesses should seek medical help as soon as flu symptoms appear: heart disease, asthma, COPD, diabetes, or HIV/AIDS.
Do not treat this information as medical advice. The above descriptions of symptom paraphrases several apparently authoritative web-sites such as Seasonal Flu — Treatmentfrom the CDC; Flu: What to do if you get sick from the CDC, and When to Call the Doctor About the Flu from WebMD.
LEARNING GUIDE MENU
Types of Symptoms
The Seasonal Flu
Flu Pandemics — 100 Years
Quarantine & Police Power
Question for a Health Class
Questions for an ELA Class
Links to the Internet
Selected Awards & Cast
QUICK DISCUSSION QUESTIONS: (1) What is the seasonal flu? (2) How many people does it kill each year, world-wide? (3) What is the best defense against this illness?
Suggested Response: (1) The seasonal flu is a world-wide epidemic of illness caused by the influenza virus that occurs every fall. The disease infects 5 - 15% of the world's population. (2) The seasonal flu kills 250,000–500,000 people each year, primarily the elderly, chronically ill and very young children. (3) The best defense is vaccination.
MOVIE WORKSHEET: See TWM's Film Study Workshee for "Contagion". This is a modified version of TWM's film study worksheet for a documentary.
Parenting Points: Tell your children that the movie is a reasonable approximation of what might occur in the case of an out-of-control influenza pandemic.
How Realistic is Contagion: The answer from the medical community is that it is very realistic.
The Seasonal Flu
Despite vaccines and advances in modern medicine, every year three hundred million to one billion people world-wide get sick from the flu; that's between 5 and 15% of the human population. Seasonal flu is a mild to severe disease. Some years are worse than others, but the seasonal flu causes between 250,000 and 500,000 deaths each year. Most susceptible are the elderly, the chronically ill, and the very young. Actually, spread over the world, the deaths from flu are less than one-tenth of one percent of the population (or less than 1 in 1000). The U.S. is not immune from influenza. The Centers for Disease Control (CDC) estimates that each year 41,400 Americans die from the seasonal flu.
Vaccines protect people from getting sick, but they don't kill the viruses that continue to live in various animal population reservoirs. Animals harboring influenza virus such as wild birds, pigs and chickens can have few symptoms or they are not sick at all. The viruses mutate frequently and some of these mutations allow them to cross from one species to another. Other mutations may make an existing human virus more communicable or more deadly.
Each year scientists are on the lookout for new influenza viruses. They create vaccines for these new viruses and put the vaccinates into the flu shots that many people get each fall. Hopefully, the doctors find all the new viruses, but sometimes they don't. It is also possible that a new virus that is very infectious and very lethal, like the virus portrayed in the movie Contagion, will spread before the doctors even know it exists.
An example of how close disaster can come is the H5N1 Avian flu virus that first appeared in 2002. Scientists rate the danger of a strain of a virus using two measures: how infectious it is (how easily it passes from one person to another) and how lethal it is (what percentage of people die once they become ill). World Health Organization (WHO) confirms that as of February 2012, 584 people had contracted H5N1 and that 345 of those people died of the disease. That's a mortality rate of 59%. However, and very fortunately, it is very hard for this virus to spread from one person to another – it cannot spread through the air or casual contact between people. The virus is found in some migratory bird populations. Recently, some scientists have suggested that this rate is too high based on the fact that only serious cases will be reported to international public health authorities, see Dread Reckoning: H5N1 Bird Flu May Be Less Deadly to Humans Than Previously Thought--or Not by Helen Branswell Scientific American, February 14, 2012. But even if mortality estimate for H5N1 is off by 75%, the resulting death rate of 14% would be about 5 times higher than the 1918/1919 pandemic which had a death rate of greater than 2.5%
Because the H5N1 virus has not developed the ability to spread easily from person to person and it has been around since 1997, scientists have had time to develop a vaccine against it that is safe and effective. If the virus mutates in a way that makes the vaccine ineffective, it will take several months to develop a new vaccine and in that time millions of people could die. However, just as there is no way to accurately predict how deadly and communicable the next mutation of the influenza virus might be, there is no way to predict the effectiveness of new ways of combatting its spread or new ways of treating the disease.
As shown in the film, modern life with international air travel has made influenza outbreaks more difficult to control. However, modern medicine, with vaccines and antibiotics, has worked in the other direction and has also made influenza easier to survive.
The Flu Pandemics of the Last 100 Years
A pandemic is a disease that occurs over a wide geographic area and affects an exceptionally high portion of the human population. In the last 100 years there have been four influenza pandemics. They are compared to the seasonal flu in the following table.
NameYearsPeople infected% of world populationDeathsDeath rate
Seasonal FluEvery year300 million to 1 billion5-15%250,000–500,000< 0.1%
Spanish Flu1918 - 1919500 million33% - 40%20 to 50 million*> 2.5%
Asian Flu1956 - 1957??2 million< 0.1%
Hong Kong Flu1968 - 1969??1 million< 0.1%
Swine Flu2009 - 2010622,000**.000009%14,000 – 18,000**0.03%
* Some estimates are that as many as 100 million people died of the Spanish Flu.
** These are from verified lab results and probably are substantially under reported. The actual numbers are thought to be much higher.
While the Spanish Flu was the worst flu pandemic in modern history, in some ways the world was lucky. While it was 20 times more lethal than ordinary seasonal flu, the Spanish Flu was not as infectious as other illness such as the common cold, small pox or measles. Still, more people died from the Spanish Flu pandemic than from the hostilities in World War I. It is estimated that half of the U.S. soldiers who died in Europe were killed by the influenza virus, and a total of 675,000 people died from the pandemic in the U.S. (550,000 of these were excess deaths, that is deaths that would not have happened but for the flu.) The life expectancy in the U.S. was cut by 11.8 years due to the Spanish Flu.
Influenza epidemics can exhibit different infection patterns from the seasonal flu which kills the elderly, the chronically ill, and very young children. The Spanish Flu was most deadly for people ages 20 to 40. It struck down the strong and vigorous. people sometimes died rapid deaths, sometimes within hours of the onset of symptoms. Entire families were wiped out; in other families, just one or two people survived. Children lost their parents, parents lost their children, husbands their wives, etc. The emotional toll on the survivors was devastating. The deaths were painful. One physician described his patients as dying while "struggling to clear their airways of a blood-tinged froth that sometimes gushed from their nose and mouth." Diary of Isaac Starr, a third year medical student recruited to treat victims
Outbreaks swept the globe. In India the mortality rate was 50 deaths per 1,000 people. Doctors of the time were powerless against the disease. The influenza virus was not even identified until 1933.
Public health officials of the affected areas were unable to stop the spread of the disease. They tried everything they could think of from distributing gauze masks to prohibiting stores from holding sales, limiting funerals to 15 minutes, banning meetings, restricting entry into the town, to name a few. Nothing worked. There was also a lack of health care workers due to illness or death. There was also a shortage of coffins and bodies piled up in morgues and funeral homes.
Scientists now think that most of the deaths from the 1918/1919 flu pandemic were the result of secondary bacterial pneumonia. Bacteria from the nose and throat were able to infect the lungs because the virus damaged the bronchial tubes and the lining of the lungs. With the development of antibiotics that can treat pneumonia, later pandemics have caused many fewer fatalities
Lasting a little over a year and killing between 20 million and 50 million people, the Spanish Flu was one of the worst pandemics in history. It compares to the Plague of Justinian, 541 – 590 A.D., in which 25 - 100 million lost their lives over 50 years, the Black Death of 1348-1351 in which 62 million lives were lost in about three years, and the current AIDS epidemic in which 34 million have died over 20 years. All of these numbers are approximate.
The 1918/1919 outbreak was dubbed the "Spanish Flu" because reporters in Spain, a country which was not a combatant in WWI, were not focused on reporting the war and were the first to realize that a new and dreadful disease was killing people. The strain of influenza responsible for the pandemic didn't originate in Spain nor was it any worse there than in other places.
Scientists have recently been able to reconstruct the Spanish Flu virus from samples preserved in wax and tissues from people who were frozen in the Alaskan permafrost and recently unearthed. It appears to have bird genes which means that it jumped from birds to humans.
There are, on the average, three influenza pandemics every century. Dr. Robert Webster, a renowned virologist has stated that "All the genes of all influenza viruses in the world are being maintained in aquatic birds, and periodically they transmit to other species. . . . The 1918 viruses are still being maintained in the bird reservoir. So even though these viruses are very ancient, they still have the capacity to evolve, to acquire new genes, new hosts. The potential is still there for the catastrophe of 1918 to happen again." The 1918 Spanish Flu Pandemic, and the Emerging Swine Flu Pandemic from NinthDay.com; accessed February 12, 2012.
THE POWER OF THE STATE TO QUARANTINE PEOPLE AND COMMUNITIES WITH INFECTIOUS DISEASES
When the people, acting through their government, enact laws or take action to protect the peace, security, safety, morals, health, and well-being of the community, they are said to be acting pursuant to the "police power." This power is broad and flexible. It has no clear limits, permitting the state to act as necessary to protect the public welfare. Other examples of the police power include zoning ordinances, building codes, the regulation of sanitation in dwellings and businesses, traffic laws, as well as safety regulations in the work place. The power of the government to quarantine persons with contagious disease derives from the police power of the state.
In the United States, the police power is limited by those rights reserved to individuals by the Bill of Rights (as to the Federal Government), the Fourteenth Amendment to the Constitution (which requires the states to recognize most of the provisions of the Bill of Rights), and various state constitutional provisions which on occasion grant more rights than the U.S. Constitution. The Fifth Amendment and the Fourteenth Amendment specifically prohibit the Federal Government and the states from taking life, liberty or property from individuals without due process of law. This means that the government cannot punish, imprison or kill anyone unless that person has been convicted of a crime. The police power often comes into conflict with these individual rights. The courts in the United States are constantly required to decide disputes about which will prevail in specific situations: the power of the state to provide for the general welfare or the rights of individuals reserved to them by various constitutional provisions. (Another film which raises the conflict between the power of the people as a whole and the rights of individuals is Inherit the Wind. In that case, the conflict was between the power of the people to regulate what was taught in the public schools and freedom of speech, guaranteed by the First Amendment.)
Quarantine deprives people of their liberty not because they have committed any crime, but due to their exposure to a dangerous communicable disease. The power of the state to impose quarantines has been recognized for many hundreds of years.
There have been situations in the past when constitutional rights have been suspended or ignored as a matter of policy by the government. Usually these occur in time of war. During the Civil War, President Lincoln suspended the right of habeas corpus. (The right of habeas corpus is exercised when a person who has been imprisoned by the government petitions a court to review the correctness of the government's action.) Another example was the detention of Japanese Americans during World War II.
BUILDING VOCABULARY: influenza, epidemic, pandemic, morbidity, mortality, "genetic shift," seasonal, "seasonal flu,"
Monday, January 8th--Return to School
Monday, January 15th--No School
Wednesday, January 31st--Refuse to Use Project Due
(Updated: due Friday February 2nd)
I am a Health Education major from the University of Florida, with background experience in adult education working with our local hospital for women and babies. A mother of three with a deeply rooted commitment to my students. I strive to promote healthy lifestyles and awareness.