Swine flu GP: now wash your hands
Updated on 23 July 2009
Kissing strangers could be deadly as they may be out to "bug" you. Dr Peter Stott blogs for Channel 4 News about preventing and catching the swine flu virus.
I've never washed my hands so often - or at least that's how it seems.
The problem is that this swine flu virus is more infectious than your average bug. It can survive on surfaces like hands, handles and computer keyboards for an hour or two and others can pick it up and get the infection.
Because my job as a GP involves a lot of people-touching, I can pick it up from all over the place and pass it on - and remember, the people I see are those most likely to be carrying the virus: children with sore throats, adults with coughs and colds; even people who seem overtly well.
So after every patient, I am now washing my hands thoroughly and using an alcohol rub.
There is an art to washing your hands properly. It is not just a matter of a quick rinse and dry-off. First you wash with soap and water, scrubbing under the fingernails. Then you dry with a clean paper towel, wiping from the fingers down to the wrists. Then you use the alcohol rub.
Wrists will always be the most contaminated area. So you must dry towards them and avoid dragging germs back up onto your hands. Always use a clean paper towel or blow drier and if your hands stay wet for a while, hold them upwards towards the ceiling so that the water flows back towards the wrists. Then you will look like a proper surgeon.
A few months ago, our GP surgery was given a fluorescent light box and a tube of fluorescent gel. The idea was to rub the gel all over your hands and attempt to wash it off. Then by putting your hands inside the box, you could see those areas where you had been less successful because they fluoresced.
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This morning I tried an experiment. I rubbed my hands with fluorescent gel and then went about my regular surgery routine. Very soon lots of places were fluorescing - the computer, the taps, the door handle, my medical equipment, my face where I had scratched it.
Even my patients would have fluoresced where I had touched them. (Of course they would not have fitted inside the box very easily.) If the gel had been virus, it was obvious how easily others could have picked up the virus from all these places.
We all touch things all the time and during this flu epidemic. We must get into the habit of trying to minimise touching strangers and of washing our hands regularly. Door handles are suspect. Shaking hands is risky. Kissing strangers is deadly.
Some things need to be thought about. All over the country, people are booking into the doctors surgery using a touch-screen. Is this OK? And how do you get out of a public toilet without touching the door handle?
Meanwhile, and most important, avoid touching your doctor. You simply don't know where he has been.
Have you been bugged?
Dr Peter Stott
Not everyone who gets swine flu will develop symptoms. The researchers are still not certain about the absolute figures but as in all infectious illnesses, there will undoubtedly be an 'asymptomatic attack rate'.
By 14 July the UK had 9718 confirmed cases and 17 deaths; but the number who had contacted the virus was undoubtedly much higher. Some cases were unconfirmed. Some people with mild symptoms would not have contacted their doctor.
But it also likely that others had the virus and not even realised it. They might simply have felt a bit more achey, or had a headache or sore throat and put it down to something entirely different - like a hang-over.
During the normal flu season, GPs see two phases to flu. In the first phase, the virus itself causes the symptoms - fever, headache, sore throat and cough, aches and pains. In the great pandemic of Spanish flu in 1918, this phase of the illness was itself severe. Patients died in great numbers of an over-whelming viral pneumonia.
In fact it is sometimes said that it was this illness which brought about the end to the First World War. There were simply no fit men left to fight. This primary phase of the illness is the one which is treated with anti-virals like tamiflu.
"Some people with mild symptoms would not have contacted their doctor; but it also likely that others had the virus and not even realised it."
Usually however, it is the second phase of the illness which creates the greater problems. A week to ten days after the primary infection, people get a secondary infection with a bacteria. Classically this bacteria is called 'staphylococcus'. Secondary is most likely to occur in older people - particularly those with pre-existing lung problems like chronic bronchitis. During an ordinary winter epidemic, our hospitals are full of older people with bacterial pneumonia being treated with antibiotics.
At the moment, swine flu is still a mild illness for most people and seems to be particularly affecting younger people. Older people seem to have some immunity - maybe because of previous infections with a similar virus. Though it is extremely infectious it has not mutated into the more serious type of flu which kills in large numbers during the primary phase - but it could. If it mutated to combine high infectivity and a severe primary phase, plus a high level of complications in a secondary phase, it would cause havoc.
We have a few things in our favour. First the schools are about to close for the summer. So the children from the 600 or more households that mix every day will not get the opportunity to do so. This effect usually causes an abrupt break to most cycles of infection. Second, a flu vaccine is on the way. If we use this effectively, we will rapidly raise our level of 'herd immunity' so that there will not be so many non-immune people around to catch the virus and pass it on. This needs to be done before the virus mutates to a more harmful form.
It is important that we all play our part in restricting the rate of rise of the epidemic until these two factors have a chance to kick in. Don't mix with others who may be unwell. Wash you hands regularly. If you develop symptoms, stay at home with your immediate family till you are all well and get someone else to do your shopping.
Remember, there will be lots of infected people out there who have no symptoms. Without even intending to do so, they are out to bug you.
Dr Peter Stott is a GP at the Tadworth Medical Centre in Surrey.
