Posted by: prepare4 | March 25, 2009

The Pandemic

Caring For Family During a Pandemic – Part 1”
By Carolyn Nicolaysen
Note: As I began preparing this article to conclude our discussion of pandemics, it quickly became apparent that I had much more information than I could include in one article. Part two of caring for your family during a pandemic will appear on December 24th).

Pandemics don’t care if it’s the holiday season; they come uninvited. And while it doesn’t seem to be in the spirit of Christmas to discuss such a dark subject, what I am about to tell you might preserve the lives of those you love someday, so they can spend many future holidays together with you. Sadly, in addition to preying on the elderly, pandemics also prey severely on children and young adults. The lack of immunity in the young is a disadvantage, as we have previously reported.

There are valuable lessons learned from past pandemics. One thing we know is that they spread very rapidly. This will leave us little or no time to prepare once a pandemic outbreak has been confirmed. Because of this, there are decisions to be made right now.

1. Determine who among you is at greatest risk of death during a pandemic. These are the people you may need to emphasize in your preparation, as they may not be able to plan for and care for themselves. According to The U.S. Department of Health and Human Services this would include:

A. The economically disadvantaged (having little or no money to stockpile food and supplies),

B. Those without a social network (many children, the homeless, those geographically separated from family including transient workers and elderly),

C. Dependent individuals needing support for daily activities (physically disabled, developmentally disabled, mental illness, substance abuse or addiction, difficulty seeing or hearing, and other medical conditions),

D. Those with trouble reading, speaking or understanding English.

2. Determine which room in your home will act as the isolation room, or room where those who are ill will be cared for. Whenever possible this should be a room with its own bathroom facilities. If you have a bedroom which is separated from other bedrooms in the home, this would be a good choice. When possible, this room should also include a TV with DVD player and enough room to set up an additional bed.

3. Stockpile food and medications. We have already talked about foods specific to pandemic planning (see Meridian article: Preparing for a Pandemic with Food Storage ), but don’t forget about those who are not ill. We need to have a three month supply of the foods we eat on a regular basis. During a pandemic there will be a great deal of stress in a home where people are ill. Be sure you have comfort foods in your storage as keeping a positive attitude is an important aspect of physical well being and healing, and nothing does that better than a brownie. While you are at it, your storage should include enough for others beyond your normal household, if possible.

It is important to store over-the-counter drugs for fever, muscle ache, nausea, diarrhea, and sore throat pain. Be sure to store both adult and children’s varieties of these medications. Remember, aspirin should not be given to children without consultation with your physician. Be sure to have a supply of all prescription drugs required by every family member. Consult your doctor and/or pharmacy on how to do this. As you help to prepare those in the high risk group, be sure to help them to legally accumulate these supplies as well.

4. Discuss pandemics as a family. Remember the insecurities children and many adults felt after 9/11? Informing your family and others you will care for about pandemics will greatly reduce the fear when it finally hits. There is a great comic book prepared by King County, Washington which can be downloaded and used as an educational tool.

Discuss exactly what your new family routine will include. Walk through your isolation room and talk about how you will care for a patient.

5. Complete a basic medical record for each person in the family, and any others you will care for. You can find a basic form by clicking here.

6. Designate a primary care giver and a second if the first should become ill. This should be a person who is familiar with patient care, which we will discuss later – hopefully a person who has a strong immune system.

Once a pandemic has been confirmed, it is time to self quarantine (you may want to do so even before local leaders get around to imposing measures, in case they are unprepared to do so). Immediately pick up others you will be caring for and bring them to your home. Now is the time to settle into a new routine. Designate times for watching TV, doing homework, crafts, reading, meal preparation, chores and playing games. If you assume all of this will just happen, then you will watch all the DVDs you own in the first week and discover you still have weeks of self isolation left to fill with activities. If you live on an acre or more, you will want to include time outside for children to play each day, within bounds of course. Exercise will be important to maintaining good health.

How does a pandemic flu spread? Primarily, it is airborne. This can happen when an infected person coughs or sneezes. Coughing and sneezing produces droplets which can pass the illness to others when inhaled. These droplets may also land on surfaces and, according to the Mayo clinic, can remain active for up to 48 hours.

Droplets from an infected person can make contact with surfaces such as table tops, door knobs, water faucets, shower handles, telephones, toys, remote controls, books and magazines, toilet seats, computer keyboard and mouse, wheelchairs, walkers, baby swings, everything and anything a person who is ill touches or sneezes or coughs on.

Anyone living in a home with an influenza patient is at risk of becoming ill. Good hygiene practices should be implemented throughout self-quarantine, and if illness befalls the household, boundaries and hygiene rituals must be observed.

Remind your family to cover their mouth and nose with a tissue when they cough or sneeze, and then to put the used tissue in a waste basket and wash their hands. When a tissue is not available, have family members cover their mouth and nose with their arm (not hands). Practice good hand washing techniques. Remain conscious of what and who you have touched. Wash frequently.

When caring for someone who is ill use alcohol-based hand wipes or alcohol-based (60-95% alcohol) gel hand sanitizers – rub these on the hands until the liquid or gel dries. Wash your hands often when you or others are sick, especially before touching your mouth, nose, and eyes. Always wash or sanitize your hands before preparing food or eating.

Cleaning and disinfecting hard surfaces and items in your home often will help to prevent the spread of the flu. When using a commercial product, be sure to follow the directions on the labels carefully.

Pay attention to any hazard warnings and always use gloves when advised to do so. Do not mix disinfectants and cleaners unless the labels indicate it is safe to do so. Combining certain products such as chlorine bleach and ammonia can produce toxic vapors which may result in injury or death.

If disinfectants are not available, use a chlorine bleach solution made by adding 1 tablespoon of bleach to a quart of water or 1/4 C bleach to 1 gallon of water. Using a clean cloth, wipe down surfaces and let stand for 3 – 5 minutes before rinsing with clean water. Wear gloves to protect your hands. Be sure to firmly cap any remaining bleach disinfectant and label it well.

Make waste baskets easily accessible throughout the house. Line them with a plastic bag and empty them at least daily. After emptying, be sure to thoroughly wash your hands.

Wash laundry as you normally would for all of those who are not ill. Remember, the germs which cause the flu are spread through the air so do not shake soiled laundry. Wash your hands after you gather laundry.

When laundering for those who are ill you may want to keep these items separate from the rest of the laundry in the home. This is primarily because you may want to assign someone to do the washing other than the person who is caring for those who are ill. Having chores to do will help each family member feel needed and we all feel more in control and under less stress when we are contributing. There is no reason to expose the person assigned to do laundry to the germs in the sheets and towel of those who are ill. I have purchased white sheets and towels for use by those who are ill. I can then bleach them if someone should vomit on them or as otherwise necessary.

For all the above tasks, gloves and masks should be worn for best protection.

Now to the Isolation Room

Have gloves, masks, a gown and anti bacterial wipes or lotion near the door of your patient room. I would place them directly outside the room so I could put them on before entering and then leave them in a wastebasket in the room before exiting. All masks and gloves should be used only once. The jury is still out on the effectiveness of masks but if they make you feel safer by all means use them. Be sure they are N95 masks (see Meridian article: Pandemics-Prepare for a Quarantine ) A gown is not a necessity, but if you prefer you can slip it on as you go into the room and remove it before exiting, leaving it in the room for next time. You can use a robe or any other easily removed item of clothing to protect your clothing from germ laden droplets. On the table outside the room place wipes to disinfect the door knob and also to wipe your hands. Also have a bottle of lotion available. All this hand washing is going to dry out your skin quickly, and you don’t want to have chapped and bleeding skin.

Keep a record on every patient. Get a notebook or make a form to complete each time you care for a patient. (a form will be available at blog.totallyready.com in the Pandemic post on December 12th). Make a separate record for each day. Include the time and patient’s temperature, pulse, and blood pressure. This should be done at least four times a day unless the patient is very ill or their condition deteriorates, and then it should be done more often. Blood pressure devices are cheap and widely available these days.

Keep track of the patient’s food and fluid intake. List everything they consume. Also keep track of output. This can be difficult as no one really wants to urinate into a measuring cup when they are ill but at the very least have the patient record every time they use the bathroom and estimate how much their output was, even if they record a little, hardly any, or lots, as their response. If you have chemical in your toilet that turns the water blue, remove them. They will make identifying problems much more difficult. This is extremely important, as the leading cause of death from the flu is dehydration.

One of the first signs of dehydration is weight loss so be sure to keep track of a patient’s weight.

Mild dehydration is very difficult to detect. Often the only sign is thirst. Take it seriously if a family member says they are thirsty and given them fluids such as water, juice and Popsicles. Never give soda or caffeinated drinks when you suspect someone may be dehydrated. It is important to pay attention to family members who are well, as it is easy to become focused on those who are already ill and to forget the others.

Moderate dehydration will result in an infant becoming thirsty, restless or lethargic, irritable and drowsy. An older child or adult will often be thirsty but still alert. The pulse rate of all who are moderately dehydrated will increase. Respiration will become rapid, blood pressure normal or low, week or dizzy when standing, eyes will become sunken and tears reduced or absent. When the skin of the moderately-dehydrated person is pinched it will not retract immediately, but more slowly. Try the test on someone you know is not dehydrated, and compare to the one you suspect may be. The membranes of the mouth and nasal passage will be dry and urine flow will decrease and darken. If you believe someone is moderately dehydrated, force fluids immediately.

A person who is severely dehydrated will be drowsy, cold, sweaty, have wrinkled skin, fingers and toes and an infant may become comatose. Pulse will be rapid and feeble and in some cases impalpable. Breathing will be deep and rapid with blood pressure low and sometimes un-recordable. A pinch will retract very slowly. Eyes will be sunken and tears absent. Mucus membranes will be very dry and the tongue will stick to the mouth. Urination will be minimal, if any. If you notice any of these symptoms, get the patient to the doctor or hospital immediately.

We have previously discussed storing commercial rehydration products for use during a pandemic. Since a self quarantine may last longer than your supply – here are a few homemade rehydration solutions you can make from items already in your food storage.

Orange Juice:
1 Cup orange juice + 3 Cups water + 1/2 tsp. salt

Apple Juice:
1 Cup apple juice + 3 Cups water + 1/2 tsp. salt

V-8 Vegetable Juice:
3 Cups juice + 2 Cups water (NO SALT) This solution may be mistaken for blood in the stool.

7 UP :
1 Cup 7 UP + 3 Cups water + 1/2 tsp. salt

Koolaid:
1/2 Cup sugar + 2 quarts water + 1 tsp. salt
OR
1/4 Cup sugar + 1 quart water + 1/2 tsp. salt. Red Koolaid may be mistaken for blood in the stool

Gatorade is not a rehydration drink but may be made into one by:
2 Cups Gatorade + 2 Cups water + 1/2 tsp. salt. Red Gatorade may also be mistaken for blood.

Solutions which are not recommended for rehydration are: solutions combining water, sugar and salt, cola drinks, soft drinks, chicken broth, salt water and sugar water.

In the pandemic of 1918, perfectly healthy young people could get up feeling normal at breakfast, come down with illness in the afternoon, and be dead by tomorrow morning. It was shocking.

If faced with the same infection today, which could happen (since we know such viruses still exist in laboratories and new ones are created in nature), at least we would have the benefit of clear hindsight, better resources for preparation, the ability to self quarantine, and public health resources to track and warn the public. But only we – you and I – can implement the advantage of self-preparation and voluntary self-quarantine. In our next article, we will conclude our discussion of how to care for your household during a pandemic.

Caring for Family During a Pandemic – Part 2
By Carolyn Nicolaysen
Most experts agree the medical community as we know it will cease to exist during a pandemic. It is critical that we all learn as much as possible now, in preparation to care for ill family and friends ourselves. It is also important to understand that the flu pandemic of 1918 did not begin during the months we normally associate with the flu. We must continue to prepare and understand that when spring arrives we are not “safe for another year”. No one knows when a pandemic may occur.

Unlike a cold, the flu usually begins suddenly with a fever between 102º to 104º F. During a pandemic we will have little warning that the flu may strike our family. There may be no time to isolate ourselves. It may already be too late if we circulate ourselves in a highly populated environment and are exposed to others who have not yet begun to display symptoms. Someone perfectly well in the morning may be confined to bed by that night. If your family member becomes ill, you should understand the progression of the disease.

Day 1- Day 2: Chills, weakness, lack of energy, loss of appetite, headache, back, arms, and legs ache.

Day 2- Day 4: Chills, weakness, lack of energy, loss of appetite, headache, back, arms, leg aches begin to decrease and respiratory symptoms begin to increase. Symptoms similar to that of a cold, croup, or pneumonia may appear. Patients may experience a sore throat, headache and a dry, hacking cough. Nasal discharge and sneezing are also common. Fever should disappear.

Day 4- Day 7: Symptoms should disappear. Coughs and a feeling of being continually tired may continue for a few weeks. A second wave of fever may occur. This is rare and means the steps will begin over again.

Patients should remain at home at least until all symptoms, except a dry cough, disappears.

There are times when you should see a physician immediately. If you, or a person in your care, have any one of the following symptoms:

  • shortness of breath while resting or doing very little
  • difficult or painful breathing
  • coughing up bloody sputum
  • wheezing
  • chest pain
  • fever for 3 to 4 days without improvement
  • feeling better then suddenly having a high fever or becoming ill again
  • extreme drowsiness and difficulty awakening
  • disorientation or confusion
  • severe earache
  • constant vomiting or diarrhea

If your family member has any of the following, go to the hospital immediately:

  • Severe trouble breathing and it is not caused by a stuffy nose
  • Has blue lips or hands, suddenly becomes pale, or has cold legs up to their knees
  • Is limp or unable to move
  • Is so sleepy they don’t respond when you try to get them up
  • Shows signs of a stiff neck, especially if they also have fever, are listless and their eyes are sensitive to light
  • Is very confused
  • Has a seizure
  • Has worsening of chronic medical conditions (such as: heart or lung disease or diabetes)

As with the common flu, time is the healer. Medications to relieve symptoms should be given to patients to help them get the sleep they need for their body to heal. These medications will all become impossible to find once a pandemic has begun. You should be storing them and have a supply in your home at all times.

Medications to relieve symptoms

Muscle pain and fever: Use acetaminophen (like Tylenol). If you take acetaminophen for a long time or in high doses, it can affect the liver and kidneys, so use only when symptoms exist. You may also choose Ibuprofen (such as Advil or Motrin). Ibuprofen can irritate the stomach and thus should only be used when stomach irritation (vomiting and diarrhea) are not present. Never give aspirin to anyone under the age of 18 (i.e., follow manufacturer recommendations).

Cough: Try a medication with Dextromethorphan (DM) for a dry cough that prevents you from sleeping or causes chest discomfort.

Stuffy nose: Use a decongestant. Nasal drops or sprays act quickly and have fewer side effects than medications you take by mouth. However, they should only be used for 2 or 3 days to avoid dependency. If a stuffy nose continues switch to an oral medication such as pseudoephedrine. Decongestants may cause dry mouth, sleep problems, rapid heartbeat or other side effects. People who have long-term health problems or who are on other medications should not take decongestants without talking to their doctor.

Sore throat: Lozenges or throat sprays with Dyclonine works best to numb the throat. Products containing honey or herbs may also soothe the throat. Herbal tea with honey is also very soothing and easy on the stomach.

Diarrhea: This should not be treated with medications. Diarrhea is the way the body rids itself of infection. This is a good thing. Treat cases of diarrhea by keeping the patient on a clear liquid diet (see below) for at least a day. Be sure to continue to monitor the amount of fluids consumed and remember the patient should be drinking more than they normally would to prevent dehydration.

Additionally, a patient should not be allowed to smoke or drink alcoholic beverages. They will make many symptoms worse and slow the healing process.

Diet Recommendations for Flu Patients:

A clear liquid diet should be used to treat intestinal and stomach illnesses. Patients suffering from diarrheal illnesses often experience abdominal cramping if they eat solid foods. In addition, a great deal of water and minerals (sodium, chloride, and potassium) are lost in the watery portion of the stool; if you are not careful this can lead to dehydration. Patients with diarrhea need to drink much more fluid than usual to prevent dehydration. This is especially important if the patient also has a fever, which increases loss of fluid through the skin as perspiration.

When a patient is ill feed them the following:

Step 1: Clear liquid diet: rehydration solution, (see Meridian article: Caring for Family During a Pandemic – Part 1) water, fruit juice, Jell-O™, ginger ale, lemon lime soda, or tea.

Step 2: When a patient tolerates Step 1 well, gradually add: white toast (no butter or margarine), white rice, cream of wheat, soda crackers, or potatoes without the skin. You may also add small servings of banana or applesauce.

Step 3: After a day, add canned fruit and chicken noodle soup.

Step 4: Next add poached eggs and baked chicken breast without skin, canned fish or meat.

Step 5: Finally add milk and other dairy products, margarine or butter, raw fruits and vegetables and high-fiber whole grain products.

A few other tips to keep in mind:

It is a good idea to use a traditional glass thermometer for each person to avoid cross-contaminating patients, or use a digital thermometer with lots of disposable sleeves. It is also important to have a back up just in case of an accident. You don’t want to be without a thermometer.

Get plenty of bed rest – you, not the patient. To remain healthy there is nothing better for healthy family members than a good night’s sleep. Your body cannot fight an illness if it is exhausted.

Do not smoke. Smoking compromises the immune system of the healthy as well as those who are ill.

Restrict visitors to your home. During a pandemic, plan to have friends and family leave supplies, dinners, or just notes and gifts, on the porch. Wait until they leave and then open the door and retrieve the items.

If you need to leave the house, try to remain at least 3 feet away from others. Also, wear a mask and keep your hands in your pockets. Yes, really. Have you ever just automatically reached out your hand to shake hands when you know someone is ill? Avoid shaking hands with anyone.

Patients should not leave the home during the time when they are most likely to be infectious (at least 5 days after onset of symptoms). When a patient needs medical care and thus must leave home, they should follow cough etiquette (cover the mouth and nose when coughing and sneezing) and wear N95 masks.

Medical facilities will be overwhelmed during a pandemic. You will not want to go to the doctor’s office or to the hospital unless it is absolutely necessary. Prepare now to obtain medical advice by other means. Check with your doctor to see if he/she has a plan to answer patient questions during a pandemic. Also, check with your insurance carrier and your state health department to see if they have a help line available. Remember the Internet may be down if the power fails so you will want phone numbers.

A pandemic should not be feared but it should not be ignored either. Now is the time to prepare for the worst and pray for the best.

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