The threat of bird flu, H5n1 can escalate into a more devastating threat than that in 1918-1919, considering its potential to recombine and form new and deadlier strains and the world’s lack of resources and preparation for it. A vaccine has remained in experimental status and still failure-prone. Meantime, the flu virus is easily and quickly transmissible by coughing, sneezing and direct contact and through the air. An infected person can transfer the infection in a day, with or without symptoms, and carry the virus for several days and continue infecting others. Many groups are at-risk and symptoms are debilitating. The community health nurse must apply a holistic approach in tending to patients or victims of this scourge.
Leading infectious disease experts recently warned about the health and economic consequences of an outbreak of pandemic influenza from a deadly strain of bird flu, H5N1, which has destroyed flocks in Southeast Asia (Russell 2005). This virus has the potential to trigger another flu pandemic far different and more virulent than those of prior years and one to which the human population has no natural resistance. Alongside, they also warned about the world’s lack of preparation to meet the disaster. Director Anthony Fauci of the National Institute of Allergy and Infectious Diseases in Bethesda, Maryland said that federal spending on influenza preparedness has gone up to $419 million from $40 million in the past five years, but added that he was dissatisfied over the United States’ current level of readiness. An experimental H5N1 vaccine is being tested, but the system for manufacturing it, the same, which produces millions of ordinary flu injections, is prone to failure. The federal government has enough reserves of the Tamiflu anti-viral, which shows promise against bird flu, for only 2.3 million Americans, or less than 1% of the population. Director Michael Osterholm of the University of Minnesota’s Center for Infectious Disease Research and Policy noted that the H5N1 pandemic strain could be more devastating than the 1918 pandemic and urged the world’s leading economic powers to confront the problem directly. He estimated that a flu strain as lethal as the one of 1918 could kill 180 to 360 million of the world’s population of 6.5 billion and emphasized that industrialized nations accustomed to the “prompt” delivery of health care good still do not have enough medical supplies to care for the sick, not even detailed plans on how to handle dead bodies.
Epidemiological Problem – Influenza or flu, a rare virus with a genome in 8 separate segments, has an increased potential to form recombinants and may also contribute to the rapid development of new flu strains (Keen 1995). Avian and human strains of the virus may recombine in pigs in the Far East to develop virulent human strains. The Influenza a virus, an avian virus, appeared to have “recently” infected mammals. Every 10 to 15 years, a major new pandemic strain appears in man with a completely new HA and a new NA, which cause a major epidemic around the world. The constant antigenic change of the flu through the years requires new vaccines on a regular basis. In addition, new flu strains spread quickly among children in schools and in crowded places. Influenza epidemics lead to economically significant absenteeism (Keen).
Description, Agent, and Data – Influenza, commonly known as flu or grippe, is a highly infectious respiratory disease, belonging to the Orthomyxoviridae variety (Smith 2005). It is rapidly spread via droplets in the air from other infected persons. When the virus is inhaled, it attacks the cells in the upper respiratory tract and brings on the typical flu symptoms, like fatigue, fever and chills, hacking cough and body aches. The person also becomes susceptible to potentially life-threatening secondary infections. Incubation period is short from a day to three days, where rapid spread leads to epidemics.
Impact – Flu is more debilitating than the common cold and occurs more suddenly (Smith 2005). The annual death tolls linked to influenza and its complications averages 20,000 in the U.S. alone. The 1918-1919 Spanish flu pandemic wiped out 20-40 million worldwide, half a million of which occurred in America. There have been regular influenza outbreaks, the most serious of which are pandemics, affecting millions worldwide and lasting for several months. A primary example was the 1918-1919 influenza outbreak. Other pandemics also occurred in 1957 as the Asian flu and in 1968 as the Hong Kong flu. Epidemics occur every two to three years and affect 5-10% of the population.
Risk Factors – Influenza occurs throughout the world. Its basic antigen types are a, B and C. Types B. And C. are known to affect only humans, while Type a may infect both humans and animals. Influenza reaches a peak from December to March in temperate climates. Between 1976 and 2002, peak influenza activity in the U.S. was noted in January and February. Influenza occurs throughout the year in tropical areas. Documents show increased morbidity in “high-risk” adults, who require hospitalization from two to five times during major epidemics. People 65 years old or older, those of any age with chromic medical conditions and very young children are likeliest to develop complications from influenza. These complications include pneumonia, bronchitis, and sinus and ear infections (Centers for Disease Control and Prevention 2004). Flu can also make chronic health problems worse, such as asthma, and chronic congestive heart failure. Winter is the time for flu in the Northern hemisphere. Other persons at-risk are residents of nursing homes and chronic-care facilities, those with chronic heart or lung problems, chronic metabolic diseases like diabetes and renal dysfunction, young people on long-term aspirin therapy, pregnant women in their second or third trimester, those immuno-compromised, those in contact with these persons and travelers to foreign countries.
A cough or a sneeze from an infected person can spread flu to others within three feet through the air and deposited into the nose or mouth of others (Centers for Disease Control Prevention 2004). It is also transmitted when a person touches the respiratory droplets of an infected person or an infected object and touches his mouth or nose before washing his hands. An infected person can spread the flu from day one before he or she can even feel sick. Adults can transmit the virus to others for another 3-7 days before symptoms show up. Children can pass it on longer than 7 days. Symptoms begin to show up from the first to fourth days after infection. Some show no symptoms yet pass the virus on to others during this time.
The Role of the Community Health Nurse – the community health nurse combines nursing know-how and public health practice in promoting and preserving the health of the population. As such, she is not limited to any specific age group and performs her functions on a continuing, rather than episodic, manner on the individual, family, and group and community levels. On the individual level, she focuses on the specific treatment of the virus and the care of the patient by verbally explaining the cause and course of the disease and how the patient can recover fast or by giving him reading materials that can help explain his condition and control the spread of the infection. If the individual belongs to the at-risk category, the nurse explains why he is at risk. If the individual is not yet infected, he should be encouraged to get an influenza vaccine injection each year before the flu season from late December till early March. On the family level, the nurse can discuss the threats of the flu with the members, distribute reading materials, conduct check-ups with the members and encourage them to get the vaccine and practice proper hygiene to avoid flu infection. She must warn them, though, that infants six months and younger will not benefit from vaccines. And in the community level, she can conduct orientation seminars or meetings with small groups on the threats of influenza and the benefit of vaccination. Community awareness may be intensified by regular newspaper and magazine write-ups, columns and teasers; radio and television spots and announcements; brochures, posters and children’s stories on comic books. The importance of hygiene, of getting the flu vaccine and prompt treatment may be emphasized during check-ups on the individual level; during regular and outreach visits on the family level; and when conducting nationwide health campaigns on the community level through radio, television, school, surveillance programs, preparedness activities and response or implementation activities in the control of the pandemic.
As a general prevention strategy, the community health nurse can motivate individuals, families and communities to acquire influenza vaccination every fall, wash their hands frequently, avoid close contact with those infected with flu, cover their mouth and nose when sneezing or coughing, and refraining from touching their mouth, nose and eyes. Employees of long-term care facilities should all be vaccinated and to stay at their nurses’ homes when infected.
In case of influenza outbreak, the community health nurse should provide anti-influenza medications to protect those in close contact, and these are the three prescription drugs, anantadine, rimantadine and oseltamivir. Medications must be continued until the vaccine becomes effective. She should contact the state of local health department immediately about the outbreak and report cases to the local health department.
The Watson Caring Theory may be infused in the role and functions of the community health nurse when treating and caring for patients or victims of influenza. Jean Watson’s 10 carative factors can translate into clinical caritas processes and bring about subject healing processes that can help speed up the recovery of a patient as an individual, as part of a family or as a member of the community. In applying Watson’s caring theory or model, the nurse can form or build a humanistic-altruistic system of values with the individual patient, the family or community; instill faith and hope; become more sensitive to them in their suffering; develop a more trusting relationship with them; elicit and accept their expression of positive or negative feelings; promote a creative problem-solving caring process with them; induce a transpersonal teaching-learning environment; build a supportive, protective and corrective or curative physical, mental, social and spiritual environment; help gratify other human needs; and allow necessary existential-phenomenological-spiritual forces to form and work for speedy healing.
Summary and Conclusion
The 1918-1919 flu pandemic makes plain the nightmarish threat of new strains that natural human resistance cannot fend of and for which the world is hardly prepared. Tamiflu can cover only 2.3 million Americans or less than 1% of its population. Health care budget rose from $40 to $419 million in the past 5 years, but the quality and level or preparedness have not been satisfactory to health experts. Experiments to counteract H5N1 have been error and failure-prone. The Influenza a virus is seen as capable of recombining and creating new strains of the viral disease every 10 to 15 years with a completely new structure that can cause major epidemics throughout the world likely to be more devastating than the 1918 pandemic. This constant antigenic change will require new vaccines to be developed on a regular basis and will always outpace these vaccines, as the new strains are expected to spread quickly in crowded places, especially schools and workplaces. Absenteeism is seen to increase and prove economically disastrous. The community health nurse must respond more effectively to the need of the hour. She must expand to combine nursing know-how and public health practice in providing assistance and support to the stricken or exposed individual, family and community.
Centers for Disease Control and Prevention. (2004). Influenza: the Disease. Department of Health and Human Services. http://www.cdc.gov/flu/about/disease.htm
Ghosh, T. (2004). Preventing Widespread Influenza: Influenza Surveillance Activities. Public Health Update. http://www.tchd.org/pdfs/update9.04_flu.pdf
Keen, a. (1995). Influenza. Virology lectures. Department of Medical Microbiology: University of Cape Town. http://web.uct.ac.za/depts/mmi/jmondie/influen2.html
La Porte, RE. (2005). Influenza: Epidemiology, Prevention and Control. A Supercourse. Global Health Network. http://www.pitt.edu/~super1/lecture/lec0652/index.htm
Public Health Agency of Canada. (2004). Canadian Pandemic Influenza Plan. http://www.phac-aspc.gc.ca/influenza/pandemicplan_e.html
Russell, S. (2005). Flu Pandemic Looms, Experts Warn World. New York Times Syndicate: Medline Plus. http://www.nlm, nih.gov/medlineplus/news/fullstory_2488.html
Smith, J.F. (2005). Influenza. Dr. Joseph F. Smith Medical Library: The Thompson Corporation. http://www.chclibrary.org/micromed/00053640.html
Zimmerman, R.K. (2005). Recent Changes in Influenza Epidemiology and Vaccination Recommendations. The Journal of Family Practice, vol 54 # 1. http://www.jfponline.com/supplements/JFP_Jan_05/WYE_J_2_influenza
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