Japan, ramping up H1N1 precautions

My friend Pete Larson, a brilliant musician who turned his back on rock and roll in order accept his fate and become a scientist, just returned from Japan, where he wrote the following. I thought some of you with mask fetishes might enjoy it.

larsoninjapanWhile the 2009 H1N1 flu has been written off by the average American as a plot by Democrats to scare the public into accepting a totalitarian socialist state, the Japanese have turned their influenza fighting amps to 12. Everywhere you go, there are masks. There were always masks, but now they come in science fiction flavors, with specially designed models that minimize the possibility of particles entering the oral cavity all the while placating you with strawberry or herbal scents. Some go so far as to act as a substitute for a burqa, covering the entire face save enough space to allow the wearer to see where she is going. Note that “she” was no accident. I hardly saw any men under the age of 90 wearing masks. The fact that it’s largely women wearing these masks leads me to suspect that, rather than being used in a large scale public health intervention, the masks are merely an excuse to not have to wear makeup.

Most people I spoke with believed that the hysteria over H1N1 has largely been overblown by the media and that the frantic mask wearing is not only likely useless in preventing the spread of H1N1, but also borders on the pathological. Granted, as in America, the people I associate with in Japan tend to verge on the jaded and cynical. During the height of the scare, people who did not wear masks were looked at with suspicion. A person seen coughing on a train without a mask could quickly see several seats open up around him/her.

When I entered Osaka, I was immediately asked what countries I had visited in the past 6 months. When I offered that I was coming from Malawi, the attendant immediately passed me a health questionnaire where I had to write what symptoms I might have, my name, address in Japan and phone number, in addition to having the attendant take my temperature. I wouldn’t be at all surprised to find out that my in-laws get a phone call asking if I exhibited any symptoms of flu or ebola during my stay.

I managed to purchase a set of “wet masks”, which obliterate germs by passing air through and antiseptic filter before they can reach the mouth. To please the user they introduce a nice smelling herbal aroma. The box claims that through the use of the mask, 99% of all pollen and virus particles can be obliterated. I’m not sure what pollen and flu viruses have to do with each other, but I’m sure there’s some truth in advertising numbers game going on here given that pollen is not only bigger than viruses, but also likely more numerous since viral infections only hit as certain times of the year, unlike pollen and dust, which can be ubiquitous.

Opening the package, one is given a set of three masks and three wet packets and the user has to assemble them before venturing out in the dangerous world. Personally, I find the whole thing too much work to prevent flu, but since the wet packets only last a day, this whole system has to be a boon to Kobayashi Pharmaceuticals. At seven bucks for three masks, you can do the math.

Drug stores all have a section out front displaying anti-viral goods, including a variety of masks, from the traditional gauze to the expensive and complicated ones mentioned above, along with a number of throat disinfectants and Lysol type bathroom and house cleaners. Anti-bacterial soaps (uhh flu is a virus?) are also exceedingly popular and people appear to obsessively hand wash.

The most impressive measure I saw was the closure of the schools and intense monitoring of children. All children in schools must take their temperature every morning and write it in their home room notebook. They must then present the notebook to the school every single day and children who report high temperatures are immediately sent to the school nurse and she reports the child’s information directly to the local health department. If the child is found to be positive for flu, the school is closed and children sit out for a week. I simply can’t imagine this kind of strategy working in the US. Parents would never want to report their child’s temperature to the school for privacy reason, and many parents would probably lie if they knew the school would be closed. The Japanese are incredibly cooperative people.

However, for all of these expensive, product based counter-virus measures and heavy handed school closures, one still has to share handles on the train with numerous other possibly infected people. Smokers abound everywhere, coughing and hacking God knows what straight into their hands, which they then use to touch just about everything you touch.

So, with all that by way of introduction, I’m wondering if we here in America are really ready for what may be coming our way. I talked with my grandmother last night, and she tells me that she’s scheduled to get vaccinated in a few weeks, so I know some education and outreach to seniors is being done, but I’m not hearing a great deal in the mainstream media. Or, for that matter, on the internet. I hope that means the strain isn’t as virulent and deadly as that species-jumping virus that killed so many millions in 1918. But, even if that is the case, it seems as though we should be having some kind of dialogue as to how we approach it. While the Japanese precautions outlined about may be overkill, at least they have a plan in place.

Oh, and on this subject of engaging people in a dialogue on the threat of H1N1, I had a dream last night involving Pete. He was back making music. He was touring the country, performing a kind of one man rock opera on swine and bird flu. I can only remember bits and pieces, but I have a clear memory of him in a Napoleon-like costume, wearing a bird mask, playing an extremely loud electric guitar on his knees, like Dorf, while kicking away at some drums with his tiny feet. And the sets were amazing. Anyway, there’s the idea, in case anyone in the world of public health wants to develop it.

So, what have you heard about H1N1?

Oh, and what discussion about the Japanese and their crazy healthcare products, would be complete without a link to the Washlet?

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  1. Posted September 9, 2009 at 10:50 pm | Permalink

    And here’s the link to the CDC’s H1N1 link.

    Oh, and a link to an Ypsi man talking about his use of the Washlet.

  2. Lauren
    Posted September 10, 2009 at 8:17 am | Permalink

    There’s a book called “Flu” abut the flu of 1918 that everyone should read. That strain, if I’m not mistaken, was also a cross-species flu, not unlike the bird flu strain that public officials were charting not too long ago. (Scientists were able to isolate the virus from frozen human tissue taken from a cadaver buried in some icy region.) The threat is very real. The strain we’re seeing now, though, according to professionals, isn’t likely to be that harmful to people unless they’re very old, very young, or have compromised immune systems. Those people should be vaccinated.

  3. dAnNy
    Posted September 10, 2009 at 10:10 am | Permalink

    Each year my company’s HR dept let’s us know where we can go to get the flu vaccine and how much it will cost. I think they even have a company come and do it in-house. THIS year they are even *coughing* up the $23 for employees to get vaccinated!

  4. Pete Larson
    Posted September 10, 2009 at 10:33 am | Permalink

    The 1928 flu and the current “swine” flu are both H1N1 flus, thus the great concern. While symptoms and outcomes are very mild for the healthy and strong, pregnant women, the elderly, small children and persons with highly compromised systems are at great risk for adverse events. The concern is not necessarily the flu itself, which essentially presents the same risk as any yearly flu, but the rapid and efficient pace at which the current flu is transmitted.

    A virus may be exceedingly virulent and may cause great harm, but may transmit poorly so that the overall risk to the population is small. Ebola would be in this category. Outside of sexual contact and direct blood transfusion, HIV would be in this category.

    Even a mild flu which can tear through a population quickly and efficiently, may devastate the public health by wiping out large numbers of elderly, children and unborn infants. The present flu is not strong, but is very good at jumping from person to person. The great concerns are rapid transmission to the weak, or a genetic change to a deadlier strain which has the capability to transmit quickly. The 1918 flu would be in this category, thus the concern.

    I feel famous.

  5. Elaine
    Posted September 10, 2009 at 1:34 pm | Permalink

    So, is there any risk at all in taking the shot? I’m told there’s no evidence linking vaccinations to Autism, but I keep hearing about health care professionals who aren’t vaccinating their own kids.

  6. Peter Larson
    Posted September 10, 2009 at 2:32 pm | Permalink

    I would say that there is no more risk in getting the present flu shot than in getting any other. The risk is entirely minimal. Getting the flu and hoping for the best is actually more risky.

    Health professionals who do not vaccinate their children are undeserving of being called health professionals. While I am sure there are some people who selectively vaccinate their own children based on understood risks and benefits, I would seriously question the level of health knowledge of any “health professional” (or any parent, for that matter) who opted to not vaccinate their children against even the most basic of diseases such as Tetanus.

    Tetanus is a bacteria which exists on every part of the planet. It lives happily in the soil and even in your own intestines. If it makes it to your bloodstream, however, you (or your child) will likely die. If you or your child does not die, they will have been put through a miserable extensive hospitalization for absolutely nothing. Children play in the dirt often and cuts and simple injuries are common. To not provide your child with a simple vaccine such as that against tetanus is absurd.

    If you’d like more vignettes from Mark and I’s lunch, I can certainly oblige. Perhaps we should have a “Lunch with Mark and Pete” column.

  7. Melvin from Ferndale
    Posted September 10, 2009 at 4:23 pm | Permalink

    Mark and Pete should also have a buddy cop movie.

  8. DRich
    Posted September 10, 2009 at 7:16 pm | Permalink

    Interesting post, Mark and Pete. I work in a school. There is certainly much discussion of the flu this year and there is certainly a plan in place. For one thing, the flu shots offered to staff are being offered one month earlier this year. For another thing, every single classroom without a sink in it has had a hand sanitizer dispenser installed. I wonder about this, having heard that anti-bacterial hand sanitizer (besides only working on bacteria, right, Pete?) actually kills off the weaker “bugs” and leaves alive only the strongest, resulting in a race of superbugs! True?

    I was expecting some abuse of the dispensers (squirting the stuff all over the floor, rubbing it into kids’ hair – anything you can think of, ninth graders will try), but haven’t had to deal with that in the first 3 days of school. Also, in the these tough times, I heard the district only has enough money to refill the dispensers once.

  9. AndyS
    Posted September 10, 2009 at 9:01 pm | Permalink

    U-M Hospital has this web site:
    We are also being encouraged to get a flu shot earlier than usual this year.
    Here’s the email we just got from the top brass at UMHS:
    Key points in this message:

    – All UMHS faculty, staff, medical/nursing students and volunteers should get the seasonal flu vaccine this month

    – Other flu-related planning, including plans for H1N1 vaccination, is proceeding

    All –

    As you’ve no doubt seen in the news media, we’re on the cusp of a “double flu season” that may have an especially large impact on our society – and our Health System.

    Both regular seasonal influenza and novel H1N1 pandemic influenza (“swine flu”) will be circulating at once. Some cases of H1N1 flu have already arrived on the U-M campus with the return of students.

    Our Health System must be ready to serve patients with both routine flu care, and with the advanced care that complicated cases of flu can require.

    At the same time, we must continue to provide a full range of care to our other patients, and continue our educational and research missions.

    We can’t do all this, though, if we have large numbers of faculty, staff and medical or nursing students out sick at once. Neither should we endanger our vulnerable patients by exposing them to flu virus while they receive care from us.

    So, we’re writing to urge you to take an immediate step:

    Get vaccinated against the seasonal flu as soon as possible, starting this month.

    Yes, it’s earlier than usual – but the vaccine will still protect you for the entire season.

    Why are we starting so early? We need to keep seasonal flu from circulating as much as possible. And we must be ready to mount a second vaccination campaign, against the H1N1 flu virus, starting in October.

    Vaccination is free for all Health System faculty and staff, and for medical and nursing students and UMHS volunteers. No matter where you work, or what you do, there’s a convenient way to get vaccinated for the seasonal flu.

    Visit http://med.umich.edu/flu/shots/employee.htm to learn more about when and how you can get vaccinated.

    The first walk-in clinics will be held next Monday the 14th, Wednesday the 16th and Friday the 18th at central locations in University Hospital. More walk-in clinics are being planned, and the Web site also describes other ways to get vaccinated at work.

    Do it for yourself, for your patients, for your colleagues, for your loved ones — and for the sake of our institution’s mission to help others.

    If you’re a clinician, please begin vaccinating your patients according to guidance for your clinical area.

    We’ll share more about H1N1 vaccination in the coming weeks, including priority sub-groups that will be targeted for vaccination if vaccine supplies are limited.

    You’ll also receive other updates on important topics related to flu, which we hope you will read to make sure you have the latest information and links to resources on the Web.

    Together, we can make it through this “double flu season” and continue to serve those who rely on us.


    Ora Hirsch Pescovitz, M.D., CEO, U-M Health System and Executive Vice President for Medical Affairs
    Doug Strong, Director and CEO, U-M Hospitals & Health Centers
    James O. Woolliscroft, M.D., Dean, U-M Medical School

  10. Peter Larson
    Posted September 11, 2009 at 4:18 am | Permalink

    The UM post here also brings to mind another important facet of getting flu shots each year. Flu patients present great challenges to health systems because they tend to all come in at the same time. And no, flu patients are not all healthy people between the ages of 20 and 40 simply seeking (often unneccessarily) antibiotics or tamiflu. They can be older individuals or young children or immunocompromised person that come in gravely ill and require extensive care. Given our already taxed health system, it makes sense to immunize as many persons as possible to make sure that the people who need care the most are able to get it.

    Flu vaccines aren’t just about you. They are also about the people that you potentially transmit viruses to. Those people could be your children, your parents, your friends or some 90 year old woman that you will never meet. If you are in a position of employment where you come into contact with many people a day, especially old people and children, you should get vaccinated. If you have children yourself, you should get vaccinated against this set of flus.

  11. Kim
    Posted September 11, 2009 at 8:24 am | Permalink

    I see it being more of a romantic comedy, with them falling in love.

  12. SP
    Posted March 28, 2010 at 8:43 am | Permalink

    I am losing nutrients in my skin, and I’m wondering if it’s due to beastiality. Does anyone know the gastrointestinal health risks associated with beastiality?

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