Flu precautions: Making sense of CDC advice

Nov. 6, 2009 | Deborah Franklin | NPR

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With the new H1N1 flu rolling through schools throughout the United States, many parents are turning to the Web site of the Centers for Disease Control and Prevention for authoritative advice on how to best care for their sick children at home. But some parents and doctors say at least some of those safety tips are over-the-top and tough to carry out at home.

Under the heading "placement of the sick person," for example, the Web site suggests that parents "keep the sick person in a room separate from the common areas of the house. (For example, a spare bedroom with its own bathroom, if that's possible.) Keep the sickroom door closed."

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The site goes on to urge parents to "avoid close contact (less than about six feet away) with the sick person as much as possible. If you must have close contact with the sick person (for example, hold a sick infant), spend the least amount of time possible in close contact and try to wear a face mask (for example, surgical mask) or N95 disposable respirator." There's even a step-by-step audio podcast on how to put on the mask.

"I wondered if the people who wrote it have kids or know what it's like to have kids," says Jen Hodsdon, a health care worker in Portland, Maine, who checked the Web site last week when her 12-year-old daughter, Soleil MacDonald, got sick with swine flu.

Suiting up in a face mask and keeping her distance from Soleil "would have terrified her," Hodsdon says. "It's like that scene in E.T. where the people come in in suits. It's horrifying."

Treating The Flu In Real Life

And that's a big problem, says Dr. Benard Dreyer, a health literacy specialist and pediatrician at New York University School of Medicine.

"People look at this Web site and sort of get overwhelmed," Dreyer says. They wonder, " 'Oh, my God, am I supposed to do this? Am I supposed to do that?' And then they end up not doing anything."

He's been working on a much simpler list for the American Academy of Pediatrics that focuses first on things like teaching children habits like frequent hand washing, use of hand sanitizers and coughing into the sleeve.

But should sick kids and/or their parents be wearing masks? Hodsdon has asthma, which puts her in the group the CDC Web site urges to wear a mask around anyone with swine flu. Hodsdon thinks that's too extreme — her asthma is mild.

"It's hard to tell a mother to wear a mask with a kid," says Dreyer. "If somebody had mild asthma, I would probably not get too excited about it. If somebody had real chronic lung disease, really bad asthma, chronic bronchitis, I would be more worried about them. And then I would say maybe you should wear a mask."

Sending A Clear Message

Dreyer was so alarmed when he saw the Web advice that he fired off a note to the CDC. Dr. Anne Schuchat, director of the CDC's National Center for Immunization and Respiratory Diseases, says the Web site is a work in progress and is always being revised.

"We're still really trying to find the best ways to get information out to people that's practical," Schuchat says.

So why push hypervigilance at all? Peter Sandman, a New Jersey risk communication consultant to companies and government agencies, says he thinks the problem stems from the CDC's urge to help parents care for their children the way a hospital would.

"And that's not realistic," says Sandman. "It's well-intentioned. It's good-hearted. It's just not smart."

Research shows that public health experts would have better success, he says, if instead of only putting out the very best, most stringent precautions, they gave parents choices: best, good and good enough.

"I suspect," says Sandman, "that if you sat down with the CDC folks who wrote this advice and said, 'All right, in a realistic situation, where a parent can't do all of this, but if they really work hard they can do some of it, which are the things they should sacrifice, and which are the things we should really try to hang on to?' — they'd have answers."

Meanwhile, Dreyer says, he expects the American Academy of Pediatrics to publish online within the next few weeks its own "how-to list" for parents of children sick with pandemic flu.

Xueen
2 weeks ago

Thanks NPR for commenting on the CDC website. I was surprised not to find more useful information on the web regarding the swine flu given how widely spread it is especially in Southern California. My daughter caught it first and I also got the fever after her. But what worried me the most is my 2-month old son. According to the CDC website, I should have someone else take care of him, and I should pump breast milk instead of feeding him myself, which I found very hard to follow. The best I could do is to wear mask and wrap the baby in a blanket, while feeling bad that I was not doing the best thing for him. I recovered from the flu, and the baby is doing fine so far. So the website's suggestions have helped, with a bit of your own interpretation.

Christina Zarcadoolas
1 week, 6 days ago

As a health literacy expert studying New Yorkers' perceptions and understanding of swine flu the 3 primary and much - repeated messages ( hand washing, sneezing into sleeve, and staying home when sick) - sound bites, are woefully, inadequate. They leave the public unarmed in the face of fast breaking, and concerning information about the serious of the H1N1.
We've developed an approach that tries to explain the reasons behind the recommendations. Our first animated video on H1N1 seems to go a long way in bringing common sense science back into the discussion.http://www.understandingswineflu.com/

Jennifer, Pittsburgh PA
1 week, 6 days ago

There is a reason that officials at the CDC are in uniform. Those uniforms symbolize the role of these officials in protecting the people of this country. I disagree with Dr Dreyer who is not in uniform. If I am a parent safeguarding the health and well-being of my family, I am not going to step down a notch or two from a "best practice" to a "good enough" practice. The CDC should put the guidelines that they deem necessary to offer the highest level of protection to individuals and families. We should not be silly and feel foolish about taking the recommended steps. CDC officicals should stand behind their recommendations and not feel that they have to be on the defensive. People complained about schools being closed and the expense of closing and re-opening them during the first wave of H1N1 and I thought these responses were ridiculous. Was the expense more important than potentially saving lives? Famililies are always free to consult their own personal physicians about healthcare concerns.

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