Health care: Dr. Scott Giffin, district medical health officer, sheds light on what people need to know about the H1N1 influenza

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SANDRA DAVIS
Telegraph-Journal

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SAINT JOHN - As the second wave of H1N1 influenza makes it way through the province, Dr. Scott Giffin, the district medical health officer for the Saint John region, took time this week to answer important questions about the pandemic.

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Noel Chenier/Telegraph-Journal

Dr. Scott Giffin, district medical health officer for the region, says most people hit by the H1N1 influenza will recover without hospitalization.

While it was still not clear why H1N1 is hitting young people harder than the elderly, Giffin did shed light on who should seek medical help and why most will not need to be tested.

What follows is a transcript of the interview:

Telegraph-Journal: What are the priority conditions?

Dr. Giffin: "If you are an adult with chronic disease, you are in a risk group, but you are not in a priority group for the vaccine. Because of the limitation in supply, we had to narrow that down and we decided to focus on pregnant women and children. The priority list is: children six months to 18 years; pregnant women 20-weeks plus; pregnant women less than 20 weeks with underlying medical conditions; parents of children under six months; and First Nations people living on reservations. Risk groups not included on the priority list for the vaccine include people with chronic diseases like immunosuppression, heart disease, lung disease and morbidly obese people. The focus groups had to be adjusted that way to give us some plan of attack to undertake this task."

TJ: It sounds as if, unless you have a child, are a child, are pregnant, or living on a reserve, you're not in a priority group?

Giffin: "There will be some provision made later on for people in risk groups to get the immunization. At this point, a difficult decision has been made to focus on women, pregnant women and children, mostly. That's who we're trying to protect in the early going."

TJ: When do you expect we will have more vaccine?

Giffin: "It's a national production problem so it's very difficult to say. There may be some increased production by the end of this week, or it may take two weeks."

TJ: If, in the next month, people are still not vaccinated, is there any point if getting vaccinated? Would it not be too late anyway, given that it takes two weeks to kick in?

Giffin: "You make a good point. It would be a benefit if there was a third wave. This is the second wave of disease. We're going to keep an eye on the epidemic curve on the outbreak and based on that, we will see how fast this is rising up in our community and how fast it's going to disappear."

TJ: Do you have statistics that would tell us how many confirmed cases we've had in the province and in Zone 2?

Giffin: "There's a number, but it doesn't reflect the number of cases that there are. You have to understand this disease comes in a whole range of degree of severity. A lot of people are only mildly ill and usually, they don't end up going to see their doctor or they don't end up getting tested. They are a case, technically, but they're not tested so they don't get recorded in those numbers. It all depends on how eager a doctor is to do tests. We have directions for the doctors: if it's clearly a case of H1N1, which we know is in the community, and there's no diagnostic dilemma or the patient's not sick enough to be going into hospital, then we recommend that they don't do a test because you're going to treat the case the same, regardless of the outcome of the test. The labs that do the tests are starting to get backed up. If you go to see your doctor about the possibility of H1N1 flu and the doctor says 'you don't need a test', that's the basis that he's saying that on."

TJ: Can you have just one of the H1N1 symptoms and have the disease? Is there a check-list?

Giffin: "No, that's very difficult. There are some cases where it probably doesn't even show up clinically. We've certainly had positively tested cases without fever. Like almost any disease, it presents in mild, moderate and severe. Most of the people we hear about are in the moderate range, where they're getting seen in emergency rooms, doctors' offices or urgent care. They're sent home to care for themselves with fluids, rest and acetaminophen. The large majority of people get better without any deterioration or anything that needs hospitalization."

TJ: Why, then, are we making such a fuss about H1N1, if the majority of us aren't going to be affected?

Giffin: "The big difference between H1N1 and the annual influenza is that the annual influenza tends to make the elderly sick, greater than 65. With H1N1, although not very many get seriously ill, those who do tend to be of a much younger age group."

TJ: What's the reason for that?

Giffin: "The reason is not clear. I don't think that's been worked out at this point. This disease was only detected on the earth about six months ago or a little better. It started in April in Mexico."

TJ: What's top of mind for you, as far as H1N1 goes?

Giffin: "I want people to know that we're trying to get vaccine as quickly as possible and we're doing everything we can to get vaccine delivered but in the meantime, we need to act as a community. We need to pull together and try to do what's necessary to get through this and that includes practising good hygiene, washing your hands a lot, particularly; cleaning surfaces that you may work on or have around your home; not going to places where you're going to make other people sick if you're sick; and seeing your doctor if you get sick enough that you would see your doctor, anyway. If you're pregnant, you should see your doctor at first signs of a disease. If people follow those directions, they will go a long way to managing this disease on a community-wide basis. Although a lot of people will get sick, a lot of people don't get seriously sick and require hospitalization. That's what we're most interested in with this disease. Instead of counting individual cases, we're interested in trying to find out what it is about patients who end up getting admitted to hospital because of the severity of the disease."

TJ: If there is a third wave, when would you expect it to hit and when would it be over?

Giffin: "This is a new disease, so we're going by historical data but there could be another uprise toward the end of the flu season or through the winter. Or it could wait until another year."

TJ: Will H1N1 keep evolving?

Giffin: "Generally they do, although one of the good things about H1N1 is that, in monitoring its evolution, it doesn't seem to be evolving dangerously at this point. I say that guardedly."

TJ: Is there anything else you would like to add?

Giffin: "If you have H1N1 and you suddenly seem to deteriorate and get a lot worse, that's a sign for a medical visit for evaluation. Also, if you become short of breath, that's another sign to get checked out in an emergency room."