Treating the Flu

Home Treatment Options

Why This is Important

Despite your efforts to stay healthy, you or a member of your family may become infected.  Current pandemic plans from the Department of Health and Human Services identify three treatment options.  If the healthcare system is overwhelmed, these will likely be reduced to one.

Hospitals:  Hospitals are already understaffed, while operating at nearly full capacity.  In a pandemic, hospital patient load increases while healthcare workers will be absent because they are also getting sick.  Doctor's offices and clinics will also experience staff illnesses.

 

 

Alternate healthcare facilities:  Local health departments and districts are working with hospitals to identify alternate facilities that can be dedicated to mass flu treatment.  Examples are schools, convention centers, and motels.  The level of care will not be that of a hospital.  These facilities may also become overcrowded.  Additionally, they are a potential source of infection just like any mass gathering.

 

Home treatment:  The third option. This is the most likely option for people during a severe pandemic.  This option also provides the most time spent with the ill person by a caregiver.

Considerations for Home Treatment of Influenza

1. Checking with your own medical practitioner and the public health department in your own area is the best place to start.  The next section has some guidelines for home treatment to provide a starting point for these discussions.
   
   
2. People who develop flu symptoms should rest and start treatment (including fluids) early, and plan on avoiding others where possible.  Early use of antiviral medication, if available, should be considered within 48 hours of symptoms (speak to your doctor or health department).
   
   
3. Preventing or treating dehydration in people with the flu will save more lives than any other intervention during an influenza pandemic.  This is done with an oral re-hydration solution, described in 'Good Home Treatment of Influenza' (see below).  Check with your medical practitioner for any prescription medications that you may need and buy basic over the counter medications to treat the flu at home.
   
   
4. Creating a "sick room" near or within your house is an important measure to reduce exposure to other family members (see Treating the Flu – Isolation and Infection Control).

Getting Help Guidelines

Again, checking with your own medical practitioner and the public health department for available resources is the best place to start.

 Detailed guidance on home care includes:

• Good Home Treatment of Influenza - Dr Grattan Woodson, MD, FACP 
  
  
• Influenza Pandemic Preparation and Response - A Citizen's Guide.
  
  

The following documents provide abbreviated guidance on home care:

• Howard County General Hospital, Howard County Health Department and The Horizon Foundation have created this guide on pandemic flu for Howard County residents.  In it you'll find information not only on what pandemic flu is and how it differs from seasonal flu, but also:
• Why you should think about an influenza pandemic now
• What you can to prepare for a flu pandemic
• How you can recognize flu from other illnesses
  
• How you can decrease the risk of getting or spreading the flu, and
• When to call the doctor
  
  
  
• Pandemic Flu: How to Care for someone with Influenza (King County, WA)
  
  
  
• SEASONAL INFLUENZA - Influenza Self-Care: It's in your hands (Alberta Health and Wellness) 
  
  
• Home Care for Pandemic Flu (American Red Cross)
  
  

All of the above SHOULD be printed out prior to an influenza outbreak and kept in a notebook.  They are not meant as a substitute for medical advice from your own medical practitioner where available, so start there if you can.

Over the Counter Medications

NOTE:  The following is extracted from "Influenza Pandemic Preparation and Response: A Citizen's Guide," by the Mid-Peninsula Citizen's Preparedness Committee.  

Providing comfort care to family members and friends sick with influenza is a task that will be easier with a good supply of specific over-the-counter  medications, some medical equipment, and a few items from the grocery or hardware store. Acetaminophen and ibuprofen for fever control are the most important OTC medicines to have on hand.

What to Have on Hand for Home Treatment of One Person with Severe Influenza

If you have more than one person in your household, multiply the amounts suggested by the number of people.  For example – for a household with 4 people, have 4 pounds of table salt available.

• Table salt:  1 lb
• Table sugar:  10 lbs
• Baking soda:  6 oz
• Household bleach:  1 gallon
• Tums Ex:  500 tablets 
• Acetaminophen 500 mg: 100 tablets
• Ibuprofen 200 mg:  100 tablets
• Caffeinated tea:  1 lb
• Electronic thermometer
• Automatic blood pressure monitor
• Notebook for recording vital signs and fluid intake and output
• Kitchen measuring cup with 500 cc (two cup) capacity
• Diphenhydramine (Benadryl) 25 mg: 60 capsules
• Anti-diarrheal medication
  

The above is not meant as a substitute for medical advice from your own medical practitioner where available, so start there if you can.

Isolation and Infection Control

Why This Is Important

If you need to treat someone in your house for the flu, you will want to do as much as you can to try to keep the illness from spreading to other family members.

In this section, we will deal with the practical realities of how to isolate someone and provide good infection control in an out-of-hospital setting. Unless we work in a hospital, these skills are no longer taught, as they were in the population before modern medicine.

In order to be able to do these things you need to obtain adequate supplies and learn NOW – once someone is sick, you will want to be able to move fast, and there will probably be no time (nor outside help) to gather supplies.

Guidelines for Minimizing the Spread of Virus 

1. Set up a separate room after a pandemic starts, before anyone is sick.

• Pre-position supplies (see below for a suggested list and amounts). Place hand cleaning materials throughout the house.

• Remove all unneeded items from the room. This will make cleaning and disinfection easier. Consider removing curtains.

• If possible choose a room that is close to its own bathroom. If no separate bathroom is possible, consider preparing for an RV chemical toilet or other separate toilet.

• Choose a room that is as far away from the rest of the family as is feasible. Possibilities include: guest house, mobile home/camper/trailer house, loft above a garage, spare bedroom, partition of a larger room (to be screened off with plastic).

2. Infection control guidelines:

• Separate the sick person from other people in the household to the extent possible. Use a separate room and bathroom, if possible.
  
  
• Limit the number of persons coming into the household to those who are absolutely essential for care giving. No visitors other than the caregiver.
  
  
• Hand hygiene. This means thorough hand washing with soap and water, or using hand sanitizer.
  
  
• Source control. The sick person should cover the nose/mouth with a tissue or their sleeve when coughing and dispose of tissues in a waste container with a plastic bag lining. The caregiver should ideally have a respirator and eye protection on before entering the separate area (masks are non-reusable, goggles need cleaning).
  
  
• Gloves. Disposable gloves should be worn by the caregiver before touching the sick person and while disinfecting the room. Always wash your hands after taking the gloves off. Dispose of gloves in a plastic bag-lined waste container when done.
  
  
• Laundry. Always put gloves on before handling any laundry – bedding, towels, clothing, etc. Carefully place laundry in a plastic bag until time to launder. Wash separately from other household laundry in warm water and detergent.
  
  
• Drinks/Meals. Use disposable cups, bowls, plates and utensils to save cleanup time and reduce the chance of the virus spreading.
  
  
• Household waste. Gloves, tissues, paper plates, etc. from the separate room should be put in a kitchen garbage bag and disposed of with other household waste.
  
  
• Feces and blood. Transmission of the flu virus through feces and blood is possible. To be safe, OSHA recommends using gown and gloves, and treating materials as potentially infectious. Place in a separate bag and then seal the bag and dispose of it.
  
  
  
  

3. Cleaning and disinfection.

• Remove clothing items that are soiled by the sick person and place them in the garbage bag for laundry. Close the bag when done.
  
  
• Clean and disinfect surfaces that are frequently touched by the sick person. Do this daily, if possible. Do NOT use a spray bottle. Use a bucket, and rag or paper towel. A good disinfecting solution is bleach diluted with water.

Guidelines:

1. Wear either new disposable gloves or disinfected reusable household gloves each time the cleaning and disinfecting process begins.
   
   
2. Each day, mix 2 tablespoons of unscented household bleach into a bucket holding 1 quart of water. This cleaning solution will be good for one day only.
   
   
3. Dip a rag or paper towel into the bleach solution and wring it out.
   
   
4. Thoroughly wipe down hard surfaces with the rag, dipping it into the bleach solution as often as needed. Used rags go in the laundry bag for this room. Used paper towels go in the plastic bag-lined garbage can.
   
   
5. Supplies: Gather adequate supplies now and store in a container kept in the room planned to be used for patients. Products and suggested amounts in the list below give an idea for supplies for one person, sick for two weeks. These are rough guidelines only and circumstances will vary.
   
   

• Bleach: One quart of regular, unscented household bleach. This will be mixed with water, when needed, to kill the virus. Important – Bleach has a short shelf life. Replace with a new bottle every three months.
  
  
• Water: At least six gallons, for mixing with bleach.
  
  
• Buckets: for mixing the bleach solutions, as a vomit receptacle, etc.
  
  
• Rags (at least 7) to wipe surfaces with the bleach solution. These can be sanitized and reused. Or, store paper towels.
  
  
• Trash bags. At least 30 sturdy, large"kitchen garbage bags" with selfclosing ties. These will be used for garbage, laundry, etc. (figure 2 per day).
  
  
• Straws. These make it MUCH easier to feed someone in bed. For example, rice cereal can be mixed into a flavored slurry to get some carbs/binders into a sick person, and can be drunk with a straw.
  
  
• Bedpan
  
  
• Hand sanitizer (at least 60% alcohol): Many bottles of hand sanitizer for the sick room and for keeping around the house.
  
  
  
  
  
• Disposable gloves (latex or nitrile if allergic to latex): one box (about 30 pairs) usually about $4/box – is a good start.
  
  
• Respirators: depends on what type you have chosen.
• Reusable P-100s: store 2 extra filters
• Disposable N-95s or N100s: 28
  
  
• Eye Protection: 1 pair of goggles to protect your eyes from a patient's sneezing or coughing.
  
  
• Medical supplies: see ‘Treating the flu: Home Treatment Resources' for medical supplies. Be sure to include the ingredients for the Oral Rehydration Solution. This is critical to keeping the patient well hydrated. Here is one recipe:

Oral Re-hydration Solution

1 level teaspoon of table salt
3 tablespoons of white sugar
Powdered drink mix (for flavoring) in a sandwich bag.

• Using plastic sandwich bags, pre-measure the above ingredients, combining all ingredients into single serving bags. Make a few bags for each family member. Label each "Oral Re-hydration solution."
  
  
• When needed, each sandwich bag is added to 1 quart of water.
  
  
• Include the water in your container. Get fluids in as much as possible, as long as the patient is conscious.
  

For more information, see Rehydration Project

• Drinkable water: at least 14 gallons nearby (one per day for two weeks) – to minimize need to move around the house.

For the rest of the family, consider:

1. Food and Water:        

• Easy, ready-to-eat meals for the rest of the family for 2 weeks while caretaker cares for sick person. Train children now if old enough to be able to help out in a crisis. For example, how to fix their own food.
  
  
• Easy-to-eat food for sick person recovering from serious illness (chicken soup packets, baby rice cereal, ginger ale, saltines, and other, well tolerated comfort foods.

2. Disposable cups, bowls, plates and utensils: Get 3 sets PER PERSON, per day. Using these will minimize spreading the virus and reduce work.

Additional information. The Centers for Disease Control and Prevention (CDC) provided guidance for another contagious disease, Severe Acute Respiratory Syndrome (SARS). Their three-page download (link below) provides excellent guidance on using a sick room at home: Infection Control in Healthcare, Home and Community Settings

Caregiving

Why This is Important

Caring for a seriously ill person is exhausting, even more so if the patient is a young child, if you are a single parent, or if you have little support.  You will need to do the best you can with what is available.

For the Caregiver

You might feel overwhelmed or angry or exhausted.  Those are NORMAL reactions.

You might feel as if you are incapable, helpless, or do not have enough training to do what you need to do.  This too is normal. But you can, in fact, do all that can be done to help, given the resources at hand.  While you do not have advanced training and equipment, the role of the caregiver (whether family or medical staff) is to help the body heal ITSELF.  This includes keeping the patient well hydrated, controlling excessive fevers and keeping the patient as clean and comfortable as possible.  If a patient needs drastic measures, such as being put on a ventilator, the odds are that the patient would not have survived anyway.  You have the ability to treat fevers, to soothe a patient's anxiety, to get the patient to take fluids, and to provide a clean, comfortable area for the patient to heal.

Because pandemic flu is an illness, as opposed to a sprain or a cut, there is nothing that can be done to ‘cure' the patient either at home or in the hospital – the patient's immune system must do that job on its own.

It is important for you to push fluids early and often – at the first sign of disease, or even before if you feel that your family has been exposed.  Stay on top of a fever with various over-the-counter medications as well as physical interventions (lukewarm baths, etc.).

REMEMBER:  YOU cannot cure your patient!  You can help the patient stay clean and well hydrated, which is something that you ARE capable of.  Either the patient's immune system will be able to win the fight against the germ, or it will not.

You might feel guilty for sleeping or eating, but understand that it is NECESSARY for you to take care of yourself as well, as you will be exposed to the flu and/or may find yourself caring for additional people.  Here are some rules to follow:

• Minimize your exposure to the virus by wearing personal protective equipment such as mask, goggles, and gloves at all times and do use infection control measures diligently.
  
  
• Do not be tempted to try to"get a few things done" while the patient is sleeping.  Sleep when the patient sleeps.
  
  
• Eat and drink as often as possible.
  
  
• Assign household chores to other members, so that you can focus on care giving.  Delegate.  Even young children can do basic chores.
  
  
• If there is no one else to help, then ONLY take care of the most basic tasks such as feeding yourself and your patient, cleaning only what MUST be cleaned, etc.  Leave the rest for when the patient is healed.

Do not berate yourself for being exhausted, for crying, for feeling irritable or angry with the patient or with other members of the family, or for taking time to address your own health needs.  It is not possible to be unaffected emotionally when taking care of a very ill loved one, especially under such unimaginable circumstances as a pandemic.  

When the burden is becoming unbearable, if you find yourself losing control in ANY way, you must take a break away from the patient, for your sake AND for theirs.  Find a private corner of the house to cry, rest, read, eat, anything that will help you regain control.  

Additionally, schedule REGULAR breaks, preferably once every two hours or less, throughout the day, even if you do not feel overburdened.  These can be short, 15 to 30 minutes.  However, schedule them often, and stick to the schedule.  This does NOT include sleeping time.

Taking these short "calming" breaks will enable you to do more for your family.  It is better to take small breaks now and then, than to be incapacitated due to emotional or physical exhaustion.

If the Patient Dies

Understand that this is a very serious illness. It is possible for you to do everything perfectly and the patient still get worse or succumb and die. While this is frustrating and heart breaking, do not allow yourself to accept guilt or blame. This is a serious, severe illness; even with the best intensive care and medical treatment, there is no guarantee that patients would survive it. Do not allow yourself to dwell in the"if only I had" or"what if" types of thinking. You have done all that could be done.

As a caregiver, you might also find yourself feeling relieved if the patient does die. This too is VERY normal! This reaction does not mean you are hard-hearted or you did not love the person. It means the circumstances were likely more difficult than anything you have ever encountered.  You may feel relief that you can finally rest, and that your patient is not suffering.  Now you are not under the stress of having to do everything "perfectly" to try to keep the patient alive. This is a very normal reaction.  Feeling relieved means that you are exhausted - mentally, physically and emotionally.  You have had to function under the most trying of circumstances.  These are circumstances that even the most well trained doctor would find unbearable.

REMEMBER:  Take care of yourself as well as the patient.  Delegate what you can.  Take moments out of EACH day to relax and recharge.  Understand that you might feel everything from depression to anger to numbness to relief, and that those are all normal human reactions.  These do not reflect a lack of love for your patient.

Again, it is possible to have done everything perfectly and the person still to have succumbed.  That is how severe this illness is.  You did the best you could.  The rest was completely out of your hands.  The patient will have died in familiar surroundings with someone who cared for them, which is how most people would want their last moments to be like.  It was a blessing that you gave them.  You did the very best you could, and it was good enough.

Caring for the Caregiver

If you are not the primary caregiver, it is your job to take care of the caregiver. 

• Enforce rest periods!
  
  
• Take every daily chore that you can off of the caregiver to give them a chance to focus on the patient.
   
• Provide food and water for the caregiver and the patient, and clean up afterward. 
  
  
• If you see the caregiver becoming upset, angry with you or the patient, or anything else, allow the caregiver to vent their frustrations WITHOUT taking offense or criticizing in ANY way.

This is not about you or the patient.  This is about a human having to do the impossible:  watch a loved one suffer, feeling fully responsible for their suffering, and yet unable to ease their suffering.  NO human can handle that with ease or grace.  YOUR job is to be the quiet, calm, cool rock that the caregiver can lean on, or crash against.  Even if that is not your normal relationship role, this is what is needed from you now.  It is your job to take care of the caregiver.

For the Patient

If someone has been sick, require that the person stay in bed AT LEAST a week (some experts recommend 3 weeks) AFTER he or she seems fully recovered.  This is a long-term illness, and there are many reports of"recovered" patients suddenly dropping over dead when they tried to do too much too soon.

Caregivers should do what they can for the patient's morale: provide constant and calm reassurance, removing themselves if they (the caregiver) are upset or angry, and reassuring the patient that they are not a burden. Remember that walls are thin - the patient might be able to hear if the caregiver leaves the room and tells others "It doesn't look good" or "I am just so tired of taking care of her" or things of that nature.

For the Caregiver, Again

Even the best precautions of isolating the patient and washing will probably not prevent others from getting sick.  Self-doubt will creep in…

"I was the only caregiver, but the rest of the household came down with flu and someone died, did I mess up?"

"Was I not careful enough?"

"One time I was too tired and left the sickroom without hand sanitizing.  Is that the reason why someone else died?"

"Was it my fault?"

It is VERY important that you understand that the germs are in the house anyway, and people are contagious before they show symptoms.  The techniques discussed in "Treating the Flu – Isolation and Infection Control" are good precautions, but there is no way to keep germs from spreading throughout the house once they are in the house.  However, it is possible to protect your family BEFORE influenza gets in the house by maintaining a strict "Shelter In Place."
(see"Staying Healthy – Good Practices").

Much of the following is extracted from Influenza Pandemic Preparation and Response: A Citizen's Guide, by the Mid-Peninsula Citizen's Preparedness Committee.  The guide is in the public domain under the Creative Commons Attribution-Share Alike 3.0 United States License.

Dealing with Death

Why This is Important

One of the most unfortunate and inevitable aspects of a pandemic is the increase in death rates in the community.  This increase might be small or may be catastrophic, depending on the traits of the pandemic flu strain.  Even in a moderate pandemic, the coroner's office and mortuary services are likely to become overwhelmed, and families might have to deal on their own with the deaths in the household.  This page gives basic information that families can use if they have no guidance from official sources.

What to Do When Someone Dies At Home

• Call your local police department.
  
  
• If no physician was in attendance, the police department may call the coroner to make a ruling on the cause of death.
  
  
• Be sure to obtain a copy of the death certificate. A death certificate is required for benefits, for insurance, and other purposes.
  
  
• While risk of infection is considered minimal, wear protective covering (gloves, mask, etc) when handling the body.  Wrap the body in plastic and secure with strong tape.
  
  
• The body would be safe in the house for about eight hours depending on the temperature inside the house. After this time it would become a health issue.  It is best to place it in the coldest environment possible, outside the house, and away from water sources, including wells.  Protect the body from predators or scavengers.
  
  
• Put towels and other cleaning supplies used with cleanup of the body in a plastic bag and tie it closed.  This will minimize further contamination and illness.
  
  
• Consider having a little service at home, allowing children to say goodbye.

How to Know if Someone Dies

To determine the death of a person, check for a pulse in the neck area over the carotid artery by pressing lightly over the artery. This will take about 30 seconds. Put a hand on their chest to feel if the chest is rising, or a small mirror in front of the nose and mouth to determine if there is any exhaling. After a small amount of time, the body will start to change from a normal complexion to a pale color.

After the person has been dead for a time (depending on the temperature of the room) the body's muscles will start to stiffen (Rigor Mortis), and the blood will pool to the lowest areas in the body, causing a bluish color.

Record and Keep This Information with the Body

• Date/time found
• Exact location found
• Name/other known information
• How identified, when and by whom
• Your name, contact information

What Can and Cannot Be Done

• Under no circumstance attempt to cremate a body. Cremation of a body needs to be performed at a very high temperature in an approved crematorium to insure that health issues are addressed.
  
  
• Under extreme circumstances where timely body pick-up is not available, the body can be buried in a well-marked grave.  If a grave must be shallower than one meter (between 3 and 4 feet), pile heavy rocks on it to keep animals from digging there.

Some Things to Consider

In the event of a pandemic, professionals dealing with the deceased will most likely be overwhelmed.

• It may take days, if not longer, for the body to be picked up from your home.
  
  
• With infrastructure damaged, the ability and capacity to store, transport, and process bodies may be severely disrupted, depending on the area and stage of the pandemic.
  
  
• While it may take longer for bodies to be picked up, authorities will do everything they can to retrieve the body in a timely manner.