Date: 06 Dec 95 18:06:26 EST
From: Mike Darwin &lt;&gt;
Subject: The Flu and You


This is a <A HREF="0034.html">BPI Tech Brief</A>

I am home ill with the flu so I can't number this Tech Brief

The Flu season has begun this year.  In my case it has begun with a
vengance.  Not only has this year's outbreak affected me directly, it has
affected BPI's cryonics response capability and has directly affected a
terminally ill cryopreservation patient.  Hence this report's status as a
BPI Tech Brief.

This year's influenza is mostly of the Type A variety with the exceotion of

California where both Type A and B are present, with Type B being very
common and perhaps slightly predominating (source CDC).

Persons taking large amounts of powerful anti-inflammatory antioxidants or
combinations thereof may have atypical presentations of the flu (and other
illnesses and injuries with an inflammatory component).  In my case I did
not have the characteristic fever which accompanies onsent of the flu and
instead had as my sole presenting symptoms profound myalgia (muscle aches)
with joint pain and fatigue.  I thus mistook my influenza infection for
other problems and, when I felt better after the first few days of muscle
and joint pain, went to do basline cerebral function monitoring studies and

other physiological measurements on a cryopreservation patient who is
immunocompromised, suffering from advanced cancer, and in the final days to

week or two of his/her illness.

Within 36 hours of my visit the patient had a temperature of 104 F,
profound fatigue, a sense of doom... and I had a sore throat and return of
my myalgia.

At the patient's request Dr. Steve Harris began appropriate antiviral
therapy with Flumantadine (a relatively new antiviral effective against
Influenza A if given within the first 24-48 hours of onset of symptoms) and

the patient pursued other medically supervised and appropriate treatment
(antibiotic coverage, etc.).

The patient did fine and went to see a movie the following AM.

I did not do so well.

I have been ill for nearly 2 weeks.  Today is the first day my temperature
dropped below 102 F since Thursday last.  This is without a doubt the worst

bout of influenza I have ever had.  In a sick or elderly person with
limited reserve, it would very possibly be life-threatening or even lethal.

 Even for me it has been very costly; over $300 in prescriptions and many
days of lost productivity.  And I am not out of the woods yet.

I offer the following points for consideration by other cryonicists both
members and service providers:

* We vaccinated our full staff against influenza (the hoped for subtypes)
over two months ago.  Despite extensive exposure to me (including 3 hours
in a closed car for 3 our staff) only one other staff member has become
ill.  Her course was milder than mine, but two of her children have become
quite ill. (We vaccinated 9 staff, 2 became ill, all were exposed for 48-72

hours to a person during his maximum period of infectivity).

* Flumantadine seemes to work.  Ribavirin (400 mg q. 8 hiours p.o. obtained

as Vilona from Mexico) alone, started after the window of opportunity for
Flumantadine or Amantadine therapy had closed *apparently* only suceeeded
in dragging out the course of the illness in my case; temporarily
supressing the fever and reducing the myalia, but not effecting the usual
cure.  Subsequently, this experience has been borne out in two other cases
not involving cryonics.

*Influenza can be a disaster to a geographically tightly knit team.  We are

fortunate in that several of our critical replacement people (like Dr.
Harris) live remote from the lab.  The infectiousness of influenza is hard
to underestimate.  Incubation time is 24 to 48 hours and can completely
disable an entire standby and perfusion team in the same time frame.

*Even for large institutions such as hospitals or schools influenza can
cause closure or in the case of hospitals, life-threating cuts in staffing
and services.

*Patients who are immunocompromised, or are fragile, or ill, are at special

risk.  Once influenza breaks out, such patients should be visited by
cryonics staff with Universal Precautions in place to protect THEM. This is

particularly the case if home visits such BPI makes are done regularly with

more than one seriously ill patient being visited.  Patients and families
should be appriaised of the risks of visitors and crowds, and in the case
of family and friends, of their own contact with the patient as a potential

source of infection.

*The above having been noted, it should also be noted that nothing short of

really good isolation will work if a household member or visitor DOES
become infected with influenza.  In most terminal-care, home hospice
situations this will require a level of infection control precaution that
will not likely be considered acceptable or desirable.

*The hospice nurse(s) may well act as a primary vector or flu from one
terminally ill patient to another.  This is not &quot;immoral&quot; or &quot;wrong&quot;, but
should taken into consideration by cryonics team members, patients and
their families during the flu season.  Formerly stable elderly patients, or

even those with WR 6 HIV or advanced cancer may suddenly decompensate and
die within 24-72 hours from influenza.

*Index of suspicion should be especially high for influenza in the ill
patient who has clear breath sounds and yet has sudden onset of profound
fatigue, a feeling of &quot;doom&quot; or terrible &quot;illness&quot;, myalgia and/or fever
without other sign of infection.

*Immunocompromised and elderly patients may present atypically and not have

fever, or have minimal muscle pain.  Most of the &quot;symptoms&quot; of the flu;
fever, muscle aches, sore throat, head-ache, etc. are due to the immune
response to the virus.  Those with compromised immune function, those on
high dose sterioid therapy (especially those with intracranial lesions on
Decadron (dexamethasone) will be at special risk not only for infection,
but for atypical presentation.  This is dangerous because it may delay
diagnosis and appropriate treatmeant, or preparation for cryopresersation
(as appropriate and consistent with the patient's wishes).

*Competent patients should *always* be offered appropriate antiviral
treatment and secondary antibiotic coverage.  Even if they have expressed a

strong desire to die in the immediarte past, there can be no guarantee that

that attitude is representative of how they will feel when confronted with
imminent death from a febrile illness.  In patients who are not competent
and who have left clear directions not to pursue such treatment, a standby
should be initiated where paid for, as the risk of death in obtunded,
immunocompromised, hospice patients (not on antibiotics or appropriate
antiviral(s)) from influenza approaches 100%.

* Where circumstances permit, as much deployment and set-up of equipment
should be done as early as possible *in all cases*.  In this case, we were
fully deployed a week before the epidemic began and the tubing circuit and
layout of supplies in OR station #1 at the 21st/BPI facility was done at
the same time.  This greatly cuts response time and the amount of physical
effort and quick thinking required to respond to an emergency.

*Try to avoid ingection personally. Wash your hands, avoid crowds, and use
respiratory protection on public transportation during epidemics.  In
particular avoid touching your face; eyes, nose, mouth.  Carrying a small
heavy-duty (freezer grade) Zip-Loc bag with antibacterial baby wipes in to
wipe your hands down before touching your face or eating is an excellent
idea.  Wiping hands after touching push-bars/glass on public doors or
turning off taps in public washrooms after handwashing is also recommended.

Those working in hospital should consider (if possible) continuous
respiratory protection during flu epidemics.

Remember, even you are a member in good health, you do not want to findf
yourself in hospital with influenza or a pneumonia secondary to influenza.

In adults 30 or over, pneumonia secondary to influenza is still nearly 25%
(even with antibiotics!).

*If at any time sanity ever returns to cryonics as a whole, it will
eventually be realized that in addition to earhquakes, coroners, floods and

tornadoes, infectious illness, even something as &quot;trivial&quot; as the flu, can
represent a serious threat to the &quot;response-ability&quot; of any cryonics team.

Try working when your vision is blurred, your temperature is 104.2 F, every

muscle aches like you've run a marathon and lost, and you are shaking with
chills and sweating like pig one after the other without relief.  I was not

even able to *read* a printed page at my worst; and I'm still not over it.

Everyone should give some thought as to what exactly they plan to do about
that contingency; member and service providers.

Mike Darwin,
BioPreservation, Inc.
10743 Civic Center Drive
Rancho Cucamonga, CA 91730