When it comes to the H1N1 flu (aka, "Swine Flu"), none of us really knows what we can do.  We hear conflicting predictions about the severity, or possible severity, of the problem.  We hear conflicting messages about recommendations with regard to whom should receive the vaccine (a vaccine, which, by the way, too few people know very much about).

In a matter of three or four days I've read conflicting messages from some of the only sources we have to rely on:  One that says that as many as 90,000 people could die as a result of this flu.  Another that says things aren't likely to be that dire.  In a matter of two days I've heard those conflicting messages about who should be vaccinated.  One was that, because of limited amounts of vaccine, the recommendations will/should be vaccinated  (I'm being careful to cover myself in the event I wasn't listening closely enough to the expert being interviewed) that only people with exposure to a lot of other people get vaccinated.  This individual stated that elderly people should not need the vaccine in that situation, since people out and exposed to many others will not bring the disease to those not out in public very much.  Today I heard yet a different message (yet again) that mentioned the "usual candidates" for vaccination.   

A young physician who, herself, along with her son,  contracted H1N1 flu said she would definitely get the vaccine, based on how "miserable" she and her son had been.  Then again, she and her son did live to tell about how miserable they had been when they got the virus.   The fact is, as with all flu, not everyone who gets the virus dies - only some do.  That "some", however, could include a very large number of people.  We don't know.  What we do know is that each year in the United States alone, over 35,000 people die as a result of getting "regular" flu.  Here's another question a lot of us may be asking:  What kind of numbers are we talking about if we add "regular flu" victims to "Swine flu" victims?    Since each flu vaccine is designed specifically for each strain of flu, how would getting a Swine flu vaccine affect whether or not we get a "regular flu" vaccine.  Can we get both?  Does anyone know what kind of negative consequences might occur as a result?    Should we all just hunker down in our homes for the Winter?  (Impractical and paranoid as that probably seems to most of us, I have to admit it sounds kind of tempting.)

Soberingly (and, for all I know, based on insufficient information),  a comparison of the flu epidemic of 1918 was brought up.   My late mother-in-law, along with her four siblings, had been orphaned by that epidemic.  She was six years old when her parents died and when she was sent to an orphanage with her siblings.   Although she never spoke about life at the orphanange, she would speak about how close she and her siblings were, and how the eldest watched out for the younger siblings.  She would also talk about how terrible it was to lose both parents so young.

As I suspect so many others have, I have concerns about what a massive flu "strike" might hold for my family.   As of this writing I still had no idea about when any vaccine will be available, whether or not anyone in my family or I will be among the people recommended to get it; or any number of other things about the vaccine or the risks in getting it or not getting it.   

Naturally, I've considered all my family members and whether or not I see them as at high risk of contracting the virus.  My children are grown, and my daughter works with elementary-school-age children, so that's a concern.  One of my sons works in the city and uses public transportation much of the time.  He has roommates and co-workers; and, of course, I, as his mother have no control over how careful they are with their sneezing, coughing, and leaving germs around.  My other son lives in another city.  He, too, uses public transportation at times.  He has asthma, so that's a particular concern.   The list of family members goes on and on, and (as the old "Magic Eight Ball" says) "all signs point to" everyone seeming to be at risk.  I remind myself that many, many, people have contracted H1N1 flu (and other flu, as well, over the years) and recovered.  That's the thought I have to hang onto right now.

With little kids flu can be even more frightening, but then again parents have some control over what some of the littlest kids are exposed to.  With grown children, all I can do is hope they take sufficient precautions (like hand-sanitizing and not inviting sick friends to "come over anyway", things like that).   I make a mental note of thinking of all the reasonably realistic precautions (even if some border on seeming like germ phobia) and planning to remind my grown children of them.  I also make a mental note that grown kids often think mothers are "too much" when it comes to worrying, and I start to realize how a lot of my reminders about precautions will most likely be disregarded.  

In any case, as I go over what I can do about the flu scare the first thing on the list is talking about precautions with my grown sons and daughter.

What else can I do?  Being something of a germ-phobic anyway, and after getting some kind of "flu thing" last Spring (before H1N1 was first detected in the U.S.) and taking, truly, months to get over it; I'm already a little paranoid when it comes to touching things like shopping carts and door handles in public.  I've been carrying around a few different hand santizers, as well as moist towelettes, for ages.    There's also always a mini-can of Lysol disinfectant spray in my handbag.  (I've considered keeping inexpensive, sandwich-sized, plastic baggies in case I want real protection against germs, but up to now that has seemed extreme.)  It has occurred to me that I kind of wish everyone would just start wearing masks, so then those of us who sort of wish we could wouldn't feel so weird; but do we really want children wearing masks in public?  I think most people would think not, unless, of course, the disease becomes a very, very, big; serious, and realistic threat.  (The thought of "sort of wishing everyone could just wear masks" is probably not one that has occurred to me, alone.)    I decide to, perhaps, be yet a little more vigilant when it comes to hand washing and trying not to touch things in public; but I'm not sure I can do much better than I am already.

In public places I try to open doors "surgeon style", using my forearms, rather than hands, to push open doors.   Being without any particular orthopedic problems,  if I think I will benefit from using a handrail on stairs I'll use my wrists as some version of a "balance stabilizer", with the idea that my hand will be close enough to the rail if I sense the need to suddenly grab it to prevent a fall.    

Someone on the radio today said how infections from MRSA, as well as other bacteria and viruses, have been effectively eliminated when a hospital has incorporated the practices in terms of sterilization, cleaning, and hand washing.  At the same time, hospitals that don't take such careful measures continue to be places known for spreading infection.  The trouble is that most hospitals, with an "average awareness" of infections don't take effective enough steps in preventing infection.  That, of course, leads me to the concern (when it comes to the flu), "If doctors and nurses don't always, and automatically, just take adequate precautions against infection; how can we believe that the general public ever will?"   I think we've all seen people leave stalls in public restrooms and head straight for the door.  An awful lot of us have witnessed someone's sneezing on the produce in our grocery store.   How many of us have seen workers at fast-food places put something like a coffee stirrer down on the counter, where everyone places his order, as well (often) his hands?  Oh my goodness - is it all just hopeless?

Besides concerns about not getting H1N1 flu, we all need to be concerned about not spreading it if we do pick up the virus.   We used to hear that when we cough or sneeze we should cover our mouths with our hand.  ("Eew, gross," was always my thought; so long ago I began aiming to use a tissue, and when that wasn't possible I'd use the crook of my arm, reasoning clothes can be washed; and in the meantime, I wouldn't be touching things or people with that part of my arm.)  Today, the "official" recommendation has changed to match what many of us thought was preferable for a long time.  

Being careful to discard tissues into closed containers or bags helps prevent spreading germs.  It isn't good to just toss them in a small bathroom trash container that isn't covered.  Tucking them into pockets where keys and cell phones may later be placed isn't good either.  Proper disposal isn't just about used tissues.  It's also about used straws, disposable cups and flatware, cigarettes butts, or anything else that may have been contaminated with saliva or other "droplets".

Speaking of cups, they and all other dishes and flatware have the potential of spreading flu germs if we aren't careful.   They shouldn't be left out and around and uncovered once they're clean.  Germs are in the air, and there's no way to no if H1N1 germs are among them.  This might be the Winter when it makes particular sense to make sure whoever washes the dishes is mature and conscientious enough to prevent unnecessary contamination.  The same applies to anyone handling food.

Reminded that we can't count on the general public (or even doctors and nurses) to always take the best steps in preventing infection; my thoughts turn to the one place where I have some control - my own home.

Also on the radio, I heard someone say that sanitization in buildings is one of the most important steps to take.  "Buildings" means homes too.   While hunkering down in our homes and not having visitors would help us avoid the flu, that's not the existence most of us want (at least without not having local health authorities officially quarantine our homes).   Remember, too, that unless we become even more paranoid, the mail delivered to our homes has not been sanitized.   It occurs to me that even if I don't plan to hunker down in the house for months (or years?), maybe I should return to the practice I had when anthrax scares were associated with the U.S. mail - immediately open all mail when it arrives, discard the envelopes, and wash my hands.  (That practice was based on the idea that it was unlikely anyone would target me with anthrax but that residue might get on my mail if any anthrax ended up at the Post Offices processing my mail.)    It occurs to me that even if someone doesn't want to be that "paranoid", it may not be idea to always have one place to put unopened mail; and make sure that place is one that can be disinfected with spray or wipes once there's no mail on it.   The chemicals used to sanitize homes and buildings, though, pose their own threats, especially to young children and anyone who may have/develop allergies.  This is something to keep in mind when selecting products used to sanitize.  Hot water, steam-cleaning, and sunlight should not be overlooked.   (A Boston news station tested objects in public for bacteria.  It was found that things like park benches were actually almost sterile, while the table at a mall food court was most dramatically contaminated.   Items that were exposed to sunlight had been naturally almost sterilized.)

Assuming health authorities don't quarantine my house, there is a germ-carrier that poses a bigger threat than the mail does - visitors.  How many times has any of us had a guest show up, just get inside the door, and then announce, "I feel like I'm getting sick."  Worse - how about the ones who show up coughing and sneezing?  (Note to self:  "Don't forget to announce to everyone you know that you've just spent months getting over last April's virus, so nobody who thinks he's getting sick, or IS sick, is welcome; and you assume they'll more than understand.")

When it comes to cleaning the house it seems simple enough to continue to clean surfaces, doorknobs,  appliances (especially refrigerator handles and washing/dryer buttons) with a good, disinfecting, cleaner.  Cleaning telephones (including germ-growing cell phones, which are often tucked away in incubating pockets and purses), computer mouses (mice?) and keyboards; and, of course, sinks and faucet handles are a sensible idea.   I'm not sure if I can make myself go this far, but it occurs to me to remove the toilet tank/lid set in order to make cleaning more effective.

Cloth, upholstery, and rugs can always be washed.  How often it would be necessary to wash such items, though, would probably depend on whether or not flu germs had made their way to these items.   The point is, though, that truly sanitizing a home (a building) would include fabrics and rugs too.  There's always spray disinfectant.  

Although I know it's flammable and must be used with care, I already keep isopropyl alcohol in a spray bottle in the bathroom for quick spritzings of faucet handles and the handle on the toilet.  Keeping a good liquid soap (and remembering to rinse the pump handle on that too) is a good idea.

Frequently cleaning counter-tops, table-tops, desk-tops, and other surfaces is important.  One thing to consider with regard to that is that surfaces without things on them are easier to clean than surfaces with several items on them.

Part of sanitizing also includes floors.  How to clean them depends on what they're made of.  Something to consider with floor-cleaning is that chemicals in cleaners get on pets' feet, and pets have been known to become very ill when they get chemicals from floor cleaners on their feet and ultimately in their systems.

Something often overlooked by people who otherwise exercise caution when it comes to contamination are things like women's handbags, library books, or kids' book bags.   These are objects that are often exposed to germs in public places and that may be then placed on tables (at home or elsewhere).   Paying attention to where these objects are placed makes sense, as does cleaning them more often than many people do.

Most risk of contamination comes with objects and surfaces that are touched, with those touched by the most people being the biggest problem.   (Light switches may be small, but the switch-plate around them can hold quite a few germs.  When it comes to children and light switches, the smaller the hand, the more likely it is the switch-plate will get a lot of touching.)   Not too many people are very likely to be disinfecting their walls, windows, and ceilings daily; but it may not hurt to mention that if there's a wall, door frame, or window sill that is frequently touched by young children it probably wouldn't hurt to give those isolated areas a cleaning regularly.

 It is said that frequent and effective hand washing is one of the best ways to prevent getting and spreading infection.  If nothing else, I hope that message gets out and gets into the heads of people who tend to be careless about hand washing.

Some people are more cautious than others when it comes to aiming to prevent spreading germs.  I'd like to think that all those less cautious people might start to take infection prevention more seriously, now that we may be facing the biggest flu scare in most of our memories.  The truth is, all any of us can really do is everything we possibly can - but that won't be enough, we all know that, and we all remain pretty nervous about the near and not-so-near future.  The fact is, though, that even if the above practices (with the exception of the daily cleaning of walls and ceilings) seem a little extreme, most of them are things that many "clean freaks" (and by that I mean  "clean freaks" who would be considered "normal" and who don't have Obsessive Compulsive Disorder) do all the time.   For those not accustomed to such diligent practices, it's actually not that difficult to incorporate them once aware of them and after getting a little more accustomed to them.

Another fact is the potentially deadly flu we manage not to get ourselves may also be the deadly flu we spread to someone else (maybe someone's child or someone's beloved and elderly parent or grandparent).

As I think about this H1N1 flu and all that remains unknown about what will develop, I don't pretend I'm not deeply concerned.    Then again, I think of three times in my life when being careful were extremely important and apparently very effective:

The first was when my baby was born 6 weeks early and was in a special-care nursery.   I was going in to feed my tiny boy several times a day, but I got an upper-respiratory virus and was worried about exposing my baby to it.   The doctor assured me that washing up and wearing the gown and mask would mean my baby was safe.  Even so, I was uncomfortable about it; but, of course, I didn't want to leave my baby without my holding him, feeding him, and talking to him.   Maybe my worries were just the "paranoid" worries of a mother of a premature baby.  In any case, all was fine.

My second story involves the time I was the only one who could change a dressing my mother had after surgery.  As I often apparently do in times when it's most important I don't, I got another upper-respiratory virus.  My mother was elderly and had just gone through surgery.  I saw it as critical she not get a virus on top of everything.  There was nobody else to change the dressing and otherwise care for her, so I used real care while at her house; and that meant washing my hands just about after touching anything at all and before touching or handing her anything at all.  It worked.  All was again fine.

Finally, there was the time my eldest son (in third grade) got Chicken Pox.  My younger son (the "premie") had spent his first few years with particular vulnerability to respiratory infections.  My daughter was a newborn.   I hoped I could prevent the two little ones from getting Chicken Pox that particular year because I thought it would be better if they were older when they got it.  When I talked to the pediatrician he confirmed that it wouldn't be great if either of the little ones got the childhood disease, but he said, "With Chicken Pox all you have to have is someone who walks in front door - and everyone in the house who hasn't already had it will get it."  With those less-than-encouraging words from the pediatrician, I decided I'd try to prevent the little ones from getting sick that particular year.    

I asked my ever-cooperative eldest child if he'd please stay in his room while he was feeling sick (and since he felt as miserable as he did that wasn't a difficult request to honor anyway).   Then, as well as later when he felt better, I asked him not to touch any of this little kids toys or belongings.   While he was in his room I made sure to go in to be with him often, and the only measure I really took other than keeping him in his room and asking him not to touch his brother's or sister's things, was to be vigilant about my own hand washing.  We got through that Winter without the baby or my little son getting Chicken Pox.  In fact, the two younger children didn't get that disease until they were in elementary school and past the risks that would have been associated with their getting the disease earlier.

The moral to each of these little stories is that good hand washing and being a little careful DOES make the difference between someone getting sick and not getting sick.   It's with this thought that I reassure myself about whatever may happen with H1N1, and it's with this thought that I leave the reader.