Frequently Asked Questions about H1N1 influenza (swine flu) for shelter and other homeless services providers

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Most of the influenza or flu that we are currently seeing is due to a newly emerged flu virus that started in pigs, and mutated into a human form of flu which spreads from human to human. It is the same strain that was circulating last spring.

Fever (oral temperature of 100.4º F) or complaint of fever and chills and cough or sore throat with rapid onset over several hours.

You may also experience one or more of the following:

• Feeling quite sick
• Fatigue, often extreme
• Headache
• Body aches (back legs, arms)
• Vomiting and or diarrhea (more common in children)

Gather information from the client. Help the client sort through how they are feeling to see if they are mildly ill or in need of medical evaluation. Most people will not need to see a doctor.

Clients should not be told to seek medical care if they are not ill (only worried about exposure) or have symptoms for which they would not ordinarily seek medical care.

• Ask them what symptoms they are having.
• Ask them when they first noticed the symptoms. Flu symptoms come on fairly quickly, usually within a few hours.
• Try to gauge the severity of the symptoms by using 1-10 scale, 10 being the worst.
• If you can take their temperature, do so. An oral temperature of 100.4 degrees F constitutes fever. If they complain of sweats and/or chills, they probably have a fever.
• Mild symptoms without fever, without complaint of feeling very sick and without complaint or evidence of extreme fatigue probably do not represent flu symptoms.

If the client is in mild to moderate pain/discomfort and has mild symptoms they are probably able to stay.

We strongly recommend that mild and moderately ill clients stay in one spot as much as possible. Please do your best to accommodate your clients' needs at your site.

• Try to situate them in a comfortable place at as much distance from the rest of the site's population as possible. Encourage the client to lie down and rest. Most will want to do this.
• Prevent dehydration. Encourage the client to drink plenty of tea, water, juices or pop.
• Provide a blanket if possible.
• Provide the client with hand sanitizer, a box of tissues and a plastic bag or lined garbage can to dispose of tissues.
• Encourage the client to cough into their elbow area or cover their mouth with tissues or paper towels when they cough or sneeze. Provide the client with a mask.
• Assure easy access to bathroom if vomiting and/or having diarrhea. Provide basin or bucket if vomiting.
• Check in on the client every 2-3 hours.

Call 911 if the client is:

• Short of breath
• Having trouble breathing
• Has a bluish tint around the mouth
• Confused or "out of it"
• Complains of chest pain
• Complains of sudden dizziness
• Becomes very lethargic, drowsy, or difficult to awaken

Many clients have underlying health conditions that may make them more vulnerable to the flu and its complications, like pneumonia. Be more watchful of your clients who are:

• Pregnant
• Elderly or fragile
• Diabetic
• Heart disease patients
• Kidney disease or cancer patients
• On portable oxygen
• COPD, emphysema or asthma patients
• HIV positive
• Having other serious health conditions

People with underlying medical conditions should be seen by a health care provider as soon as they develop flu symptoms because they can develop complications very quickly.

These clients should be asked if they are feeling OK before they complain of any symptoms so they can seek assistance as soon as they begin to feel sick.

If any clients with these conditions become mildly or moderately sick, enlist the assistance of your on-site RN if you have one, or help the client call their health care provider for advice. If the client has no health care provider, help the client call a local community clinic, ER triage RN, or the Community Health Access Project (CHAP) at 206-284-0331.

If you don't have a health piece on your intake form, you will need to help the client get a list of medications he or she takes and where she or he is usually seen and where he or she was last seen for any kind of medical care.

• Question all clients who feel they have flu symptoms as outlined above.
• If several people are complaining of similar symptoms, try to situate the group of ill people together as far from the rest of the site population as possible.

There have been no unusual adverse reactions to the H1N1 in vaccine trials. It is made and given exactly the same way as seasonal flu vaccine. At this time we understand that vaccine will probably be available in mid-October, with priority groups having first access to the vaccine.

Health Care for the Homeless Network and the Vulnerable Populations Action Team are currently planning several large scale "clinics" to occur at designated locations in the City and the county. We will keep you apprised of our planning and will enlist your help in advertising these "clinics" and getting the word out to the clients.

The community clinics and private providers will have a supply of the vaccine. On-site Health Care for the Homeless shelter RNs will also have vaccine available. (DESC, St. Martin's, Compass Center, etc.)

Yes.

Yes. Seasonal flu shots will be available at the large scale "clinics" as well as at community clinics and private providers and on-site shelter nurses.

• Make sure you and all other staff are well informed and giving consistent information. If you are asked a question you are unsure how to answer, tell the client you do not know but will try to find out, or direct them to seek information or call the Public Health Flu Hotline at 877-903-KING (5464). There is information in English and Spanish. The Flu Hotline provides health and safety information on the current Swine Flu (H1N1) outbreak. If you need personal medical advice, contact a healthcare provider.
• If you are informed and confident, the clients will feel more relaxed and calm.
• Try to get the same message about the flu to as many people as you can at once. If you have any sort of house meetings, call one as soon as possible to let the people know that you are concerned about them, and let them know your agency's plan.
• Let the clients express fears and concerns; let them know this is normal and that you want to address their concerns.
• Emphasize that it is important to be alert and aware and informed. Information changes frequently as the situation develops. We realize this can be frustrating for you and your clients.
• Encourage the clients to seek information from credible sources (on line sources include CDC, WHO, King County, Web MD, Mayo Clinic.)
• There is a tendency for some media outlets to fan the flames of panic, causing distress and worry. Help clients sort out fact from fiction.
• Keep lines of communication with your clients as open as possible. Provide informational handouts and answer questions. Hold house meetings to keep people apprised of the situation as it develops.

Current advice from the Centers for Disease Control (CDC) for people with flu-like symptoms is to stay home for 24 hours after fever is gone without the use of fever-reducing medication. Health care workers are advised to stay home for 7 days after the onset of symptoms or until symptoms are resolved, whichever is longer. This is because they have close contact with people who have underlying medical conditions that put them at risk for complications from the flu. Each agency will determine policy for ill employees.

Once you have had H1N1 you have immunity to the virus, but most people will not know for sure what flu they had, so we recommend you get the vaccine when it becomes available anyway to be sure you are fully covered.

For more information and on-going updates:

• Recorded information in English and Spanish on the Flu Hotline, 877-903-KING, (877-903-5464)
• Public Health - Seattle & King County, www.kingcounty.gov/health/h1n1
• Centers for Disease Control & Prevention (CDC) www.cdc.gov/h1n1flu
• Washington State Department of Health, www.doh.wa.gov/swineflu