www.CostaRicaTicas.com

I asked my pharmacist here in Chicago, just out of curiosity if he had any of this new flu medication. He said he already ran out and then said don't you dare travel anywhere.

I have had enough. Is this epidemic panic or for real? Top experts on US epidemics said yesterday that the worst case scenerio is 1,700 cases in the country over the next month. It was all over the news and papers. That means you are in more danger if you just walk outside your house. That should barely be news since outside the nation of orgin this is no more than a severe cold virus unless you are very young, weak or ill.

To make matters worse a friend told me he went to a local gentleman's club last night and some of the dancers were wearing facemasks and gloves and giving dances. I have been to that club and my first impression was some of those girls would probably do more business if they always wore facemasks. But seriously is this not going too far.

I am concerned because I have planned a business trip to L.V. in less than 2 weeks, plus a pleasure trip to the D.R. next month, and another trip to C.R. shortly after that. I am not as concerned about the virus as I am about the panic. Could the panic cut down on my pleasure?

I wish if there is anybody in any of these places, could you keep us informed on the situation if there are any changes. I am looking forward to these trips.

I know in TJ the numbers of available chicas are way down.Many are staying home.Probably not as dramatic a response in CR.

IMHO, I wouldn't use the over-reactions of some stupid dancers, panic buyers or nervous nellies on this board, as any sort of basis to assess the situation. If I were you, I'd go with your gut which seems to be telling you this is mostly much ado about nothing.

Let's try some sloppy math for a BOTE estimate of risk here (with ID's indulgence ). If you take that WORST case and increase it by a factor of 10, it would still come out to a rate of less than .06 per 100K people. That is less than 100th the murder rate in this country, which means you have a much greater risk of being shot by someone if you go out than catching this virus. How much do you normally worry about that? It also means that you have twice as much chance of DYING from REGULAR SEASONAL FLU (which kills 35K people each year in the US) than you do of merely CATCHING this swine flu.

And even if you DO catch this flu, that doesn't mean you're going to die. So far there has been only 1 fatality in the US and that was of a baby from Mexico that was already really sick for at least the last 3 weeks (btw, NONE of the immediate caregivers in the baby's family who were in close contact with the baby have become ill). Of course, there are bound to be some more US deaths as this flu spreads, just as there are from regular flu. Even looking in Mexico, so far there have "only" been some 150 or so deaths out of more than 2000 people suspected of being infected and there are probably even more people infected than that. I suspect the main reason why there have been more deaths in Mexico is because the people who INITIALLY got it didn't realize how potentially serious it could get and let it get a lot worse before seeking treatment. And that theory seems to be supported by the fact the 150 death figure hasn't increased significantly in days and more recent cases seem to be responding to treatment. But even so, we're looking at a mortality rate of less than 10% at this point in time, which is bad but hardly anything like a death sentence.

This flu is expected to spread some more over the near term before abating naturally over the summer season as flu viruses normally do. Or course, it COULD come back with a vengeance next winter but, hopefully, they'll be have enough time to come up with a vaccine and mass-produce it between now and then. Let's all hope so AND that it proves safer than the last swine flu vaccine that they came up with 30 years ago.

I accept Prolijos math as a good guideline regarding the risks, percentage wise.

That being said, there are precautions that seem worth taking. Why? Because minimizing the spread of the disease will save lives.

What steps are reasonable?
Staying away from large groups of people makes sense.
Not being in confined spaces with large groups (airplane, subway, the DR).
Frequent washing of hands.
Not touching your face unless you have just washed.
Cough or sneeze into your elbow instead of your hand.
Quarantine yourself if you have symptoms.
Avoiding any kissing with sex workers sure seems reasonable.

Mostly common sense stuff, right?

Now the silliness:
What good will wearing gloves do?
The gloves will become contaminated just like the hands would be. The gloves will spread the disease just as fast as your hands. The risk to the wearer does not reduce because of gloves. After all, the disease does not enter the body through the hands.

The classic surgical blue mask that you see everyone wearing on tv are essentially worthless. Why?
Because the virus is too small to be stopped by the porous masks.

Of course, an infected person wearing the mask will help minimize the spread of disease.

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It is cheaper to pay now and get it over with.
It is also easier to get them to leave.

Thanks TnV for the common sense.

Another problame with the masks is that even if the porosity of the weave would stop the virus, the masks gap at the bridge of the nose and sides of the mouth. Surgical masks are used by doctors so as to not infect the patient, not the other way around. So why is everybody wearing the masks? I believe it is because we are basically self-serving. If the Mexican government told the people "These masks won't protect you, but they'll protect others," nobody would wear them. Instead, the masks are distributed, the folks wear them and feel safer, and the transmission of the virus might be reduced. Most folks who don the masks don't realize that they are for the protection of others.

Yes,, all the stuff TnV wrote above is absolutely correct. Here are a couple other points:

1. Hand sanitizing gels/liquids are not magical. They are only as effective as a good scrubbing with soap and hot water. However, if you can't get to a sink and soap, these substitute nicely. But don't expect any special protection from antibacterial hand sanitizers

2. This flu virus can also be spread through unprotected sex of any kind. If it's a bad idea to kiss sex workers, it certainly is an equally bad idea to accept BBBJ. Sorry.

3. If there are cases reported in any of the hub cities where we switch from our domestic flights to the international flights (Houston, Miami, Atlanta, L.A.), it might be a good idea to delay your trip if possible.

4. Build up your immunity by taking vitamins, hydrating yourself and getting plenty of sleep, good food and exercise before your trip. Being in better general health will help you recover from any flu faster.

5. Presume if you have any symptoms that you are contagious. As TnV says above, quarantine yourself.

6. Finally, don't panic. Unless you are among the risk groups (very young, immunity-compromised, chronic respiratory problems or very old age), you'll probably be fine even if you catch this bug.

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Pura Vulva! Wandering through the dark, I am El Ciego.

Well since we want to rule out stupid dancers, panic buyers and nervous nellies on this board (if they change their mind and recommend you go do they become fearless freddies?) lets ask the medical professionals.

In my case 3 of them the first a retired MD from Florida who now lives here, my personal physician at Clinica Biblica and my brother in law a retired MD from New Jersey all advised against me taking my planned trip to the U.S. next week.

Obviously each case is different so you have to seek out competent advice and make your own informed decision and not rely on advice from nellie or freddie.

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Pura Vida
Only Irish coffee provides in a single glass all four
essential food groups:
alcohol, caffeine, sugar and fat.
Alex Levine

Geez, El C.......you have really rained on my upcoming parade. ....

I may as well figure on catching the flu in CR towards the end of May.

The professionals that I'd rely on are the CDC and WHO. They haven't put in force any ban on travel but they have ADVISED against "NON-ESSENTIAL" travel TO MEXICO and they have NOT advised against travel to places other than Mexico. And that is speaking on a widespread basis because they don't want this virus to spread any more than it already has (and actually its already too late for that). But individual cases may vary. No one knows who has this or who doesn't. So if you can avoid coming into contact with someone who may have it or accidentally spreading it yourself, why take any chances?

For all I know I may already be infected but not yet symptomatic and might help further spread the disease if I get on a plane. I highly doubt it, but it's certainly at least possible. And, in particular, anyone who suspects they may be coming down with SOMETHING even if they aren't sure its the swine flu should DEFINITELY delay their trip.

Besides that, even if we're currently completely healthy, going into an airport and getting on a plane where we cross paths and share air with people traveling from only god knows where, puts us at even greater risk of coming across the virus, catching it and spreading it to someone else than simply going out on the street or to work. After all, like El C pointed out, even if we're just going to CR, there's a larger likelihood we'll encounter someone just coming from Mexico when we pass through places with other international travellers. However, avoiding having to get on a stuffy tightly packed plane with international passengers is hardly the same thing as people in general wearing paper masks, of highly questionable effectiveness, at this stage of the flu cycle, as those silly and ignorant dancers were doing.

If you HAVE to travel internationally on business and CAN'T put it off, then do it (taking the other precautions that El C qnd T&V laid out of course). The chances are you'll be perfectly fine. If you've already scheduled a trip and can't cancel it without financial penalty, then you'll need to assess what sort of risk you're willing to assume (it may not be great but it is there) and decide whether it is worth it for you. With just 2-3 cases of swine flu in CR from a couple of the many flights from Mexico, I'd have to say the risk of coming down with swine flu from a flight to CR from the US has to be insignificantly small. However, if you haven't already booked a trip, personally speaking, I wouldn't say now is the best time to do it. Right now the situation doesn't seem to be too severe, but even if it isn't things can change rapidly and by the time you take your trip. It seems prudent to me to at least DELAY all discretionary foreign travel until we know with greater certainty which way this thing will go.

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btw, are ALL masks ineffective at preventing the spread of the swine flu or just the cheapie disposable paper masks that they've been handing out to the general public. I suspect that the reason the Mexican government has been handing them out has as much to do with PR and making the public THINK they are on top of the situation so they can FEEL safe as it has to do with slowing the spread of the virus. Anyway, I heard somewhere that the N95 respirator type masks ARE effective (but maybe that just means against TRANSMITTING it as El C said). Another thing that strikes me as silly is when I see people on TV wearing the masks incorrectly such as over the mouth but not the nose or without the nose wire pressed down. I also wonder, how much these poor people are reusing those disposible masks which are designed for one time use since you see people alternately putting them on or pulling them down to hang on their neck when they don't feel like wearing them. Are they aware that when they're through wearing the mask they're supposed to wash their hands thoroughly after handling the mask each time and dispose of the mask as medical waste? Finally, I also wonder how many people get a false sense of security and think those face masks will protect them and thus are less averse to going out in public during this situation when the best course of action is really to avoid those crowd situations altogether.

Prolijo,

I heard a radio interview yesterday with the head epidemiologist from the U. of Minnesota who has devoted his career to researching influenza. He said, regardless of the type/cost of the masks, they are ineffective. This is not due to user error, manufacturing flaws, or even in differences between masks as far as porosity goes. It is due to the basic design of all such masks, which will inevitable allow passage of unfiltered air through open areas between the face and mask. He also said that the only type of mask that would be effective would be a gas mask type of arrangement with a sanitized silicone seal around the mouth and nose, combined with a HEPA filter...

What he said was a bit politically risky on several fronts, not the least of which is that Minnesota's largest employer, 3M is one of the principal providers of breathing masks, such as the ones being distributed in Mexico at this time.

Hope this answers your question. Hey, maybe you can find a surplus Israeli gas mask (I mention Israeli, because IMI manufactures more gas masks than anyone else in the world, the Israeli people buy/refresh gas masks as a matter of course, and surplus masks of high quality are readily available). Might get you some strange looks going through TSA, though.

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Pura Vulva! Wandering through the dark, I am El Ciego.

When the CDC and WHO are as familiar with my medical history as my personal physician is then perhaps, I might, give their opinion equal weight. Until then I will continue to follow the advice of those medical professionals who are a little more familiar with my particular situation.

_________________
Pura Vida
Only Irish coffee provides in a single glass all four
essential food groups:
alcohol, caffeine, sugar and fat.
Alex Levine

My daughter who is a nurse in the military always carries a package of sanitize wipes. When she gets on an airplane she wipes down everything where she is sitting or where the K*ds will sit.

Today, I went over to the Target store in East Los Angeles (a predominately Mexican, Mexican-American area) and all those sanitizing wipes were sold out as well as the hand gel sanitizers, etc.

I have been on six flights (in-side the US) since this scare started and have been scrupulous washing my hands thoroughly and regularly (about every hour), avoiding touching my face, and drinking lots of liquids including liquids which may or may not kill germs -- large quantities of Scotch - but it is fun trying!

Apparently, you must have some special condition that puts you at greater risk than most people since what your personal physician recommended for you is so at odds with the GENERAL advice that is coming from the public health professionals. If I had some special condition instead of the typical good health I do, I'd probably check with my personal physician too and anyone else who had some special condition (like suppressed immune system from AIDS, SARS, chemo, congenital causes or simply advanced age, or perhaps like a pre-existing respiratory weakness). Since there is nothing special about my own personal medical history (other than a complete lack of anything beyond your usual childhood diseases), I think I can safely rely on what the epidemiologists, viral influenza specialists and other experts at the CDC and other high level public health institutions are saying rather than having to refer to my own GP.

You did say in your original post "In my case ... [they] advised against me taking my planned trip ..." and you added "Obviously each case is different ...". OTOH, when you said "lets ask the medical professionals" and then offered up the answers you got, you didn't mention anything special about your case that would cause those answers to be different than they'd be for most others and so seemed to suggest that your answers had more general applicability than I think they do, even if you allowed that there may be exceptions for some others. Based on what the general pronouncements I have read on the CDC, either YOU seem to be the exception or you got some bum advice from your doctors.

The CDC has not issued any travel bans. What they have done is recommend that U.S. travelers avoid all nonessential travel to Mexico. They had no recommendations against travel within the US or to any other countries, so presumably it should be okay for someone to travel from another country, such as CR, TO the USA. As for those who have to travel to Mexico, they also recommend those "who are at high risk of severe illness from influenza. This would include persons with certain chronic medical conditions, persons aged 65 or older, Ch*ldren younger than 5 years old, and pregnant women" consider (their bold, not mine) taking along antiviral medications such as Tamiflu and to talk to their doctor about correct indications for using them. You should note a few things here. This last part applies to higher risk people who travel to Mexico, so they're not even saying such people should under no circumstances go to Mexico. And they're not saying such people have to bring special medication only that they should consider it. If even high risk people can go to Mexico under some circumstances, then shouldn't even high risk people be able to travel to other places for which there is no sort of swine flu travel advisory at all?

For the full detail of travel advice relating to this health crisis, one should refer to:
http://wwwn.cdc.gov/travel/default.aspx
http://wwwn.cdc.gov/travel/contentSwineFluUS.aspx
http://wwwn.cdc.gov/travel/contentSwineFluMexico.aspx
http://wwwn.cdc.gov/travel/destinationCostaRica.aspx (keep in mind that like the US State Dept. Security Warning site, there is lots of scary sounding information on these country pages, but it is interesting to note that there has been NO update on the CR page and NO reference on it at all about swine flu)
http://new.paho.org/hq/
http://www.who.int/csr/disease/swineflu/en/index.html

PRO... Excellent analysis you have done on this.
I agree on most of your statements, if you think about it the CDC has to be over vigilant for many reasons, first they lose their jobs if they missed warning us appropriately, second it is their job to do this, third when people are scared they take more precautions with wipes and cleaning exposure etc.which helps reduce the spread,,,, so this extreme drum beating by the CDC et al makes good sense to why it is happening.
I agree with your stats as well. Im not worried at all that this will strike me down dead tomorrow on the plane but I understand the vigilance we are seeing.
Pro are you a lawyer or in some analytic profession? because if not you should be.

OTOH, the other hand the various government agencies also have forces that may lead them to minimize the situation too. In the case of Mexico and CR, they have to balance doing whatever they can to control the spread of the disease amongst their populations with not going so far as to completely destroy the tourism that their economies are so dependent on. And all these countries have to balance not panicking their populations with reassuring them that they're doing everything that is necessary to prevent the situation from getting much worse. Everything they do has BOTH some economic and public health aspect to it.

For example, I heard that the US government has decided to refer to this only as H1N1 rather than swine flu. It was always really more of a hybrid between human avian and swine flu rather than a pure swine flu, but now that it transfers directly from human to human, they figured its better to refer to it differently rather than to continue the swine reference. Evidently, there are still some people who think that you might be able to get this from eating pork from sick pigs (you can't) and the pig farmers in this country were complaining that the reference to swine was hurting their business.

Similarly, any actions that dissuade people from going to work, shopping in malls, going out to eat at restaurants, buying airline tickets, etc. depresses economic activity and therefore employment at a time when our economy is already stressed and is struggling to recover from the last series of shocks that hit it last fall. So maybe the CDC is minimizing the risk for political-economic reasons (politics certainly overrode science in the last administration) but personally I'm inclined to believe the career managers at the CDC this time around, especially since the new political appointees are not yet in place and Brownie is back doing a helluva job riding show horses in Saudi Arabia.

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I think the ways this whole thing might affect most of us really lies more in other areas besides the purely medical ones.
1) How will it effect the US economy (and our ability to afford trips to CR)?
2) Will it reduce the number of people that travel (probably) which in turn will lead to lower airfares (probably not since, airfare pricing doesn't really work that way)?
3) Will it mean any hassles or delays passing through immigration when we travel due to increased bureaucracy and heightened screening?
4) Will it lead to reduce the number of mongers traveling to CR (probably) which in turn lead chicas to lower their prices due to decreased demand (perhaps but chica pricing is usually based on even less logic than airfares)?
5) Will it lead chicas to avoid crowded places like the HDR/BM?
6) Will it lead all chicas to practice safer sex (no more DFK's or BBBJ's)?

It IS anxiety provoking for me, given I am set to depart in several days....and when you're the high strung type such as myself, anxiety provoking is not something needed.

The largest concern I think I have is riding in the airplanes because the air exchange systems are pretty useless on planes and are well known for spreading disease. Ya won't get sick from the air of wherever you go to or be....but you're exposure takes quantum leaps for each flight you take.

http://74.125.95.132/search?q=cache:RL- ... clnk&gl=us

_________________
"Actual happiness always looks pretty squalid in comparison with the over-compensations for misery. And, of course, stability isn't nearly so spectacular as instability. And being contented has none of the glamour of a good fight against misfortune, none of the picturesqueness of a struggle with temptation, or a fatal overthrow by passion or doubt. Happiness is never grand."
- Aldous Huxley, Brave New World, Ch. 16