This guest post by Bam Bam and entry in our non-fiction writing contest.
This is the second part of a two-part series on H7N9 (you can read part one here). The first part provided background information on the new bird flu. Most significantly, H7N9 is mutating rapidly. Authorities in China are watching carefully to see if the virus mutates into a form that can easily spread from person to person. What can you do to protect yourself and your family? There are some common sense steps you can take. These steps include: (1) social distancing, (2) proper hand washing, (3) use of hand sanitizers, (4) cleanliness and sanitization, (5) the effectiveness of elderberry tincture, and (6) building a makeshift isolation chamber.
Scientists across the world are working on a vaccine for H7N9. Until a vaccine becomes widely available to the general public, the best way to protect your family is social distancing.  For a strain of the flu to become a pandemic, it must gain the capacity to spread easily from person to person. The best policy for keeping your family safe in a pandemic is to close the gate—don’t allow anyone in or out. That’s what many families did back when the Spanish Flu hit. No one went in or out.
Back then, however, folks routinely had everything on hand they needed to survive; they were self-sufficient. According to census data, more than 90 percent of American families back then lived on small family farms. Each family had chickens and pigs, and perhaps a milk cow. Folks put up food from the harvest to get their families through the winter and to guard against a bad harvest.
If we do start seeing reports of H7N9 in the U.S.—in cities like Los Angeles, New York and Chicago—start thinking about self-sufficiency. Make sure you have enough food, water, medicine, and hygiene and cleaning supplies on hand to last at least six months. (I personally feel more comfortable with having 18 months of supplies laid in.) By then a vaccine will likely be available. (Note: The CDC began work on a vaccine April 4, three days after Chinese authorities released the genetic profile of the virus.)
What if you do need to go into public? To answer this question, we need to see how the flu is spread during a pandemic.
People with flu can spread it to others up to about 6 feet away. Most experts think that flu viruses are spread mainly by droplets made when people with flu cough, sneeze or talk. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs. Less often, a person might also get flu by touching a surface or object that has flu virus on it and then touching their own mouth or nose. 
To protect yourself, wear an N-95 respirator mask. Be advised that there is a difference between a surgical mask and a respirator mask.  A surgical mask prevents you from spreading the flu; a respirator mask helps stop you from exposure to droplets made when infected people sneeze, cough or talk.
There is quite a bit of controversy over whether respirator masks work. Much of the controversy rests on the observation that the flu virus is small enough to pass through the fibers in the respirator mask. While it is true that the flu virus is tiny enough to pass through the fibers in a respirator mask, the flu virus does not exist in nature as an isolate; the flu virus is found in droplets and the droplet cannot pass through the fibers of the respirator mask.
If you are interested in seeing the latest technology in facemasks, check out the new BioMask by Medline. This is what the company says about its product:
BioMask is the first-ever FDA-cleared antiviral medical face mask that is shown to inactivate 99.99 percent of laboratory-tested flu viruses on five minutes contact, including imminent pandemic and seasonal strains of influenza (flu) viruses, such as H1N1, Avian flu, Swine flu and H3N2, this year’s dominant flu strain in the United States. Traditional facemasks act only as an air filter and do nothing to neutralize the harmful germs that remain active on the mask itself. 
Note that you can also catch the flu by touching surfaces infected with the virus. According to a report entitled Pandemic Influenza published by the Australian government’s Department of Health and Ageing, the flu virus can survive on some hard surfaces for up to two days.  You may wish to wear surgical gloves. And remember not to touch your mouth or nose.
There is some debate on whether eye protection is necessary. Here is a statement by OSHA.
Eye protection generally is not recommended to prevent influenza infection although there are limited examples where strains of influenza have caused eye infection (conjunctivitis). At the time of a pandemic, health officials will assess whether risk of conjunctival infection or transmission exists for the specific pandemic viral strain.
Personally, I would feel better with a whole face shield like this one.
Proper Hand Washing
Okay. It will likely be a difficult decision when to “close the gate”, so to speak. At what point do you tell your boss you can only work from home? At what point do you pull the children out of school? These are questions each of us must answer for ourselves. (Having a six-month reserve of cash to pay the mortgage and the electric bill will help in making these decisions, as will a deep pantry.)
In the meantime, another step you can take to keep your family safe is proper handwashing. This may seem obvious. But most Americans do not wash their hands correctly. And studies have shown that Americans do not improve their handwashing during cold and flu season.
According to Bradley Corporation’s research, “Americans don’t wash their hands as often as they should, don’t wash their hands for a long enough amount of time and don’t increase their handwashing during the cold and flu season.” 
The Bradley Study focused on handwashing after using a pubic restroom. According the study, 62 percent of respondents report simply rinsing their hands after using a public restroom. The top three reasons cited:
1.Use of hand sanitizer instead of washing hands.
2.There was no soap available in the restroom.
3.There were no paper towels available in the restroom.
This is troublesome, the CDC notes, because although hand sanitizer is beneficial, washing your hands with soap and water (for a full 20 seconds) is the most effective way to reduce the number of germs, including the virus that causes the flu.
Washing hands with soap and water is the best way to reduce the number of germs on them. If soap and water are not available, use an alcohol-based hand sanitizer that contains at least 60% alcohol. Alcohol-based hand sanitizers can quickly reduce the number of germs on hands in some situations, but sanitizers do not eliminate all types of germs. 
Washing your hands does not kill the flu virus; it simply allows the virus to slide off your hands into the sink.
Please click here to watch the CDC video on how to wash your hands.
The FDA has raised concerns that American consumers place too much confidence in commercial hand sanitizers. The fact is, the FDA says, there are currently no hand sanitizer products on the market that kill the flu virus. Check the label on that bottle of hand sanitizer. Such products may only claim to “help reduce bacteria and viruses that potentially can cause disease.” 
How is it that such products can claim to “kill 99.9 percent of the germs”? Here’s the answer I found from about.com:
The manufacturers of the products test the products on inanimate surfaces hence they are able to derive the claims of 99.9 percent of bacteria killed. If the products were fully tested on hands, there would no doubt be different results. Since there is inherent complexity in the human hand, testing hands would definitely be more difficult. Using surfaces with controlled variables is an easier way to obtain some type of consistency in the results. But as we are all aware, everyday life is not as consistent.
This is why the FDA recommends that hand sanitizers not be use in place of proper hand washing. Nonetheless, the CDC recommends the use of hand sanitizer if handwashing facilities are not available.
This conclusion is supported by research. According to one study,  use of alcohol-based hand sanitizers may play a role in preventing illness.
A multifactorial intervention emphasizing alcohol-based hand sanitizer use in the home reduced transmission of GI illnesses within families with children in child care. Hand sanitizers and multifaceted educational messages may have a role in improving hand-hygiene practices within the home setting. 
The “multifaceted educational messages” involved proper hand washing and the use of alcohol-based hand sanitizer when handwashing facilities were not available.
Cleanliness and Proper Sanitation
If you look on the shelves at the grocery stores, there are all kinds of antibacterial products—antibacterial soap, antibacterial cleaners and so forth. This is a marketing gimmick. According to a Columbia University study published in the Annals of Internal Medicine, products containing ingredients that are labeled “anti-bacterial” are no more effective than similar products without the antibacterial ingredients. 
In the study, inner-city households were randomly assigned to one of two groups: the group that received products containing antibacterial products or the group that received identically packaged products containing no antibacterial products. Incidence of infectious disease was recorded over a period of one year. Researchers found no significant difference in rates of infectious disease between the two groups. Here is the conclusion these researchers draw.
Our findings do not support the conclusion that use of antibacterial products reduces the risk for primarily viral infections in households of healthy persons. However, this does not preclude their potential contribution in reducing bacterial symptoms or their potential usefulness in specific instances, such as when household members are immunosuppressed or have skin or gastrointestinal infections. This suggests that manufacturers and care providers need to educate consumers about the appropriate use and limitations of household antibacterial products. Additional research is indicated to better understand potential health benefits associated with increased use of cleaning products, regardless of whether the products contain antibacterial ingredients.
Which products are effective in combating the flu virus? I have to tell you when I researched this question I was schooled by the CDC. First, there’s a difference between cleaning, disinfecting and sanitizing.
Cleaning removes germs, dirt, and impurities from surfaces or objects. Cleaning works by using soap (or detergent) and water to physically remove germs from surfaces. This process does not necessarily kill germs, but by removing them, it lowers their numbers and the risk of spreading infection.
Disinfecting kills germs on surfaces or objects. Disinfecting works by using chemicals to kill germs on surfaces or objects. This process does not necessarily clean dirty surfaces or remove germs, but by killing germs on a surface after cleaning, it can further lower the risk of spreading infection.
Sanitizing lowers the number of germs on surfaces or objects to a safe level, as judged by public health standards or requirements. This process works by either cleaning or disinfecting surfaces or objects to lower the risk of spreading infection. 
The flu virus is relatively fragile outside the human body. According to the CDC, the flu virus can live for hours after being deposited on a surface. The EPA is tasked with approving disinfectants, and evaluating whether a disinfectant is effective against the Influenza A virus. There are 500 cleaning products on the market that have been cleared by the EPA to kill Influenza A.  These products kill the flu virus on nonporous surfaces; the catch is that the product must remain on the surface for a period of five minutes to be effective. If an EPA approved product is not available, the CDC recommends using a solution of chlorine bleach. Add 1 tablespoon bleach to 1 quart of water or for a larger supply ¼ cup bleach to 1 gallon of water. To be effective, the solution should be applied to the surface with a cloth and allowed to stand for 3-5 minutes. Note: if you use Clorox wipes, you need to use enough wipes to keep the surface wet for 3-5 minutes.
The bottom line here is that expensive “antibacterial” cleaning products are unnecessary. In a report published in PLOS: One, researchers draw the following conclusion:
During an influenza pandemic, the majority of people who develop symptoms will stay at home, where informal lay care will most often be provided by relatives. It is therefore crucial to gather specific information about how the virus is shed around the home and how transmission may be reduced by the adoption of appropriate hygiene measures, including cleaning of surfaces likely to be contaminated by virus. This is especially important in households containing young children as the latter are well known for their poor respiratory etiquette and higher virus shedding. Whilst numerous commercial virucidal agents are currently available, they may become scarce during a pandemic and are not available in low-resource settings. The purpose of this work was to assess a representative selection of simple, household cleaning agents and commercially available wipes which might be readily utilised to reduce the amount of virus spread around the home. We find that dilute solutions of washing up detergent, bleach or vinegar provide suitable means of disinfecting surfaces of influenza A virus. 
This quotation brings up a very important point. If someone in your family gets sick, you will very likely be caring for that person at home. The hospital is the last place I would want to be in a pandemic.
Including Elderberry Tincture in your Flu Kit
Okay. Next question: What if, despite your best efforts, someone in your household comes down with H7N9? What should you have in your flu kit? We have already talked about respirator masks, surgical gloves, eye protection and sanitization supplies like bleach, Lysol, trash bags, (lots, and lots and lots of trash bags). I will assume that you already have at least a six-month supply of hygiene supplies—e.g., toothpaste, soap, toilet paper and feminine hygiene products.
To this list, I would add a six-month supply of prescription medicine. You may have to pay for this out of pocket. But if cases of H7N9 start popping up in the U.S. and you explain your preparedness concerns to your doctor, I am sure he (or she) will write you scripts for six months.
You will also need a supply of over-the-counter medicines. These medicines will not help you recover faster; but they will make you feel better. Here I would recommend that you include fever reducers, antihistamines, decongestants, anti-diarrheal medicine, cough medicines and electrolyte replenishment products.
I also recommend that you add elderberry tincture and the supplies necessary to make elderberry syrup. To make elderberry tincture, you will need some elderberries (Sambucus nigra) and some 100-proof vodka. A trusted source of elderberries is Mountain Rose Herbs. However, they are out of stock. I ordered mine here. Note: When using herbs for medicinal purposes, I recommend that you spend a few extra dollars and purchase organic product.
The recipe I followed said to fill a quart-sized canning jar one third of the way full with the dehydrated elderberries. Then fill with100 proof vodka. Place in a cool, dark place for two weeks. Gently shake the jar once a day. After two weeks, strain the mixture through cheesecloth to remove the berries and place in a clean jar. Label and store as you would any other medicine. To use elderberry tincture, place 2-3 teaspoons in a cup of hot tea. (A cup of steaming hot ginger tea with raw honey and a bit of lemon works great.)
Here’s a list of ingredients you will need to make elderberry syrup: 1 cup dried elderberries, a large piece of fresh ginger, 6 whole Chinese star anise, 4 whole cinnamon sticks, 18 whole cloves, 13 cups water and 4 cups raw honey. For step-by-step instructions, click here. http://www.thehungrymouse.com/2013/03/07/how-to-make-elderberry-syrup/
Let us turn now to the scientific evidence supporting the use of elderberries in the treatment of Influenza A. In a study published in the Journal of Internal Medicine Research, Zakay-Rones et al., examine the efficacy and safety of elderberry extract in the treatment of Influenza A and B. Here is the abstract to their article.
Elderberry has been used in folk medicine for centuries to treat influenza, colds and sinusitis, and has been reported to have antiviral activity against influenza and herpes simplex. We investigated the efficacy and safety of oral elderberry syrup for treating influenza A and B infections. Sixty patients (aged 18-54 years) suffering from influenza-like symptoms for 48 h or less were enrolled in this randomized, double-blind, placebo-controlled study during the influenza season of 1999-2000 in Norway. Patients received 15 ml of elderberry or placebo syrup four times a day for 5 days, and recorded their symptoms using a visual analogue scale. Symptoms were relieved on average 4 days earlier and use of rescue medication was significantly less in those receiving elderberry extract compared with placebo. Elderberry extract seems to offer an efficient, safe and cost-effective treatment for influenza. These findings need to be confirmed in a larger study. 
Another widely cited study is Kong (2009), published in the Online Journal of Pharmacology and PharmacoKinetics.  This is a pilot, randomized, double-blind, placebo-controlled clinical trial. Elderberry extract (tincture) was standardized into a slow-dissolve lozenge. Sixty-four patients who had three or more flu symptoms for no more than 24 hours were randomly assigned either the experimental group or the control group. The experimental group received 4 doses of 175 mg lozenges; the control group received identically packaged lozenges without elderberry extract.
The experimental group (treated with elderberry extract) showed significant improvement in their symptoms; the control group’s symptoms were either unchanged or had worsened. After 24 hours of the onset of treatment, the experimental group showed significant improvement in severity of symptoms; the control group showed either no improvement or their symptoms became more severe. After 48 hours, 28 percent of patients in the control reported no symptoms, 60 percent showed relief from one or more symptoms, and the remaining symptoms were mild, and the rest reported improvement but only mind improvement. In contrast, none of the patients in the control group were void of all symptoms, 16 percent showed improvement in one or two symptoms, the rest of the patients in the control group showed either no improvement or their symptoms worsened.
These results are corroborated by (Thom 2002).
The study involved 60 patients who had been suffering with flu symptoms for 48 hours or less; 90% were infected with the A strain of the virus, 10% were infected with type B. Half the group took 15 milliliters of Sambucol and the other group took a placebo four times a day for five days.
Patients in the Sambucol group had “pronounced improvements” in flu symptoms after three days: Nearly 90% of patients had complete cure within two to three days. Also, the Sambucol group had no drowsiness, the downside of many flu treatments.
The placebo group didn’t recover until at least day six; they also took more painkillers and nasal sprays. 
Thom (2002) identifies the active ingredient in elderberry extract. “It’s likely that antioxidants called flavonoids — which are contained in the extract — stimulate the immune system,” writes Thom. “Also, other compounds in elderberry, called anthocyanins, have an anti-inflammatory effect; this could explain the effect on aches, pains, and fever.” 
In yet another study published in the European Cytokine Network, Sambucol, a commercially produced elderberry extract, was claimed to be effective against ten different strains of Influenza virus. “In a double-blind, placebo-controlled, randomized study, Sambucol reduced the duration of flu symptoms to 3-4 days. Convalescent phase serum showed a higher antibody level to influenza virus in the Sambucol group, than in the control group.” 
Let me make a further point. Elderberry tincture is superior to Tamiflu. You can order some elderberries online and keep them in storage until needed. You can find 100-proof vodka at any liquor store. You need a prescription to get Tamiflu. The doctor’s office (or the pharmacy) is the last place I would want to be during a flu pandemic. Moreover, to be effective, Tamiflu must be started within 48 hours of the onset of flu symptoms.  How many people go to the doctor within the first 48 hours of the onset of flu symptoms? We must also acknowledge that during a pandemic, frontline medicines such as Tamiflu may not be available. (I might add that Tamiflu is $100+.)
Building a Make-shift Isolation Room
My dh and I have already had a discussion about pandemic flu. What would we do if his daughter showed up with symptoms? What would we do if my mother showed up with symptoms? There’s no way we could turn them away to die on the streets. We would take them in and put them in isolation. Hence, we need to build an isolation room.
We plan on keeping sick family members in the guest bathroom, which has a window for ventilation. It has a tiled floor so all surfaces can be cleaned with bleach. The room will need to be cleaned and sanitized daily while the sick person is recovering. We will use the hallway as an anteroom. The bathroom and the anteroom will be sealed off top to bottom with plastic sheeting secured with duct tape. Anyone who enters the sick room will first enter the anteroom to put on eye protection, a respirator mask, surgical gloves and a lawn sized garbage bag. When the person exits the sick room into the anteroom, the person will remove the protective clothing (eye protection, mask, gloves and trash bag) and put the protective clothing in another trash bag. The outside of the trash bag will be sprayed with disinfectant.
Nothing can come out of the sick room unless first processed in the anteroom. Nothing comes out of the anteroom without being bagged and sprayed with disinfectant or soaked in a 20 percent bleach solution for five minutes. All trash will be taken to the curb immediately or burned, if country services are no longer available. As soon as trash is taken to its assigned location, the person will utilize proper handwashing techniques. The caregiver will then shower with a soap solution containing shower gel, aloe and 90 percent alcohol. For additional information on building an isolation room, see .
I certainly hope I never experience pandemic flu in my lifetime. But I read the news. Right now it is 8:30 p.m. Tuesday evening. As I write, there are 77 confirmed cases of H7N9. Only two patients have recovered, a four-year-old boy and a seven-year-old girl. There have been 16 deaths. The remaining patients are in critical condition. This point is worth emphasizing: out of 77 patients, only two have recovered.
The latest news is that 40 percent of those infected had no clear contact with poultry. The discovery of the asymptomatic boy in Beijing who tested positive is troublesome; there may be significant numbers of carriers in the population. We do not have a clear handle on what kind of animal we are dealing with.
How worried should you be? At this point, I think it’s a good idea to keep an eye on the new flu. Fill in the holes in your preps. Nothing I have recommended here is terribly expensive. If this does progress into something more troublesome, you will begin to see reports online about “family clusters”. A significant increase in the number of family clusters is a sign the virus has mutated into something that can be spread person-to-person. Next, you will begin to see reports of cases outside China. You should begin to worry if the State Department begins issuing travel restrictions. You should begin to worry if cases start popping up in the United States.
Until then, get your preps in order and pray for the folks in Boston.
M.D. Creekmore recommends “How to Survive the Coming Plagues” by Ragnar Benson.
This contest will end on April 22 2013 – prizes include:
- First Place winner will receive - A $500 dollar gift certificate courtesy of LPC Survival that is good for $500 off anything on their site. And a Wonder Junior Deluxe hand-mill courtesy of Kitchen Kneads,
- Second Place winner will receive – Two cases of MRE’s courtesy of Camping Survival and a $150 gift certificate off of Hornady Ammo from LuckyGunner.
- Third Place winner will receive - a one year subscription to Personal VPN service courtesy of unspyable.