Stay Home If You Are Sick

As most of us have recently heard, pertussis is on the island. This is not a surprise. The instances of Pertussis cases is well-known to rise and fall cyclically. And, as we know, a mostly non-immune population is more susceptible.

As in, the adult population.

While media is quick to point out the 33% of children on Vashon who are under-vaccinated, [Source: Beachcomber] there has historically been little mention of the low immunity within the adult community. This is because, prior to 2006, there was no pertussis vaccine available for adults. If you can’t vaccinate against it, you typically don’t hear much about it. So, then and now, the 20-90 year old crowd has been a weak link in the battle to reduce the incidence of pertussis.

Why? Because, the vaccine wears off around the age of 12-14.

[From the CDC Website: Immunity to pertussis wanes approximately 5--10 years after completion of childhood vaccination, leaving adolescents and adults susceptible to pertussis.]

Pertussis is a low-efficacy vaccine with only 59-89% efficacy rate. [Source: Beachcomber, CDC, Vaccine Maker Insert] Further, full efficacy doesn’t occur until the end of the series. Thus, the efficacy for newly vaccinated infants (those at greatest risk from the disease) is much less than 59-89%.

So, given the overall limitations of the vaccine, what ELSE can we do? In other words, how can we protect vulnerable islanders of all ages?

Well....I’m curious if you know someone who has had "the crud" this winter? [From the CDC website: B. pertussis infection among adults covers a spectrum from mild cough illness to classic pertussis; infection also can be asymptomatic in adults with some level of immunity. When the presentation of pertussis is not classic, the cough illness can be clinically indistinguishable from other respiratory illnesses.] Most likely, some of our island cases of "the crud" are undiagnosed and untreated cases of pertussis in adults. But, do you hear anyone talking about this?

As a close friend of mine recently said, "The sociology of the vaccine has caused pertussis to become unthinkable and unspeakable. This silence is causing a lot of needless illness and suffering."

How does the "vaccine-only" discussion harm our communities? Well, if you had the crud this winter, ask yourself this:

Did your doctor suggest it might be pertussis?

Did your doctor suggest getting tested?

If not,...you are not alone.

Where does this leave us? Well, I would suggest that the best tool in our tool kit, at all times, is what you see on the top of public health signs in every public bathroom.

STAY HOME IF YOU ARE SICK.

When you begin to feel sick, staying home is beneficial in two ways: (1) you will heal faster, and (2) you cannot pass the illness on to vulnerable individuals in public places. Yes, you can be contagious before you notice full-fledged symptoms, so this is not the only solution - just as a vaccine with a 59-89% efficacy rate and potentially, albeit rare, life-threatening side effects is not a perfect solution. But both tools can offer significant value, especially when both are on the table and available for use.

STILL, just imagine if everyone stayed home when "beginning" to feel ill?

Imagine NOT spreading your germs/virus to everyone in the school bus, the locker room, the grocery store, the pharmacy, the library, and elsewhere! Instead...you can go get tested, get antibiotics (unless it is a virus), and eventually return to work or school contagion-free.

However, I realize that many individuals struggle when they cannot go to work. Our society often values work over health, and many people have no sick leave. Clearly, this is bad for community health. Maybe now is the time for friends, neighbors, and family members to say, "I will shop for you. I will clean your house so you can really rest and get back to work asap. AND, I will come over and stay with your mildly ill child while you go to work." I realize that this won’t keep ALL contagious people out of public places, but it would help a lot.

Is caregiving dangerous to the person offering support? Not necessarily. If the sick person is later diagnosed with pertussis, the incubation period means they will have a diagnosis before you show symptoms. You can take antibiotics prophylactically if you wish, which is often quite effective at preventing the onset of pertussis. Of course, if it’s a virus, then you’ll need to fight it off yourself. So, take reasonable precautions to protect yourself. Take care of your immune system. Wash your hands. Wear a mask, if you think that is appropriate. And of course, don’t volunteer if your immune system is weakened or you have other unusual medical circumstances that put you at risk!

So what do you think?

Can we support each other, so more of us can stay home when sick?

Can we increase early testing for pertussis?

Can we return to an ethic that "going into public when you are sick" is not okay?

Can we possibly get parents to keep their sick kids home?

ALSO...public sanitation and immune strength play roles, and a health practitioner on the island is preparing a statement about a "green clean" method that has been shown to facilitate a significant reduction in the spread of disease. Plainly said, it is time to look beyond "just vaccines," when considering the health of our community.

Yours in empowered self-care and public health awareness,

March Twisdale