Why were Boston's Latinos and Blacks hit hardest by swine flu?

MccarthyClaire111408There were days last spring at Martha Eliot Health Center when I felt like all I was seeing was swine flu. Patient after patient had the classic symptoms of high fever and cough. Even when I was doing a routine checkup on a patient, it was not uncommon for a sibling to be in the room coughing–and when I touched them, hot with fever.  In my nearly 20 years of being a primary care pediatrician, I had never seen anything like it.

Martha Eliot is a community health center that serves a population that is predominantly African-American and Latino. So it wasn’t surprising to me when I read that that African-Americans and Latinos were disproportionately hit by swine flu–I certainly felt like our patients were getting hit particularly hard. And the reasons offered made sense to me too. It’s not that African-Americans and Latinos are genetically more susceptible; it’s a life circumstance thing.  Swine flu, or H1N1, is very contagious and is spread by droplets–so people who live in crowded living situations are particularly at risk.  Many of my patients share their living spaces with lots of people; even the fact of living in an apartment building as opposed to a house means there’s more chance of exposure to germs, as there are lots of common surfaces (like doorknobs, elevator buttons and banisters) that sick people might touch with germ-covered hands.

H1N1 is an illness that mostly affects children and young adults, who don’t have as many antibodies to illnesses as older people who have, well, been catching germs longer. So schools were hard-hit by H1N1, and were the place many kids caught it. This was very much the case in Boston, which has lots of minority students in its public schools. Officials tried to cut down on the spread of illness by asking that all children with flu-like symptoms be kept home for seven days. The problem with keeping kids home for seven days is that someone needs to stay home to to take care of them. For many of the low-income families living in Boston, this was really hard–or impossible. They need every single day’s pay, and missing work may mean losing their job. So some parents had no choice but to send their sick children to school. Many schools were closed, which was really hard for families to manage and didn’t necessarily mean kids weren’t still being exposed. I remember seeing an infant who was very sick with H1N1. Her two school-age cousins were in the room with her; their school was closed and their parents had to work, so they were spending the days with their aunt and sick baby cousin.

We don’t know what it’s going to be like this fall, when experts expect cases of H1N1 to rise again. We’ll be vaccinating everyone we can, and educating our patients about healthy habits like handwashing (doing that frequently is your best protection against all germs) and covering coughs and sneezes with the inside of the elbow instead of the hands (since you don’t usually touch things with the inside of your elbow). The public schools are now saying that children should stay home until they’ve been well for 24 hours, instead of seven days, which will be easier for families. And this week, the Department of Health and Human Services encouraged employers to help out by allowing employees to stay home with sick children. As hard as last spring was, it taught us a lot about H1N1–and that knowledge will make all the difference when it comes to preventing and treating the illness this fall.

Claire McCarthy, MD, is a primary care physician and the medical director of Children’s Hospital Boston’s Martha Eliot Health Center.

For more information on Flu (seasonal and H1N1) from Children’s Hospital Boston, visit http://www.childrenshospital.org/patientsfamilies/Site1393/mainpageS1393P385.html