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Health
Internet resources for what you need to know about NYC Health
Five Favorite Sites For Beginners

The Topic
"Health" refers to the health issues facing the city, touching on everything from the mayor to Medicaid to managed care to mosquitoes.
The Context
New York City is one of the biggest public health challenges in the world. With 7 million residents--over 1 million of whom are uninsured--the city has the largest number of HIV cases and the largest number of intravenous drug users in the U.S. Efforts to contain a tuberculosis outbreak that threatened the city in the 1990's have been a major success--between 1992 and 1998, the deadly multi-drug resistant cases of TB declined by over 90 percent.

New York City has 20 public hospitals which served 1.5 million people in 1998 alone. Run by New York City's public Health and Hospitals Corporation, the hospital system now has a surplus of $21 million, following years of deficits and cutbacks.

The Reporter
Maia Szalavitz is author, with Dr. Joseph Volpicelli, of "Recovery Options: The Complete Guide: How You and Your Loved Ones Can Understand and Treat Alcohol and Other Drug Problems." She writes frequently on health, science and public policy for the New York Times, New York Magazine, the Village Voice, and other publications.

by Maia Szalavitz

The Flu

(Nov-Dec '00) Many people consider the flu to be an annoyance at most. But it is actually one of the top ten causes of death in the U.S. Each year, about 10,000 people die as a result of influenza infections and their complications. There are several myths which tend to discourage people from getting vaccinated. And this year, with a national delay in availability of the vaccine, even more New Yorkers than usual may avoid the shot.

So just what is the flu? It is not, contrary to popular belief, characterized by gastrointestinal symptoms: there is no "stomach flu." The symptoms of influenza include significant fever, chills, cough, headache and general aches and pains.

On October 25, Mayor Giuliani urged city residents to get vaccinated, "I encourage all New Yorkers, particularly those 65 and above, to protect themselves from the flu and pneumonia this year by getting their shots." he said,. "Although the U.S. Centers for Disease Control and Prevention have announced that there will be a nationwide delay in the delivery of some of this year's flu vaccine shipments, be aware that the NYC health department clinics, senior centers, Health and Hospitals Corporation facilities and other sites across New York City do have flu vaccine available." A website lists locations, dates and times where free flu shots are available.

Though most flu deaths occur amongst the elderly, children under five are also at high risk, as are those with chronic illnesses like diabetes and HIV. And new research suggests that flu-mortality increases dramatically at 50, so physicians now recommend that people 50 or older, not just those over 65, be routinely vaccinated. Others who should consider vaccination include health care workers and those who provide vital services (firefighters, etc.), those who work with high-risk people and anyone who just wants to avoid the flu.

Unfortunately even among people at highest risk, only 10 percent or less tend to get the shot. One reason may be the myth that the vaccine itself causes the flu. While about five to 30 percent of patients do suffer fever or malaise following the vaccine, this is not the flu itself. Unlike the real flu, which can last up to two weeks, these symptoms generally last fewer than 48 hours.

"I haven't had one complaint," said Dr. Alex DeLuca, a physician in private practice. "No one said it made me sick and I've done about 20 so far this year." Risks related to the vaccine are small. Although past vaccines were linked to rare cases of a (usually temporary) paralytic illness called Guillian-Barre syndrome, the link has not been seen with more recent batches.

Another reason people forgo the vaccine is due to a perceived lack of efficacy. Because flu viruses vary each year, the effectiveness of a particular vaccine varies as well, depending on how well its makers were able to predict which strains would dominate. Most years, the shot is about 70 percent effective in preventing illness entirely in elderly people living outside nursing homes; in nursing homes, it is less effective. However, though in some cases it does not prevent illness , it is 87 percent effective in preventing death from the flu among elderly people living on their own.

In 1918, a particularly virulent influenza virus killed more Americans than both World War I and World War II combined. For years, it was a mystery as to which particular virus caused this flu, and what made it so deadly, not only to the usual flu victims, but to healthy people in the prime of life. New research suggests that the 1918 virus had a particular form of a chemical called neuraminidase. In most flus, this chemical can only allow the virus to infect lung cells -- but in the 1918 flu, it could affect numerous cell types, making it uniquely lethal.

Two new drugs block neuraminidases -- Relenza (Zanamivir} and Tamiflu (Oseltamivir) -- offering comfort to those who worry about a repeat of that deadly epidemic. They can also treat ordinary flu. If given within 48 hours, both can reduce time spent suffering flu illness by about one day. If given within 30 hours, they can cut the illness by two to three days. For the very young and the elderly, these drugs also offer the advantage of preventing secondary infections. In children, these drugs cut the odds of a secondary ear infection almost in half.

Two older antivirals -- amantadine and rimantadine -- can also be used to fight flu. If you have not been vaccinated and come in contact with someone with flu symptoms, if you start taking one of these drugs, you can reduce your odds of getting ill by 70 to 90 percent, depending on what strain of flu it is. Rimantadine is preferred because it has fewer side effects.

All this means that New Yorkers may have one less reason for staying home from work. Perhaps that's the real key to explaining why so few choose vaccination.


Maia's Favorite Five Sites For Beginners:

  • New York City Department of Health - Includes health alerts (including West Nile info), information on restaurant sanitary conditions and information on various health-promotion programs.
  • New York State Department of Health - More health data for New Yorkers including information on how to sign up for Child Health Plus and Family Health Plus-- the insurance programs for those who are presently not covered by other plans.
  • Medscape - This site, aimed at doctors, allows you to search Medline, the database of medical journals, for free. Abstracts of most journal articles are available for free as well. Once you have some basic knowledge about a condition you are researching, you can look here to get a sense of what is going on in terms of study in the area. There is a companion consumer-focused site, CBSHealthWatch, which is linked.
  • American Cancer Society - Half of all Americans will face cancer at some point in their lives-- and the New York and Washington-based American Cancer Society web site provides a wealth of information for those dealing with the disease. Includes links to other major cancer sites and resources.
  • AIDS Information - A sort of "AIDS central" for New York city with links to major HIV/AIDS organizations and information sites.


Other Recommendations:

  • Quackwatch - Debunks medical scams and inflated claims made by "alternative" medical practitioners.
  • AccentHealth.com - A consumer health information site, affiliated with CNN.
  • Citizen Action - Healthcare is one of the primary focuses of this New York advocacy group. Includes information on New York's health plans for low income people lacking insurance.
  • Oncolink - An incredible research resource for cancer patients and others concerned about this disease.
  • National Alliance for the Mentally Ill - An organization of advocates for people with mental illness which includes information on treatment and support for various disorders like depression, bipolar disease and schizophrenia.
  • Insure Kids Now - Information on New York state's insurance program for poor kids and information on other state's policies, from the federal government and the governors' association.

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Gotham Gazette is published by Citizens Union Foundation and is made possible by support from the Robert Sterling Clark Foundation, the John S. and James L. Knight Foundation, the Altman Foundation,the Fund for the City of New York and donors to Citizens Union Foundation. Please consider supporting Citizens Union Foundation's public education programs. Critical early support to Gotham Gazette was provided by the Charles H. Revson Foundation, Rockefeller Brothers Fund and the Alfred P. Sloan Foundation.

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