Swine's fine, but germs are v. difficile

Enough with swine flu panic. It's essentially a false alarm. Despite the dire warnings pumped out by medical scientists and the World Health Organization, it's likely that the second wave coming this fall will be as harmless as the first one. "This pandemic is a dud," says Dr. Richard Schabas, the former chief medical officer of health for Ontario. About 60 Canadians have died from the disease - not quite the 10,000 or more that some alarmists had predicted.

If you've really got to worry about catching something, worry about the germs you catch in the hospital. They are far more deadly. Superbugs and similar infections contracted in the hospital kill about 8,000 Canadians a year, far more than all our recent so-called pandemics put together. They are our real public-health challenge.

"The risk of dying from swine flu is extremely small," says Dr. Michael Gardam, a top infectious disease specialist. "But the mortality rate with C. diff is 15 to 20 per cent."

Clostridium difficile is a superbug that makes you extremely sick. It's a miserable way to die. It lasts for weeks and features prolonged diarrhea. "People say it feels like they've swallowed shards of glass," says Dr. Gardam. One woman caught it after she went into the hospital for routine knee surgery, then came down with pneumonia. She was treated with a type of antibiotic that made her highly vulnerable to C. diff.

An epidemic of it broke out in Quebec a few years ago. About 2,000 people died before it was brought under control. Hundreds more have died in Ontario, which is still seeing 300 new cases every month. C. diff is easily spread from feces to hand to mouth, and is the most common cause of infectious diarrhea in hospitals. The infections result from our massive overuse of certain antibiotics, which can alter the normal intestinal flora and make your gut a happy hunting ground for deadly microbes.

Hospitals are germ factories. If you're already sick, they are a dangerous place to be. These superbugs are especially tenacious. Their spores stick around for months, on hand rails and toilet seats, and once introduced, they quickly spread around a whole building. Ordinary cleaners won't kill them. You need super-duper caustic cleaners to kill them, along with rigorous cleaning protocols. But hospitals are under extraordinary cost pressures, and cleaning staff are often cut back. Too often, infection control is given about as much attention as "a lump of sod on the front lawn," Dr. Gardam gripes. Even hospital design is a problem. Many were built with four-bedded rooms and shared toilets - "nicely designed to spread infection," he says. The answer is single rooms and toilets, which are more expensive at first but vastly cheaper in the long run.

To curb the superbugs, doctors will have to make big changes in the way they prescribe antibiotics. But the biggest challenge of all is how to get health-care workers to wash their hands as much as they are supposed to. One recent study found that approximately 40 per cent of them don't.

Simple? Not at all. It's remarkably complicated, Dr. Gardam says, "because it involves human behaviour."

So stop fretting about getting your vaccine for swine flu. What you should really think about is how to protect yourself or your dear old mother the next time one of you is in the hospital. Here are some tips from Dr. Gardam: Get a private room if you can. Be mindful that the system and the people in it are busy and highly stressed. Stuff can get overlooked, so have someone who can ride shotgun for you. If you're like most of us, you are no doubt far too intimidated to ask your doctor whether she's washed her hands before she pokes you. But if you aren't, go ahead and ask. And wash your own hands too. Just assume there are germs all over the place.

As for how you should prepare for the deadly second round of swine flu, Dr. Schabas advises this: Relax, and enjoy your summer.