Small blind vs. big blind: One will catch swine flu



This column first appeared in Ante Up Magazine in November 2009.

I felt badly for Daniel Negreanu. In a recent World Series of Poker event he was hacking and dripping and sneezing and spreading swine flu all over everyone. Now I don’t know for sure it wasn’t just a simple cold, but if he had muscle aches and fever, too, it was probably flu. And more than 95 percent of flu cases in the world since June have been H1N1 — the proper name for swine flu.

Watching Daniel made me realize what a great winter this virus is going to have on the poker circuit. Hundreds of people in the same room sitting in close quarters for hours at a time, passing around chips and cards and occasionally playing the tournament version of musical chairs — virus heaven. And if you don’t catch it in Barcelona, there’s always Tunica, Foxwoods or Aruba. Remember, a sneeze shoots 40,000 droplets across the poker table at about 100 mph. Scientists estimate 50 percent of the general population will get H1N1. If you’re a professional poker player (or a dealer), the pot odds are even worse.

I’d like to try to put this whole flu thing in perspective and answer three questions: If you’re exposed, should you get tested? If you get the flu, should you take antiviral drugs? Should you get the flu shot?

Let’s take the last one first. At the time I’m writing this article, the Chinese, Europeans and Americans are racing to produce a H1N1 vaccine estimated to be available by mid October. There are a lot of unanswered questions about the vaccine, but one thing is quite certain, there won’t be enough for everyone.

So who gets it? As an ER worker and guardian of our nation’s healthcare safety net, I get one. (Hooray, I knew there had to be some perks to my job!) Pregnant women can have one. Sick people with heart disease, emphysema, asthma, diabetes, hepatitis and immuno-compromise, sure, you get one, too. Do we have any doses left? How about school-aged children? Senior citizens? Do we have enough?

If we haven’t run out by the time all those other people get theirs, there might be some left for you brick-and-mortar poker players. Convince your doctor that your job puts you at very high risk for exposure and get the shot if you can because you WILL get exposed.
Let’s say you get the flu. What do you do? Unless you’re in one of those risk groups I just mentioned (sick, older or pregnant), just stay home, have some soup and take Tylenol. Do not go back to work, or to the poker room (I’m talking to you, Daniel) until you have been fever-free for at least 24 hours. Play online instead. That’s why God invented Internet poker.

The antivirals like Tamiflu don’t work very well. They make you less contagious, reduce the symptoms a little and shorten the course by a day or two, but they are expensive (about $16 per pill) and they’re certainly not a cure. And you have to start taking them within 48 hours of the first symptoms to be effective. Geez, it takes me at least 48 hours to figure out whether I’m really sick.

Here’s a key point: “The Flu” comes around every winter killing about 35,000 people in the U.S. H1N1 isn’t particularly severe, it’s just very, VERY easy to catch, so eventually most everyone in the world will get it or be exposed. It may seem like a lot of people end up dying from this flu, but it’s a very tiny percentage of a very big number. For most of us, it will be a relatively mild illness. For a tiny few, it can be pretty bad.

Last question, if you get sick or exposed, should you go to your doctor’s office or the ER (horrors!) to get tested? For gosh sakes, no! If you have flu symptoms (think sniffly Daniel plus muscle aches and fever), you’ve got it. End of story. It’s swine flu. There’s no need to prove it. All other flu viruses on earth are hibernating on some pretty beach up some seagull’s nostrils waiting for next year’s contest to see who’s going to be virus of the year.
Truly, there aren’t enough nasal swabs or healthcare dollars in the world to test everyone who’s going to get exposed. It’s all swine flu anyway. The Florida Department of Health has asked doctors to stop sending swabs. We’re supposed to become the Soup Nazi: “No test for you!”

So basically, try to limit your exposure. Wash your hands — a lot. If you’re an active live player or in one of those risk groups I’ve mentioned, get the flu shot. If you do get the flu, there’s no need to infect your doctor or your local ER personnel (like me) unless you’re truly dying. Stay home. Drink some hot tea and stiff it out.

Here’s one final curious point: Nearly everyone who’s gotten sick from H1N1 is younger than 60. Scientists believe swine flu may be related to the virus that caused the 1957 pandemic. If you were old enough to go to grade school (and get exposed) in 1957, you may have some immunity to H1N1. In 1957 I was home watching Howdy Doody on a TV the size of a dinner plate and wearing jammies with footsies, so I’m probably still at risk.
This leads me to my final piece of advice: If you’re old enough to remember the first time Jimi Hendrix set a guitar on fire, you’re probably old enough to have some immunity to swine flu. That means this is a great year to sign up for some winter tournaments because all of the Internet phenoms will be home sick.

— An avid poker player, Frank Toscano, M.D. is a board-certified emergency physician with more than 28 years of front-line experience. He’s medical director for Red Bamboo Medi Spa in Clearwater. Email your poker-health questions to 

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