Swine Flu Updates and Issues - page 7

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  1. by   indigo girl
    http://www.cnn.com/2009/HEALTH/06/02...iref=hpmostpop

    This is the first time that I have read anywhere that the WHO is assessing severity as moderate. That is not the same as mild. What happened to mild? Hello?

    Quote from www.cnn.com

    Fukuda was quick to remind journalists that the designation does not reflect the severity of the disease, but how widespread it is.

    "Our overall assessment of severity is moderate," he said, "because although the overall number of serious and fatal cases is relatively limited ... we really don't have a full handle on the number of people with serious illness."
  2. by   indigo girl
    Swine Flu Warning Signs That Someone Has Gone Sour

    http://scienceblogs.com/effectmeasur...gns_that_s.php

    Quote from scienceblogs.com

    Infection with influenza virus is always potentially serious and when the young and healthy are in the cross-hairs even more so. Many other viruses can cause the same initial symptoms ("flu-like symptoms"), outside of flu outbreaks the likelihood those symptoms represent influenza infections is small. When flu is circulating in the community, however, the likelihood that the very same symptoms are from an influenza infection goes way up (the reasons can be found via an elementary application of Bayes Theorem in probability theory). So knowing when things are going sour is more important.

    The context is the extra risk from swine flu infection (or any flu, for that matter) for those with "underlying medical conditions." There are two questions here. The first related to what constituted an underlying medical condition. Some of the examples cited seemed quite common (asthma, COPD, pregnancy), so much so that a large proportion of the population might be considered to have an underlying condition. So CDC's Dr. Schuchat addressed the question of warning signs that indicate the person should seek immediate medical attention.

    In children, signs that need urgent medical attention include fast breathing or trouble breathing; blueish or gray skin color; not drinking enough fluids; severe, persistent vomiting; not waking up or not interacting.; being so irritable that the child doesn't want to be held; and flu-like symptoms improve, but then return later with a fever and a worse cough. Those are warning signs we physicians think about all the time, with respiratory infections. And they're good to have in mind with this new influenza-like illness caused by the novel H1N1 strain. Just good things for parents to have in the back of their mind.

    In adults, we look at another set of warning signs that suggest the need for urgent medical attention: difficulty breathing or shortness of breath; pain or pressure in the chest or abdomen; sudden dizziness, confusion, persistent or severe vomiting that doesn't go away; and flu-like symptoms that improve, but then come back again with a fever or worsening of cough. (Statement by Dr. Anne Schuchat, CDC Press Briefing, May 28, 2009)

    Once again, I think this is pretty good messaging. It tells many people exactly what they want to know: when should I start to get worried? Anybody who has had to deal with these questions appreciates the difficulty. You don't want to falsely minimize something that later could turn out to be serious, but you don't want to cause people to do things that burden the system when it's not necessary. The best thing is usually to provide the best information you have. Most people then act rationally and responsibly.
    The Editors of Effect Measure are senior public health scientists and practitioners. Paul Revere was a member of the first local Board of Health in the United States (Boston, 1799). The Editors sign their posts "Revere" to recognize the public service of a professional forerunner better known for other things.
  3. by   indigo girl
    The Pathogenesis of Influenza in Humans

    http://www.virology.ws/2009/06/02/pa...nza-in-humans/

    As I read the Effect Measure commentary from the post above this, I was struck by the fact that flu-like symptoms can improve, but then return later with a fever and a worse cough. This was one of the indications that a flu victim's situation is becoming critical.

    Why is that? Why would someone seem to be better than suddenly get worse?

    I think that the answer may be addressed in this link, and also explained is why it takes so long to recover.

    Quote from www.virology.ws

    When influenza virus is introduced into the respiratory tract, by aerosol or by contact with saliva or other respiratory secretions from an infected individual, it attaches to and replicates in epithelial cells. The virus replicates in cells of both the upper and lower respiratory tract. Viral replication combined with the immune response to infection (which we'll discuss in later posts) lead to destruction and loss of cells lining the respiratory tract. As infection subsides, the epithelium is regenerated, a process that can take up to a month. Cough and weakness may persist for up to 2 weeks after infection.


    Influenza complications of the upper and lower respiratory tract are common. These include otitis media, sinusitis, bronchitis, and croup. Pneumonia is among the more severe complications of influenza infection, an event most frequently observed in children or adults. In primary viral pneumonia, the virus replicates in alveolar epithelial cells, leading to rupture of walls of alveoli and bronchioles. Influenza H5N1 viruses frequently cause primary viral pneumonia characterized by diffuse alveolar damage and interstitial fibrosis. Primary viral pneumonia occurs mostly in individuals at high risk for influenza complications (e.g. elderly patients) but a quarter of the cases occur in those not at risk, including pregnant women.


    Combined viral-bacterial pneumonia is common. In secondary bacterial pneumonia, the patient appears to be recovering from uncomplicated influenza but then develops shaking chills, pleuritic chest pain, and coughs up bloody or purulent sputum. Often influenza virus can no longer be isolated from such cases. The most common bacteria causing influenza associated pneumonia are Streptococcus pneumoniae, Staphylococcus aureus, and Hemophilus influenzae. These cases can be treated with antibiotics but the case fatality rate is still about 7%. Secondary bacterial pneumonia was a major cause of death during the 1918-19 influenza pandemic, during which antibiotics were not available.
  4. by   oramar
    Quote from indigo girl
    Woman dies of swine flu during childbirth

    http://journalstar.com/articles/2009...1193538839.txt

    She was twenty years old.
    It sounds like she had two pregnancies fairly close together. I always thought that could have a weakening effect on the body, even if it was a young body.
  5. by   oramar
    Quote from indigo girl
    WHO will stick with criteria for declaring pandemic, but also assess severity

    http://www.google.com/hostednews/can...OmHBa9O23D6IXg

    As always, excellent reporting by Helen Branswell.
    Here I go with my memories again. I suspect I had H2N2 in 1957, I was 10 years old and I remember I was extremely ill. I had hallucinations from the fever that were so sever I can still remember some of them. Then in 1968 I was a young nurse working on a 41 bed ward when H3N2, which they called the Hong Kong flu back then, came through. It is the only time in my life we had beds lining the halls because the patients just kept coming. You couldn't say no. We worked a 41 bed ward that went up to 50 patients during the pandemic with 2 RN, 1LPN(me) and two aides on a good day. There were times when it was 1 RN, 1LPN and 1 aide. I didn't get sick then. Perhaps my immunity was still high from the flu Ihad just 10 years before. But I did get it in spring of '72 when it came back. By then I was a young mother. my year and half old son got it first, I think the exposure was so heavy and I was a little run down from taking care of kids so this time I got it to. I remember how hard it was taking care of a sick child and being so sick myself.
    Last edit by oramar on Jun 3, '09
  6. by   indigo girl
    Quote from oramar
    It sounds like she had two pregnancies fairly close together. I always thought that could have a weakening effect on the body, even if it was a young body.
    I noticed the closeness of the pregnancies also. Dance keeps the body in tremendous shape though. She might as well have been an athelete.
  7. by   oramar
    Quote from indigo girl
    The Pathogenesis of Influenza in Humans

    http://www.virology.ws/2009/06/02/pa...nza-in-humans/

    As I read the Effect Measure commentary from the post above this, I was struck by the fact that flu-like symptoms can improve, but then return later with a fever and a worse cough. This was one of the indications that a flu victim's situation is becoming critical.

    Why is that? Why would someone seem to be better than suddenly get worse?

    I think that the answer may be addressed in this link, and also explained is why it takes so long to recover.
    I remember an old timer nurse who worked during the 1918, who is no longer with us, telling me when I was a young nurse that they were culturing a lot of people that died during the 1918 epidemic and getting Hemophilus Influenzae. That is how it got it's name. She also said the flu epidemic lead them to postulate that there was something much smaller than a bacteria causing the infections and that they needed new technology to find it. The 1918 epidemic probably led to the science of virology and development much later on of the technology that permits us to study virus DNA.
    Last edit by oramar on Jun 3, '09
  8. by   indigo girl
    What Happened to Mild?

    http://www.alertnet.org/thenews/newsdesk/L21023176.htm

    It is interesting to see how the language describing this virus is changing as we go along. They really have no idea how many people have been infected since most of them are not tested because they are not sick enough. Are we to think that the numbers that have been tested are not in the mild category?

    Quote from www.alertnet.org

    The newly-discovered strain had caused more infections than seasonal influenza at the start of Chile's flu season, raising concern about how it would spread in the southern hemisphere, according to Keiji Fukuda, the WHO's acting assistant director-general.
    The virus has mainly affected people aged below 60 and caused 117 deaths worldwide, including some otherwise healthy people, he said. For now, the WHO's pandemic scale remained at the second-highest level but the threshold may soon be crossed.

    "Globally we believe that we are at Phase 5 but we are getting closer to Phase 6," Fukuda told journalists. "The future impact of this infection has yet to unfold."

    He added: "It is probably fair to call the situation something like moderate right now. We do have some hesitation to call the situation mild."

    Fukuda said that, while many countries had reported only a small number of infections linked to people travelling to the disease epicentres of Mexico and the United States, others were starting to see more sustained patterns of infection in schools, offices and neighbourhoods.

    "There are a number of countries that appear to be transition, moving from travel-related cases to more established community types of spread," he said, citing Australia, Britain, Chile, Japan and Spain as examples.
    "We still are waiting for evidence of really widespread community activity in these countries. It is fair to say that they are in transition and are not quite there yet which is why we are not in Phase 6 yet," Fukuda said.

    Experts say it is nearly impossible to gauge how widespread the H1N1 flu has become because many patients suffer only mild symptoms and are not formally diagnosed, treated and documented.

    "We don't know the full number of people who are infected across the entire spectrum. So right now it appears that the number of severe illnesses appears relatively limited, but again we don't have a perfectly good handle on the numerator and the denominator of what we are seeing," Fukuda said.

    In Chile, which is just entering its normal flu season, Fukuda said the H1N1 variety appeared to be eclipsing other strains in circulation. "Most of the influenza viruses that they are seeing so far are the new influenza A-H1N1 viruses," he said. "They are seeing many fewer of the normal seasonal influenza viruses and the majority of viruses are the H1N1.
    "We need to see whether this pattern holds up in other countries," Fukuda continued. "This is one of the patterns that have been seen with earlier pandemics so I think it bears very close watching."
  9. by   indigo girl
    Swine flu: on not knowing

    http://scienceblogs.com/effectmeasur...owing.php#more

    Quote from scienceblogs.com

    The unpredictability of flu and difficulty of making any predictions with confidence is tiring to repeat and tiresome to listen to. Unfortunately that doesn't make it any less true. There are things we know -- because we see them happening -- and things we don't know -- because the information isn't available (like an accurate estimate of CFR or prevalence) or they have yet to happen.

    What we know is that we are confronted with a new influenza virus that is spreading with ease outside of its normal season, is infecting an age group that normally doesn't get easily infected (the 5 - 24 year olds), and is causing most of its serious illness and deaths in that same age group. In North America it is now the only significant circulating flu virus, present in all 50 states. WHO's Dr. Keiji Fukuda ((WHO presser .mp3) said yesterday that preliminary data from Chile, in the southern hemisphere, suggests it has similarly displaced the usual seasonal flu strains there. 64 countries have now reported over 17,000 cases and there is no doubt this virus is now a pandemic strain, whatever WHO chooses to call it. So that's what we know, because it is happening and we can see it.

    What we don't know is exactly how nasty this virus is or how nasty it might become. The general impression is that clinically it is like many seasonal influenza viruses, producing mild illness in many, a very uncomfortable but self-limited illness in many more, and a serious or fatal illness in some (117 deaths as of Tuesday). However we don't have accurate data from many localities and in others we strongly suspect the reported cases are just the tip of the iceberg. The UK is almost certainly chock full of swine flu cases, although by Monday they had only reported a few hundred. The number is more likely in the thousands. Government officials would rather not know, afraid evidence that sustained transmission was occurring would trigger a declaration of a pandemic, with unknown consequences for international trade and the economy. Said another way, the UK health officials have panicked, along with their counterparts in some other European and Asian countries. Their talk of wanting to prevent hysteria is just a projection of their own mental state. Given the lack of good data, we don't know how bad this virus is with certainty.

    But assuming it is as advertised -- a virus that produces a typical flu illness -- we still don't know what it will do from now on. It's the end of the flu season in the north and the beginning of the flu season in the south, but the virus is circulating with alacrity in both hemispheres. On first evidence it is crowding out the previous seasonal flu strains, although this could change overnight. Like all flu viruses, notoriously sloppy reproducers, it will change its genetic characteristics as it circulates in different populations in many different climates and parts of the world. For all we know it will establish itself in other hosts as well. Will it keep going throughout the summer up north? Many experts doubt it, but as of this moment it seems this is a possibility. Flu is notoriously patchy in its distribution, so the variation in prevalence we see in weekly surveillance does not mean it is dying out. But it could mean that. Or not.

    Given all the uncertainty, experts are having a hard time arriving at a consistent message. With good reason. They no longer have a firm basis to say anything with confidence. In the UK, noted virologist Dr. John Oxford is quoted as saying there is much more flu than the government is admitting but not to worry...

    What happens in the southern hemisphere in the coming months will be a good indicator of how the virus will behave in Europe and North America later this year. There would be particular concern if H1N1 mutated substantially to become a more virulent illness. Thankfully, there are no signs of that yet.

    Makes sense. Except that we can't be sure of any of it and so far nothing this virus has done has been according to expectations. Back to the old adage: hope for the best but prepare for the worst.
    The Editors of Effect Measure are senior public health scientists and practitioners. Paul Revere was a member of the first local Board of Health in the United States (Boston, 1799). The Editors sign their posts "Revere" to recognize the public service of a professional forerunner better known for other things.
  10. by   indigo girl
    Manitoba health officials won't comment on mystery flu on northern reserve

    http://www.google.com/hostednews/can...iempeR7E3HIQqw

    I posted on this situation yesterday. At that time, we only knew that two women were critical, and one of them lost her unborn child. Now we know that both women were pregnant.

    I have read from another source that the second woman had an emergency C-section, and remains critical as does her newborn son. That info comes from a blogger commenting on what they heard on their local TV. I cannot confirm this info though I suspect that it is true.

    Apparently this community is like a 3rd world country with overcrowding, and no running water in some living quarters. Exactly what Dr. Chan of the WHO has been warning about. The developing world will be more adversely affected by a pandemic virus.

    Quote from www.google.com

    While most people are experiencing mild symptoms, the flu has caused two pregnant women to fall seriously ill, including one who lost her child, according to Chief David McDougall of the St. Theresa Point First Nation.

    The provincial and federal governments have sent more doctors and nurses to the remote community of 3,200, which is accessible only by air.

    Health officials would not discuss St. Theresa Point on Wednesday, and would only say that 27 new cases of swine flu have been confirmed across the province, bringing the total to 38. Of the new cases, three were from the sprawling health region that includes St. Theresa Point.

    "We don't provide community names because we don't want to breach any personal health information," said Elise Weiss, the province's acting chief public health officer.

    "People are asked to limit contact with each other and also to use proper coughing etiquette," McDougall said. "I don't want people to get overly alarmed."

    Limiting contact is a tall order in St. Theresa Point, where a housing shortage has forced some families to share homes. Some two-bedroom homes are shared by up to 12 people.

    Such conditions make it harder for reserves to fight disease outbreaks, says the Assembly of Manitoba Chiefs.

    "Those communities in that area, many of them lack even running water (and) there's overcrowding," assembly Grand Chief Ron Evans said. "Those are real big issues that we all have to try and contend with and find a workable solution."
  11. by   oramar
    Quote from indigo girl
    Manitoba health officials won't comment on mystery flu on northern reserve

    http://www.google.com/hostednews/can...iempeR7E3HIQqw

    I posted on this situation yesterday. At that time, we only knew that two women were critical, and one of them lost her unborn child. Now we know that both women were pregnant.

    I have read from another source that the second woman had an emergency C-section, and remains critical as does her newborn son. That info comes from a blogger commenting on what they heard on their local TV. I cannot confirm this info though I suspect that it is true.

    Apparently this community is like a 3rd world country with overcrowding, and no running water in some living quarters. Exactly what Dr. Chan of the WHO has been warning about. The developing world will be more adversely affected by a pandemic virus.
    Oh dear, I think we are going to see the negative and positive effects of poverty and wealth magnified 10 fold.
  12. by   indigo girl
    Quote from oramar
    Oh dear, I think we are going to see the negative and positive effects of poverty and wealth magnified 10 fold.
    Yes. That is why India alone lost 20 million people from the Spanish Flu.
  13. by   lamazeteacher
    Friends in New York City (Bronx) became ill with flu-like symptoms 48 hours ago. When I spoke to one of them last night, I emphacised the importance of getting to a doctor to be tested and get a prescription for Tamiflu. He laughed and said that he didn't need to go to a doctor, as Tamiflu is OTC at the corner grocery store, near their home.

    Since his wife is asthmatic, and possibly pregnant, and I told him that made her high risk, and she had to be on it, too. They have a 7 year old healthy son, and said they'd have a symptomless family member take him to his doctor at the first sign of a cough, fever, sore throat - whatever. I suggested that he stay with that family member for at least a week, or until he became ill, and they're discussing that possibility...... He is a student at the school where the assistant principal died of swine flu........

    I told them about indigogirl's post about warning signs for children: "In children, signs that need urgent medical attention include fast breathing or trouble breathing; blueish or gray skin color; not drinking enough fluids; severe, persistent vomiting; not waking up or not interacting.; being so irritable that the child doesn't want to be held; and flu-like symptoms improve, but then return later with a fever and a worse cough.

    Can anyone tell me if that's a well known fact, about the OTC availability of Tamiflu in NYC or elsewhere?

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