Swine Flu and the 1918 Connection

*cries*

I know. But, still, most cases are mild so far. Let's concentrate on what we can do to make things better for our families and our workplaces. Find out what the plan is for your workplace. Make a plan for your family.

What will you do if your kids have to stay home from school? Can you partner up with other families? You have to think about this now before the surge happens, if indeed does happen.

Stay informed. Buy what you need now. Have a flu kit containing what you may need. If you live alone, have a flu buddy, someone who will agree to check on you if you get sick, and do the same for them. Gather your supplies in a place near your bed to have at hand if you get sick. Things like Gatorade, maybe a basin if you have GI s/s and can't make it to the bathroom. OTC meds for diarrhea, cough, fever, aches and pains...It is not panicking to do this, it's practical. Take care of yourself. Think ahead.

'Good chance' H1N1 will be part of flu season

http://www.the-daily-record.com/news/article/4627251

Here's some good advice from a public heatlh commissioner in Ohio.

Who would care for your children if schools closed?

How would you respond to an inability to report to work?

Are you prepared to be isolated for up to two weeks?

Recognizing a lull in media coverage of the H1N1 pandemic, but not intent on inducing undue panic, Holmes County's health commissioner is encouraging residents to take advantage of a window of opportunity to prepare for a likely resurgence of the virus as part of the regular flu season.

"Because we're not hearing about H1N1 in the news, the misconception is it's gone," said Dr. D.J. McFadden.

"If H1N1 is the dominant flu strain this winter, we could see a much different picture," said McFadden, adding he expects to see a vaccine for it no earlier than the start of 2010. "It could (continue to) act like the normal flu, and that would be great, but it might not."

Already the virus has become part of the seasonal flu outbreak in the southern hemisphere, he said, noting "the concern is, as it circulates and drifts (from its original makeup) a bit, it will cause a more aggressive immune response." That's what could cause morbidity and mortality rates to climb at an accelerated rate.

"Let's not count on a vaccine and use basic public health we've used for centuries before then," he said. "We have a unique opportunity right now. We see where we were in the spring. Now, we've had the first death in Ohio. There's a relatively good chance H1N1 will be a major player in this fall's flu season. We have no vaccine. So we need to start planning in our family."

There is no better time than the present to make healthy lifestyle changes -- shedding extra pounds, eating right, stopping smoking, getting proper sleep. All can be factors in building a healthy immune system that is better prepared to serve as the first line of defense.

"These are things we don't think about every year, but this year we don't have the luxury to rely on a vaccine for H1N1," he said, anticipating vaccines for other flu strains will be available and should be employed as in the past.

It also will be "even more important to practice social distancing" throughout the flu season. "Don't go to work or school if you're sick and practice basic hygiene -- wash hands, cover coughs," McFadden said.

To that end, families can anticipate the best, but should be prepared for the worst -- the need to be isolated from others and the possibility spread of the virus could interrupt and shut down services on which people rely daily.

He suggests families have stores of food and necessary supplies to last a full two weeks, if necessary. These include water, batteries, a flashlight, medications, pet food, extra clothing and bedding, diapers and formula, a can opener, entertainment for children and spare cash.

It also is a good time to revise a list of essential contacts, allergies and medications and devise backup plans for who would be available to care for children and elderly members of the family should daily routines be interrupted by the virus. Employees should also talk with their employers to discuss the possibility of working from home in the event an H1N1 infection prevents them from leaving the house.

http://scienceblogs.com/effectmeasure/2009/07/swine_flu_yet_another_paper_in.php

I like these epidemiology guys at Effect Measure. Reading them gives us yet another view of the Kawaoka research comparing the 2009 pandemic virus with the 1918 virus. It's just more food for thought, and there is no way to know for sure what will happen. We just have to wait and see.

Karaoka and his team looked at nursing home residents and workers from 1999 and from workers and patients in a hospital from this year (2009). Almost all the sera with neutralizing antibodies came from people born before 1920, a fact they interpreted as meaning that the current swine flu is related to the original 1918 virus before it diverged. So these data are not consistent with the CDC data nor do they explain why those over the age of 60 continue to be a striking minority in the current crop of swine flu cases. After raising the question of the CDC data and the discordance between pre-1957 lack of susceptibility and post 1977 sensitivity, they find yet a different result but do not comment on it. Very strange.

These three papers, by three highly competent teams of scientists, provide us with new information and raise still more questions than they answer. Indeed they answer very few questions at all, nor do they reduce any uncertainty about how this virus is acting now or in the future. I'll confess that just reading this paper and the news reports about it I might feel increased anxiety.

Until, that is, I look out the window. Then I'm right back where I started.

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.