Swine Flu Updates and Issues

indigo girl · Jun 3, 2009

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?

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."

indigo girl · Jun 3, 2009

Swine flu: on not knowing

http://scienceblogs.com/effectmeasure/2009/06/swine_flu_on_not_knowing.php#more

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.

indigo girl · Jun 3, 2009

Manitoba health officials won't comment on mystery flu on northern reserve

http://www.google.com/hostednews/canadianpress/article/ALeqM5i0wF62wFhFnyUliempeR7E3HIQqw

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.

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."

oramar · Jun 3, 2009

Manitoba health officials won't comment on mystery flu on northern reserve
http://www.google.com/hostednews/canadianpress/article/ALeqM5i0wF62wFhFnyUliempeR7E3HIQqw
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.

indigo girl · Jun 3, 2009

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.

lamazeteacher · Jun 4, 2009

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?

indigo girl · Jun 4, 2009

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

Only available by prescription for infected patients in the high risk groups or those that are more than mildly ill. CDC guidance says pregnant women if infected should be started onTamiflu.

Never OTC. This is a precious commodity.

indigo girl · Jun 4, 2009

Chicago woman is state's fourth swine flu-related death

She was only twenty.

How many times has this happened since April?

http://www.southtownstar.com/news/1605132,Swine-Flu-Illinois-Chicago-death-0603.article

A baby was successfully delivered at the University of Illinois Medical Center on the Near West Side last week to a 20-year-old woman who later died from the swine flu (H1N1) virus.
The 20-year-old woman was the second person in Chicago and the fourth in Illinois to die of the swine flue virus, according to the Illinois Department of Public Health.
She was admitted to the hospital on May 23 suffering from influenza-like symptoms, according to a release from UIC. She was diagnosed with pneumonia and the swine flu, and her condition deteriorated rapidly.
Doctors successfully delivered her 27-week fetus by Caesarean section May 29, the release said. The mother died at 12:03 p.m. the following day.
The baby is being cared for in the hospital's Neonatal Intensive Care Unit.

Girl Scout · Jun 4, 2009

Tamiflu, OTC at a corner store? Boy, I bet their orders are through the roof! I've not heard of anyone in the US selling Tamiflu or Relenza OTC. I know that in China, farmers get oseltamivir and maybe zanamivir to give to their livestock, or so went the story time and again as I read it during one of the recent H5N1 scares there.

I wasn't thinking that any anti-flu drug had been okayed by the FDC for OTC? I mean, there are plenty of OTC remedies that can take the edge off the aches and lower the fever and make the coughing not-so-bad, but nothing anti-flu, AFAIK.

indigo girl · Jun 4, 2009

I stand corrected. Post 76 and post 92 are referring to the same unfortunate young woman, Caitlin Huber.

indigo girl · Jun 4, 2009

Queens, New York

http://www.yournabe.com/articles/2009/06/03/queens/queens_efulbuc06032009.txt

City Comptroller William Thompson and Borough President Helen Marshall pleaded with the state and city Monday to provide Queens' overcrowded hospitals with more resources in order to combat serious health threats, such as swine flu.
Speaking outside Jamaica Hospital's emergency room, Thompson unveiled the findings of a new report issued by his office that examined the borough's hospitals since the closing of Mary Immaculate and St. John's Hospitals in February. The comptroller said emergency rooms were overloaded and ambulance turnarounds are longer at the Queens medical centers.
"Our health care system has been threatened like never before," he said.
The comptroller and Marshall said the swine flu outbreak, which has killed two Queens residents and sent dozens more to the hospital, has created a heavier burden for the borough's medical centers and doctors during the last couple of weeks. Last week, Jamaica Hospital's emergency room saw 663 patients with flu−like symptoms, double the normal patient intake, according to the borough president.
Jamaica Hospital has leveled out some of its ER visits by setting up two triage units outside the hospital dedicated specifically to treating patients with flu−like symptoms, but Thompson warned the situation at Jamaica and other hospitals could get worse without additional resources.
"This is only going to snowball," he said.
"By asking those hospitals that are financially challenged and that are near the two that closed to spend money they do not have, [the state Health Department] is threatening the very survival of those hospitals," the comptroller wrote in his report.
Marshall said she hopes the city and state would act on Thompson's report because the hospitals were being too overcrowded after the closing of Mary Immaculate and St. John's.
"When this pandemic hit us, it became worse," she said of the cluttered ERs. "Really and truly we need help."

indigo girl · Jun 4, 2009

swine flu: distraction and leadership

http://scienceblogs.com/effectmeasure/2009/06/swine_flu_distraction_and_lead.php#more

preparing for our seasonal flu season, and a bigger than usual surge in cases than we are used to is what needs to happen.whenever there is a bad flu season, many hospitals go on divert. there is a very real possibilty that we will have an unusually bad flu season ahead of us. maybe it is better that this virus is infecting many now.

the uk is having quite a swine flu outbreak, although the authorities aren't owning up to it. as for the public, they are being whipsawed between the usual poles of "it's all hype" and "we're all going to die," with the latter fading in parallel with the fading of effectiveness in selling tabloids. so, yes, there's a lot of dreadful stuff in the news about swine flu, but there's some pretty astute stuff, too. here's something i ran across in timesonline [uk] by melanie reid:
when we heard that the only deaths were a few mexican peasants, we gave a collective shrug: this is not our problem. nobody has died apart from a few foreigners. why, even those brits who brought it home just had mild symptoms. why make a fuss? just overexcited health staff keen to test emergency planning procedures, we thought; just another scare whipped up by the media. i bet most of us chucked our government swine flu leaflet away as junk mail.
up to now, we've treated the disease as a form of entertainment; a hollywood plot. we've reacted, in other words, like thoughtless, cynical consumers.
but wouldn't it be ironic if swine flu kills in part because it is that most old-fashioned, unfamilar enemy: a slow-motion event, one that terminally confuses a society addicted to constant change and bored by anything that hangs around for longer than 24 hours? (melanie reid, timesonline)
what will make a difference is a concerted, steady and systematic effort by public health and social service authorities to get ready for what might be a very difficult flu season ahead. there is no requirement that this be done in a noisy and highly visible way. much can be done quietly and methodically.
but it will require political leadership. some places have it. some don't. the ones that have it will do better should things go as they well might. if they don't -- if swine flu is a temporary but unrealized threat -- generic efforts to make a community more resilient to flu will still pay off handsomely, and those places will also do better. either way the[y] win.
and either way, places with weak and gutless leadership will lose.

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.