There has been some discussion of this my thread. I'm starting this new thread so that more people can benefit from the doc's advice

Kidzdoc said
Right, urania, let's hope that this doesn't become a pandemic. From what I've read so far, the cases in Mexico (1300 cases, 81 deaths, of which 18 were confirmed to be swine flu, according to The New York Times) are much worse than the "mild" cases seen in California, Texas and New York—but why?

Could there be a difference in these two viral strains (types)? The WHO web page indicates that 18 of the cases in Mexico have been confirmed as H1N1, but only 12 are identical to the cases identified in California. That would suggest that there is at least one other strain of H1N1 in Mexico (assuming that there weren't any lab errors in processing the other six cases in Mexico). The WHO doesn't mention how severe the illness was in these 18 patients, so we can't assume that the deaths reported are due to this previously unidentified H1N1 strain. The page says that most cases have occurred in previously healthy young adults, the group that is least likely to die from influenza; however, there is still no information about the fatal cases, other than they had an "influenza like illness".

Bottom line: we need more data, which hopefully will come in the next few days.

Murr said:
Are cats in any danger?

Seriously, though, it would be great if you could keep us all informed, doc. Meanwhile, are there any simple precautions we can take to protect ourselves and our loved-ones?

kidzdoc said:
1. Avoid crowds, as best you can. (Hmm...maybe I'll stay in my hotel room. Or not.) You might think that you should just avoid people who obviously appear ill. The problem with that thought is that people who contract a viral URI (upper respiratory infection) are often asymptomatic for 2-3 days before they manifest signs of illness (coughing, sneezing, runny nose, fever, etc.). For those 2-3 days the virus is multiplying in their noses and mouths, and they can unknowingly pass on the virus to others in close contact (usually three feet or less, longer distances if they cough or sneeze).

2. Basic hygiene is always important. You all certainly know the basics, but one thing most people don't realize is that these viruses can infect the conjunctiva (which covers the eyes), and be spread from there to the respiratory system. It's spring in the northern hemisphere, and many of us have allergies to pollen, with itchy eyes, noses or mouths that beg to be rubbed. It would be better to use a clean facial tissue or medication for allergy than to contract a viral infection by rubbing (I'm using Visine Allergy eye drops).

3. In general, the youngest (infants and toddlers) and oldest people are most likely to have severe complications from the flu, as are the sickest, especially those with compromised immune systems (e.g., people receiving chemotherapy for treatment of a cancer). A common category of people with temporarily compromised immune systems are people with asthma who are taking an oral corticosteroid, such as prednisone, for an asthma flare up. Prednisone is an anti-inflammatory medication which affects the immune system's normal function, so those taking it for more than a few days are somewhat more likely to become ill from a viral or bacterial infection. People who are taking this medication or a stronger medication for a rheumatologic condition, such as rheumatoid arthritis or lupus, can become very sick from an infection, as their immune systems may not be able to fight it adequately.

4. Day care centers are germ factories! Those of you with young children know that there is always someone sick with something at day care, pre-K, or kindergarten classes. This is more often the case from early fall to mid spring, but there are plenty of viral infections that are prevalent in the summer. For example, enterovirus, which causes summer colds and mild cases of gastroenteritis ("stomach flu"), is the most common cause of viral meningitis in children, a common cause for hospitalization for these kids; fortunately it is a self-limiting illness.

5. In general, flu gives you high fever, muscle ache and a dry cough, as opposed to other URIs, which usually present with lower fevers, runny nose and sneezing, without as much myalgia.

6. According to the CDC swine flu web site, oseltamivir or zanamivir can be used to treat infection or prevent those exposed to the virus from getting the infection (or, at least, getting a severe case of the infection). Oseltamivir (trade name Tamiflu in the US) was not effective against the prevalent strains of influenza A in the 2008-09 flu season, so we weren't prescribing it as we had been doing in previous years, so you may have to mention this to your health care provider if you're unlucky enough to contract swine flu. Zanamivir (trade name Relenza in the US) has fallen somewhat out of favor in the US, as it was linked to reports of altered mental status (delirium and abnormal behavior) in kids in Japan, but is FDA approved for patients 7 years of age and older. On the other hand, Tamiflu is approved for patients 12 months and older.

Meddelelse redigeret af dens forfatter, apr 26, 2009, 9:33pm.

This is the latest from the Guardian website this morning.

http://www.guardian.co.uk/world/2009/apr...

tamiflu generally has a much better side effects profile than relenza. The side effects of relenza are often so unpleasant that patients discontinue - which given how miserable the flu can make you feel - is saying something.

If the media has taught me anything in the last 24 hours, it is that this is not the time for considered actions - this is the time to panic. I suggest that we all run around screaming, "We're all going to die!"

*runs around screaming* "We're all going to die! We're all going to die!" ... Now I'm glad I built that hermetically sealed bunker when the bird flu panic took root ... knew it would come in handy some day!

Meddelelse redigeret af dens forfatter, apr 27, 2009, 5:09am.

Numerous studies have shown that flu multiplies best in hermetically sealed bunkers. ;-)

Today's New York Times has an article about the decision in the US to declare the swine flu a "public health emergency". This initially sounds like overkill, but the reason for this is to "{allow} the government {to} free more money for antiviral drugs and give some previously unapproved tests and drugs to children". The article notes that "American investigators said they expected more cases here, but noted that virtually all so far had been mild and urged Americans not to panic" (italics mine).

I guess this is it for me if avoiding crowds is the #1 tip for staying healthy (see post #1), as I take the NYC subway daily and often work in midtown . . .
But seriously, I also read today that it is possible that many many more people have been mildly sick with the swine flu and never sought medical attention, so the fatality statistics could be skewed. The eight teenagers in NYC who got sick (some kids from the school had been to Mexico) are apparently all getting better on their own, without hospitalization. If we had never heard of swine flu in Mexico, they would have gotten better on their own without media attention.

I don't mean to sound flippant, and as a confirmed pessimist I've actually believed for a long time that a pandemic of some sort is around the corner, but with the "all crisis all the time" kind of media coverage, it's sometimes hard to tease out the facts from the hoopla. So it's wonderful that Darryl and others are here to give us straightforward information.

>8 Having returned from Australia late last August with the flu which took most of September to get over, I can tell you that I don't wish to catch ANY strains of flu!!!

Thank you for all the info. Darryl, I have copied your advice and pasted it in an e-mail I sent to friends and family. You never know....

I don't know why anyone is worried. Personally I can't wait for the film about this outbreak. I can see it now: the flu mutates the pigs into giant man-eating swine, and there is only one man who can save us now - a rogue butcher who is tormented by the memory of causing the death of his wife by accidentally knocking her into the mincer (preferably played by either Jean-Claude Van Damme or Steven Seagal, and with a screenplay by Kuzuo Ishiguro).

Meddelelse redigeret af dens forfatter, apr 27, 2009, 7:22am.

The Van Damme movie will be competing with "House of Flying Cleavers," by Zhang Yimou, wherein a secret society of blind Chinese butcher-monks cut the virus particles into pieces in midair.

With love interest provided by the ubiquitous and thoroughly irritating

Tom Cruise!!

Blacked up and IN DRAG!!!!!!

Empire magazine will call it (again): "THE role of his career"... and all the Scientologists will gloat...

I bet we are the only LT group with a swine flu thread. Who would've thunk it.

>12 well, the movie is off my list then.

lol yes, mine too!

LOL! However, I propose substituting Zhang Ziyi for (ecch) Tom Cruise. You can watch her in action in this Visa commercial, in which she battles with waiters in a restaurant after complaining that her soup is too salty.

If this isn't the only swine flu thread, it is certainly the only one that is working on a swine flu movie...

http://www.promedmail.org/pls/otn/f?p=24...:

If you're really obsessive - or just interested - promed is THE infectious disease epidemiology site - animal/vegetable/human ..not mineral as best i know. But it is updated multiple times each day by public health workers/doctors/researchers etc. There is a "area" set aside for the current swine flu outbreak.
...
a typical posting, from an zoonosis expert @ NC State

We are dealing with an H1N1 swine-associated type A influenza that carries
both human and avian characteristics. It is a novel virus that had not been
described previously. It appears to be resistant to some antivirals, but
sensitive to Tamiflu and similar drugs.

Human cases from this virus emerged nearly simultaneously in the border
counties (San Diego and Imperial counties) of California (27 Mar 2009) and
in north-central Mexico (22 Mar 2009). The news reporting out of Mexico is
not consistent, and I am not privy to the official consultations between
the 2 countries, but it appears the Mexican outbreak is in the Mexico City
area (south central Mexico), the sectors in and around San Luis Potosi
(about 400 miles north of Mexico City), and in Mexicali (on the border with
Calexico in Imperial county California).

To date, 8 cases in the US have been documented, all of whom recovered/are
recovering (only one was hospitalized and that was an immunocompromised
individual with other disease issues). There are over 900 cases in Mexico,
with over 60 fatalities (approx 6 per cent case fatality rate). Why the
disparity in severity between the 2 countries is unknown, but with the US
numbers being so low, it could just be a luck of the draw kind of thing
right now: my back of the envelope calculations suggest that if the US had
the same base case fatality rate as in Mexico, the likelihood we could have
8 cases without a death is nearly 60 per cent.

None of the US cases have any known exposures to either swine or poultry.
To date, though epidemiologic trace backs are far from complete, none of
the Mexican cases have swine or poultry exposures either. There are a
couple of apparent family clusters in Mexico, so with that evidence and no
recognized pig/bird exposures, it appears that we are seeing human to human
transmission.

We do not know if this virus is circulating in swine populations. We have
no evidence of it in domestic swine, although the industry does not have
the depth of influenza surveillance that we see in poultry, and there is
some doubt that this new H1N1 strain would be identified as unusual with
standard tests anyway. Groups are doing rapid assessments right now, so
that information may change momentarily as data come in. Feral swine are
another possible source/reservoir, but we have no information on them. I do
not know if anyone is currently chasing the potential of this virus to be
in birds.

Nobody knows right now where we are in the epidemic -- if this will burn
itself out in a few weeks or not. It is nearing the end of the influenza
season, so that is on our side. However, there are historical precedents
that should give us pause:

1. It was an H1N1 directly from birds that caused the 1918 pandemic that
killed more people than all the wars in the 20th century combined;
2. The 1st cases of that agent showed up in May 1918 in an army base in
Kansas -- it went quiet over the summer -- and started ravaging the globe
in early fall that year.

Source: Barrett Slenning
Animal Biosecurity Risk Management Group
College of Veterinary Medicine, North Carolina State University

I feel that I must post this hilarious comic on swine flu, since it is occupying my every spare moment of thought.

HAHAHAHA
I'm gonna go out and find me an autistic kid to lick!!

From my local news site "the virus is widely being called swine flu although it has components of classic avian, human and swine flu viruses and has not actually been seen in pigs."

Can't we refer to it as "Flying Pig Flu" or FPF for short ;-)

ETA especially if Zhang Ziyi is going to play the lead in the movie. Maybe the movie title could be "The Year of the Flying Pig"

Meddelelse redigeret af dens forfatter, apr 27, 2009, 9:58pm.

>19 I think you missed an element in your naming, so perhaps "year of the flying hu-man pig flu"?

Much better avaland ;-)

fannyprice@17,

I do love XKCD. Is that three or four major falsehoods packed into the 23 words of the last tweet?

and in a rational response:
"On Monday, Israel's deputy Health Minister Yakov Litzman, who belongs to an ultra-Orthodox Jewish sect, said the outbreak should be renamed "Mexican flu" in deference to Jewish and Muslim sensitivities over pork." (bbc).

Not to mention our fine republican senators slicing flu pandemic preparation out of the Obama stimulus package as "pork."

#23, Mexican flu? Seriously? That's really made me chuckle.

#23. Mexican Flu? Fair enough - I'm sure only ultra-Orthodox Mexicans would be sensitive enough to object to that.

>23, I (heart) the Israeli health minister. What a useful and thoughtful response.

The Knesset web site for Litzman indicates that his educational background consists of a high school diploma in Yeshiva studies. I would guess that his ultra-Orthodox background was the reason why he was appointed to this position by the Netanyahu (Netanyahoo?) government.

Meddelelse redigeret af dens forfatter, apr 28, 2009, 8:02pm.

He is, after all, one of the chosen ones. No further qualifications are necessary.

http://www.huffingtonpost.com/2009/04/28...

A posting of the video to last evening's Daily Show bit about the Swine Flu. As usual, it is pretty funny...

The CDC reported the first US death from swine flu today, in a 23 month old child from Texas. No further details are available at this time. I would certainly want to know more about this child, his/her illness, and what other factors may have played a role in the death. It would be one thing if this was a child with a chronic illness, such as a child born extremely premature with chronic lung disease, or one with a severe genetic or metabolic disorder or cerebral palsy. These kids can die from respiratory infections that would cause minimal illness in most kids. However, if this was a healthy child that sought prompt medical attention, that would be more concerning to me.

Every few years we see a more severe outbreak of flu that causes death in some previously healthy children. For example, in the 2003-04 flu season, the CDC (Centers for Disease Control & Prevention) reported 153 deaths in children due to influenza. This is usually due to pneumonia, either directly from the influenza virus or from a secondary bacterial infection, usually from a strain of Staphylococcus, especially MRSA (methicillin resistant Staphylococcus aureus), which is a frequent cause for hospitalization for kids in the US.

IMO, this situation bears close monitoring and moderate concern. However, at this early stage and with very limited data, with the exception of the apparent cases in Mexico this flu outbreak in the US and Europe has been no worse than influenza in any other season.

>30 I wonder if we will actually be able to get any real information about this child over the media din. I've reduced my news to PBS, Rachel Maddow, and NPR because of the atmosphere of hype detected when channel-surfing. Ironically, I'm reading Atwood's forthcoming dystopia satire, The Year of the Flood - the flood mentioned in the title is....not a flood of water, but...yes, a pandemic!

CBC news reported this morning that the child in Texas had come from Mexico. That's all I know.

#32: The New York Times also reports that this child traveled from Mexico to Brownsville, Texas with his family, and was brought to Houston after becoming ill while in Brownsville. The article says that this information came from Houston's Director of Emergency Services. The Houston Chronicle reports that the child was brought to a hospital in Brownsville on April 13, and was transported to Texas Children's Hospital in Houston that same day. He died on Monday (April 27). I haven't found any information on this child's medical background, as it is important to know if this was a previously healthy child or not.

#31: I think the best single source of information is the daily Swine Flu Press Briefings on the CDC web site, which are led by the new director of the CDC. However, a lot of the information on new cases is coming from communities and local and state officials, so the CDC information will often be a day or more behind the local reports. So, "trusted" news sources and the local media will still be important, if not always reliable, avenues for information.

More information is now available on the boy who died in Houston on Monday, from the Texas Department of State Heatlh Services web site. He was a 22 month old with "several underlying health problems", who flew on a commercial flight from Mexico City to Matamoros on April 4, and then traveled to Brownsville to visit family there. He became ill on April 8, while in Brownsville, and was admitted to hospital there a few days later. He was transported to Houston the next day, and died on Monday. The site reports that "none of the boy's known close contacts has subsequently become ill with influenza-like symptoms."

So, this was apparently not a "healthy" child, and it seems more likely that his health problems were a major contributing factor to his death, especially since others in his family have not become ill. As I mentioned above, kids with chronic illness can become seriously ill and even die from influenza or a less severe upper respiratory infection.

It is also not unusual for Mexican families who have child with chronic health conditions to come to the US, to obtain better care and/or a diagnosis for their child. I'm sure that a lot of kids go through the border states (TX, NM, AZ, CA), but we see a few every year in the children's hospital I work at, in Atlanta.

Thanks for that, Darryl.

this flu variant is genetically kind of neat (and yet another object lesson in how readily the flu virii(?) sort and resort). 4 (at least) virus sources have been sequenced:

"Nucleotide blast results for the virus A/California/04/2009 isolated
from case A (Table 1), show that the HA, PB2, PB1, PA, NP, NS genes
contain gene segments from influenza viruses isolated from swine in
North America such as, A/swine/Indiana/P12439/00, while the NA and
M genes are most closely related to corresponding genes from
influenza viruses isolated in swine population in Eurasia."

However, the NA and M genes from 2 swine virus isolates from America
are also closely related to the novel H1N1 virus
(A/swine/Virginia/670/1987, A/swine/Virginia/67a/1987), if a
reasonable nucleotide substitution rate is accepted. Thus, H1N1 from
Mexico may be a swine flu virus strain of entirely American origin,
possibly even of relatively ancient origin.

--
Dr Peter Petermann
WAI
Wissenschaftsforum Aviaere Influenza (Science Forum on Avian Influenza)

(i'll put my money on Smithfield Farms - they've been pretty slack in re environmental responsibility in NCarolina w/ respect to "hog lagoons" and the like - one might suspect that they operate w/ even less "oversight" in Mexico.)
In Mexico, state health authorities looking for the initial source of
the outbreak toured a million-pig hog farm in Perote, in Veracruz
State. The plant is half-owned by Smithfield Foods, an American
company and the world's largest pork producer. Mexico's 1st known
swine flu case, which was later confirmed, was from Perote, according
to Health Minister Jose Angel Cordova.

of course a company PR dude denies any possible link: ""We're just as worried about this as everyone else,"
said Mike Hawn, a Smithfield spokesman."

a couple of years ago, i moved to New Zealand just in time for avian flu to be a huge worry. they disinfected ALL my shoes when i went through customs because i'd lived on a farm.

now, i just moved to texas 2 months ago. i seem to have a knack for locating pandemic sites and then flocking there. but i didn't get avian flu and i think i'm gonna pass on swine flu as well.

kidzdoc, thanks for those updates. My son is 31-months and that child's age triggered all my irrational fears (perhaps a rational one or two, although that's debatable). I feel terrible for his family.

>36, Bob, Whaaaa????

Does this mean that the virus probably originated from an American farm? Well, of course we will blame the Mexicans. Isn't that what we do?

#39 - merely on a factory farm in Mex that's merely run by an American agri-business heavily into hog farming. (This IS just a guess, but not one that's totally out from left field).

In one of life's little ironies. When NCarolina got hit by hurricanes Dennis and Floyd, the other major NC hog company, Murphy "Family Farms" , built a luxury development for its top execs along the bend of ..damn i forget..one of the rivers down east, probably the Cape Fear outside of Rose Hill. The lagoons failed there (as they did in many other settings) and the yards of all these hog rich execs were, literally, covered w/ hog waste.

#37, atlargeintheworld: Given the way flu outbreaks correlate with the seasons, I think you might have picked the best hemisphere to be in for the next few months. Down here in NZ, we're just heading into winter ... but I would like to avoid this beastie too if I can.

#42. Aha, Tim this could add an interesting new angle to our July "Polar regions" theme on the Reading globally thread, assuming there are enough northern hemisphere LTers still around by then...

Although it's hard to disentangle from other viroses (principally dengue), flu is common here all year, with some seasonality correlating with the rains and start of school terms: May, when the first rains come, often heralds the onset of the coughing season, while in September the kids pool their ailments. Still, May is mango season. Besides, our leadership has announced that we are "bulletproofed" against this - like most of us of course I cherish an unconditional belief in politicians, and I don't eat much pork anyway.

I don't know what kidzdoc and any other medics here would say, but it strikes me that the virus could get along quite nicely in the tropical parts of Mexico and Central America for the next few months - besides, of course, rampaging in New Zealand where Tim, is ideally placed to write this up and take advantage of the growing appetite for post-apocalyptic literature.

looking more and more like origins of the virus were from the hog farms of the American midwest (Iowa & NCarolina are the 2 "leaders" in hog production in the USA) .. from the CDC's analysis so far:

One little detail we haven't discussed is that these Midwestern
viruses were exported to Asia. Korea and many countries import from
the US. Swine flu is economically not such a big deal that many
countries don't check for it. There are some parts of the puzzle I
don't have the answer to such as the European lineage
contributions. The genetic lineages of Asia and Europe mix quite a
bit.
http://www.promedmail.org/pls/otn/f?p=24...

Archive Number 20090501.1646
Published Date 01-MAY-2009
Subject PRO/AH/EDR> Influenza A (H1N1) - worldwide (03)
INFLUENZA A (H1N1) - WORLDWIDE (03)
***********************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

In this update:
1 More on origin
2 NYC school outbreak
3 Outbreak history
4 WHO - update 7

******
1 More on origin
Date: Wed 29 Apr 2009
Source: Science Insider, American Association for the Advancement of
Science (AAAS) abbreviated and edited

Interview with Ruben Donis
--------------------------
Virologist Ruben Donis, chief of the molecular virology and vaccines
branch at the US Centers for Disease Control and Prevention CDC,
spoke with Science Insider at length last night 28 Apr 2009 about
the swine flu virus causing the current outbreak. CDC's early
analyses raise several provocative possibilities. The stage appears
to have been set for this human outbreak by an outbreak over the past
decade of flu viruses in swine that combine strains from several
species. The 1st infected human may not even have been in North
America, let alone Mexico. Patient samples from Mexico taken over the
past several months reveal that this swine flu clearly exploded in
late March 2009, suggesting that it was not rapidly spreading in
that country, undetected, for very long.

Donis discussed the genetics of the virus -- the clues in this
mystery -- in detail. These include several of its 8 genes, which
code for surface proteins hemagglutinin (H) and neuraminidase (N),
the matrix that surrounds the nucleus, the nucleoprotein itself, and
3 polymerase enzymes called PA, PB1, and PB2.

We know it's quite similar to viruses that were circulating in the
United States and are still circulating in the United States and that
are self-limiting, and they usually only are found in Midwestern
states where there is swine farming. There's only one well-documented
case where the infection spread from one human to another. What we
know is that it is not common that there is sustained transmission in
people. Hemagglutinin, neuraminidase, and matrix, the 3 genes that
have the most public health interest, were sequenced, and then the
whole genome was completed. There similarities of about 94 percent in
the hemagglutinin H to the nearest strain we know. It's almost
equidistant to swine viruses from the United States and Eurasia. And
it's a lonely branch there. It doesn't have any close relatives.

The neuraminidase gene has close relatives in Asia. It's also swine.
The matrix gene same as neuraminidase.

For the avian and human sequences we have to step back 10 years to
1998, actually. Chris Olsen is one of the first that saw it, and we
saw the same in a virus from Nebraska and Richard Webby and Robert
Webster in Memphis saw it, too. There were unprecedented outbreaks of
influenza in the swine population. It was an H3 virus. The disease
was not very severe in healthy pigs. Everyone was very curious about
these H3 viruses. Since 1918, normally it's only H1N1 in swine. Then
all of a sudden there's H3N2 in swine in the Midwestern US. When
people analyzed what was inside those viruses, they realized there
were 3 different things. The PB1 gene, that was human. H3 and N2 also
were human. The PA and PB2, the 2 polymerase genes, were of avian
flu. The rest were typical North American swine viruses. Those
strains were the so-called triple reassortants.

The reality is good molecular surveillance in the pigs started in the
1970s. So if there were strains that were not very dominant between
the 1930s and the '70s, we wouldn't have detected them. This triple
reassortant was very successful and took over and dominated the
picture-to the point where the classical H1N1 was almost extinct. H3
was a different subtype, so there was no immunity in the pigs. It was
probably that they had new polymerase genes, too. The neuraminidase
and the matrix are the newest to be seen in North America. They were
not part of the team -- I talk about flu virus as teams of genes.
There are 8 players. They have these 2 new players from Asia.

One little detail we haven't discussed is that these Midwestern
viruses were exported to Asia. Korea and many countries import from
the US. Swine flu is economically not such a big deal that many
countries don't check for it. There are some parts of the puzzle I
don't have the answer to such as the European lineage
contributions. The genetic lineages of Asia and Europe mix quite a
bit.

> bob

i was going to point out that North Carolina is not in the American midwest, but then i checked your profile and... i think you might already know that.

no..we're not the midwest. Merely the proud host state to the slimy Smithfield
Farms and Murphey Farming mega hog producers. I love bbq & we have really good bbq just outside of Pittsboro, but as much as i love it, i eat it MUCH less often than i used to, just knowing something of what the hog production process has become in NC. And god knows what a "farm" w/ 100,000 hogs produces; my brother lived on a small farm w/ about 150 hogs outside of Charlottesville, Va (just down the road from Monticello) and god, the smell there could take your breath away.

I get really annoyed because our local folk who post on the chatham cnty bboard get so rabid about Hispanics and, of course, assume that swine flu is totally due to our (sizable) immigrant population(?????). I've stopped reading because i get too p'od, but Patty who's more even tempered, fills me in on what i'm missing.

Meddelelse redigeret af dens forfatter, maj 2, 2009, 6:49pm.

i'm originally from Knoxville, TN. i spent the first 17 years of my life living on a farm and blissfully ingesting animal flesh. and then i started to realized exactly what goes into processed/mass-farmed meats. my father's favorite joke at the dinner table has always been "wipe its a** and slap it on the plate" but he won't touch processed pork. he witnessed something at a hot dog plant that he still isn't willing to speak of to this day... (and yes, i know people aren't GETTING swine flu from actually EATING pork, but it's the byproduct of the pork industry)

i'm not a doom and gloom kinda of person (usually), but i've just come to the point in my life that if i'm not willing/able to kill it myself, i'm not eating it (which means i live on fish and chicken). we've become so distanced from our food that we don't even realize that we are making it possible for things like swine flu, mad cow, and countless other ickies to run amuck.

eta: i agree about the blame shifting. we have to own up to the fact that the people who pioneered mass agribusiness and control most of it still today are Americans. they just happened to figure out it was cheaper to buy land in mexico and hire Mexican workers there and at home than it was to run biologically and ethically sound companies. stupid structural violence!

Meddelelse redigeret af dens forfatter, maj 2, 2009, 7:48pm.

A few years ago the Florida electorate passed a constitutional amendment banning the breeding of pigs in crates -- there was a huge brouhaha about such an amendment going into the state constitution, but it did halt any plans for huge hog farms in the state. Power to the people and piglets!

You all are echoing the current book I'm reading, Margaret Atwood's forthcoming dystopia satire, set in the same future as her Oryx and Crake called The Year of the Flood. So, guess what the waterless flood is? It begins with "P" and ends with a "C"...

Meddelelse redigeret af dens forfatter, maj 2, 2009, 8:30pm.

doesn't end with a "T" ?????

>50, Lois, I want to get my hands on this book! When is it out?

September.

A contrarian view about swine flu and how much it will affect us in the fall. Being thoroughly contrarian myself, I tend to go along with it, just on the principle of it. But these guys DO have credentials.

SWINE FLU
Swine flu: How scared should we be?
July 25, 2009

Lynda Hurst
FEATURE WRITER

In 2005, the world faced a looming catastrophe.

Avian flu virus had jumped from birds to humans in Southeast Asia and was expected to spread throughout the world, causing up to a billion deaths.

Canada, like most Western nations and the World Health Organization (WHO), began stockpiling the anti-virus drug, Tamiflu. Ottawa bought 22.5 million doses; Ontario, 10 million. People were hoarding it.

By August, Margaret Chan, then WHO's chief of influenza pandemic preparedness, now its director-general, was no longer talking about if a pandemic was going to happen:

"The only question is: When? We have to be on the lookout for it any time, any day."

Dr. Richard Schabas, an internal medicine specialist and former Ontario chief medical officer, was withering about that assumption and didn't hesitate to say so:

"Our science just isn't strong enough for us be making these kinds of alarmist predictions that we're hearing from WHO and others."

Schabas was right. The bird flu pandemic never materialized.

Any more than the 2003 SARS pandemic. WHO predicted it would cause 100 million deaths. Worldwide, 774 died and, alas for the victims and for Toronto tourism, 44 of them lived here. But SARS turned out to be a hospital-acquired, not community-spread, series of outbreaks, not a pandemic.

Flash forward to the present.

Schabas, now the medical officer of health in Hastings and Prince Edward Counties, is at it again.

He's calling the swine flu H1N1 virus that has been making its way around the globe since April – killing more than 700 on its journey – a "pandemic dud."

Despite WHO's forecast that a more severe second surge of H1N1 will arrive this fall, causing up to 2 billion cases and many more deaths, Schabas insists the evidence strongly suggests "that's very unlikely.

"Historically, viruses starts to dissipate in a second surge because a lot of people get immunity from the first."

Swine flu was supposed to hit Canada "fast and hard" during the first wave this spring, he says: In fact, the official projection was "10,000 to 50,000 Canadian deaths and eight to 12 million cases of infection in the first two to three months."

As of this week, four months later, only 55 Canadians have died. Officials stopped counting cases of infection after they reached about 3,000 earlier this month.

"Swine flu may return in flu season, in October and November," says Schabas, "but the incidence of serious illness will be low."

He points to Australia where swine flu arrived in May, at the start of its autumn and winter. As of this week, 45 people have died there and the number of cases is about 16,000.

Schabas says a flu virus with a second surge more potent than the first has never happened before – and he includes the influenza pandemic of 1918-1919. An estimated 500 million people, one third of the world's population, were infected then. Lacking antibiotics or ventilators, anywhere from 20 million to 50 million died.

Schabas says there is nothing but anecdotal evidence to support the common belief that the Spanish flu, as it was called, consisted of a first wave in the spring of 1918, then a second, more lethal wave in the winter. He suspects it was an altogether different virus the second time round (but that's also unproveable).

He blames the media for exaggerating fears, not so much with inflammatory stories, but by being "amazingly uncritical" of the public health establishment. It's been consistently wrong, he says – about SARS, about avian flu, about the first wave of swine flu, "but no one in the media takes them on and says that."

The current WHO warning "will almost certainly be the latest pandemic false alarm in a growing list. I think H1N1 is just going to fizzle away."

Is Schabas out there on his own again, a contrarian whistling in the wind? Almost, but not quite.

Enter Dr. Neil Rau, medical director of infection prevention and control at Halton Health Services. He too flatly says swine flu's second wave isn't going to be a "a bestseller pandemic" any more than the first.

"It's not going to be the evil foe they're expecting. We'll see more incidence this winter, but there is no evidence of more virulence coming."

Why are he and Schabas seemingly alone in their contradiction, or at least downplaying, of what public health officials nationally and internationally have been saying since April?

"Fear of sticking out? Empire justification?" he offers, then adds: "Schabas and I aren't funded by organizations whose existence relies on appearing prepared. There are a lot of people out West, in B.C. (where H1N1 first hit in Canada), who tacitly agree."

The infectious disease specialist says he's not a contrarian for the sake of it. He's skeptical because of the evidence to date: the vast majority of swine flu cases have been mild, there has been no surge in emergency admissions, and no extensive absenteeism.

"We've spent so much time and money preparing for a pandemic, but just because we're planning for one doesn't mean this one is it. With SARS, the world was too slow; we under-shot, now we're over-shooting."

The frequently heard view that a flu pandemic is overdue because it's been 41 years since the last one is a non sequitur, he adds: the longer you go without something does not increase the likelihood of it happening.

Not that Rau is oblivious to the "mongrel" H1N1 virus, which is a hybrid of human, swine and avian flu strains: "I give it some respect because it broke out of season; there's no immunity in half the population, it's a new virus, it spreads person-to-person and selectively attacks young people."

(One theory is that H1N1 virus may kill via a "cytokine storm," an overreaction of the body's immune system. The strong immune systems of young adults are vulnerable, the weaker ones in children and older adults far less so.)

This week, the UK revised its death count down from 29 to 26 – many of whom had underlying medical conditions – and has been debating the pros and cons of closing schools in September.

Rau doesn't think the threat requires such "incredibly disruptive" actions.

"The virus is in the community so closing schools won't do anything. I'm against futile interventions. I'm not saying do nothing – preparedness is a good thing – but a healthy dose of pragmatism is needed now."

Canada's National Public Health Agency and its Ontario counterpart (created in response to the SARS outbreak) haven't caused excessive alarm with their communications, Rau notes approvingly. But other comments have been needlessly alarming, he says, citing a hospital official who said last week that "people will die" because the civic strike is disrupting public-health workers from pandemic planning.

"Public health used to quash information, now they are thinking aloud. It's easy to cause fear to an ordinary person."

The Canadian government says that when a swine flu vaccine is ready and has been tested, probably by early November, there will be enough for every Canadian.

Will Rau be among them? "It will likely be safe, but I won't get one until there have been a million doses given and there is evidence it is safe."

Toronto Star

there's no question that H1N1's qualifies as an epidemic. So far, however, it's generally not been an esp. serious variant of the flu. Basically one just hopes that no seriously dangerous mutation pops up, since it circulates a bit more readily than "normal" flus.

From an Australian point of view, we are being advised to take normal hygiene precautions. Wash hands etc.
Also, there are a few pregnant women on life support in the country and pregnant women are being asked to take flu symptoms seriously.

My healthy 20 year old son has had the most recently available flu vaccine. He works in retail part-time and thought it was a good idea to be vaccinated so his studies weren't affected by a serious bout. About 2 weeks ago he came down with mild flu symptoms for a week and then recovered.
The recommendations for healthy people are that a doctor's advice should really only be sought now by people who are having serious breathing difficulties or chest/stomach pains.
I'm in a higher risk category, having a Spinal Cord Injury, looked after my son while he was sick and washed my hands each time after leaving his room. So far so good, touch wood.

Currently, a vaccine is being tested in South Australia and could be available by September here at the end of our normal flu season.

The current strain really doesn't seem to be any reason to panic, just taking normal precautions seems to be the way to go.

Meddelelse redigeret af dens forfatter, jul 26, 2009, 4:33am.

To further lighten the mood. A very short joke...

First it was mad cow disease, then bird flu, now swine flu.
Its Farmageddon !

epidemic/pandemic stages are, in some ways, technical terms that only really have to do w/ how readily/easily a disease is transmitted (how many personal contacts are needed for a new infection/case to develop). The terms are independent of the severity of a disease. They are ALSO general descriptions so when WHO says a disease has reached pandemic stage that's usually not all that well explained - or, the same thing at all, when a newspaper headline uses the same terms.
see the link below for technical definitions.

http://docs.google.com/View?id=dc769n44_...

I couldn't resist bringing this thread back up to the top!

Well, who here has had it? (don't worry, the H1N1 virus is not known to be transmittable through the internet). Have you had your vaccination yet?

i'm going to try to convince the local health dept. to give me an injection; they just got the serum, and having pretty severe asthma and a recurrent case of mycoplasmosis (aka walking pneumonia) i'm in the high risk group if well out of the prime age group. Got the seasonal flu shot a couple of weeks ago.

Raises hand. It just swept through the family, and what a lovely weekend it was.

I think that the boyfriend and I had it. Fortunately, cats are immune. We're still languishing, though the worst is over. It seems to take forever to get rid of it.

I think hubby had it.
Because he was up-to-date with the usual Flu injection and he had flu symptoms.
With a spinal cord injury, I'm in a high risk group but I didn't seem to come down with it, using normal hygiene precautions, i.e. Lots of hand washing!

The Vaccine is available here and has been in circulation for a few weeks, I'm not sure if people are rushing out to be vaccinated or not, but I'm a bit hesitant with any new drug, so I'll wait a couple of months.

I've taken care of at least half a dozen kids in the hospital with documented influenza A infection, who probably all had H1N1; our state lab decides which samples to perform additional testing on, and the two kids of mine who were tested were H1N1 positive. We normally don't see the garden variety influenza A until December, at the earliest, so it is unlikely that any influenza A strains are non-H1N1.

I haven't gotten sick yet (knock on wood), as we use special precautions in the hospital for any kids with flu-like symptoms; this includes a disposable gown, gloves, and an N95 particulate mask. I have received the standard flu vaccine, but the H1N1 vaccine wasn't available by the time I left town on Thursday; hopefully it will be in stock when I return next week. I do have a supply of Tamiflu on hand, in case I start having flu-like symptoms before then.

Meddelelse redigeret af dens forfatter, okt 20, 2009, 7:29am.

Both my children have had it but neither my husband nor I came down with it. It wasn't a particularly bad flu, even allowing my daughter to read the third Harry Potter and get a good start on the fourth.

We had a cluster of cases (20+/-) at the school where I work (gr.9-12, 800 boarders, 200 day students) shortly after classes started in September. Gallons of hand sanitizer everywhere, unrelenting and dedicated steps taken by health and dining services, and ongoing efforts by everyone involved seems to have stemmed the flood for the moment (knock wood).

But...last weekend was parents weekend, so there was an influx of new exposures added to the mix. In addition, many students went away with their families over the long weekend, returning with who knows what as additional luggage.

We'll see what develops over the next week or two. Fingers are crossed for the rest of the term!

>61 if it was a 'weekend', it doesn't sound like the flu.

#67 Our pediatrician told us it was swine flu. I was abbreviating a little. My daughter got it Tuesday, and had fevers through Thursday. I got it Wednesday evening and had fever mostly that night, but also through Friday. My son got it Friday and had fevers through Sunday. The kids seem back to normal, but I was really weak Sat & Sun and am still don't feel normal today...

Meddelelse redigeret af dens forfatter, okt 25, 2009, 11:39am.

Re "who has had it": my wife and I had it (we think) during the New Zealand winter, in July. By the time we got it, mandatory testing of suspect cases had ended in NZ, so neither of had a test - however, the pattern of symptoms fitted: in particular, taking a long time to shake it off, and periods of extreme lethargy during the recovery period.

Our son either didn't get it, or was asymptomatic.

This is old news now, of course, but in the light of #59, I thought I should add it. The outbreak in NZ peaked sharply in July, then dropped away quickly in August, coincident with the advent of warmer weather.

No sign of H1N1 in our household yet, but my 29-year-old sister-in-law in Texas has been hospitalized with H1N1 and a skin infection (MRSA). She has been in the hospital for a few days and is expected to stay at least a few days more, but she will be fine and is in good spirits. The MRSA is the main problem, not the flu, but I believe the docs think it probably became an issue because her body was busy fighting the H1N1.

getting the injectable vaccine next tuesday at our county public health dept as i qualify as "at risk."

I was at my doctor's office in New Hampshire today and according to him:
1. They are not seeing any H1N1 flu cases (he is a GP but doesn't see a lot of kids)
2. They have not seen any H1N1 vaccine at all
3. They got approximately 1/4 of the regular flu vaccine they ordered. The supplier called just before the expected delivery to give the bad news. Obviously, I'm going to have to get my regular flu shot elsewhere this year...
4. My doctor has pretty resigned himself to catching the Swine flu - no vaccine and a high risk profession.

*however, a hour or so later, I stopped to see my daughter at the company she works for and they were in the midst of holding a flu (regular flu) clinic - vaccinating employees and their families. Apparently, they have installed Purell dispensers throughout the building also.

how r we all going to die???

not with a bang, but a whimper.

Some say the world will end in fire,
Some say in ice.

Well, after a hiatus of about three weeks, H1N1 is back with us here at school. Seven students are out with it today, and more anticipated. We still have not received any vaccine, according to health services communications, despite the fact that we've already had one go-round with it and we have 1,000 students plus faculty and staff - with most everyone living in close proximity 24/7.

Sheesh!

Someone told me that all the hand sanitizer stations are pointless because the flu is a virus. Can any of our doctor-readers in the club set me straight?

#77: That's incorrect. The alcohol-based hand sanitizers are very effective against nearly all viruses (including H1N1) and bacteria, as the alcohol dissolves the cell membranes of microorganisms. The hospital I work at (and probably most hospitals) has several hundred hand sanitizer stations, one in each patient room and outside of every other room in the patient care areas and in the ER. The most effective hand sanitizers contain at least 60% alcohol; of course, they should be kept away from very small children, due to the risk of alcohol intoxication if it is ingested.

Fanny - I believe that comes from the anti-bacterial soap and anti-bacterial covers that come on plastics . . . but washing with soap and water is the important part, not the anti-bacterial ingredients. The public library has a great poster outside the bathrooms that says something along the lines of "Most people wash their hands for 5 seconds . . . you need to go 20 seconds longer" (yeah, well, it's more eloquent than that). Ever since I read that last month, I remember to sing the "row, row, row your boat" song slowly while I wash my hands.

due to the risk of alcohol intoxication if it is ingested

oh cool, so free alcohol available at hospitals now? I'm heading down there.

#79 Ever since I read that last month, I remember to sing the "row, row, row your boat" song slowly while I wash my hands.

hmm...Maybe I need to try that with my kids. (My 3-yr-old washes by putting soap on his hands, and then rinsing (most of) it off with water. He doesn't get the scrub part. If I'm there I shut the water off until he actually scrubs a little.)

#80 Murr - I don't think it's good for cats, just saying. It tends to cause problems with that landing-on-your-paws-when-falling bit.

At my children's elementary school, a person wielding a giant bottle of hand sanitizer is posted at the entrance and each child is given a squirt of the stuff as they enter the school.

On a similar note, I took the dog to the vet for her annual physical and before I knew what had happened, she got a flu shot. The dog. The cat had her appointment the day before and wasn't offered one.

And completely off topic; the cat and dog are great friends, with much mutual grooming. The vet said he had never seen such clean ears in a dog before. Blech.

>82, Apparently there is a dog flu going around. It does not impact cats. Yet another reason cats are superior animals. ;)

got my H1N1 shot today - how the Chatham county health dept managed to get a decent supply of vaccine when Durham and other area counties have had major problems is totally a mystery to me.

Those alcohol based hand sanitizers, distributed liberally within and around hospitals might be the last defense against MRSA as well...If anyone IS in the hospital, is awake, and sees that a nurse or doctor hasn't washed his/her hands prior to examination, it's not being rude to remind them to do so. Staff ARE often overworked, even in the best hospitals:
"Dec. 5, 2008 -- Every dab of alcohol hand sanitizer used in British hospitals lowered multidrug-resistant staph (MRSA) infection rates by 1%, a U.K. study shows.

In-hospital infections -- particularly MRSA -- are a huge and growing problem. As part of the solution, the U.K. National Health Service in 2004 launched a national "clean your hands" campaign among health-care workers."

An acquaintance ended up spending an extra two weeks in a major Uni hospital after a "routine" procedure due to MRSA; presumably acquired post-surgery.

I'd be more worried if I was diagnosed with MRSA than H1N1.

Speaking of MRSA, my sis-in-law is out of the hospital, with the understanding that she'll rest up at home and take her oral antibiotics. Still having some problems with the MRSA, but it's improving and hasn't spread in the past few days.

MRSA (methicillin resistant Staphylococcus aureus) has become a "four letter word" for me and my colleagues. Last week I took care of three kids in the hospital with culture proven MRSA. One had a pneumonia, with a "white out" of the left side of her chest and an empyema, a collection of pus in the pleural sac that surrounds her lung, which needed to be surgically drained. The second had pansinusitis (infection of several sinuses) that led to orbital cellulitis, or an infection within the orbit, with an associated abscess; he underwent functional endoscopic sinus surgery (FESS). The third had cervical lymphadenitis, an infection of the lymph nodes in the neck, with an associated abscess; she had an I&D (incision & drainage) of the abscess.

The problem now with MRSA is that it is primarily acquired in the community, and it has become a common problem, especially for kids playing contact sports, such as football or wrestling. But I've seen it in all age groups; the youngest patient I've cared for was 4 or 5 days old, who had a thyroglossal duct cyst that became infected with MRSA. The bug used to be acquired in the hospital setting, which was known as HA-MRSA (hospital acquired MRSA). However, about 5-6 years ago, community acquired MRSA, or CA-MRSA, began to appear in the US. It is now the most common cause of skin and soft tissue infections, and it's becoming a more common cause of more serious infections, such as orbital cellulitis, complicated pneumonias with empyemas, osteomyelitis (bone infection) and sinusitis. We're routinely covering kids with these infections with the antibiotic clindamycin, which is effective against the vast majority of strains of MRSA isolated in the US.

One thing I've seen repeatedly is the use of a sulfa drug, usually trimethoprim-sulfamethoxazole (or TMP-SMX, trade names Bactrim or Septra), to treat MRSA by primary care or ER docs, with subsequent progression of the infection. One of my good friends, who is a pediatric infectious disease specialist, taught us that TMP-SMX is not as effective in killing MRSA as clindamycin is, which does come in oral form. The oral suspension (liquid formulation) of clindamycin tastes awful, which is why many docs prefer to prescribe TMP-SMX. But, it's better for a kid to take a nasty tasting medicine that works well than a pleasant tasting medicine that doesn't!

Sorry, this was probably TMI...

it's not TMI..i ended up w/ 3 months of an incredibly swollen left forearm w/ a MRSA acquired...as best i can guess...from a modest scrape picked up while falling when running in my very last "competitive" road race ~10 Yrs ago. A few days later beset w/ high fever and weirdly engorged arm, i dragged myself to my family doc who started pumping me full of a couple of anti-biotiocs and draining and debrading. Gyms, yoga classes, etc. all should be using alcohol/ammonia(?) wiping by everyone post equipment use. I guess my scrape came into contact w/ someone else's jersey or something in a big, crowd of runners somewhere near the start and that was that. If it had been a freely bleeding cut i doubt the same would have happened?

*TMI would be describing the final "resolution" of the problem.

Bob, I admitted a kid to the hospital today with a very similar story, except he scraped his elbow while playing football last week, and did fine for several days, before his elbow blew up yesterday. He also failed outpatient TMP/SMX, and I'll know in a day or two if he has MRSA or not--but I'm pretty sure that he will have it.

I agree with you; that probably wouldn't have happened, to you or him, with a freely flowing cut.

I got my H1N1 vaccine today, and I've already received my regular flu vaccine. I'm all set for winter (yeah, right).

Update: hubby was diagnosed by his doctor today: swine flu. Even with handwashing and Purell and reasonable precautions, I'm feeling pretty resigned...

I have volunteered to man tables at the public health clinics the county health department is giving, so I was given the vaccine for H1N1 at the training class last Thursday. It has been going around the school this fall big time. One of my kids (they are teenagers) had it a few weeks ago and the other one seems to be coming down with it now, but it apparently just hits their age group like regular flu - only the under five set apparently are in any danger from it.