swine flu
revere | May 10, 2009The spate of swine flu articles in The New England Journal of Medicine last week included an important "Perspective, The Signature Features of Influenza Pandemics — Implications for Policy," by Miller, Viboud, Baliska and Simonsen. These authors are familiar to flu watchers as experienced flu epidemiologists and analysts of archival and other data. Analysis of archival data is sometimes described as archeo-epidemiologic research. In their NEJM article Miller et al. summarize what they see as some common features in the three flu pandemics of the last century (so the generalization that there…
revere | May 9, 2009Maryn McKenna has a great piece at CIDRAP News today about something that should worry all of us as we wait to see if the other shoe drops with swine flu. Our acute care health services system is so brittle it won't take much to break it:.
With the global outbreak of novel H1N1 influenza (swine flu) entering its fourth week, physicians at emergency rooms, clinics, and hospitals around the United States say they are overwhelmed with "worried well" who have as much as doubled their patient loads.
All the clinicians work at medical centers that have planned and practiced for pandemics and…
revere | May 8, 2009While swine flu as a public health issue is starting to fade from the headlines (its true status as a public health issue is another matter), the problems for the pork industry might just be starting. The industry wasn't well to begin with, and for some of its members, swine flu could be a terminal event, just as with people. Hog prices were very low even before the outbreak and hog futures have declined another 20% since then. This is on top of increased costs related to feed (70% of the cost of production). Even if people can't get sick from eating pork, pigs are getting sick from being…
revere | May 8, 2009Late yesterday The New England Journal of Medicine published a number of papers on the recent swine flu outbreak. The first paper, "Emergence of a Novel Swine-Origin Influenza A (H1N1) Virus in Humans" by large federal-state team of epidemiologists describes 642 confirmed cases in 41 states as of May 5, 2009, two days before publication. What I find remarkable is the speed the problem was recognized -- literally days. Identification of the virus was first made in the CDC laboratory on April 15, just 3 weeks ago. Now we are already reading scientific papers providing a wealth of detail.
Among…
revere | May 7, 2009It seems a conversation on one of the comment threads about "swine flu parties" at Effect Measure has made the New York Times:
One of the first open debates of the idea of intentional self-infection was on Effect Measure, a public health blog with many posts by thoughtful people who say they are clinicians, epidemiologists, veterinarians and other professionals, sometimes in government, but who post under pseudonyms to speak freely.
On April 28, a user calling herself OmegaMom posted: “Just a quick note — I just got a Tweet from a mom suggesting ‘swine flu parties’ because the U.S. version…
ddobbs | May 7, 2009
I should just have a permanent pointer from here to Effect Measure. But as I've not figured out how to do that, here's some more sensible thinking from Revere:
No one on the public health side has over reacted. When an outbreak or pandemic is unfolding, you get only one chance. The window is a narrow one. CDC (and WHO) have acquitted themselves well, so far. CDC's daily briefings have been straightforward and informative. The public, understandably, has bounced back and forth from fear to relief and back again. I don't think either pole is avoidable. If the scientists are baffled and…
revere | May 7, 2009Breathing easier, may be an apt phrase for an almost audible collective sigh of relief. So far, the incipient swine flu pandemic is not extremely nasty. Is this perhaps premature? The world's premier scientific journal, Nature, and many flu scientists, suggest it is:
Complacency, not overreaction, is the greatest danger posed by the flu pandemic. That's a message scientists would do well to help get across.
[snip]
There is ample reason for concern: a new flu virus has emerged to which humans have no immunity, and it is spreading from person to person. That has happened only three times in the…
ddobbs | May 6, 2009I've noted several times here how more measured heads keep emphasizing that a) we're working on partial information in responding to the current swine flu outbreak and b) new developments may complicate things at any point along the line.
Here's a great example of what these folks (like Effect Measure, Crof, and Avian Flu Diary) are talking about.
From Reuters :
Second strain of flu may complicate picture-study
06 May 2009 15:02:09 GMT
By Maggie Fox, Health and Science Editor
WASHINGTON, May 6 (Reuters) - A second strain of influenza, one of the seasonal strains, may have mutated and may…
ddobbs | May 6, 2009
While I'm at it, here are a few other recent posts about modulating our thinking about the swine flu outbreak that is a) so far less horrid than our worst fears and b) still working its way around the globe, as it may well be doing for some time to come.
Greg Laden notes that nothing has changed.
The Avian Flu Diary first considers, in the wonderfully titled post, "Before We Ride Down and Shoot the Survivors," the editorializing about "panic" ; and then ponders what might change as/if this flu works its work in the southern hemisphere over the coming months.
Peter Palese writes on why…
ddobbs | May 6, 2009In a post titled "Dead, Your Majesty," H5N1, Crof ponders why we scramble to deal with swine flu while ignoring other problems ranging from cancer to the 3000 children a day who die of malaria in Africa :
Most of us are comfortably settled in rich industrial countries where problems like TB and AIDS are rarely in the news. Zimbabwe, like our own homeless, is a deplorable problem...but not our problem. We'd prefer to focus, via high-speed internet connections, on a conjectural disaster instead of the many real disasters killing people somewhere else.
If a thousand people died in the US…
revere | May 6, 2009How fast flu spreads is related to how many susceptible people an infectious person can infect (a measure called R0) and also something called the serial interval. The serial interval is the average length of time between the start of one infection and the start of the infection of that case's infected contacts. The horter the serial interval the faster a virus can spread. So what is the serial interval for this virus and how can we determine it? The answer to the first question is the usual. We don't know yet. The answer to the second one tells us a little about why we don't know and why we…
revere | May 5, 2009If you've ever wondered how spammers got your email address, the answer might be that you gave it to them by following a link you thought had important or interesting information. We all know the kind of "interesting" information people will follow. Sex is the biggest business on the internet. But spammers have also learned that breaking news events can also be a lure, especially if there is public anxiety and uncertainty. About things like swine flu:
About five per cent of global spam volume mentions 'swine flu' to trick people into opening the e-mail message, say security experts.
As the…
revere | May 5, 2009As I write this the US has 279 confirmed cases and one death from H1N1/2009 in 36 states. WHO has tallied 1085 1124 cases in 21 countries with 25 deaths. There is a backlog of samples waiting for confirmation, so by the time you read this the counters will probably have rolled upward, especially as state laboratories become facile with the new primers and are able to do their own confirmation. And predicting an increasing case count is about all anyone can say with certainty at this point. What we said once about flu pandemics can be said just as appropriately for the flu virus: "If you've…
revere | May 4, 2009Cytokine storm is a graphic phrase that doesn't do justice to the complexity of one of the things that made the 1918 H1N1 virus so virulent and is also implicated in the frightful case fatality of H5N1 ("bird flu"). The current H1N1/2009 is not showing a propensity to cause this nasty effect, but the subject has come up several times in the comments. The post I am sending you to was written just before the current outbreak. It is about recent work that is trying to unravel the mechanism behind the serious immune system dysregulation called cytokine storm. While it's mainly about cutting edge…
terrasig | May 4, 2009My clinical counterpart, surgical oncologist Dr David Gorski, has an excellent post up today at Science-Based Medicine on the irresponsible and misleading information being provided at The Huffington Post during the current H5N1/2009 influenza ("swine flu") outbreak. "The Huffington Post's War on Medical Science: A Brief History" provides a cautionary tale for us in embracing web-based news sources as our excellent print newspapers are going by the wayside.
Within the post, Dr Gorski shows that he is even more familiar with my writing than myself by citing a post at the old Terra Sig on the…
revere | May 4, 2009There have been questions in the comments about where the CDC estimate of 36,000 to 40,000 influenza related deaths a year comes from. It's a figure I've used a number of times here to say generally that regular old seasonal influenza may be a mild disease for some but not for many others. Even if you don't die of flu, it can be a miserable illness and lay you low for several weeks of acute illness and months of fatigue and malaise. Now the 36,000 deaths number is taking on a life of its own, so it's time to explain exactly what it is and what it isn't. There are more things it isn't that it…
revere | May 3, 2009Newspapers and wireservices are doing a terrific job keeping a flow of information on H1N1/2009 (the virus formerly known as swine flu). And so, I am happy to say, is the blogosphere. I don't want to slight some terrific bloggers by mentioning some and not others, so I won't do a blogroll. OK. I will make one exception to the "not mentioning" by mentioning crof over at H5N1, not only for his usual splendid job of gathering the news but for his great blog roll and resource list on the sidebar.
And, yes, I am going to make another exception for an exceptional blog post by my long time blogging…
rskloot | May 3, 2009
Yes, that's right folks, the end of the world is near, but at least we won't look silly wearing our N95 respirator masks. No. Thanks to Flu Fashion Respirators, we can now avoid swine flu and other plagues while looking like ... bandits from cheesy western movies! Or ... better yet ... hippie bandits! And we can even get designer swine flu respirator masks for the family dog (never mind that dogs can't get the swine flu -- we wouldn't want them to feel left out). What could possibly go better with an over-hyped pandemic threat than
fashion accessories? This press release speaks for…
revere | May 3, 2009It's now fairly certain that humans have returned the favor and given H1N1/2009 to pigs, another example of a cozy flu swapping relationship now almost a century old. At the time of the 1918 pandemic, pigs were also suffering a serious influenza-like illness which was quickly dubbed "hog flu." The pigs got sick suddenly with fever and respiratory symptoms but recovered quickly and mortality was fairly low. The same thing occurred elsewhere (Europe, China) during and after the pandemic, so it wasn't hard to make a connection between the "Spanish flu" and "hog flu." But in 1918 it wasn't known…
revere | May 2, 2009CDC has posted images of the H1N1/2009 (aka swine flu) virus. This looks like it is grown in tissue culture (probably dog kidney cancer cells). It presents the ideal picture of a spherical virus studded with HA and NA protein spikes on its surface and enveloped with capsular material derived from the host cell. When flu virus infects actual organ tissue in an intact host it is pleomorphic, i.e., it has a variety of shapes, including a long threadlike one. However this is its ideal shape, often rendered in cartoon or diagram form in textbooks.
Here's a typical diagram of a flu virus:
Source…