In this 76th hour of the swine flu emergency, President Obama urges that we take "the utmost precautions." And the World Health Organization (WHO) has raised the pandemic flu alert level to 5 out of 6, warning that this international outbreak will pose a prolonged threat.
What do "utmost precautions" mean for all of us? What follows is a crib sheet on what we've learned so far about the swine flu, what we still don't know, and a few steps we can each take to reduce the likelihood of getting sick.
1. How long before everyone gets sick? How fast can a pandemic strike?
In 1918, the so-called Spanish pandemic flu spread across the United States in less than one month. Today, with international jet travel, experts say a pandemic flu strain will probably spread even faster. It's still too soon to tell how quickly this swine flu strain will spread. "Flu is like fire," Angela McLean, director of Oxford University's Institute for Emerging Infections, tells The Daily Telegraph. "You have an outbreak and it spits out sparks. You have to wait to see whether the sparks die out or start new fires."
"What happens next is chiefly up to the virus," adds John Barry, author of The Great Influenza, in The New York Times. "What's important to keep in mind in assessing the threat of the current outbreak is that all four of the well-known pandemics seem to have come in waves," Barry continues.
In the 1918-1919 pandemic, according to the CDC, the first mild wave started in March and swept through the United States, Europe, and Asia. A second much deadlier wave spread from September to November 1918 . And a third severe and lethal wave arrived in early 1919.
2. Will we all die from swine flu?
No. In the next few weeks, here are two key concepts that will probably become very familiar. First, CFR, which stands for Case Fatality Rate, the probability that someone infected with, say, swine flu will die from it. So far, we don't really know the CFR's for this strain of swine flu. Another key concept is virulence: the severity of the disease produced by a virus. Around the world, scientists are urgently trying to figure out the CFR's and virulence of this swine flu. So far, public health experts say, the data is confounding.
The 1918 Spanish flu pandemic had CFR's of 2.5 percent or higher, according to the CDC. The virus was very virulent. An estimated 500 million people -- one-third of the world's population -- were infected. Some 50 million people perished, and some experts put the death toll as high as 100 million. The pandemics of 1957 and 1968 had CFR's of 0.5 percent or less. A typical flu season has CFR's of around 0.1 percent or less.
3. Are there enough antiviral medications to go around?
No surprise, pharmacies and online suppliers report a big run on antiviral medications. That's because the government says this swine flu strain is treatable with two antiviral drugs: Tamiflu (oseltamivir) and Relenza (zanamivir). Manufacturers of both drugs - Roche based in Switzerland and GlaxoSmithKline based in London - say they're already increasing production.
The US government has stockpiled enough antiviral treatments to take care of 50 million people while different states have 22 million treatment courses. Homeland Security Secretary Janet Napolitano says the government will release 25 percent of its emergency stockpiles -- some 12 million doses - of Tamiflu and Relenza to various states just in case.
If it needs to ramp up significantly, Roche (maker of Tamiflu) says it has an annual production capacity of 400 million treatment courses.
4. When will the vaccine arrive?
Baxter International, manufacturer of flu vaccines, has already requested samples of the swine flu virus to begin work on a vaccine. On a fast track, it will take between four to six months to create and distribute a new vaccine. On a global level, if a pandemic strikes this year, according to CIDRAP, manufacturers could produce 2.5 billion doses of vaccine in the first 12 months, but it would take four years to produce enough vaccine to meet total global demand.
5. What can I do to protect myself?
If swine flu spreads widely, no single step will protect you 100 percent, the CDC says, but a combination of steps can slow down the likelihood of transmission. Collectively, these preventive actions can help buy precious time to manufacture more antivirals and produce and distribute a vaccine.
There are basically three things you can do to reduce the chance of infection, according to the CDC:
- First and foremost, wash your hands. Sounds easy, but an estimated 80 percent of infections are passed around by germy hands. So wash them regularly with soap and water for 20 seconds each time. And if you can't wash your hands, use a hand sanitizer with more than 60 percent alcohol content.
- Second, avoid large crowds and unnecessary social contact. So-called "social distancing" doesn't mean you need to seal yourself inside your home. Just try to minimize your time in large groups and your close contact with sick people or others who have traveled to infected areas. If you're sick, definitely try to stay home and away from others.
- Pay attention to your health and get help if you experience flu symptoms. One reason that early swine flu death rates in Mexico may be higher than the US is that people delayed getting help.
Swine flu symptoms are similar to regular flu: Fever, body aches, sore throat, cough, runny nose, vomiting, diarrhea, and lethargy.
It may be tempting to stock up on (or take) Tamiflu and wear a protective face-mask, but will they make a difference? Probably not. For starters, unnecessary use of antiviral drugs can help produce resistant strains. So you should only take those drugs if you're getting sick and a physician prescribes them.
Snug-fitting medical masks approved by the FDA - like dental or surgery masks - are better than nothing if you need to come in close contact with infected people or you're in crowded situations, but the CDC says that information on their effectiveness is limited.
In the weeks ahead, there will be plenty of hysteria (and misinformation) about the swine flu. If possible, try to focus on what you can control: Your hygiene; your contact with others; and your health. Given the nature of a pandemic threat and the challenges that will confront every level of government and the entire health care system, it's essential to be as well informed, well prepared, and self-reliant as possible.
For more information about swine flu and surviving other kinds of life-changing adversity, please go to The Survivors Club Website.