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Ben Sherwood

Ben Sherwood

Posted: April 29, 2009 07:33 PM

Swine Flu Crib Sheet: The Five Things You Need to Know

What's Your Reaction?

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.

 

Follow Ben Sherwood on Twitter: www.twitter.com/survivorsclub

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...
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...
 
 
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05:10 AM on 05/01/2009
You say that the CFR of the 1918-19 flu was 2.5 percent. Yet, in the same paragraph, you say that 500 million people were infected, and 50 to 100 million died. By my rather basic math, that would indicate a CFR of between 10 and 20 percent, not 2.5. Is there something off in one of your figures?
06:53 AM on 05/03/2009
The estimates range form 20-100 million dead. In all likelihood basically everyone was exposed to the flu, with 20% showing symptoms. Given a world population of around 1.8 billion people at the time, this would range from 1-5% mortality. 1% would be at the low end since the "ordinary flu" (at least for those who are hospitalized with it) has a mortality of 0.6% already. It just happens that his mortality is not equally distributed among age groups, so we do not think much about it... until we hit old age, have to go to the hospital with it and it becomes a real problem.
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odyssey58
07:10 PM on 04/30/2009
No. 6 Make sure your household has a working thermometer. If your temp is above 99.5 F STAY HOME.

Advice from a nurse
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Carrie-On
Most you receive is the least deserved.
09:42 PM on 04/30/2009
Yes, but . . . also remember that viruses don't live in the body above 99 F - so rejoice with a fever but call your doctor - and do stay home unless otherwise instructed, unless breathing problems begin, then call 911 - only. They know what to do.

One caveat, in the 1918 pandemic, the deaths were not from the virus but from pneumonia. We are far advanced now, and can help people breathe - unless they are far too late in seeking medical help. Those who survived the 1918-19 horrors, were often left with cardiac conditions, and other problems not unlike the polio survivors, now.
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odyssey58
01:58 PM on 05/03/2009
"also remember that viruses don't live in the body above 99 F"

I'm not sure where you got that information. An elevated body temperature ,i.e. above 100F orally, is a symptom of many viral infections, including influenza.
04:34 PM on 04/30/2009
According to the World Health Organization, there have only been seven confirmed deaths from the swine flu, not 152 as the media is reporting . All of the people who died came from Mexico, even the child that died in Texas yesterday. This flu panic is the same as the avian flu panic. The media will play it for all its worth, the public will be too afraid to think straight, the drug companies will make billions of dollars and then the epidemic will just quietly disappear.
03:36 PM on 04/30/2009
People might want to ask representatives why when reported, unsanitary transportation & warehousing as well as kickbacks in transportation, aren't looked into?

www.nextrevolution.net

I don't know what conditions are like in Mexico or all there is to know about swine flu, but if you look at pictures on Nextrev., I think any American with an ounce of common sense would be of the mind, {considering this swine flu pandemic possibility} this is not dairy or pork we want sold to millions of people.
04:21 PM on 04/30/2009
This so-called "swine flu" epidemic cannot be contracted from eating pork. Not one single case of this flu has been contributed to contact with or eating of swine.

When CDC scientists discovered this new strain of the flu to be a mix of pig, human and bird viruses, it was unfortunately shortened to the name "new swine flu." It refers to one of the components of the virus, not how the disease is spread.

I agree that the unsanitary conditions for transporting and warehousing hogs is deplorable, but you are doing the public a big disservice to suggest that not selling the product would prevent this flu epidemic.
11:33 AM on 04/30/2009
For those unfortunate enough to contract the swine flu, they will be treated primarily with the Tamiflu vaccine. And who was wise and forward-thinking enough to begin stockpiling Tamiflu four years ago as a precaution for this kind of situation?

Thank you, President Bush.

Happy Dae·
http://ShoeStringGenealogy.com
12:31 PM on 04/30/2009
And thank you Susan Collins (R-Me) for cutting $800 million in flu preparedness funds from the stimulus bill.
03:43 PM on 04/30/2009
NO thanks to republican Idaho US Senator Jim Risch, Republican Idaho Gov Butch Otter, & republican Mike Johanns as Secretary of the USDA & now Nebraska US Senator who refused to look into unsanitary transportation & warehousing in the highly subsidized dairy industry as well as kickbacks in transportation.

Pictures can be seen on www.nextrevolution.net

Bush appointed Mike Johanns to Secretary of the USDA even though Johanns as Gov of Nebraska didn't want to know about my boss at the NE Dept of Forestry who was stealing tax $, both federal & state. Military equipment US soldiers were later dying without!
03:44 PM on 04/30/2009
No. 6:

Is this a hoax like the "Swine flu" hoax of 1976 or the Bird Flu hoax of 2004 or ....?

Tamiflu only eases the flu, it doesn't cure it. And it's a dangerous drug. Vaccines are full of poison -- formaldahyde, mercury, aluminum, bacterias.

I would expect a good liberal site to at least throw up some red flags about this but everyone is believing it. Why?
04:07 PM on 04/30/2009
I don't thank Bush for a damn thing. For all I know this is a manufactured event that was completely planned. Just like how Baxter "accidentally" shipped live avian flu virus to Czechoslovakia. Who stands to benefit most from a flu pandemic? Makers of tamiflu and other pharmaceuticals. Besides, as someone mentioned below, vaccines are dangerous and not a guaranteed cure. Especially since these viruses constantly mutate. But you go ahead and get that vaccination...
11:07 AM on 04/30/2009
This is an ORDINARY DAY as far as influenza goes, and I think the media-induced panic is despicable. Observe the normal protocols, but the time to get super-duper vigilant is AUTUMN.

The economy being FAIL and all, I can see how breakdown in the supply chain, a compromised health care system, and people's lack of health insurance could turn an ordinary flu season into a horrific MESS. At least we have time to stock up for periodic winter quarantines. Bleach, Advil, tissues, toilet paper, books, ginger ale, Scrabble, food for all, including pets.

Meanwhile, while nobody was paying any attention, the Conficker virus went into attack mode:

http://news.zdnet.com/2100-9595_22-292858.html

Call me a cynic but I figure Empire is up to something and wants to make absolutely certain that while it’s doing it’s dodgy business the English speaking world is at home wringing its hands, without internet access, glued to the TV to find out when the Mexican Zombie Frankenswine Apocalypse is coming to their town. Too bad the U.S. didn’t make the switch to digital in time!

But are we close enough to the point where we can just drink gin in public and walk around pantsless, since we’re all gonna die from ManBirdPig anyway? Because that’s what I’m holding out for: Drunk, and no pants.
12:38 PM on 04/30/2009
I'm on board. Any excuse to run naked in the streets.
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rivahcat
You can't teach a dogma new tricks--D. Parker
03:02 PM on 04/30/2009
Hedonist--you don't by chance write for South Park, do you???
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laissezleswontonsbrulez
Semi-retired Family Physician
11:06 AM on 04/30/2009
One other tip worth knowing about: elderberry actually works as a neuraminidase inhibitor, the same mechanism of action as Tamiflu or Relenza. Neuraminidase (the 'N' in the H1N1 designation) makes up the spikes on the surface of the virus particles, which is how they attach to body cells, so blocking it blocks the cycle of infection.

In my experience as a family practice doc, it actually is pretty effective, comparable to the Rx. drugs, if started as early as possible. It's cheap and readily available, not quite as common as echinacea but any GNC or Vitamin Shoppe should have it. The recommended dose is 2 capsules (usually ~500mg) 3 or 4 times a day.
03:49 PM on 04/30/2009
The pharmaceutical companies, which will reap huge monetary benefits from this hoax, are part of the same cabal. Baxter International, the corrupt pharmaceutical company that was recently caught red-handed sending vaccines contaminated with Bird Flu to 18 countries, has apparently been “chosen” to make a vaccine for “Swine Flu.”
07:54 PM on 04/30/2009
Thanks for sharing this knowledge, Doc! I knew there had to be some info on this. I haven't gotten any kind of flu for 5 years since I started taking 3000 to 4000 mgs of vitamin C per day, and I usually get the ester-c or with bioflavanoids so that it is easier for my body to absorb. I'm no doctor but I can see the amazing results both mentally (depression greatly reduced) and physically from taking all the vitamins and supplements that I need. I am of absolutely no use to pharmaceutical companies. And thanks, doc, for not being beholden to them either!
10:54 AM on 04/30/2009
There is only 1 thing that needs to be known and thats that Medicine is essentially quackery and the Swine flu epidemic is a scientific hoax - accept for the science of economics which is what it is.
The same incompetents created a 1976 fiasco with 1 death "claimed to be a virus" that followed with a massive vaccination fiasco generating huge profits and numerous vaccine disabled victims.
The same system is behind the current farce.
In the NYC high school 125 we sick and tested - 117 were negative and 8 positive. Since they all had similar symptoms a virus wasn't necessary . The credibility of the tests is in serious doubt with the 8 positive out of 125 symptom matches being false positives.
The one death in Texas was a 23 month old infant who spent over 2 weeks hospitalized. The infant illness began before the Mexican sensationalism was news - yet a very ill and dying infant in the US with a new strain of a supposed deadly virus and amazingly there were no news reports.
We will never know what toxins are reponsible for the real deaths in Mexico now that the Medical Industrial complex and the business loyal media have " gone to work " - You can count on expanded business activities, drugs, vaccines, testing sales, to explde under the quise of science.
Everyone is in great danger - danger from the Medical Industry !
04:10 PM on 04/30/2009
I totally agree...
06:59 AM on 05/03/2009
I want you to refuse the services of a surgeon quack the next time you have a burst appendix. And please refuse to take even their painkillers while you die from a trivially fixable medical condition.
10:42 AM on 04/30/2009
I am not going to try and minimize all the great advice given above, However Swine flu is the Flu, just by another name. Influenza has alway been in the top 10 list of leading causes of death in the USA, and in recent years moved out of the top 5.

Acording to the National Vital Statistics Reports, Vol. 56, No. 5, November 20, 2007, :
Influenza and pneumonia Caused 59,664 USA deaths in 2004 and 65,163 USA deaths in 2003,

I am just trying to point out thousands have been dying due to the FLU for years without this whole "Sky is falling" reporting that is happening now.

I also wonder even with this outbreak, if the increase in deaths due to all Flu strains will jump up any real percentage point when looking at the statistics years from now.

I do not know why the media feels they need to "SELL" panic, but it does seem to distract us from some of the worlds real problems while we hide from eachother behind masks, and stay indoors to watch the Media telling us "to stay indoors and watch, FOR THE LATEST OUTBREAK UPDATES"
03:46 PM on 04/30/2009
It's all about profits for drug companies. BIG PHARMA is suffering and so they need to create a panic. Visit www.drday.com to read the whole story about this Hoax.
07:28 AM on 05/03/2009
Big pharma is not suffering because of the vaccine business. It's in trouble because the easy drugs have been discovered, are running out of patent life and the drugs left are very hard and expensive to develop. In any case... there is no vaccine they could sell to you for this one. So there is absolutely no upside for them.
10:16 AM on 04/30/2009
I read quite a bit about influenza a few years ago. We didn't get a bird flu pandemic then, but I'm sure we'll get a flu pandemic eventually. Is this it? We'll see.

As Obama said in his press conference, if you cough, cough into your elbow, not into the open air or your hand. Wash or sanitize (with Purell or equivalent) your hands frequently. Stay home from work or school or crowds or traveling in mass transit if you're sick.

Other things you could do now:

Accumulate food and water at home in case supplies are interrupted.

Download the CDC's home care advice (just as the stores might be empty if this hits hard, the hospitals will definitely be full) - it's at the CDC site or search for the terms "swine influenza" "taking care of a sick person in your home"

www.cdc.gov/swineflu/guidance_homecare.htm

While antivirals and antibiotics require prescriptions, CDC says over-the-counter cold and flu medications will give symptomatic relief (but don't give them to children under the age of two; don't give aspirin-containing drugs to teenagers or younger). You might check that you have some of these on hand, just in case.

Aches and fever can be helped with acetaminophen (Tylenol®), ibuprofen (Advil®, Motrin®, Nuprin®), and naproxen (Aleve).
07:32 AM on 05/03/2009
None of your suggestions would help anyone who has a serious case of flu. They would be quite counterproductive, actually. The longer people stay home and burrow in and quack around with symptomatic relief instead of seeking help for secondary infections, the higher the chances that they can't be helped in the hospital, either.

The very second a flu feels worse or different than in the past SEEK PROFESSIONAL MEDICAL HELP. There is next to nothing you can do to survive pneumonia at home. There are plenty of things doctors can do for your IF YOU SEE THEM EARLY.
08:58 AM on 04/30/2009
To prevent the spread of swine flu, people must...

DRINK MORE COFFEE.

Thanks,

Douwe Egberts
04:18 PM on 04/30/2009
Don't mind if I do.

Love that D.E.
06:41 AM on 04/30/2009
This was the most complete thing I have read so far in terms of simple prevention.

Is the flu in Mexicio a more virulent strain, as opposed to what we are experiencing here? People without health insurance need specific information about what to do if they get sick. Should they go to emergency rooms and risk infecting many other people? Is there a plan where the uninsured can get quick treatment for the swine flu?
07:39 AM on 05/03/2009
All people, with or without medical insurance need to see a doctor if they feel worse than usually during a bout of flu. Chances to contract a pneumonia or worse are high and only professional medical care can cure these infections without lasting effects. We do not spend hundreds of thousands of dollars on raising a human being to let them die from a trivial (or not so trivial) medical problem that can be cured with proper treatment.

As for infections in ERs: the flu is the smallest of problems. Nobody will care about that.
10:41 PM on 04/29/2009
Tell me how all these disparate genetic components from all over the world end up in Mexico. Tell me how this was not made in a Lab with access to all the pathogens. Breaking the viruses down to thousands of gene segments with acid. Then splicing gene segments together randomly by the billions and then infecting a few pigs with the billions of random combinations to allow the succesfull combinations to thrive. See the facts below

The new virus has genes from North American swine influenza, avian influenza, human influenza and a form of swine influenza normally found in Asia and Europe, said Nancy Cox, chief of the CDC's Influenza Division.
10:18 AM on 04/30/2009
Are you an epidemiologist?
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Carrie-On
Most you receive is the least deserved.
09:50 PM on 04/30/2009
Have you looked at this virus in a Petri dish? If so, look again.
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ConnieInCleveland
One Lonely Voice trying to make a difference
09:14 PM on 04/29/2009
This is a link to an old post, do you know if it is true. Why is no one talking of it today? It says it was put out by the CDC?

http://www.cdc.gov/od/oc/media/pressrel/r051005.htm

Did something go wrong? Did they bring back the 1918 Pandemic Influenza Virus, and mishandle it?

For Immediate Release
*October 5, 2005* Contact: CDC Media Relations
404-639-3286

Researchers Reconstruct 1918 Pandemic Influenza Virus; Effort Designed to Advance Preparedness

Scientists at the Centers for Disease Control and Prevention have successfully reconstructed the influenza virus strain responsible for the 1918 pandemic, a project that greatly advances preparedness efforts for the next pandemic.

“This groundbreaking research helps unlock the mystery of the 1918 flu pandemic and is critically important in our efforts to prepare for pandemic influenza,” said CDC Director Dr. Julie Gerberding. “We need to know much more about pandemic influenza viruses. Research such as this helps us understand what makes some influenza viruses more harmful than others. It also provides us information that may help us identify, early on, influenza viruses that could cause a pandemic.”
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ConnieInCleveland
One Lonely Voice trying to make a difference
09:31 PM on 04/29/2009
continued...

The work, done in collaboration with Mount Sinai School of Medicine, the Armed Forces Institute of Pathology and Southeast Poultry Research Laboratory, determined the set of genes in the 1918 virus that made it so harmful. Prior to this study, which is published in the Oct. 7 issue of Science, flu experts had little knowledge of what made the 1918 pandemic so much more deadly than the 1957 and 1968 pandemics. This week’s issue of Nature also includes a related article entitled “Characterization of the 1918 influenza virus polymerase genes” which describes the final three gene sequences of the 1918 influenza virus. The work reported in the Nature article was done by scientists at the Armed Forces Institute of Pathology.

The 1918 pandemic killed an estimated 20-50 million people worldwide, including 675,000 in the United States. The pandemic’s most striking feature was its unusually high death rate among otherwise healthy people aged 15-34. During normal seasonal flu outbreaks, severe complications and death are most common among the elderly and young children.
10:49 AM on 04/30/2009
Thank you for that link. You know this info will 'disappear' into the general chaos if a true pandemic is incubating.

Just read yesterday about the tissue samples that were harvested in 1997 from a 1918 flu victim buried in Brevig Mission, Alaska. Those samples, along with some preserved slides of lung tissue from soldiers who died, allowed the virus to be sequenced. The Inupiat elders were against digging up the grave as they did not want to allow any evil spirits to escape.
They were told that the victims had been given a Christian burial, so no evil spirits lingered.
Right.
07:45 AM on 05/03/2009
They did recreate the 1918 virus (well, at least one of its variants). But this isn't even close to the virus of 1918. You can do all the genetic testing necessary to prove that at home if you get chemicals and lab equipment for about $10k. That and an education in life sciences, of course.

:-)
08:17 PM on 04/29/2009
Is there any chance that if somebody catches the swine flu in an early mild wave they will have antibodies against a more serious later wave of the flue. Find out: http://travelvaccineforum.wordpress.com/