Swine Flu: Remain Vigilant!

Swine flu came to international attention within the past two weeks. Now, almost as quickly, it seems to be fading from the attention of the news media at least. This roller coaster has little to do with emerging infectious disease realities.

To be sure, many questions remain unanswered -- public health experts are still working 24/7 to clear the fog associated with rapid outbreak investigations. And they will!

The outbreak investigations are complicated, in part, because they cross international boundaries. Yet two foremost questions remain: Will there be a Swine flu pandemic? And, if so, how severe will it be?

There are three key factors that will ultimately govern Swine flu's pandemic potential.

1. Transmissibility or the ability to pass from infected persons to susceptible persons. At this point, Swine flu has proven that it can be transmitted from person to person. When a susceptible person comes into close contact with a Swine flu-infected person, the chances of transmission are about 20% according to preliminary reports by outbreak investigators in North America. This figure will be refined with more data but it appears sufficient to sustain a pandemic.

2. Immunity or the ability to protect against infection once exposed. Swine flu appears to be a new influenza strain for many if not most people. In other words, most humans worldwide are susceptible and have little, if any, prior existing immune protection. Whether past influenza infections or vaccinations will offer any benefit to certain individuals remains unclear. It is nevertheless clear that Swine flu will require a new vaccine to reduce human susceptibility on a worldwide scale. The lack of widespread prior immunity makes conditions sufficient to sustain a pandemic.

3. Virulence or the ability of the virus to morbidity and mortality. For unknown reasons, Swine flu appears to be more deadly in Mexico than in other countries, including the United States. Yet investigators do not have good explanations for these difference. Is it related to: Nutritional factors? Baseline health of certain populations? Access to health care? Access to medications? More undetected infections than realized with some causing deaths? Counting deaths not caused by Swine flu? Intensive outbreak investigations are underway to solve this riddle.

The good news is that Swine flu appears to have relatively low virulence outside Mexico. The bad news is that Swine flu is constantly rolling its genetic dice, so virulence could vary (increase or decrease) over time. At this point, it is impossible to guess or calculate what will happen next.

The current predicament: Swine flu has already fulfilled two criteria -- efficient transmissibility and limited prior immunity worldwide -- to sustain global spread. The often used definition of a pandemic is that 25% of the world's population becomes infected by the same influenza strain. The new Swine flu certainly has that potential.

The situation at present is fluid. Swine flu has not yet fully revealed its propensity for virulence, including the ability to cause health care visits, hospitalizations, pneumonias, respiratory failure, cytokine storm, and death. If virulence remains low, the pandemic could be mild. If virulence increases significantly, the pandemic could be severe.

The World Health Organization's pandemic alert levels signal the spread and distribution of Swine flu cases. Yet they do not signal how bad a pandemic might be. These levels are more a reflection of transmission and immune vulnerability, rather than an indicator of severe outcomes. There are six WHO alert levels, numbered one to six.

Before the Swine flu appeared, the alert level was set at 3. After the Swine flu spread in North America, it escalated from 4 to 5 within days. Alert level 5 reflects spread of a new strain to at least two countries or one continent -- we are there. Alert level 6 reflects community level outbreaks in multiple countries and continents -- we are almost there. News reports indicate that Swine flu has been seeded in 21 countries, with total WHO-reported cases at 1,409. There are indications that WHO may declare Alert Level 6 very soon, especially if a large outbreak cluster is documented on another continent.

This is no time for complacency. We must remain vigilant. The new H1N1 Swine flu remains a real, unpredictable and worldwide threat.

Artwork by Paul Wein.

Comments

[quidam56]

Hospitals and emergency rooms are probably the worst place you can go if you have or think you have the flu, especially for the vunerable kids and elderly people. Our health care system is so filthy, MRSA (Methicillin Resistant Staphylococcus Aurea's) is breeding where we trust to go for health care. In Tennessee and Virginia, Profit care comes ahead of Patient care. Children should not be dying from a not to long ago hospital acquired infection. It is shocking to see what is deemed, defended and supported as "the acceptable standards of health care" in E. TN and SWVA.

http://www.wisecountyissues.com/?p=62

[spaceknife]

Dont forget that life itself, is a sexually transmitted disease and is always fatal

So enjoy it while you have it instead of living in constant fear.

Very few things in life are really more dangerous than driving your car to work every day.

[Mnemanth]

Nice to see the fear bomb has fizzled once again.
Yep, wash your hands, eat your veggies, get out and play in the dirt from time to time to build that immune system. Same stuff mom told me when I was a kid.
Movin' on...

[marignymitch]

Well, yeah. But it's never too late to panic, according to CNN.

[Thurber]

This whole post summarized.

You might catch a flu.

It might be bad.

Sometimes flu kills people.

It might kill you someday, although you're probably more likely to be run over by a bus ... filled with pigs

[KillTheMessenger]

The good news is that the swine flu wasn't a pandemic.
The bad news is that some people feel that they were seriously cheated because they didn't get their 15 minutes of fame.

[dayala]

must read on article on Smithfield's assault across Europe.

http://www.nytimes.com/2009/05/06/business/global/06smithfield.html?pagewanted=all

[spaceknife]

We also could say the same for a comet hit on earth

The question is not "if " it will happen but actually "when".

It was quite clear since the beginning of this swine flu scare that it was just this, a scare.

These same folks encouraged people with high blood pressure to eat margarine and avoid fat fish.
We now know margarine is one of the best source of trans fat and fat fish is full of omega 3 of the right kind

[vippy]

I was leery back in 1976 when my husband had to take the mandatory swine flu shot in the Army.
Never ever heard about it since or that it was a problem back then. 2 weeks ago I clicked on an
article which stated that the MISHANDLING OF GERMS IS ON THE RISE IN THE USA and the article
was removed from the site. I drew my own conclusions. Merck just announced the USA is no longer
their Number One Customer but the rising markets in Southeast Asia.

[BloodPudding]

This is interesting:
Seattle Times Mum On Swine Flu Deception
http://www.youtube.com/watch?v=Xa57Am0wScM&feature=channel_page

[Waldmeister]

We are full of viruses, germs and fragments of cellular and genetic debris.

Humanity has managed to survive every insult thrown at it - specially over the last 200 years of 'so-called modern medicine - and we're still here.

Remember the SARS outbreak a few years ago? 8,000 infected and less than 800 deaths. Recently, I asked a physician doing research into viruses and AIDS "Why do people get fevers"? His response "To kill viruses."

Knowing the adverse effects of suppressing fevers; using drugs like Tamiflu, Relenza or even that old standby , aspirin, probably caused at least 50 percent of the SARS deaths by prolonging the viral infection to the point the patients succumb to pneumonia.

Country doctors knew that you feed a fever and starve a cold. The native shaman of the American aboriginals, Africans, the Vikings, the Laplanders, the Inuit and the traditional herbalists knew this and employed saunas, sweat lodges, hot springs, steam baths and fasting with great success.

If you look after and treat your body with respect in regard to food and drink and do not allow your self to succumb to fear - an immune suppressor in its own right - your immune system will do its work and protect you.

[spaceknife]

Excellent post

[RonGallion]

Swine Flu, Right up there with Global Warming. Not much to either,

[Agent420]

Well, out of 642 "swine flu" cases we have had only on death and in that death the were "chronic underlying health conditions."

[Fernando Cavallo]

While I appreciate this blog and the people whose job is to take disease seriously, the fact is that H1N1(in this current mutation) appears to be as dangerous as a garden variety flu. I'm all for keeping flu levels to a minimum and people should practice proper hygiene, but not all of us can or should operate with a heightened level of super danger. That should be reserved for real dangerous situations. What the media has -once again- done is to over-emphasize something that doesn't merit it. If the media keeps crying wolf over stuff like this then the day the real one hits, most people will just dismiss it. I bet $20 with a friend that this would not last three weeks as a news item. Looks like I win.

[archtoplee]

The chances of the "Trifecta of flu viruses," the current swine flu going pandemic is as likely as Christie Alley fitting into a size 2 dress anytime soon.

Obama has obviously taken some terrible advise from Rahm "don't let a crisis go to waste" Emanuel and the president will have to pay for it by having Letterman, Leno and the other comics lampooning him for his poor judgement in letting this latest flu scare go the Gerald Ford way.

There is one US Congressman who is a medical doctor who disagrees with the hyteria and hype put on swine II
http://jbs.org/index.php/news-feed-archive/4810