Bill, how bad do you think it will get? (Swine Flu)

Rising Star · Post by **Rising Star** » Wed Apr 29, 2009 2:10 pm

I note that the first US death from swine flu was reported this morning in Texas. How widespread do you think this will get and with what toll?

John

Bill Glasheen · Post by **Bill Glasheen** » Wed Apr 29, 2009 4:00 pm

The most honest answer is this - we need more data.

My hunch is that this isn't "the big one."

Just to put this in perspective... Typically around 35,000 people die in this country every year from influenza. We now have one (1) death from a new strain - from a 23-month-old child.

The worst case scenario is the H1N1 virus that killed about 50 million people worldwide during and after World War I. That's a bigger human slaughter than that caused by the bubonic plague. That virus (either from swine or avian origin from a farm in Kansas) jumped species and subsequently took a few years to wreak its toll. The fact that we had a World War going on with people tightly packed in barracks and individuals under great stress traveling the globe to fight aided in the spread. But it's more than that.

Typically influenza is most likely to kill the very young and the very old. It is in fact one of the ways Nature culls the elderly in our population. Influenza leads to pneumonia which leads to death from respiratory failure. Epidemiologists often refer to the U-shaped risk curve by age, with the very young and the very old having the highest probability of death from infection.

World War I's H1N1 was different. For reasons that we're still trying to understand now, it caused immune systems to overreact. Thus the very healthiest ended up having their strong immune systems attack their lungs. Within 24 to 48 hours of the onset of symptoms, some of our very healthiest ended up turning so cyanotic from poor ventilation that it was said you couldn't tell what race they were. Thus for this virus, the risk of death by age was characterized by a W-shaped curve. The very young, the very old, and the very healthiest were most likely to succumb to the disease. The results were frightening to say the least.

Why are people so concerned about this virus? Here are the following reasons.

The virus is also an H1N1, although its precise behavior is still being monitored and documented.
Some of the deaths in Mexico were from seemingly healthy young people.
The virus is part swine, part avian, and part human in origin.
It has just jumped species, AND has now shown easily to be passed from human to human.
It is new, and it is spreading outside the typcial flu season.

However... For whatever reason, the cases in the U.S. have been relatively mild in comparison. Why is that? We don't know yet. It could be that the virus has mutated as it developed its ability to pass from human to human, and became less virulent in the process. Or it could be that there are many, many more undocumented cases of influenza in Mexico, that their Public Health system is incapable of detecting (hence a bigger denominator when computing risk of death).

Right now its spreading in this country, albeit at the tail end of flu season. We may escape a major outbreak before a vaccine is developed by fall. But its going to run its course in a manner that we have yet to be able to predict at this point.

My suggestion is to make sure you wash your hands, stay away from closed, unventilated spaces where you are exposed to cough and sneeze spray, and encourage your friends to stay home when they get sick. And EVERYONE needs to learn how to cough and sneeze. View the following video.

Why Don't We Do It In Our Sleeves?

Send a copy of this link to everyone you know.

Also... Make sure you have a family doctor. This virus appears to respond well to anti-viral medication (Tamiflu and Relenza). It's expensive and it shouldn't be taken prophylactically because you don't want the virus to develop an immunity. But if you get the medicine within a few days of the onset of symptoms, then you can significantly blunt the course of the illness.

No need to panic yet. Stay tuned.

- Bill

Valkenar · Post by **Valkenar** » Wed Apr 29, 2009 5:18 pm

Bill Glasheen wrote:
Why Don't We Do It In Our Sleeves?

Haha that was hilarious

This virus appears to respond well to anti-viral medication (Tamiflu and Relenza).

This cdc page, http://www.cdc.gov/swineflu/ mentions oseltamivir and zanamivir. Are those the generic names for the ones you listed, or are they different drugs?

Bill Glasheen · Post by **Bill Glasheen** » Wed Apr 29, 2009 7:10 pm

Valkenar wrote:
Bill Glasheen wrote:
This virus appears to respond well to anti-viral medication (Tamiflu and Relenza).
This cdc page, http://www.cdc.gov/swineflu/ mentions oseltamivir and zanamivir. Are those the generic names for the ones you listed... ?

Yes, and in that order.

- Bill

Mary S · Post by **Mary S** » Wed Apr 29, 2009 9:37 pm

Just had a friend return from her first ever trip down south...yes, Mexico. She came home with a cold and has been asked NOT to return to work.

The WHO (not the band) raised the level to 5 out of 6 today. That can't be a good thing.

When do we start to worry?

And...I've heard stay away from those hand-sanitizer products (they contain alcohol which strips the skin of all natural defences)....can anyone confirm this?

Shana Moore · Post by **Shana Moore** » Wed Apr 29, 2009 9:57 pm

Mary S wrote:And...I've heard stay away from those hand-sanitizer products (they contain alcohol which strips the skin of all natural defences)....can anyone confirm this?

I'm curious on that issue as well, because it's my understanding that we overuse "antibacterial" products in general, leading to more resistant bacteria as well as killing the good bacteria. Germa-phobic hysteria maybe?

I'm curious how much of this is true and how much of this is urban myth? A quick web search shows the following:

Web MD article (http://www.webmd.com/news/20080529/safe ... erial-soap)
*notes potential concerns about the chemicals used, as well as effectiveness, and possible contribution to resistant bacteria
CDC article (http://www.cdc.gov/ncidod/eid/vol7no3_supp/levy.htm)
*discusses resistant bacteria, negative impact to a person's microflora (the good bacteria, etc. mentioned , earlier), as well as use of these products in healthy households

So there may be some truth to this. Also, the flu is a virus, right? So antibacterial products wouldn't really have any use against something of this nature, would it?

Bill Glasheen · Post by **Bill Glasheen** » Wed Apr 29, 2009 10:30 pm

You've pretty much nailed it, Shana.

Regular hand-washing with soap and water is best here. Hand sanitizers don't kill viruses. But washing will physically remove them, and send them down the drain.

- Bill

Bill Glasheen · Post by **Bill Glasheen** » Wed Apr 29, 2009 10:36 pm

Mary S wrote:
The WHO (not the band) raised the level to 5 out of 6 today. That can't be a good thing.

When do we start to worry?

According to the WHO website, the move to phase 5 indicates that the virus is causing multiple outbreaks in at least two countries in one region and that "the time to finalize the organization, communication, and implementation of the planned mitigation measures is short."

The virus strain's mortality rate is not known, so it's unclear whether any pandemic would be mild or severe. From the evidence in the U.S. to date, we have no reason to believe (yet) that the pandemic would be severe.

- Bill

Van Canna · Post by **Van Canna** » Thu Apr 30, 2009 12:07 am

http://www.boston.com/

The beginning of the end

Bill Glasheen · Post by **Bill Glasheen** » Thu Apr 30, 2009 12:57 am

From the article...

President Barack Obama pledged "great vigilance" in confronting the swine flu outbreak Wednesday night as it began hitting home across the U.S.

Great vigilance, eh? Sounds like desperate measures to me!

- Bill

Van Canna · Post by **Van Canna** » Thu Apr 30, 2009 2:50 am

BOAKYAGB

Can someone interpret this

MikeK · Post by **MikeK** » Thu Apr 30, 2009 4:12 am

Barry O says not to worry who am I to say otherwise. The Messiah wouldn't lie would he?

It's fun to read what the tin foil crowd make of this.
http://www.prisonplanet.com/

I've heard of one local company here that has told people coming back from Mexico to stay home for a few days instead of coming into work.

IJ · Post by IJ » Thu Apr 30, 2009 5:44 am

Good stuff here so far. I just recommend carrying alcohol gel with you and using it on your hands if you've been out in the world (like, where you touch anything other's touch). This is more of an issue for real pandemics, but I had 5-6 weeks of every itis I could have had in january... pharyngitis, otitis, REAL sinusitis, bronchitis... THEN I got Pertussis. Never stopped. I've always been a BIG handwasher, and germ freak (UVa, medical home, is big on this; other places = shockingly bad). But only then did I really pay attention to how many door knobs etc there are out there. I started opening doors thru a sleeve (I would always use a shoulder if I could). I've always used the towel for drying my hands to get out of bathrooms, but what about the cart at the market? Elevator buttons? It's too easy to get this stuff.

If you keep your hands clean your risk plummets.

That said, remember how everyone had a cow when we had a billionth of the humans in world catch mad cow? I mean, maybe not a a great idea to feed cows cows (or cows corn, it turns out, but that's another story). People were wiggin' out. Gosh, what if I was one of those 3 people with mad cow? Well, now that the outbreak is over, guess I'll go back to McJunkfood and die from the biggest killer in the entire USA (cancer's pulled even now).

We frame our risk very oddly. The "US death" was a sick 2 year old who got infected in Mexico. There haven't been any US deaths, folks; everyone has survived this, and meanwhile, tens of thousands of people are dying of other things; is Obama calling the families of everyone who died of lung cancer this week? The issue is, could this really take off? Wait for THAT news; meanwhile, hygiene is a good idea all year round.

IJ · Post by IJ » Thu Apr 30, 2009 9:39 pm

I was down at San Ysidro today, doing a rather bad job of following my own advice. Lots of masks being worn there (all latinos) but I wonder how careful everyone was with their hands. I didn't have alcohol gel myself, so after I opened a few doors and handed over a credit card, even if I was careful not to touch my face, I still had soon contaminated... a wallet, phone, keys, the steering wheel, stick shifts, door handles and radio buttons. I washed when I got home, but will have to look up the lifespan of influenza on various surfaces to see when I can do anything else

Mary S · Post by **Mary S** » Fri May 01, 2009 12:49 am

BOAKYAGB

Yes but I think I'd better use the sanitzer first!!