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Influenza Pandemic … further thoughts:

By Doctor Tom on April 30, 2009 at 2:35 AM in Current Affairs, Health Care, Influenza Pandemic

(Bumped up from Wednesday morning.)

Thanks to all who responded to my piece regarding the administration response to this pandemic of influenza. As I go through the news sources today, there really isn’t much exciting unless one examines the response of the locals. What I am seeing is an admirable effort to educate the public in the lay press and an immediate and rather thorough communication to the physician community regarding this illness. This includes methods of identifying suspicious cases, actions to take in response to identification of suspicious cases, and an effort to collect blood to serologically track this disease.

The ‘alarm’ I was talking about has been sounded. This illness must be approached with more than concern; markedly heightened awareness bordering on alarm would be a more effective attitude.

For instance, in Nebraska, the Dept. of Health has e-mailed all physicians with reminders of identifying features of patients who may suffer this illness and recommendations regarding the handling of these persons. This includes the immediate masking of persons with suspicious symptoms, masking of health care delivery personel, isolation of the patient, hand washing, and collection of appropriate blood samples. The news media has published very nice explanations of the varying symptoms of influenza-like illnesses so that the public knows what to expect and how to respond. I am impressed with the local responses.

I am also impressed that I heard nothing stupid from the government today. Did they read my criticism previously published? I’m sorry…sometimes I imagine stuff. Hopefully, they realized that the CDC efforts and the local efforts were more appropriate than our President’s previous unintelligent responses.

In answer to those respondants who drew comparisons of past ‘epidemics’ and scares. Viruses are an enteresting group of biologic molecules; there is even debate as to whether they constitute a life-form. Most scientists do consider them ‘life’ since they replicate, but they, themselves don’t have a specific metabolic machinery. They are extraordinarily efficient parasites….that is, they replicate only in biologic cells for the most part. The scary part is that they can adapt. They can mutate as all DNA and RNA material may and some of those mutations may be more resistant to anti-viral drugs, more infectious than their forebears, or just plain more destructive to the cells they infect. As a rule, viruses either destroy or severely damage the cells they infect and subsequently multiply within; and they multiply by using that cell to make millions of copies of themselves. That is, until our immune system figures out there is a foreign invader and produces enough antibody to neutralize the viral particles rendering them non-infective. One of the reasons HIV is so resistant to treatment is that it infects the very cells that direct effective immune responses against foreign organisms including viruses.

One of the largest dangers in viral infections…and the one which sparks the interest of virologists with this one…is that ability of the virus to morph into a form that is different than previously experienced. Influenza does this on a regular basis, year by year. This is the frightening fact: what if the virus morphed into a really virulent form once again…and is this current pandemic indicative of that. At this time, I don’t think there is an answer to this. Time will tell. But, this is the cause for heightened concern bordering on ‘alarm’. This particular virus has popped up pretty fast simultaneously in a number of spots world-wide and has appeared to manifest enhanced virulence and a poorer outcome than past epidemics. Usually, the mortality associated with influenza is due to the secondary infections that develop because of the damage to the respiratory system, the debilitation of a more prolonged illness, or acute cardiac events as a result of the stress of the illness in those at risk . Once the score is recorded in this pandemic we will know far more about this particular virus.

My point is simply that when dealing with a suddenly more virulent viral infection, it is inappropriate to panic, but it is also completely irresponsible to repress markedly heightened diligence. People should be informed to be alert, observant, and worried. Not paralyzingly worried, but worried enough that common-sense measures become more important; hand-washing, not ignoring febrile upper respiratory illnesses, reporting these illnesses to their physicians, and segregation of ill persons from the populace until they begin to recover. In addition, those who are suggesting travel to Mexico (for instance) is ill-advised, are absolutely worth heeding. This appears to be an area heavily affected and to travel to that area at this time seems foolhardy.

Hopefully our administration will continue to let the experts and the local health officials continue to put forth what seems to have been an effective strategy. Politics has no place in this arena….none, whatsoever. I’m holding my breath; the track record of politicians in affairs they have no business interfering in is dismal. I hope this post answered some of the questions in the queries of the prior article. By the way, one of the best educational sources regarding this subject in general is Scientific American magazine which can be accessed on the internet (Sciam.com).

:::::::::

Dr. Sears, a cardiologist, is Larry Johnson’s brother-in-law.

MrMike

If what I have read is true that this strain evolved or mutated in the manure lagoons at a filthy factory hog farm in Mexico, will there any attempt to clean these places up. Or is the dollar more important than a few dead babies?

MrMike

Typically these animals are left to live in knee deep manure until the farmer get around to cleaning their pens. To compensate they inject them with antibiotics to try to keep them healthy. The bacteria mutate in resistant strains and since the antibiotics are in the meat you eat they do the same thing.

margaret

the animals shouldn’t have to live that way

Docelder

Yes, but therein lies the reason these operators moved to Mexico to begin with. Here we are worrying about the small portion of atmospheric CO2 that comes from using the very energy we need to function as a civilization and meanwhile, we are letting our food be produced in deplorable third world conditions. These hog farms have probably polluted the local surface water. Probably few of these people in this village have deep wells or access to clean deep well water. This is deplorable.

Betty

I hear ya, I will never buy a Smithfield ham again. Actually, I don’t think I will buy pork ever again.

I hate those money grubbing bastards who put their bottom line ahead of providing decent jobs and wholesome food in a decent community. That is what the Harvard Business School produced, CEO’s who will put the whole planet at risk so they can sit in the steam room of a private club and brag about how much money they made.

Ronnie Reagan dissed a welfare mother for getting food stamps but lavished taxpayer money on corporate giants, when are we going to look at Corporate America’s entitlements?

gonzotx

When pigs fly…
andrew 191

On the topic of mutations, isn’t it amazing that a discussion of a new flu virus has mutated into a slam of Ronald Reagan, a great American that hasn’t been president for more than twenty years. Betty, your whole rant is so bizarre, that even though you may have accidentally touched upon some real concerns, any of your valid points are erased when you throw in weird theories that sound like transmissions from Pluto.

andrew 191

Viruses and bacteria are two very different things. While bacteria can live and multiply on inanimate organic matter, like the soup in a pig pen, viruses cannot. Viruses need living cells (even bacteria will do) to provide them with the DNA that they need to replicate. They’re just as happy in a clean pig as a filthy one. Antibiotics don’t work on viruses, and until the viral infection has allowed secondary infections like pneumonia, they should be used cautiously so that they don’t eventually lose their effectiveness.

It is when birds, pigs, and humans (clean or filthy) come together that new viruses arise, and when new the virus is able to be transmitted intraspecies, like this new one, that is when it can become serious. The mutation is caused by the mixing of DNA of these animal groups, not filthy conditions or the overuse of antibiotics.

andrew 191

It should read “when the new”, not “when new the”.

While cleaning up pig pens is just a good idea, keeping pigs from accidently ingesting bird feces or birds themselves would be more effective in preventing viral mutations. Also, WASH YOUR HANDS!

http://noquarter foxyladi14

thanks for that bit of information.i didn’t know that.
washing my hands now..

Docelder

I have been watching BBC World news lately, giving FOX some time out. Last night they were in that village in Mexico and talked to that little boy and his father. Some people that town were told not to talk about this. Others did talk, one man said he would not work there and wished they would leave. The BBC tried to go into that farm and was turned away by guards. It would be interesting… I haven’t tried yet to go into Google satellite and see that operation. Provided there is coverage of it. I suspect it is filthy. The point being filthy conditions are likely what has allowed this viral soup to mix. If waste from chickens, hogs and human waste are running into these hog pens… or the hogs are being fed meat scraps of chickens… there are a multitude of possibilities wherein filthy conditions of workers and the animals could have greatly contributed to this virus. That operation is likely a viral lab of sorts in it’s own right. Since the town is 8 km away, and so many there are sick. I think the possibility that the surface water there is compromised with sewage from that hog farm is also something to look at. The question is, once we don’t care anymore about this virus… is anybody going to start to care about Mexico? or these mega farming operators?

andrew 191

Docelder, I agree completely with your points, I’m just concerned about people confusing bacteria with viruses, and antibiotics with immunizations. This confusion causes people to take antibiotics (that they may have left over from something else) for colds or the flu, and think that if they’ve had a bacterial infection before, they are now immune to it. As an EMT I’ve also seen patients with bacterial infections that they let develope to dangerous levels because they thought that their bodies would naturally develope immunity from the infection. Few people remember a time before most antibiotics when blood poisoning was almost a death sentence. Two of my kids have graduated high school and they were never taught the difference between bacteria and viruses, until I taught them. While people are paying attention to the current situation, it’s a good time for some basic education on these health issues. Never let a crisis go to waste.

Benjamin Franklin Berfle

This confusion causes people to take antibiotics (that they may have left over from something else) for colds or the flu, and think that if they’ve had a bacterial infection before, they are now immune to it.

My suggestion to you, then, would be to lecture the doctors who are prescribing antibiotics for viruses. Patients don’t get these on their own.

BTW; I was a Medic and EMT in the Army from 1976-1979.

andrew 191

There actually are Doctors that sometimes prescribe antibiotics for viral infections. They do so to give the impression to their patients that they are actually capable of curing viral infections. I know several such disreputable Doctors. However, sometimes antibiotics are correctly given to patients with viral infections as a prophylactic measure, when it is likely that the viral infection may lead to a bacterial infection. What I was referring to in my post Ferd was the common practice of many people who use left over antibiotics from a previous illness, to treat a cold or other virus.

BTW; If you haven’t been a medic or EMT for 30 years, and you haven’t actively kept up, the current SOP’s are vastly different from 1979. It’s a pain in the ass, but even the basics of CPR seem to change monthly, and if you don’t perform to current SOP’s, you open yourself up for a possible lawsuit. It’s one of the main reasons it is getting more difficult to recruit and retain unpaid volunteers in the smaller rural departments like mine. Another casualty of a bigger, more complicated, government intrusion.

MrMike

Sorry abut that I should have been more clear on the subject of bacterial mutations and antibiotics.

Judy L. NC

I am also impressed that I heard nothing stupid from the government today.

I beg to differ. It was enough to get Kathleen Sebelius’s confirmation rushed through.

http://noquarter foxyladi14

maybe he will get those other posts filled now,

SHV

This includes the immediate masking of persons with suspicious symptoms, masking of health care delivery personel, isolation of the
**********
Two nights ago, the head of the Infectious Disease division of the CDC said that “surgical” masks are not effective. I guess that they would stop droplets and foamites but the virus particles go right through?

MrMike

I thought it was the same as cold viruses, that the mask elevated the temperature of the sinuses and killed the virus.
ziggy

Surely a mask is quite effective for that specific purpose, though: catching infected airborn droplets from coughs and sneezes that would otherwise be inhaled. That’s a serious mode of transmission. The CDC spokesman ought to have clarified the point. Masks do provide a clear measure of protection in public environments. Nobody said they were virus filters.

Benjamin Franklin Berfle

Surely a mask is quite effective for that specific purpose, though: catching infected airborn droplets from coughs and sneezes that would otherwise be inhaled. That’s a serious mode of transmission.

Oh, brother.

Now on to the next part of the process, Zippy: What do you do with the used and potentially contaminated masks? Oh, YOU never thought of that, now did you? It is biohazardous waste which must be disposed of in a regulatory-specified manner, otherwise the potential exists for another outbreak.

I mean, really, kindly refrain from commenting if you haven’t done a lick of homework.

MrMike

The virus won’t survive for long outside of a living body.

Owllwoman

Masks have a limited time of usefullness. Usually one hour tops. Once they become wet from resperations they allow the travel of bacteria and virusus through the material. And if a person wearing a mask touches the mask with their hands, all bets are off.

listing starboard

I wonder what company is making a fortune from selling surgical masks.

Benjamin Franklin Berfle

Those that Zippy works for.

SHV

I thought it was the same as cold viruses, that the mask elevated the temperature of the sinuses and killed the virus.
********
They vary but viruses are pretty tolerant of heat. IIRC, inorder to kill viruses with heat, high pressure steam at 350 degree temp. for > 15 min.
mountainaires

Bad news.

My spouse has a cold. Usually that’s no big deal, and we’re not alarmed by it. Unfortunately, my beloved has commercial airline reservations for tomorrow out of NYC.

Ruh-roh.

My spouse is sneezing, has a runny nose, and all the hallmarks of a normal everyday cold, or allergies. No fever, aching, or anything else.

We fear my spouse may not be allowed on the airplane. And, if we’re lucky, and he is, I feel sorry for anyone sitting near him who may unduly fear the worst, even though he has a mask and will wear it. Sigh~

It’s almost funny–in my oddball sense of humor way–to be caught up in the fear over H1N1, because of a routine a cold, but it’s not to amusing to my beloved, who just wants to get home, but could end up stuck in a hotel room, or worse, for the duration of a simple cold.

Oy.

Katmoon

Oy is right! SO sorry,the fever is the hallmark, that is what to watch for, and that is when this virus runs crazy with contagion. I know Ferd and I are due to go to No. Ca. after graduation. We also have the added problem of my system being wiped out by immune suppressants(kudos again to Dr. Sears for answering my questions. All I am waiting for now is will I be “allowed” to take tami-flu if I should end up needing it. AS I have put myself in a study so as to obtain my next step medication for R.A. I did this because we can’t afford the co-pay on a very good health insurance policy for my next level meds. They are $18,000, after co-pay. Decisions required I volunteer for a study, so I won’t be any worse off, just at the same level for the first three months if I get the placebo. However, I do not believe I can break continuity on the study, and do not know if we have to be clear of the immune suppressants in advance for the Tami-flu to work. Waiting for that information from the doc right now.
Meanwhile, watch for the fever Mountainaires, I pray your spouse does not have this flu, H1V1 or whatever flavor they are calling it.
I’m a Linda too

“Oy” indeed. You know, he should be wearing a mask to make sure HE doesn’t pick up something from someone else. So, maybe if he has a mask, a simple over the ears across the mouth and nose, will help him and others.

I’m a Linda too

Wish I had time to send you some, I have a ton of them.

Well, not a “ton”, but a box of them. We have them for all the construction work we’ve been doing. Harbor Freight sells them CHEEP, only 4.99 for a box of 50. I don’t know if a local store has them, besides the mail order, or if one of these New York stores are near you, but I’d give a quick call.

http://www.harborfreight.com/cpi/ctaf/retail_stores.taf#NY

Hank

The pig farm is 50% American owned by Smithfield Foods, the world’s largest pork packer and hog producer. Oh by the way let me change channels, TOTUS is holding a town hall meeting in Missouri.

mel in tx

I pray that this virus does not become a pandemic.
On a side note will Obama ever stop campaigning but
that is all he knows how to do.

I’m a Linda too

Yes, hopefully the admin will let the experts do their job, without interference, but one thing extremely troubling, besides their effort to squash the story instead of dealing with the importance that this is, is the continuous counter effort by HSC chief, Napolitano. Every time we hear a word out of her mouth, it’s the opposite of what she should be doing. It’s always, NO, LETS NOT DO THAT, I DON”T THINK WE NEED TO GO THERE YET. She’s waiting for the disaster to happen and then react instead of what we expect, at least a DEMOCRAT, plan and act BEFORE it’s too late.

And even if she now keeps her mouth shut, I still fear her “guidance” from the top is the same attitude.
Barry 0351

Dang folks, The wife came down with gall bladder attack one night in March on the 20th we went there around 9:00 PM and the places was full of sick kids and elderly people. all had the flu.
This flu has been circulating since then and was reported first in Mexico March 28th suddenly a rash of flu sufferers turns into a pandemic, wasn’t it Hillary that said, “Never let a good crisis go to waste” sounds like a crisis came along didn’t it.

Docelder

Never let a good crisis go to waste

That was Rahm.

http://noquarter foxyladi14

Hillary would never say something that stupid.

Linda Anselmi

Dr. Sears – Thank you for both of your informative and reassuring posts. I am passed them on to family and friends along with links to CDC family planning for pandemic and Scientific American.
Pearl

Unsuccessfully attempted to order some surgical quality N95 masks. (CDC recommends the N95 for protection from avian flu. Presumably this influenza strain is similar in size.) Apparently the government has “allocated” all of them to surgical centers only. Consumers aren’t allowed to purchase the effective versions at the moment. (I plan on stopping by my local construction store this evening to see if this allocation applies to non-online retailers as well.) And according to the representative I spoke with, the government isn’t even releasing the masks to surgical centers until “after” a confirmed case.

On the one hand, I can see that they are concerned about supply of the masks.

On the other hand, allowing consumers to protect themselves with an effective mask would seem to me to contain or at least slow transmission of the virus.

Seems to me that they’re expecting this one to get a whole lot bigger.

ziggy

Who the hell really knows? Virtually no one is totally outside of the media feedback-loop these days, so even the experts get confused about where reality ends and delusion begins.

Consider the actual numbers: So far this is only a pandemic in the imagination. I’m not sure that the rate of infection is actually higher than any normal flu season, nor that the mortality rate is demonstrably any higher. We don’t actually know the medical specifics concerning the fatalities in Mexico, do we?

The medical establishment is naturally very concerned, but they’re justifiably concerned about the epidemiological potential of any newly emerging influenza virus.

Benjamin Franklin Berfle

Blahblahblahblahblahblahblahblah

The Oracle(TM) speaketh.

I think your table structure is a couple of columns short of a primary key, Zippy.

Diana

Sams Club, Lowes, Home Depot have them for a little over $10 a box for a pack of 20. The ones with the Particulate Respirator and Mask are about $30 for a box of 20. Briggs Corp is also selling of them online.

http://tinyurl.com/cu9jxl
vireo

Try this source, Pearl: http://www.conney.com/Page_STATIC-CONTENT-PAGE-49_50001_10102_-1

Pearl

Ziggy, I totally agree. Not panicking, just wanted to be prepared with some masks “in case” before the laws of supply and demand kicked in. My grandmother died from the 1918 pandemic so it hits close to home for me. I thought Friday night was early enough to beat the crowds but apparently not early enough to beat the government, ha.

Dianna & Vireo, HD is a stop on the way home tonight for my “plan b”. Problem is I was looking for a specific N95 (3M 1860).

Thomas Sears

The N95 mask you speak of is the standard required for biocontamination precautions for all medical facilities…not just surgical centers. In fact, they are usually not worn in surgery. They are now, however, used in most autopsies. They must be properly fitted prior to issuance, by the way.

Jackarooty

For those who are interested…this is the PBS special I referenced the other night about the 1918 Pandemic.

http://www.pbs.org/wgbh/amex/influenza/

I hope they rebroadcast it.

http://noquarter foxyladi14

i.m sure they will

smiles

Can somebody tell me why is it that when it came to Obama’s birth certificate, that piece of paper was quarantined with a body guard in Hawaii no one to see, but a virus that can cause death is “no cause for alarm”?

I don’t care what’s on that birth certificate — I’m sure that whatever it is isn’t going to kill anybody. But this swine flu has been out for MONTHS! The mainstream media never covered it. I read about it often in foreign papers and was shocked that few in this country were aware of what was going on back in February when action could have been taken to quarantine the virus.

Just my thoughts.
Liz

It’s worthwhile to note that there have only been 7 – not 152 – confirmed deaths due to this virus. Seven, according to the CDC. http://www.cnn.com/2009/HEALTH/04/29/swine.flu/index.html

The first cases of the virus were detected in Mexico, where health officials suspect swine flu in more than 150 other deaths and roughly 2,500 illnesses. Only 26 cases have so far been confirmed, including the seven fatal cases.

It’s also helpful to note that 13,000 people die in the US alone from ordinary flu viruses.

I think all out panic may be somewhat premature.

Liz

That’s 13,000 annually in the US.
Thomas Sears

I suggest you read the entire article and the WHO report. Please note that a ‘confirmed’ case is one where serology has been employed to confirm a particular infection. Contacts of that person who become ill with a flu-like illness then become counted as probable cases. Serology is not commonly available for ALL illnesses. As of this morning there were 148 serologically proven cases in 9 countries. Total infections are many fold this number for obvious reasons and not all deaths are reported.

WHO does not panic, as you might imply. They do take this very seriously and are alarmed..enough to raise this alert to level 5….the alert scale goes only to ’6′. This particular virus is demonstrating a significantly higher level of infectivity than prior influenza outbreaks. This fact alone is of huge concern.

Tuppence411

Good Morning Dr. Sears. I really appreciate you taking the time to be with us and share your expertise. I am not a medical provider, but I am a public health professional. I don’t believe the numbers out of Mexico will ever be accurate. They just don’t have the underlying medical and public health infrastructure nor capacity, even with assistance from WHO and CDC.

Instead for clues I am looking at NYC, which has an excellent public health system and lab, along with epidemiologists that can do detailed and timely case investigations. NY has confirmed cases in contacts. They have suspected cases in contacts of contacts. A troubling sign. The current statistic that 85% of US cases originated in Mexico is going to change.

Thomas Sears

Thanks for your response. I completely agree with you. This story will ultimately, like the 1918 pandemic, be more fully explained as time rolls on; our reporting and discovery techniques are still (unfortunately) very similar to that time period. You appear to have excellent insight into this issue. Keep digging. I continue to have more faith in local health authorities and the CDC / WHO than I do in the federales. Grass-roots common sense and appropriate use of the available knowledge continues to be the best strategy.

http://noquarter foxyladi14

thank you Dr.Sears for all your helpful information on this,it is really appreaciated.
http://N/A breeze

Only 7 swine flu deaths around world, not 152, says WHO

April 29, 2009
The Sydney Morning Herald

A member of the World Health Organisation (WHO) has dismissed claims that more than 150 people have died from swine flu, saying it has officially recorded only seven deaths around the world.

Vivienne Allan, from WHO’s patient safety program, said the body had confirmed that worldwide there had been just seven deaths – all in Mexico – and 79 confirmed cases of the disease.

“Unfortunately that [150-plus deaths] is incorrect information and it does happen, but that’s not information that’s come from the World Health Organisation,” Ms Allan told ABC Radio today.

“That figure is not a figure that’s come from the World Health Organisation and, I repeat, the death toll is seven and they are all from Mexico.”

Ms Allan said WHO had confirmed 40 cases of swine flu in the Americas, 26 in Mexico, six in Canada, two in Spain, two in Britain and three in New Zealand.

Ms Allan said it was difficult to measure how fast the virus was spreading.

She said a real concern would be if the flu virus manifested in a country where a person had had no contact with Mexico, and authorities were watching all countries for signs of that.

“There is no pattern that has emerged at this stage to be able to say that it is spreading in a particular way or it is spreading into a particular country … the situation is continuing to evolve,” she said.

She said the WHO was not recommending against overseas travel, but urged those who felt sick to stay home and others to ensure they kept their hands clean.

No decision had yet been made about vaccinations.

“This virus is not airborne, it’s caused by droplets … so it’s not a time for worry. It’s a time to be prepared,” Ms Allan said.

Thomas Sears

This is a classic case of parsing words and taking comments out of context. This interpretation of the events in an epidemiology course would merit an ‘F’!

bone

In your previous post you seemed to be more interested in, for some reason, blaming the Obama adminstration for something with this flu. You said this is not a polical issue, but you bring politics into it.

One interesting point that is being missed is that there is a good chance this Swine Flu outbreak originated from an american owned farm in Mexico.

Where is the outcry about regulating big Agribusiness to better combat all the health issues around it? Where is the outcry of Americans business acting more responsibly in Mexico? Could be another case of big American business taking advantage of the third world.

“Residents in Perote, Mexico complained to local authorities after about a third of the population came down with the flu, which they blamed on a local pig farm operated by Smithfield Foods Inc. (SFD), according to local media reports.”

http://money.cnn.com/news/newsfeeds/articles/djf500/200904271833DOWJONESDJONLINE000645_FORTUNE5.htm

________________________________________
Daisyjane

I received this via email. Evidently it was posted on one site first, then brought to Free Repulic. Take it for what it’s worth. Sounds authentic to me.

To: pwatson
A friend of mine on another board posted this email she received from her doctor in Texas. It’s sounding pretty scary to me:
New Braunfels, TX
After I returned from a public health meeting yesterday with community leaders and school officials in Comal County and Hays County, Heather suggested I send an update to my patients in the area, because what we are hearing privately from the CDC and Health Department is different from what you are hearing in the media. Some of you know some of this, but I will just list what facts I know.
- The virus is infectious for about 2 days prior to symptom onset
- Virus spreads more than 7 days after symptom onset (possibly as long as 9 days) (this is more unusual than ordinary flu)
- Since it is such a novel (new) virus, there is no “herd immunity,” so the “attack rate” is very high. This is the percentage of people who come down with a virus if exposed. Almost everyone who is exposed to this virus will become infected, though not all will be symptomatic. That is much higher than seasonal flu, which averages 10-15%. The “clinical attack rate” estimation from CDC and WHO may be around 40-50%. This is the number of people who show symptoms. This is a huge number. It is hard to convey the seriousness of this to those outside of the medical fields.
- The virulence (deadliness) of this virus is as bad here as in Mexico, and there are folks on ventilators here in the US, right now. This has not been in the media, but a 23 month old in Houston is fighting for his life, and a pregnant woman just south of San Antonio is fighting for her life. In Mexico, these folks might have died already, but here in the US, folks are getting Tamiflu or Relenza quickly, and we have ready access to ventilators. What this means is that within a couple of weeks, regional hospitals will likely become overwhelmed.
- Some of the kids with positive cases in Comal County have had more than 70 contacts before diagnosis as a minimum figure.
- There are 10-25 times more actual cases (not “possible” cases — actual), than what is being reported in the media. The way they fudge on reporting this is that it takes 3 days to get the confirmatory nod from the CDC on a given viral culture, but based on epidemiological grounds, we know that there are more than 10 cases for each “confirmed” case right now.
- During the night, we crossed the threshold for the definition of a WHO, Phase 6 global pandemic. This has not happened in any of our lifetimes so far. We are in uncharted territory.
- They are advising President Obama to declare an emergency sometime in the next 72-96 hours. This may not happen, but if it doesn’t, I will be surprised. When this happens, all public gathering will be cancelled for 10 days minimum.
- I suggest all of us avoid public gatherings. Outdoor activities are not as likely to lead to infection. It is contained areas and close contact that are the biggest risk.
- Tamiflu is running out. There is a national stockpile, but it will have to be carefully managed for law enforcement and first responders as it is not enough to treat the likely number of infections when this is full-blown. I don’t think there is a big supply of Relenza, but I do not know those numbers. If I had to choose, I would take Relenza, as I think it gets more drug to the affected tissue than Tamiflu.
- You should avoid going to the ER if you think you have been exposed or are symptomatic. ER’s south of here are becoming overwhelmed today— and I mean that — already. It is coming in waves, but the waves are getting bigger.
- It appears that this flu produces a distinctive “hoarseness” in many victims. The symptoms, in general, match other flu’s; namely, sore throat, body aches, headache, cough, and fever. What is not too common in regular flu cycles is vomiting and diarrhea which seems to be associated with this, further dehydrating victims. Some have all these symptoms, while others may have only one or two.
- N-Acetyl-Cysteine — a nutritional supplement available at the health food store or Wimberley Pharmacy, has been shown to prevent or lessen the severity of influenza. I suggest 1200mg, twice a day for adults, and 600mg twice a day in kids over 12. It would be hard to get kids under 12 to take it, but you could try opening the capsules and putting it on yogurt. For 40 pounds and up, 300-600 mg twice a day, for less than 40 pounds, half that.
- Oscillococinum, a homeopathic remedy, has been vindicated as quite effective in a large clinical trial in Europe, with an H1N1 variant. You can buy this at Hill Country Natural Foods, or the Wimberley Pharmacy.
I will try to keep everyone posted if I have any new information. Meanwhile, don’t be afraid, stay informed and try to avoid infection. The fewer people infected the easier it will be for our public officials to manage it.
If any of my patients become ill, or suspect infection, call the office, do not come without calling and DO NOT go to the ER. If one member in a family is identified all would be given the Tamiflu or Relenza (that is normal course of action) if there is enough distributed to fill prescriptions. Public health stated that one family member identified or suspected to have contracted the flu it will require the whole family to be ‘quarantined’ in their own home until enough time has passed for the remaining household to have contracted it or be considered infection free ( 7 to 10 days per person). As another suggestion, if any member of the family is on routine medication- fill those prescriptions now. Have plenty fluids, Motrin, soups, etc available and make contingency plans in case your family is affected.

114 posted on Wednesday, April 29, 2009 10:15:15 PM by battletank

Linda Anselmi

PLEASE DO NOT POST COMMENTS MULTIPLE TIMES.

Our span filters sometimes snag comments – for various reasons including ones that are overly long . When we have to delete duplicates, it only makes it more likely that the filter will snag future comments of yours.

Once comments are snagged by the filter, they have to be manually approved. That happens only periodically through out the day. So If a comment doesn’t show up, try sending a nicely worded email to Susan – it will usually produce good results.

Thanks.

Katmoon

Lat night we were made aware of our first case in Tennessee, outside of Nashville. I posted a link that has information for each states pandemic plan, which really is important to read, IMHO, so you have a better understanding of what can or may happen if the outbreak goes to a level 6, as well as what is in place at a level 5. The plans are relative to how cases are handled, how steps are taken and why, and how it comes into play with the law. Just a thought on surgical masks; which I am sure can help to some degree, to always keep in mind they are not a sure thing in prevention. As discussed many times, hand washing, can’t be said enough, and the proper way to hand wash. Sounds silly, but not a quickie wash…. so here I go again with the site for each state’s pandemic plan, and proper hand washing. Also to keep in mind two things we drag into our homes that have been on the ground/floors where spit and other filth is Shoes and purses. We keep our shoes outside, or in a mud room, then transfer over to our inside shoes, the purse is hung up on a hook never to touch the surface of a counter top or table, or desk.

Hand Washing-From the Mayo Clinic

http://www.mayoclinic.com/health/hand-washing/HQ00407

State Pandemic Plans

http://www.pandemicflu.gov/plan/stateplans.html

Common Areas-Common Items:
* The telephone receiver and mouthpiece (this is most important since your mouth could touch the surface directly; make sure you get all the phones in your home)
* Faucet handles
* Refrigerator and microwave door handles (also very important since you will be eating with the same hands you used to touch the handles)
* Kitchen and bathroom counters and faucets
* Light switches
* Computer keyboards, remote controls, and handheld games

Car: Steering wheel, dashboard,door handles,carseat,seatbacks/headrest ,console,KEYS House-Doorbell/knob,lightswitches,phones,computers,remotes,electronic devices CELL PHONE toys,books (especially library books.

Grocery Store cart handles

Switch children out of school clothes, into clean clothes, when they get home from school. Same thing for anyone who travels on public transportation.

New toothbrush required after being ill.
Daisyjane

Twice, I posted an email, from a doctor in public health and twice, it did not appear on this site.

This was not a political email, not in the least. It contained much common sense, nuts and bolts advice. I hope the moderators get a case of “religion” because people need to be protected.

This is life and death, not politics.

Linda Anselmi

Daisyjane -

your comment is posted. Please read my response above.

Daisyjane

Linda,

I’m sorry. I should have exercised more patience.

mountainaires

Recent developments in the analysis of the H1N1 swine influenza virus have shown that the lethal viral strain does not combine genes from humans, birds and pigs, as first thought, but that it’s rather made up of a combination of two swine flu strains, which, brought together, are deadly to us. Scientists studying the strains have told Wired that the find may help researchers get a better understanding of how the virus acts, as well as of what methods could be employed to limit and eventually stop its spread.

Two articles:

http://news.softpedia.com/news/Swine-Flu-Does-Not-Contain-Human-and-Bird-Genes-110423.shtml

http://www.wired.com/wiredscience/2009/04/swinefluupdate/
http://360.yahoo.com/ommotherlifeforce fred heidrick

if [N-95] resperators were no good why did heath care workers wear them when they were killing all those thousands of birds that had bird flu in the past years?i think they want people to get sick so that they can get more emergency moneys.

allso what else is going on in the world that they dont want us to see as we focuse on this stuff?
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