Swine Flu

Burrell College of Osteopathic Medicine
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About time somebody started this thread.

It might be a bit too early to be 'scared' about this just yet. Yes, it's fairly infectious, but it's also a fairly low-mortality strain of H1N1, and most people are getting by fine with it (only one hospitalization in the US). Not to belittle what may be a very serious public health threat, but if we recorded the amount of people with ugly symptoms after traveling to Mexico, I'm sure it wouldn't look too different from this.
 
It was newer then (less specific vigilance), less was known about it, and they might have less access to antivirals. It looks like the death rate has dropped off dramatically. Then again, mutations happen.
 
good point on the whole 'newness = virulence' thing. But whileve got someone eager to answer questions:

1. Why so late in the flu season? Flu usually disappears in the late spring/summer and then picks up again during late fall/winter.

2. Other countries like Canada and New Zealand have cases as well (discrediting the above sense of flu "season" as NZ is in late fall/early winter), so either it has been able to be carried around the world by travel, or it had always been there, and is not very virulent?

What we do know:
1. Last year's vaccine is not effective against it.
2. It's resistant to ramantidine, but sensitive to Oseltamivir.
 
gracias por la informacion, Vasca!

Por favor, ten cuidado y escriba aqui con frequencia.
 
If only the media were all over things like HIV like they salivate over pig flu. It's a tragedy that 80+ have died in Mexico and I appreciate that steps are being taken to educate and contain, but you can watch the news for weeks on end and I'll be damned if they once mention HIV, a much more preventable yet proven deadly killer of Americans, Mexicans, Canadians, etc etc. I bet my life savings of $109.57 that today hundreds if not thousands of Americans will watch the news and go "oh crap, swine flu, we're all going to f'ing die!" and then proceed to have unprotected sex with a partner whose HIV/STD status they don't know.
 
I live in mex city and I agree with vasca, it suddenly came and people in here used to think the flu isn't really a big deal, hopefully til now. I've heard in the news that there's already an effective cure if treated on time. Right now in the city u can't sneeze or cough cause people start to panic and u can feel the fear in the air, there are no classes at school and churches remained closed today. It's strongly recommended not to go to the movies theather or public places unless it's necessary. Student clinical rotations were cancelled too. Working people have to work tho. I still wonder how is it possible that some guy got the flu but his mom who he lives with didn't... what's the factor, they don't tell us that...
 
nogolfinsnow said:
If only the media were all over things like HIV like they salivate over pig flu. It's a tragedy that 80+ have died in Mexico and I appreciate that steps are being taken to educate and contain, but you can watch the news for weeks on end and I'll be damned if they once mention HIV, a much more preventable yet proven deadly killer of Americans, Mexicans, Canadians, etc etc. I bet my life savings of $109.57 that today hundreds if not thousands of Americans will watch the news and go "oh crap, swine flu, we're all going to f'ing die!" and then proceed to have unprotected sex with a partner whose HIV/STD status they don't know.
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There are a lot of public health programs working on improving safe sex everywhere. But its not news. There's nothing new to say about HIV, so why would it be news?

A new flu outbreak however, thats news worthy. You have to remember this isn't some stupid panic over "mad cow disease" this is a new strain of influenza. Something that has always been very worrisome to health officials. Thank goodness its not too virulent and most people have recovered.

Even numbers wise, sorry HIV just not that exciting compared to this. In the 1918 flu pandemic 50 million people died worldwide (some say as many as 100 million) over a period of only 2 years before it stopped. Whereas something like 33 million have HIV/AIDS worldwide and there are 2 million deaths/year. Tragic? Sure. But numerically similar to what would happen if we truly ended up with another deadly influenza strain? No. And we are definitely due for one since historically there were about 3 per century.

Realistically it doesn't look like this influenza strain is that, and the CDC doesn't seem too concerned about it. But for once I was actually proud of the news for reporting on a realistic health concern.
 
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nogolfinsnow said:
If only the media were all over things like HIV like they salivate over pig flu. It's a tragedy that 80+ have died in Mexico and I appreciate that steps are being taken to educate and contain, but you can watch the news for weeks on end and I'll be damned if they once mention HIV, a much more preventable yet proven deadly killer of Americans, Mexicans, Canadians, etc etc. I bet my life savings of $109.57 that today hundreds if not thousands of Americans will watch the news and go "oh crap, swine flu, we're all going to f'ing die!" and then proceed to have unprotected sex with a partner whose HIV/STD status they don't know.
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You're totally missing the point here...

While I too deplore the media's ineptitude at really delivering the health news that actually matters, for once a little bit of good old fashion worry is in order! (keep in mind, I say, worry, not panic!)

We are WAY overdue for a pandemic. A pandemic does not necessary kill people and wipe out the whole human race like you see on TV. What is more likely is that it will overwhelm our health care resources to the point where preventable deaths are no longer prevented. (What if that 0% fatality rate in the US moves closer to 5%? Still low, but from what I understand it acts through a cytokine storm which scares a healthy, 25 year old like myself a lot!)

Now you ask, how would it overwhelm our health care resources and reach a higher death rate? Well, we are consistently running @ approximately 95% utilization of ventilators, leaving very little excess in ICU respiratory care for when POTENTIALLY there is a surge of patients with severe (but treatable) respiratory complications.

Finally, this thing spreads relatively easily from what we have seen so far. I don't think it is unfair to say that the population should start at least becoming prepared to take some substantial precautions should things move for the worst! I mean, if the planets lined up in the right way, a lot more people would die of this in the US and worldwide than die through HIV/AIDS even @ a 2% death rate vs. a near 100% death rate, just because so many people could get it!
 
Upgrayedd said:
You're totally missing the point here...

While I too deplore the media's ineptitude at really delivering the health news that actually matters, for once a little bit of good old fashion worry is in order! (keep in mind, I say, worry, not panic!)

We are WAY overdue for a pandemic. A pandemic does not necessary kill people and wipe out the whole human race like you see on TV. What is more likely is that it will overwhelm our health care resources to the point where preventable deaths are no longer prevented. (What if that 0% fatality rate in the US moves closer to 5%? Still low, but from what I understand it acts through a cytokine storm which scares a healthy, 25 year old like myself a lot!)

Now you ask, how would it overwhelm our health care resources and reach a higher death rate? Well, we are consistently running @ approximately 95% utilization of ventilators, leaving very little excess in ICU respiratory care for when POTENTIALLY there is a surge of patients with severe (but treatable) respiratory complications.

Finally, this thing spreads relatively easily from what we have seen so far. I don't think it is unfair to say that the population should start at least becoming prepared to take some substantial precautions should things move for the worst! I mean, if the planets lined up in the right way, a lot more people would die of this in the US and worldwide than die through HIV/AIDS even @ a 2% death rate vs. a near 100% death rate, just because so many people could get it!
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As much as I'd like to agree that we should worry more about the morbidity than the mortality, a round of oseltamivir only costs $18, and since we've got a pretty well-developed EMS system, it hopefully won't progress to the point of ventilation support for most people. I think the bigger problem is that viruses mutate, and quickly. Rapid transit from host to host stimulates a Darwinian pressure on any microbe to select for the most resistant and virulent species. If we shove a pack of Tamiflu down everyone's IV, how long will it take until that stops working?
 
neuroprotector said:
As much as I'd like to agree that we should worry more about the morbidity than the mortality, a round of oseltamivir only costs $18, and since we've got a pretty well-developed EMS system, it hopefully won't progress to the point of ventilation support for most people. I think the bigger problem is that viruses mutate, and quickly. Rapid transit from host to host stimulates a Darwinian pressure on any microbe to select for the most resistant and virulent species. If we shove a pack of Tamiflu down everyone's IV, how long will it take until that stops working?
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Meh... could be. I looked into it a bit more, and it looks like tamiflu works on this strain, which pretty much validates what you said about the EMS being able to stop it effectively.

Also, rapid host-to-host transmision could stimulate a resistant variety of the H1N1, but I don't see how it would lead to an increase in virulence (am I wrong?!?).

I still think this is a major problem though and things could go south relatively quickly since people today travel faster and greater distances than at any point in human history when we have had one of these germs... With that said, I'm hard pressed to see how things could really get out of hand in the US, but I still think its the right thing to do to get this on everyone's radar! If we keep the incedence rate in the US low, we will also keep the mortality rate low.
 
Along the lines of what was stated above:

So far this is not the virulent, deadly pandemic everyone has been dreading...though through selective pressure, it has the ability to become that. The idea that selective pressure will make this more virulent is not completely true, but should the virus become more virulent, it also will most likely become more infectious b/c a dead host is not worth living in, and the virus would have to find someway to "jump" to a new host.

However, this is evidence that our preparations, our people, and our science has the ability to pick up on a problem like this, and relatively contain it. Now, I admit we're early in this thing, and it will either: blow over, or blow up.
Still, I think it's cool (my apologies to people who have lost loved ones in Mexico) to watch the application of the principles we have been taught in epi/infectious disease. I mean, somewhere (probably in Atlanta) we've got people working on mathetical models with varying degress of infectivity and virulence who are following this stuff. Sorry for being a math nerd, but I think this stuff is really cool, albeit too boring for a career in between outbreaks.
 
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rachmoninov3 said:
Along the lines of what was stated above:

So far this is not the virulent, deadly pandemic everyone has been dreading...though through selective pressure, it has the ability to become that. The idea that selective pressure will make this more virulent is not completely true, but should the virus become more virulent, it also will most likely become more infectious b/c a dead host is not worth living in, and the virus would have to find someway to "jump" to a new host.

However, this is evidence that our preparations, our people, and our science has the ability to pick up on a problem like this, and relatively contain it. Now, I admit we're early in this thing, and it will either: blow over, or blow up.
Still, I think it's cool (my apologies to people who have lost loved ones in Mexico) to watch the application of the principles we have been taught in epi/infectious disease. I mean, somewhere (probably in Atlanta) we've got people working on mathetical models with varying degress of infectivity and virulence who are following this stuff. Sorry for being a math nerd, but I think this stuff is really cool, albeit too boring for a career in between outbreaks.
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Its in Washington DC. They started using it about the time the SARS corona virus hit. I saw a demo of it once. Its pretty cool the parameters that they enter into the model.
 
rachmoninov3 said:
Along the lines of what was stated above:

So far this is not the virulent, deadly pandemic everyone has been dreading...though through selective pressure, it has the ability to become that. The idea that selective pressure will make this more virulent is not completely true, but should the virus become more virulent, it also will most likely become more infectious b/c a dead host is not worth living in, and the virus would have to find someway to "jump" to a new host.

However, this is evidence that our preparations, our people, and our science has the ability to pick up on a problem like this, and relatively contain it. Now, I admit we're early in this thing, and it will either: blow over, or blow up.
Still, I think it's cool (my apologies to people who have lost loved ones in Mexico) to watch the application of the principles we have been taught in epi/infectious disease. I mean, somewhere (probably in Atlanta) we've got people working on mathetical models with varying degress of infectivity and virulence who are following this stuff. Sorry for being a math nerd, but I think this stuff is really cool, albeit too boring for a career in between outbreaks.
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I agree with that. It's nice when our field gets noticed more than Angelina Jolie's babies, though I'm sure it won't last.

And yeah, CDC has this whole epidemic intelligence service (EIS) that rapidly deploys epidemiologists to areas in need during times like this. Personally, I just like the image I get of parachuting a bunch of secret agent nerds into hotzones. Comedy gold.
 
Hey Vasca, thanks for keeping us updated. I've read many accounts of docs in mexico city who claim a widespread systematic cover up of the conditions by the gov't. This is one account from the BBC:

"I work as a resident doctor in one of the biggest hospitals in Mexico City and sadly, the situation is far from "under control". As a doctor, I realise that the media does not report the truth. Authorities distributed vaccines among all the medical personnel with no results, because two of my partners who worked in this hospital (interns) were killed by this new virus in less than six days even though they were vaccinated as all of us were. The official number of deaths is 20, nevertheless, the true number of victims are more than 200. I understand that we must avoid to panic, but telling the truth it might be better now to prevent and avoid more deaths.
-Yeny Gregorio Dávila, Mexico City

Another annonymous doc claimed they have been urged to put resp failure or sepsis on the death certificate to cover up swine flu deaths. He also claimed that the vaccines are proving ineffective.

I'm trying to avoid dusting off my tin foil hat, but I was curious to know what your perspective is on this as a member of the medical community there? Thanks.
 
vasca said:
A lot of mexicans will stall going to the doctor until it's their last resort. Not everyone has universal health insurance you know and when you're a bus driver working for minmum wage and have 7 kids at home (and that 8th rugrat is coming real soon and your wife doesn't work to boot), you're not going to go spend a month's pay on a doctor visit for nothing.

It's public reaching hospitals like mine that get the worst work because it's the hospitals the impoverished with no health insurance go to. We already have l death of suspicious causes, at least 2 isolated patients that seems like sure bets and a few other suspicious cases. The amount of people coming in and out makes containment harder (we're literally shipping pregnant women by the trucklod sometimes). 🙄 We also have a lot of HIV positive patients as regulars that come back every month.

So far nobody in the staff has gotten sick, but pople are taking it seriously. There's rumors that doctors of major hospitals all over the city have already died but they won't diffuse the deaths on the news because it will scare the hell out of people. The population density of Mexico City is another factor that doesn't help trying to contain things. My area alone has virtually l million inhabitants.

Most people aren't vaccinated against influenza either. All good factors that contribute to more deaths here.
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Thanks for the info from the frontline. Keep us updated.
 
The 1918 strain of Swine H1N1 killed huge amounts of young adults unlike the majority of flu strains. The stronger the immune system, the larger the immune response and therefore maladaptive reaction to the flu.

The problem with influenza is how contagious it is. HIV is not very easily transmitted. It also isn't going to kill you in a week or two.

Lets hope this thing doesn't mutate again and become more virulent/resistant to antivirals.
 
Realistically, how long would it take to develop and implement a vaccine that is effective against this stuff? So far the government has pulled out the reserves of Tamiflu.
 
Azadre said:
13 Weeks?
http://www.chicagotribune.com/business/chi-baxter-swine-flu-27-apr27,0,3579388.story
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Although the egg-based method has produced safe and effective vaccines, analysts say Baxter's method can cut production times in half compared with the older process.
Click to expand...
Hmmmmm.....sounds like the makings for a sci-fi movie. "Those smarty-pants scientists thought that they developed a new way of making vaccines.....but it turned out that the vaccines turn people into NAZI ZOMBIES OH NOES"

:laugh:
 
I work at the CDC, and this investigation/response has become a pretty big thing here. Some of my co-workers have been called over to the emergency operating center to work on this, and the office of director has been good about sending us updates on the situation. As stressful as these situations can be, I believe that it is events like this (being on the frontline of a response) that attract many people to work for organizations like CDC and WHO. BTW, if any of you are interested in working at CDC in the future, EIS is a great way to go.
 
Our school (which borders one of the states with test-verified cases) sent out a bunch of diagnostic and therapeutic guidelines to everyone, including us medical students. In it they're recommending oseltamivir and zanimivir, both of which we're about to cover in class. Best time to study immunology ever.
 
vasca said:
Sounds a bit exagerrated to be giving out like halloween candy those drugs in states that don't even have reported cases yet to me.

Oh, I was like working starting the paperwork at my job after the usual rush against time to get blood samples done before 9:30 am when I got a serious phone call from the teaching department at my hospital. I get there and the doctor tells me by orders of my university I must leave the hospital right NOW. 😱 I had to leave right now or risk losing internship. I was literally kicked out kicking and screaming but had to comply.

Things must be real bad if they are forcing us to get the hell out of our hospitals like this. It still works at my hospital because we were just a tiny minority of interns, but so far interns from other universities must continue working.

Oh, I heard there was another death at my hospital, confirmed influenza, but it isn't the swine flu, the death was a case of seasonal flu which has a higher death rate. The person that died was a young person too. I think it's getting really serious down here and they aren't giving out the meds.
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oh man, vasca. take care of yourself. you can't help anyone if you're sick too. have you seen any cases personally?

based on my school email i thought there was lots of unnecessary panic here. that's exactly the opposite of what's going on down there.
 
vasca said:
Yeah, it seems like the media is covering a lot of the deaths to avoid severe panic. It's one thing that some homeless person got sick that didn't have access to health care, it's another that DOCTORS are dying. There's rumors flying around that there's at least 1 death of a doctor at one of the big honcho hospital in Mexico City.

My hospital was worried sick whether I had been vaccinated or not against the deadly seasonal strain that's lurking around and were requesting me to tell them the names of every intern in my rotation to vaccinate them pronto. Stark difference in attitude from my regular shift done 3 days ago when the hospital stated they weren't going to vaccinate any interns or residents, only attendings. I believe they are also massively vaccinating nurses and other staff that's in close contact with patients.

Like I stated before, if you're too wussy to go work during an epidemic, don't become a doctor because it's just a risk of the job. I accept the risks, but was forced to leave because I still respond to my university's demands. It is nice to see that my hospital and other hospitals as well are starting to worry about the safety of their personnel. If we get sick and die, then everyone is screwed.

As for seeing cases firsthand, I'm in pediatrics and see for the most part babies, babies and more babies. I reanimate them when they are born and detect babies that are born and don't breathe or are born overweight or with other health problems and ship them to the baby ICU and continue treating them there under the supervision of neonatologists. The deaths at my hospital have been adults in Internal Medicine so no, I haven't had close contact with them. I was with a kid last week that has suspicious pneumonia and today I was taking a blood sample from a premature baby at the ICU whose mother is apparently a suspicious case. Baby looks okay with no fever though so chances are the mother doesn't have it. I've heard suspicious cases are popping up at every service though. The ER is insane, glad I was in the ICU until I got sent home today.
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I'm curious if it is common for average citizens of Mexico to receive the yearly seasonal flu vaccine and also how the fatality rate to the seasonal flu compares in Mexico vs. the US (not that I expect you to have these numbers, just curious).

I was talking to my father-in-law, who runs a public health lab in CA, and asking his opinions of what's going on. He said the two most curious aspects are 1) the apparent disconnect between the disease in Mexico and the disease in the US and 2) why the virus is going strong this late in the flu season.

Hopefully the situation in Mexico calms down. Keep yourself healthy and thanks for the information.
 
b9vfl4b63mteaxzq2gcsEXgto1_500.jpg
 
Hey vasca, can you let us know what your take on the situation is after your day back at work? I'm sure we aren't getting the whole story from the US and Mexican media. Apparently a good amount of people are sick in NYC. So far they say ~159 deaths are suspected to the flu in Mexico, but only 26 of those deaths have been confirmed (going slowly mostly because these are being confirmed by labs in Canada, but now it seems Mexico is hooked up to be able to confirm it down there themselves).
 
I also heard the deaths are starting to taper off. How does it look?

Thanks for being our personal journalist.
 
Vasca your insight is so appreciated, you workaholic : ). The attention does seem to be dying down a bit. Do u think they've gotten this under control yet?
 
Vasca: you seem to have an amazing attitude. First they told you they'd fire you if you didn't leave the hospital, now you'll face academic troubles if you don't return, Holy Cow!!! You do a great job keeping perspective, thanks for keeping us informed.
 
The media is making this thing 100x more scary than it really is. Don't blame them. No news is better than bad news.
 
Good Yeast said:
The media is making this thing 100x more scary than it really is. Don't blame them. No news is better than bad news.
Click to expand...

I don't think it's nearly that simple. It's easy to criticize the response of the CDC and the media with the benefit of 20/20 hindsight, but frankly that's totally unfair. Regardless of the end mortality of any outbreak, there's significant concern for a reason. After all, the big flus, like in 1918, were very similar to this (widespread spring virulence with low mortality followed by fall outbreaks with high mortality).

It's not like it's easy to figure out just how much to "sound the alarm." Too much and you get people making fun of you, too little and you risk a public health disaster. I wish people would get off their high horse about criticizing the media. It's too easy, and it makes you look cool when you can nonchalantly dismiss people's concerns post-hoc.
 
Hey vasca,
How are things going down there? What do most of the people with the swine flue died from? Pneumonia? I hope you and all of your colleagues are alright.
 
neuroprotector said:
I don't think it's nearly that simple. It's easy to criticize the response of the CDC and the media with the benefit of 20/20 hindsight, but frankly that's totally unfair. Regardless of the end mortality of any outbreak, there's significant concern for a reason. After all, the big flus, like in 1918, were very similar to this (widespread spring virulence with low mortality followed by fall outbreaks with high mortality).

It's not like it's easy to figure out just how much to "sound the alarm." Too much and you get people making fun of you, too little and you risk a public health disaster. I wish people would get off their high horse about criticizing the media. It's too easy, and it makes you look cool when you can nonchalantly dismiss people's concerns post-hoc.
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I wouldn't criticize the response of the CDC or WHO, but the breathlessness with which the media (esp. cable "news") has reported this epidemic is ridiculous. The endless scaremongering gets old after a while, especially when you watch it and realize that half the **** they say is patently idiotic. The whole media cluster**** deal can be rather amusing during elections, but it's just plain annoying in this case.
 
turkeyjerky said:
I wouldn't criticize the response of the CDC or WHO, but the breathlessness with which the media (esp. cable "news") has reported this epidemic is ridiculous. The endless scaremongering gets old after a while, especially when you watch it and realize that half the **** they say is patently idiotic. The whole media cluster**** deal can be rather amusing during elections, but it's just plain annoying in this case.
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I think the argument can be made that they're just following WHO's (melodramatic) lead. I mean, when you've got people like Margaret Chan saying things like "all of humanity is under threat," it freaks people out.
 
I think currently there is no cure, but I think you have to wear masks.
 
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