Category Archives: swine flu

Playing The Swine Flu Prediction Game

British researchers have stated that by the time the swine flu has moved into the new year a third of the world will have been infected. It’s a reasonable prediction. The truth is predicting is all that science can do at this stage in the swine flu game.
The last flu pandemic that left millions dead was in 1957. The swine flu could spread as widely as that strain of flu but because of medical advancements the death toll should be much lower according to researchers at London’s Imperial College.


Sky News
reports:

Prof. Ferguson said: “What we’re seeing is not the same as seasonal flu and there is still cause for concern – we would expect this pandemic to at least double the burden on our healthcare systems.”

“However, this initial modelling suggests that the H1N1 virus is not as easily transmitted or as lethal as that found in the flu pandemic in 1918.”

Studies are now showing that the swine flu is fatal in around four of every 1,000 cases.

When a person becomes infected with the virus on average they pass it on to between 1.2 and 1.6 others.

This suggests that the new strain of flu is more easily spread than seasonal flu but less infectious than other strains that lead to previous flu pandemics.

The one thing that is known for sure about this pandemic is that we don’t know for sure how the game will play out. That is a becoming the overall theme when it comes to the swine flu. We just don’t know what to expect.


Gazette.net
reports:

“I think the right answer is we don’t have all the information yet, and anyone who is predicting what we’ll see from this day forward is hoping to get lucky,” said Dr. Ivan C.A. Walks of Potomac.

Walks is part of a six-member Swine Flu Medical Advisory Board, holding conference calls with O’Malley (D) at least once a day to discuss new developments in the illness, also known as the H1N1 virus.

That’s what has been tossed about with the CDC and WHO. There is no denying that the swine flu will touch most people’s lives in the Northern Hemisphere by the end of the fall but hopefully because of medical advancements it will not be as deadly as other pandemics.

The reason that the strain will be considered milder is that we have advancements in the medical sector and much better pandemic planning than in the past. Global communications allow for rapid staging before the illness is in the lead.

Of course it’s all a roll of the dice in the end. The models, patterns and predictions may be right on the mark or they may be out to lunch.

The Wall Street Journal reports:

“Disease outbreaks are fundamentally unpredictable in detail,” argues public-health academic Philip Alcabes, author of “Dread.” Instead of looking to physicians to predict epidemics, “we should leave the job of seeing the future to the mystics, prophets and fortunetellers.”

This is a time period for the scientists, researchers and doctors to deal with what will come hoping that they are prepared enough to deal with it. Having reasonable markers as predictions help the science community prepare for the worse scenarios. If the worse case does not pan out it could well be that it was because of the preparation time given to the science community.

KYW Newsradio 1060 Philadelphia reports:

Dr. Stephen Ostroff, Pennsylvania’s acting physician general, said last week that a lot of what’s been learned about swine flu, so far, has been somewhat reassuring, however:

“I always look to the great philosopher Yogi Berra, who once said that predictions are always difficult, especially about the future. And one of the things that we’ve always learned about influenza is that it’s very unpredictable.”

Because of the disease being relatively mild much of Europe has played down the concern. Experts have been warning though not to let down guard until the flu season hits in the fall. That will be the true marker of the swine flu as it battles it out with seasonal flu.


Four Toronto Hospital Employees Test Positive For Swine Flu

Four staff employees from the University Health Network in Toronto have tested positive for swine flu. Of those that have the virus only one had had direct contact with the patients.
All of those who have the virus have mild cases and should be healthy soon according to Hospital president Bob Bell.

Two of the employees came down with the virus from within their community.

The other two cases were in contact with one of the community-acquired cases while they were at work.

CTV reports:

“It’s not an unsafe environment,” Dr. Susy Hota said Monday night. “They should continue to go to their scheduled appointments and their treatment’s important.”

Patients who are experiencing flu-like symptoms should contact the hospital for directions of what action they should take.


Toronto-Princess Margaret Hospital worker infected with swine flu

A health care worker at Princess Margaret Hospital has tested positive for swine flu in Toronto. The hospital employee is at home recovering from the virus.
Spokesperson, Gilliam Howard from Princess Margaret Hospital has said that the worker did not provide patient care. Colleagues who had direct contact with the employee are being evaluated and followed up with by the hospital.

The worker had no connect to Mexico.

Hospital employees are being advised not to come to work if they have symptoms of the virus. They are to report the symptoms to the occupational health clinic at the hospital.

The Toronto Star reports:

“Occupational health would then do a nasal swab on them,” Howard said.

“It’s taking about five days or more for the swabs to come back,” she said. “You cannot confirm this flu until you get a swab back.”

At this time the breakdown of swine flu in Canada is:

Ottawa, 1
Durham, 7
Halton, 2
Middlesex-London, 1
Oxford County, 1
Peel, 6
Simcoe, 2
Sudbury, 2
Toronto 12
Windsor-Essex, 5
York, 9
Unknown, 1

City News reports:

“It’s like the flu season,” Dr. David Williams, the province’s acting chief medical officer of health explained. “So wash your hands frequently and use alcohol rubs if you haven’t got a sink and water and soap. Clean common surfaces like doorknobs and counters and even things like TV monitor changers. Stay clear of people who are coughing or sneezing and cough or sneeze into the sleeve of your jacket or shirt. If you’re ill, stay at home and monitor the situation.”


CDC media briefing: Expect more deaths

On Tuesday’s media update from the CDC, Kathleen Sebelius, Secretary of HHS and Richard Besser, M.D., Acting Director, CDC took questions from reporters concerning the latest findings by the CDC on swine flu.

Kathleen Sebelius the new Secretary of Health and Human Services toured the CDC labs in Atlanta today.

“It was with great delight for my first time out of Washington, D.C. trip to be to the CDC. Not only observing what the scientists are doing regarding the swine flu but with the day in, day out operations that the CDC is giving the American public.”

At this time there are 44 states with confirmed swine flu cases. Sebelius said that there are likely to be more deaths. She noted that the virus is not as severe as it was once thought to be and that President Obama wanted science to be the guide in this case and that science will continue to be the guide as to how the United States prepares for more cases of the swine flu.

As for school closings new guidance has been introduced. Closings are not being recommended unless a school has so many cases it can not function properly. The new guidance is for children who are ill to remain at home for seven days following the first symptoms. If your child is ill this does not mean to send them to the mall instead of school but to keep them at home to help slow the spread of disease.

As for the severity of the disease it is unlikely to know what to expect until this flu during the normal season.

Sebelius wanted to clarify that at this time there is not a vaccine available. It is hoped that it will be ready for production in the fall. At this stage the vaccine process is in the testing phase. Right now there is an accelerated production of seasonal flu vaccines ongoing. If the need arises then at that point the production of the vaccine, that should be ready will be started.

“Our goal is to move forward. There is not a vaccine, research is underway. Science is leading this process right now.”Around 25 per cent of the Tamiflu stockpile has been sent to the state level. The government is expecting it to be used as many more cases are now coming forward.

Questions as to why the government has been slow in getting people into the key positions for this outbreak were asked. The question has to do with the Senate confirmation process. There are 20 of these key positions that require a confirmation by the Senate in order to be filled.

“There are very dynamic discussions going on with world health groups, WHO, Homeland Security, the CDC and other organizations everyday. These talks are taking place as to what the right protocol, the use of Tamiflu, staging and preparing should be. We want to be sure that everyone is on the same page.”

China has quarantined people and that was brought up. The answer given was that it may gain countries not yet hit a few more weeks of preparation time. Those countries need the extra time to be prepared.

Sebelius had to leave the conference call early to return to Washington.

Dr. Richard Besser told reporters that there are now 1105 confirmed or probable cases of swine flu in the United States. Over 740 of those are at the probable stage. The median age of infection is 15 years old with the age range at 3 months to 81 years-old. Sixty-two per cent of United States cases are in those under the age of 18. There are 35 cases of severe disease requiring hospitalization.There is evidence that the cases in Mexico City are leveling off. More cases of mild flu are being now reported in Mexico. There is now a lab in Mexico so that testing can go more quickly. While cases are leveling off in Mexico City other areas in Mexico are starting to see new cases. As for more mild cases starting to emerge it is not that mild cases were not always the larger amount of cases but looking at those who were seriously ill was the first priority.

That is not the case in the United States and it is expected that there will be more hospitalizations. It now appears that the swine flu is on the same page as the regular seasonal flu.

“This is not to downplay the severity of the disease. There is no question that seasonal flu is a major burden on a person’s health each year.”

At this point the CDC has recommended that schools not be closed. This is due to further understanding of the disease and weighing benefits on each side of the issue. It is known now that once the virus is in the schools it is also already in the community. Because of this it is even more important for those who are ill not to go to either work or school for seven days from onset to help slow the spread of disease.

When the CDC weighed the benefits using the current guidance it was decided that missing school was more detrimental than closing the schools. These decisions go to the highest level of government.

“It is impossible for us to know how many actual cases that there are in the United States. At this time we are more concerned about the curves than the actual numbers.”

Questions are still being asked why the majority of the cases have occurred in young adults. Some possible reasons are that the cases are a result of Spring Break, younger adults have a lack of protective factors and that the elderly may be protected because of previous exposure to seasonal flu.

While tracking the virus via web site hits has been useful in the past at this time it is not because of the sheer increase of hits to sites like the CDC. The CDC is registering 8 million hits a day.

What can the general public do to protect themselves from swine flu?

“We want to channel people into action. Just as families need to have disaster kits ready during hurricane season this is the time for families to make a flu plan so that they know what to do if the virus hits.

Hand washing is the number one way at this time to slow the spread of disease. Covering coughs is number two. Staying home when you are ill is the third most important key to helping slow the spread of the virus.”


Reactions To Egyptian Pig Cull

The decision by the Egyptian government to cull the nation’s pig population has brought out the critics. The government ordered the slaughter of the pigs on Wednesday saying that it would stop panic about the swine flu in the largely Muslim country.

The United Nations has repeatedly told the world’s population eating properly prepared pork is not a way of getting the swine flu.

Joseph Domenech, the chief veterinary officer for the UN Food and Agriculture Organisation has called the cull “a real mistake.”

The Egyptian government is now saying that the swine cull was not because of the swine flu.

Medical News Today reports:

“The authorities took advantage of the situation to resolve the question of disorderly pig rearing in Egypt,” health ministry spokesman Abdelrahman Shahine told Agence France-Presse (AFP).

The World Health Organization’s move to put the pandemic alert to phase 5 confirms that the situation is not a pig problem but a human problem, he added. The government is calling the decision a “general health measure” rather than a measure to fight swine flu.

Most of Egypt’s swine population has been raised by Christian farmers who are saying that the government pledges of compensation of $105 per animal were inadequate. Ten per cent of Egyptians are Coptic Christians. The majority of those live in Cairo slums where their pigs feed on garbage. The majority of Egyptians are Muslims who do not eat pork for religious reasons.

Medical News Today
reports:

Saber Abdel Aziz Galal told AFP that the government wants to restructure pig farming so that it takes place on “good farms, not on rubbish”. At the moment the pigs live with “dogs, cats, rats, poultry and humans, all in the same area with rubbish,” he said, explaining that the government wants to build new farms in special areas, like they have in Europe.

“Within two years the pigs will return, but we need first to build new farms,” he said.

The government is attempting to speed up the culling process by importing three machines to accelerate the slaughters Almasry Alyoum daily said on Sunday.

Xinhua
reports:

“We will import three new slaughtering machines to increase the capacity to 3,000 pigs a day,” said Minister of Agriculture and Land Reclamation Amin Abbaza in a statement.

The actual culling started on Saturday. The country plans to have slaughtered all the swine within six months. Egypt is facing a large problem on what to do with the culled meat. There are not enough factories to contain the pork.

Al Jazeera reports:

“Our pigs are healthy. They are our capital and they have no diseases,” Adel Ishak, a rubbish collector from Manshiet Nasser, northeast of Cairo, told the AFP news agency.

“How will they replace the capital if these pigs are killed?”

Police are guarding areas that have large pig farms to stop farmers from smuggling their pigs out.

On Sunday pig farmers and police clashed in Manshiyet Nasser, a shanty district east of Cairo, because of the pig cull.

Philstar.com
reports:

“About 5,000 pig farmers clashed with the police forces in Manshiyet Nasser shantytown on Sunday as the government wants to cull all the pigs in Egypt,” Atta, a pig rearer on the scene, said.

“There are about 30 police cars, and about 1,000 policemen who started to fire tear gas towards us,” Samir Kamel, another pig rearer on the scene said.

“The still going-on clashes came because the government refused to compensate the rearers,” Samir added.

“About 12 protests got minor injuries,” he added.


Singer Being Tested For Swine Flu

N-Dubz singer Tulisa Contostavlos is being tested for swine flu after getting sick on a flight to Greece says her manager.
The 20-year-old was on a flight to Athens for a quick vacation after finishing up a 23-date tour in the UK.

On the flight she needed medical attention after fainting. A doctor said she had all the symptoms of swine flu. She is undergoing tests while isolated in hospital.

The Sun reports:

“Tulisa is very poorly indeed. She has gone from a huge high of chart success and the tour to panicking about her health.

“Tulisa’s family have been forced to wear masks and have only been allowed minimal contact. It is a terrifying time.”

The band’s spokesman said: “We are hopeful Tulisa will be given the all-clear and will be well enough to leave hospital in the next couple of days.”

BBC reports that the band’s manager Jonathon Shalit says there that he has no idea how she got ill but “the nature of being a singer is that you meet and shake hands with a huge amount of people”.

The band is due to perform next weekend at Radio 1’s Big Weekend in Swindon.


First American Swine Flu Death Grandson Of Mexican Media Baron

The baby in Texas who died from the swine flu was the grandson of media baron Mario Vazquez Ráña, 76. The toddler came from one of Mexico’s most influential families.
The toddler became ill while with his mother vacationing in Brownsville. He was not an illegal immigrant as has been reported in the press. After the child became ill he was taken to Texas Children’s Hospital.

Miguel Tejada Vazquez
and his mother were in Brownsville for much of April. The family visited Houston’s Galleria Mall on April 5.

Miguel’s family is very well connected in Mexico. His grandfather not only owns 41 newspapers but has been involved with the Olympics organizations since the mid-1970s.

His great-uncle Olegario controls one of the largerst private Mexican health providers, the Angeles Hospital chain, a newspaper and Mexico’s Camino Real hotels.

Miguel is survived by his parents Miriam Vazquez and architect Jose Manuel Tejeda and five siblings.


Britain has first human-to-human swine flu transfer case

England has its first case of swine flu where the source was not in Mexico. An NHS worker has become infected with the flu. Graeme Pacitti, 24, caught the flu from his friend Iain Askham.
Askham had been honeymooning with his wife in Mexico when he picked up the virus.

One London student is in hospital. According to Professor Sir Roy Anderson, rector of Imperial College, London the pandemic is begun and the focus has to become on drug distribution.

The Daily Mail reports:

Sir Roy said the disease was being transmitted in a sustained way in the US, and this would happen in other countries.

He said: ‘The definition of phases five and six [of the WHO’s pandemic alert scale] is somewhat irrelevant. A pandemic has started.’

At this time bundles of antiviral drugs have been sent to hospitals and clinics in the nation.

A public leaflet will be posted on Tuesday to advise people on the virus and how to take precautions.

If the phase level goes to Phase 6 then schools in the UK may be closed.

The Guardian reports:

The Cabinet Office’s document said: “As children will have no residual immunity, they could be amongst the groups worst affected and can be ‘super spreaders’. In the 1957 pandemic, up to 50% of schoolchildren developed influenza and, in some residential schools, attack rates reached up to 90%, often affecting the whole school within a fortnight.

“Closing schools to pupils as an adjunct to the antiviral treatment planned for a pandemic might reduce its peak impact by an additional 10%, and the total number of clinical cases by 10%, compared with antiviral treatment alone.

“Advising all schools in an affected area to close may offer the most practical option … While this would disrupt education and have a significant negative effect on services and businesses, particularly those highly dependent on working parents, these disadvantages would be outweighed by the children’s lives saved.”

What frightful aspect being discussed in the UK is who will get ICU treatment in the nation if hospital beds run out. One option is a lottery system.

The Daily Mail reports:

The Department of Health dossier, called ‘Pandemic Influenza: Surge Capacity and Prioritisation in Health Services’, details how intensive care patients would be ranked according to their risk of death and the benefit of treatment on a ventilator.

It says: ‘Ranking according to benefit will determine access for many patients. However, in the face of high demand there may be patients between whom the clinicians cannot differentiate on the basis of benefit.

‘At this stage, allocation of Intensive Care Unit treatment may require a random selection (lottery) process.’

Of course the disease outbreak is not near that level at this time.

Vaccine manufacturers do not have the capacity to produce enough vaccine in time for the fall for everyone. It is being discussed if pensioners may be put at risk form the seasonal flu because of vaccine shortfalls.

Professor John Oxford, virologist at Barts hospital in London, said: ‘Even if swine flu gets going, there’s still seasonal flu to contend with.

We don’t want a sizable population of over-seventies going down with seasonal flu.

‘I think that could be a crisis. If the supply of seasonal flu vaccine falls, it will put the elderly at risk of normal seasonal flu.

‘This winter we saw high rates of flu and that could easily happen again next year. We could see excess deaths.’

Another possible problem is that stocks of drugs like Tamiflu could be depleted because of the focus of the swine flu. That would leave seasonal flu victims without. At this stage of the outbreak it is still a wait and see game.


CDC Confirms 109 Swine Flu Cases in U.S., 1 Death

Confirmed cases of swine flu in the United States is at 109 with 1 death. At this time six of those cases are in hospital with more serious symptoms, a CDC media conference explained.

Richard Besser, M.D., Acting Director, CDC gave today’s briefing to reporters at the CDC on the latest swine flu information.

On thoughts about closing borders it was noted that once the disease has crossed the border there is not an added value. There will continue to be surveillance at all borders for the disease.

In past modeling cases of flu outbreaks, mild cases protect future infections. It is not known if this will be the case though in the fall when it is suspected that there will be a larger outbreak.

Earlier today on TV Vice President Joe Biden said that he nor his family will be flying. Doctor Besser assured the reporters that public transport is safe at this time. Besser also noted that if you are ill do not use public transportation.

There have been some slight changes to the way the outbreak is behaving. A few more serious cases are beginning to be reported. Six patients are now in hospital. Besser had no other details on those cases. Besser also did not have the numbers of people going to the emergency rooms across the nation with suspected cases of swine flu.

We do know that the flu virus spreads easily in community settings. This virus is being investigated as to how easily it spreads but if it is like other flu viruses it does not require close personal contact.

“We don’t know yet how easily it is transmitted.”

If the need for a vaccine, which will [-b]not be ready until the fall arises it will then be decided who will get the shot. It will be impossible to produce enough vaccine for everyone in the US. The final decisions will be a matter of public discussion and knowing who the risk groups are at that time.

According to the latest numbers at WHO there are 236 confirmed cases worldwide.

As for suspected cases Veratect has non going non-stop in the past 24 hours that I have been monitoring them on twitter. The service is available for anyone who wishes to monitor them for free.

Last night President Obama spoke to the press about the swine flu.

Well, first of all, as I said, this is a cause for deep concern, but not panic. And I think that we have to make sure that we recognize that how we respond — intelligently, systematically, based on science and what public health officials have to say — will determine in large part what happens.

I’ve consulted with our public health officials extensively on a day-to-day basis, in some cases, an hour-to-hour basis. At this point they have not recommended a border closing. From their perspective it would be akin to closing the barn door after the horses are out, because we already have cases here in the United States. We have ramped up screening efforts, as well as made sure that additional supplies are there on the border so that we can prepare in the eventuality that we have to do more than we’re doing currently.

But the most important thing right now that public health officials have indicated is that we treat this the same way that we would treat other flu outbreaks, just understanding that because this is a new strain we don’t yet know how it will respond. So we have to take additional precautions — essentially, take out some additional insurance. That’s why I asked for an additional $1.5 million, so that we can make sure that everything is in place should a worst-case scenario play out.


WHO media briefing on swine flu, April 29

The latest news from the World Health Organization is much the same as in past days. WHO meet with reporters online at 5 pm Geneva time April 29 with Dr Keiji Fukuda, Assistant Director-General ai, Health Security and Environment answering questions.
What is known at this point:

The virus spreads person to person
The virus started as a swine flu and has been able to adapt to acting like a human flu virus.
The cases are mostly mild except for in Mexico at this point.
Studies are underway to study the transmission methods of the virus.
Eating cooked pork will not cause the swine flu.
That all of the test samples look very much the same globally.
Right now there is no evidence that other bacterial infections are involved with serious cases. This could change with further studies.

The numbers as of 5 PM at WHO Headquarters are:

Canada- 13 cases
United States- 64/ 1 death
Mexico-26/7 deaths
Israel- 2
Spain-4
United Kingdom-2
New Zealand-3

Where We Are Now

The transmission rate does not slow signs of slowing.
We are not yet at a Phase 5 level, although that could change quickly. While there is evidence that the swine flu does spread well in a school situation the Phase 5 status will come if it starts to spread in neighbourhoods of two or more countries.
While the swine flu is very much like seasonal flu there is a higher rate of diarrhea and vomiting associated with it.
There are now cases that have been reported where Mexico may not have been a factor. WHO is investigating to see if there is a link.

WHO is not sure yet of the ratio of mild/serious/fatal cases as of yet.
WHO is not sure yet if there are risk factors for those with serious disease.

“One of the features of this type of outbreak is that the initial numbers are confusing. WHO can’t address why the numbers are conflicting. I can’t address the specifics.”

Where We Are Going

Because the evidence is that the transmission of the swine flu virus is not likely to stop spreading we must be prepared. The WHO has mentioned a number of times the similarities between this outbreak and the 1918 Spanish Flu pandemic. During the 1918 pandemic the initial start was a mild period of outbreak with a very quiet summer period and then a very deadly fall pandemic.

“It’s premature to think of the swine flu as mild. We just don’t know yet. In the 1918 Spanish Flu the patterns were similar. This is the time to prepare and figure out how to proceed.”

When asked why some of the new global cases cite Cancun as a location where the virus was imported and yet Cancun is not listed as an outbreak area Dr Keiji Fukuda said it was quite possible that the test results have just not gotten in right in that location.

For the near future WHO and other health agencies will be focusing on how the overall picture of the disease is going and how best to protect people. In the future they will turn back and look for the origin of the outbreak.