A Sign Of Things to Come?

In what may be a sign of things to come in this country, Britain is reporting 100,000 new cases of swine flu recorded in the last week. Of those cases, 840 have been hospitalized and 63 in intensive case.

The situation is getting so bad that one patient has been sent to Sweden because of a lack of beds.

The WHO has stopped tracking swine flu cases and deaths around the world. Still, it is has asked countries to be on the look out for "unexpected clusters of severe or fatal cases of H1N1 or "unexpected, unusual or notable changes in patterns of transmission" (WHO Pandemic (H1N1) 2009 briefing note 3, 7/16).

One such notable event may be occuring in Mexico where it appears they are seeing a bit of a reurgence of the swine flu. Several states in southern Mexico have seen massive increases in swine flu infections in the past few weeks. H/T H5N1

Another notable event is a sharp increase in hospitalizations in Australia. Once again being tracked by H5N1, probably one of the best swine flu blogs out there and conveniently provided in the Swine Flu blogroll on the left column of this blog.

As if this weren't enough we are being told to expect shortages of any possible vaccine as the viruses aren't producing large quantities of active ingredient. (WSJ)

This virus is already acting different than other flu viruses. It has not tapered off in the summer months as most viruses do. Though not expected at this time, worst case scenarios suggest the possiblity that 40% of American workers could be affected.

Of course ultimately, these are only guesses. Perhaps the best advice is to "hope for the best and plan for the worst." This is common sense of course and good advice in any situations, be they medical, or weather or man made disasters.

Toward this end I offer this advice from Avian flu Diary:

The HHS’s Flu.gov website offers this advice on preparing for a pandemic:

You can prepare for an influenza pandemic now. You should know both the magnitude of what can happen during a pandemic outbreak and what actions you can take to help lessen the impact of an influenza pandemic on you and your family. This checklist will help you gather the information and resources you may need in case of a flu pandemic.

To plan for a pandemic:
Store a two week supply of water and food. During a pandemic, if you cannot get to a store, or if stores are out of supplies, it will be important for you to have extra supplies on hand. This can be useful in other types of emergencies, such as power outages and disasters.

Periodically check your regular prescription drugs to ensure a continuous supply in your home.
Have any nonprescription drugs and other health supplies on hand, including pain relievers, stomach remedies, cough and cold medicines, fluids with electrolytes, and vitamins.
Talk with family members and loved ones about how they would be cared for if they got sick, or what will be needed to care for them in your home.

Volunteer with local groups to prepare and assist with emergency response.
Get involved in your community as it works to prepare for an influenza pandemic.


Given the current virulence of the novel H1N1 virus, having 2-weeks worth of supplies on hand is probably sufficient. And two-weeks is also a reasonable amount of supplies to have on hand to weather practically any other major disaster.

Why Keep an Eye on the Flu

I know, I know we have about had it up to here and there and back again with the talk about this or that flu. To the point where many are discussing the possibility that this is/was much ado about nothing. People who I respect and who are much smarter than I am (certainly doesn't narrow the field by any stretch, does it?) have suggested that we are perhaps not getting the whole story and perhaps the thing is overblown.

If you are in this group may I commend to you two very informative blogs which you can find on the left hand side of my own toward the top of the page.

The first is Effect Measure a blog by scientists who look at this stuff day in and day out and not just when its in the news.

The second, which I have read a great deal of today is titled the Avian Flu Diary, which also is keeping tabs on the current virus.

These blogs explain both past outbreaks, present outbreaks and possible future outbreaks and goes along way toward explaining the confusing picture that often arises and why we cannot ignore even "mild" outbreaks:

...As we continue to try to sketch out the descriptive epidemiology -- the spectrum of severity, who is getting sick, what is the incubation period, where is disease happening -- the recommendations and judgments of CDC, WHO and local agencies will change in response. That may be confusing or unsettling but it is the only rational way to proceed. We are all learning as they go along, and in some cases, making it up as we go along....

...35 of the 279 cases in the US have been hospitalized, and two patients in Canada are reported severely ill. The fever, headache and joint and muscle pains characteristic of this and all influenza can be miserable and keep you out of work or school for a week or more and feeling lousy for weeks after that.

Relatively benign isn't benign, unless your comparison is a stay in the intensive care unit or a fatal outcome.... (Effect Measure- Swine Flu-Where we are)


Further examples of the good info below. In addition to learning the difference between "shift" and drift" and why it matters, they have provided an excellent description of the "Liverpool Flu" which to me, more than anything, underscores and explains why the CDC and WHO need to watch these things so carefully.

With a novel influenza virus suddenly appearing at the end of our flu season in the Northern Hemisphere, all eyes will be on the Southern Hemisphere over the next few months to see how `fit’ the virus is, and to get some idea of what our next flu season may bring.

The A/H1N1 has the potential to mutate (drift) or re-assort with other flu viruses (shift), which could result in a more virulent strain. The more people (and other hosts) who acquire the virus, the more chances the virus has to evolve.

Of course the virus could lose virulence, or even its ability to spread, as well. We’ll just have to wait and see.

While the public’s attention is on this new, emerging virus, scientists have long known that abrupt changes can occur even in well established seasonal flu viruses.

The infamous `Liverpool Flu’ of 1951 has faded from most people’s memory, but for about 6 weeks a super-virulent strain of flu swept out of north western England, killing at a rate faster than the pandemic of 1918.

I chronicled the details of this outbreak last October in Sometimes . . . Out Of The Blue, but briefly: for about 6 weeks the UK (and to a lesser extent Canada), saw a horrific rise in flu fatalities in 1951.

This `rogue flu’, for reasons we don’t fully fathom, disappeared as suddenly as it appeared.

While we are learning more every day, there is still a great deal that scientists do not understand about how influenza viruses spread and evolve. (Shift Happens)


Did I mention that the blogs are also timely and updated often?

Proving that timing is everything, a couple of hours later we are getting reports of a newly discovered mutation in the seasonal H3N2 virus that may be clouding the A/H1N1 picture.

Maggie Fox, Science Reporter for Reuters, brings us the story.
Second strain of flu may complicate picture-study
06 May 2009 15:02:09 GMT
Source: Reuters
* Mutations seen in seasonal flu strain
* May have caused Canadian late-season outbreak
* May complicate picture in Mexico
By Maggie Fox, Health and Science Editor
WASHINGTON, May 6 (Reuters) - A second strain of influenza, one of the seasonal strains, may have mutated and may be complicating the picture in Mexico, Canadian researchers reported on Wednesday. (more)

First Texas Resident Fatality of H1N1 Flu?

DSHS is reporting the first death of a Texas resident with H1N1 flu. A woman from Cameron County who had chronic underlying health conditions died earlier this week. the exact casue of death is till not known at this time.

Meanwhile:

H1N1/2009 (aka swine flu): where we are
Over at Effect Measure an excellent summation about where we are with the current Flu (soon to be) pandemic. I'll let it speak for itself while I get back to work...

H1N1/2009 (aka swine flu): where we are : Effect Measure

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A social cytokine storm?

Catchy headline, eh? I've posted my opinion on the flu in earlier posts. And I still feel that way, namely, its not time for panic but we should stay informed on the matter and be aware of any change in lethality or if it reappears in wore way in the Fall. And this article talks a bit about the overreacting part:

A cytokine storm is a gross overreaction by the immune system to a perceived infection...something like dropping an H-bomb on a suspected burglar in your back yard. The result is to kill, or needlessly harm, the patient.

We may be inflicting something like that on ourselves. Via the New York Times: Fort Worth Closes Schools as Number of Swine Flu Cases Rises in U.S.
Taking extreme precautions to stop the fast-spreading swine flu, Fort Worth became the nation’s first major city school district to close on Thursday, as the Centers for Disease Control and Prevention confirmed 114 cases in 12 states, up from 91 cases in 10 states on Wednesday. ...

... About 80,000 students are expected to be kept out of their classrooms through May 11 in that city, adding to the 53,000 pupils already out of school in Texas, where 26 people have been confirmed with cases of the swine flu. (more)

And in related news from UK Reuters:

White House issues advisory after Obama Mexico trip
(Politico) -- The White House is issuing a health advisory outlining "protective measures" for anyone who traveled on President Barack Obama's trip to Mexico, after a member of the U.S. delegation came down with flu-like symptoms - and tests on his family showed they're probably infected with the swine flu.
The individual - an advance security staffer for Energy Secretary Steven Chu -appears to have spread the flu to his wife, son and nephew. All three have tested probable for swine flu, White House Press Secretary Robert Gibbs said.(more)

The Mexican Flu and the Weather

Many of you know that I am a weather forecaster in the Air Force. I do this primarily for the Army as part of a Combat Weather Team. The Army doesn't have its own weather forecasters, the Air Force does it for them. Where our Army customer goes, we go. Thus the "combat" prefix. We carry weapons and temperature gauges but I've always said that if the weather guy is firing his weapon at the enemy then its really not a question of whether you're going to win or lose that battle but rather just how bad the loss will be. But I digress...

So what does this have to do with the Mexican Flu? Well, nothing. But there are a number of occasions where an analogy might be made, the latest being Hurricane Ike, which hit Texas this year.

Ever since Katrina the State of Texas begins to get spun up whenever a tropical system approaches the Gulf. Usually, long before. It is somewhat a source of amusement for us in the weather business as many things can happen that far out. But after Katrina/Rita (aka "Katrita") the State takes no chances and begins preparations far in advance.

On one hand this makes good sense. On the other many people point to the false alarms and begin to not take the words of warning seriously.

As Ike approached the Texas coast the models seemed to indicate that the trajectory might affect Austin (a couple of hundred miles inland). You may laugh but there is historical precedence for hurricane effects to be felt in Austin and they included tornadoes, high winds, and flooding.

When warnings are given there are typically three types of response. First, there are those who, without filtering the hysterical TV headlines (designed not so much for information as for ratings) rush out a week in advance (a lifetime in weather terms since so much can change) and start stocking supplies, generators and boarding up the windows. The second response is from those who say, we've heard this before and nothing has come from it and this will be the same. (when this group is on the coast, they make up the large portion of 9-1-1 calls in the midst of the storm seeking a rescue that cannot be made) The third group, hears the warnings and begins to pay closer attention to news and weather and makes prudent preparations as the storm gets closer.

It occurs to me that much the same thing is happening with the Mexican Flu outbreak. There are those who rightfully point to the the shrill TV anchors and the "All Flu, All the Time" mentality and say its vastly overblown. The virus is so far mild in the US and no fatalities have been reported except for the toddler who came from Mexico. They point to the African diseases that kill many more and the alcohol related deaths and even the thousands that die from "regular" flu every year in this country. And they have a point.

But while I will agree that there is a danger in over reacting and blowing the situation out of proportion, the opposite error is perhaps even more dangerous.

Because the danger here is not necessarily a short term threat. It may be. It may fizzle out in a few weeks and never be heard from again. but it also may not. Or it may fizzle out and then reappear in the Fall in an even more virulent form.

The concern (among others) is that the public begins to think that the whole thing is being hyped:

With the H1N1 swine flu virus, the world appears — at least for now — to face a much less fearsome foe. That fact leads to some relief and some concern. The concern is that people may not be taking the threat of a pandemic seriously enough.

“I think that people misunderstand the word pandemic,” Thompson said from Geneva. “Pandemic speaks to the geographical distribution of disease. That it’s widespread, that it’s global.”

“Then there’s the question of severity. How severe is that disease? And we can have very mild pandemics. But we can also have pandemics that can come in waves.”

“And a first wave might be mild. And that might lull people into complacency thinking — `we’ve seen this, it’s not so difficult to deal with, it’s not so scary.’ And then another wave comes along. That has been a pattern. And that’s something we have to keep thinking about.”
Officials have started to point to the example of the 1918 Spanish Flu, the worst infectious disease outbreak in known history. It’s estimated upwards of 50 million people around the globe succumbed in that pandemic, which was caused by an H1N1 virus believed to be of avian origin.


The professionals over at Effect Measure are a great place to go for info. The Editors of Effect Measure are senior public health scientists and practitioners.

If there is normally so much respiratory disease around, why is this an outbreak or even an epidemic? It's a more difficult question than it appears, and it relates to "what did you expect?" An epidemic is an increase in the number of new cases beyond what you would expect. Four or five cases of human rabies in an area in the US would be an outbreak or even an epidemic. Hundreds of colds or even serious pneumonias in an urban area is normal. It's not an epidemic. What makes the swine flu an outbreak is that it is an infection with a virus we haven't seen before and which we believe may be new. Hence these cases are not what we expect and it is an outbreak.

The thing is there is much we do not know:

Another thing that most people and probably most clinicians expect is that we know a lot about influenza. Perhaps because of the increased scientific interest since bird flu (an increased interest which will pay off handsomely in this outbreak, by the way) we do know quite a bit, but we also now know many of the things we thought we knew about flu, like the main ways it is transmitted from person to person, we don't really know. For example, how likely is it that you can get flu by touching a door knob or arm rest that someone with the flu just touched? Or that you can get the flu by sitting in the same emergency department waiting room (but not next to) other flu cases? These are open questions (see some of our many posts on this here, here, here, here). Why is flu seasonal? We don't know. ...

...the influenza virus is highly unpredictable and our certain knowledge of it very scant. If you've seen one flu pandemic, you've seen one flu pandemic.
If this outbreak becomes a sustained worldwide one -- the definition of a pandemic -- you should not expect it to be the same as any other pandemic. It might be like 1918, 1957, 1968 or just a bad flu season. Or not. (Effect Measure)

Wash your hands, cover your mouth when you sneeze/cough, stay home if you're sick and stay informed.

WHO Moves Pandemic Alert to 5- Mexican Flu is not Swine Flu

RadioNetherlands is reporting that the World Health Organization says the virus is not caused by pigs and has moved the pandemic alert phase up a level. H/T H5N1

WHOs call new strain of H1N1 "Mexican flu"
Published: Wednesday 29 April 2009 17:32 UTC Last updated: Wednesday 29 April 2009 18:04 UTC The World Health Organisation (WHO) has said that the most recent research on swine flu has shown that the virus is not caused by pigs. The disease is now being referred to as Mexican flu or "2009 H1N1 flu". The WHO has moved the pandemic alert from four to five, the second highest. The first case of what was called swine flu was reported in Mexico and its first fatality was confirmed there two weeks ago. The 23-month-old infant who died in the US state of Texas, in the first fatal case from the swine flu outbreak in the United States, was also Mexican. The child came from Mexico to Houston for medical treatment, officials said.(more)

According to the WHO website:
Phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short.