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.
Showing posts with label WHO. Show all posts
Showing posts with label WHO. Show all posts
Saturday, July 25, 2009
Thursday, June 25, 2009
Why Keep An Eye on the Flu- Part 2
A while back I wrote about why we should keep an eye on the new H1N1 virus despite the waning coverage in the press and the mildness of the outbreak here in the states.
Despite the pandemeic declaration there is no need to panic, yet many signs to note in the developing situation. It is why I have kept the Flu blogs and links posted. Over at Effect Measure they rightfully say that this is a teachable moment and a time that we are blessed with to get prepared:
For years those concerned about the consequences of an influenza pandemic from an exceptionally virulent flu virus, like A/H5N1 ("bird flu") have despaired about motivating business, government and neighbors to take it seriously enough to make serious preparations. It's understandable. There's are a lot of potential catastrophes competing for our attention and while each can be made plausible if we can get someone to listen long enough, it's rare we can do this. As I said, too much competition. Now that a real life influenza pandemic has arrived, the concern of some is that the public isn't being told how bad this could become, possibly even 1918 level. My view is different. In terms of stimulating genuine pandemic preparedness, I think we are extremely lucky to have a pandemic that so far is nowhere near worst case scenario (and let's be clear: it isn't anywhere near worst case). The pandemic is no longer theoretical. It is here and tangible. And it is having some tangible effects in unlikely places...
Unlikely places like Hedge funds.
And there are some disturbing trends.
First the flu is not subsiding here in the US as summer begins. Typically the flu viruses taper off or disappear completely in the summer months. The question now becomes what will it look like when the usual flu season comes around in the fall and winter?
Second, the southern hemisphere (currently experiencing winter) is having a tough go of it:
It is still relatively early in the flu season south of the Equator, with the peak not expected until next month, but already Argentina and Chile are reporting serious demands on their medical system.
Elective surgeries are being canceled in some Buenos Aires hospitals, and mobile flu clinics are being dispatched to some neighborhoods. Of 111 people hospitalized in the country’s capital, 75 are on ventilators. (Avian Flu Diary)
Last but certainly not least is the disturbing news that the virus may be mutating into a more virulent strain:
Virologists in Sao Paulo, Brazil, have just announced they have indeed identified a variant of the flu gene after testing samples taken from a 26-year-old swine flu patient.
Lead researcher Terezinha Maria de Paiva, of the Adolfo Lutz Bacteriological Institute, says it is too soon to know if the new variant, dubbed the A/Sao Paulo/1454/H1N1 variant, will be more aggressive than the type A/H1N1 that prompted the official declaration of pandemic by the World Health Organization (WHO) but the patient from whom the sample was taken has completely recovered from his bout with swine flu. The patient began experiencing flu-like symptoms after returning from a trip to Mexico.
This one had a happy ending. As I said, its worth watching.
Despite the pandemeic declaration there is no need to panic, yet many signs to note in the developing situation. It is why I have kept the Flu blogs and links posted. Over at Effect Measure they rightfully say that this is a teachable moment and a time that we are blessed with to get prepared:
For years those concerned about the consequences of an influenza pandemic from an exceptionally virulent flu virus, like A/H5N1 ("bird flu") have despaired about motivating business, government and neighbors to take it seriously enough to make serious preparations. It's understandable. There's are a lot of potential catastrophes competing for our attention and while each can be made plausible if we can get someone to listen long enough, it's rare we can do this. As I said, too much competition. Now that a real life influenza pandemic has arrived, the concern of some is that the public isn't being told how bad this could become, possibly even 1918 level. My view is different. In terms of stimulating genuine pandemic preparedness, I think we are extremely lucky to have a pandemic that so far is nowhere near worst case scenario (and let's be clear: it isn't anywhere near worst case). The pandemic is no longer theoretical. It is here and tangible. And it is having some tangible effects in unlikely places...
Unlikely places like Hedge funds.
And there are some disturbing trends.
First the flu is not subsiding here in the US as summer begins. Typically the flu viruses taper off or disappear completely in the summer months. The question now becomes what will it look like when the usual flu season comes around in the fall and winter?
Second, the southern hemisphere (currently experiencing winter) is having a tough go of it:
It is still relatively early in the flu season south of the Equator, with the peak not expected until next month, but already Argentina and Chile are reporting serious demands on their medical system.
Elective surgeries are being canceled in some Buenos Aires hospitals, and mobile flu clinics are being dispatched to some neighborhoods. Of 111 people hospitalized in the country’s capital, 75 are on ventilators. (Avian Flu Diary)
Last but certainly not least is the disturbing news that the virus may be mutating into a more virulent strain:
Virologists in Sao Paulo, Brazil, have just announced they have indeed identified a variant of the flu gene after testing samples taken from a 26-year-old swine flu patient.
Lead researcher Terezinha Maria de Paiva, of the Adolfo Lutz Bacteriological Institute, says it is too soon to know if the new variant, dubbed the A/Sao Paulo/1454/H1N1 variant, will be more aggressive than the type A/H1N1 that prompted the official declaration of pandemic by the World Health Organization (WHO) but the patient from whom the sample was taken has completely recovered from his bout with swine flu. The patient began experiencing flu-like symptoms after returning from a trip to Mexico.
This one had a happy ending. As I said, its worth watching.
Wednesday, May 6, 2009
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)
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)
Tuesday, May 5, 2009
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
Posted using ShareThis
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
Posted using ShareThis
Thursday, April 30, 2009
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)
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)
Wednesday, April 29, 2009
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.
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.
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.
Monday, April 27, 2009
Phase 4 - What Does it Mean
The World Health Organization moved to phase 4 today. So what does that mean?
Well, in addition to what has already been posted here and here this article from the Canadian Chronicle Herald does a fine job of describing the situation. Once again, no need to panic but worth keeping an eye on and taking basic precautions that include washing hands. Of course we should do this anyway with all illnesses (but usually don't). H/T AFluDiary
...``A pandemic is not considered inevitable at this time,'' Fukuda said in a late evening press conference in Geneva.
The committee concluded there is definitely person-to-person spread of the virus, but felt it wanted more information about how capable the virus is at continuing to spread through generations of human hosts.
If the WHO saw a widespread community outbreak, he said, the committee would be reconvened and a decision likely made to go to Phase 5. Phase 6 is a pandemic.
``It's fair to say that the move from Phase 3 to Phase 4 signifies that we have taken a significant step closer but ... we are not there yet,'' said Fukuda, a leading influenza expert.
Influenza viruses are notoriously unpredictable. When asked about how the outbreak might evolve, Fukuda painted a picture containing a surprisingly wide range of options, given how quickly this outbreak has unfolded.
The world first learned of the existence of this unusual virus and that it had infected a human on April 17. Less than two weeks later infections have been found in Mexico, the United States, Canada, Spain and Scotland and experts expect it to be found elsewhere soon.
Mexico has linked upwards of 100 deaths to swine flu infection. The U.S. has diagnosed 40 cases, Canada six, Spain one and Scotland two. No country outside of Mexico has yet seen severe disease caused by the virus.
``It is possible that we could stay in Phase 4 for quite a long time. It is possible that as the situation evolves over the next few days, it could evolve to the point where it appears that we have moved into Phase 5. And it is also possible that the disease situation could be quieter and we could move backwards to Phase 3.'' ...(more)
Well, in addition to what has already been posted here and here this article from the Canadian Chronicle Herald does a fine job of describing the situation. Once again, no need to panic but worth keeping an eye on and taking basic precautions that include washing hands. Of course we should do this anyway with all illnesses (but usually don't). H/T AFluDiary
...``A pandemic is not considered inevitable at this time,'' Fukuda said in a late evening press conference in Geneva.
The committee concluded there is definitely person-to-person spread of the virus, but felt it wanted more information about how capable the virus is at continuing to spread through generations of human hosts.
If the WHO saw a widespread community outbreak, he said, the committee would be reconvened and a decision likely made to go to Phase 5. Phase 6 is a pandemic.
``It's fair to say that the move from Phase 3 to Phase 4 signifies that we have taken a significant step closer but ... we are not there yet,'' said Fukuda, a leading influenza expert.
Influenza viruses are notoriously unpredictable. When asked about how the outbreak might evolve, Fukuda painted a picture containing a surprisingly wide range of options, given how quickly this outbreak has unfolded.
The world first learned of the existence of this unusual virus and that it had infected a human on April 17. Less than two weeks later infections have been found in Mexico, the United States, Canada, Spain and Scotland and experts expect it to be found elsewhere soon.
Mexico has linked upwards of 100 deaths to swine flu infection. The U.S. has diagnosed 40 cases, Canada six, Spain one and Scotland two. No country outside of Mexico has yet seen severe disease caused by the virus.
``It is possible that we could stay in Phase 4 for quite a long time. It is possible that as the situation evolves over the next few days, it could evolve to the point where it appears that we have moved into Phase 5. And it is also possible that the disease situation could be quieter and we could move backwards to Phase 3.'' ...(more)
UPDATE 8 Swine Flu- The current WHO phase of pandemic alert is 4- What It Means
***UPDATE 8*** The current WHO phase of pandemic alert is 4
Phase 4 is characterized by verified human-to-human transmission of an animal or human-animal influenza reassortant virus able to cause “community-level outbreaks.” The ability to cause sustained disease outbreaks in a community marks a significant upwards shift in the risk for a pandemic. Any country that suspects or has verified such an event should urgently consult with WHO so that the situation can be jointly assessed and a decision made by the affected country if implementation of a rapid pandemic containment operation is warranted. Phase 4 indicates a significant increase in risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion.
Original Post
OK- Don't panic. That's the main thing to remember in all of this but its good to be informed. As usual, the biggest weapon against this is simply washing your hands. And doing it right. It also appears that the cases reported in the US are milder than those reported in Mexico.
Also as the WSJ reports, the fact that more and more are being reported doesn't neccessarily mean its spreading faster:
The fact that five more cases have now been confirmed isn’t an indication of the rate at which the flu is spreading; rather, it’s the result of intensive surveillance by the CDC and state health officials to try to figure out exactly what’s going on. And that surveillance is likely to lead to more confirmed cases in the coming days, Anne Schuchat, a CDC respiratory diseases expert, said on a press call this afternoon.
Indeed, the very fact that this strain was identified in the first place is likely the result of the way flu surveillance has increased in the past few years. The first two cases were both detected by special programs — one at a Navy facility that was studying a new kind of flu testing, and another at a project set up to do intensive surveillance around the U.S.-Mexico border.
“We haven’t seen this strain before, but we haven’t been looking as intensively as we are these days,” Schuchat said. (more)
Previous post
Officials at the U.S. Centers for Disease Control and Prevention and the California Department of Public Health said they expected to find more cases in the coming days and weeks.
Little can be done to prevent an outbreak of flu from spreading, health experts caution, but they say common sense measures can help individuals protect themselves.
Number one is hand-washing, they say -- a surprisingly effective way to prevent all sorts of diseases, including ordinary influenza and the new and mysterious swine flu virus. (more)
The first place one should go for information is to government sources such as the Center for Disease Control but it appears that much of the information on the site is on the incidence of Swine Flu up till February 2009 and does not yet address the latest mutant strain of bird/pig/human which has people concerned. The report on the new strain can also be found on the CDC website with some digging or you can go here.
Special guidance has been provided for Texas and California residents. Once again much of this is common sense but very important to prevent spreading the infection:
Residents of California and Texas
CDC has identified human cases of swine influenza A (H1N1) virus infection in people in these areas. CDC is working with local and state health agencies to investigate these cases. We have determined that this virus is contagious and is spreading from human to human. However, at this time, we have not determined how easily the virus spreads between people. As with any infectious disease, we are recommending precautionary measures for people residing in these areas.
Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hands cleaners are also effective.
Try to avoid close contact with sick people.
If you get sick, CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.
Avoid touching your eyes, nose or mouth. Germs spread that way.
There is no vaccine available at this time, so it is important for people living in these areas to take steps to prevent spreading the virus to others. If people are ill, they should attempt to stay at home and limit contact with others. Healthy residents living in these areas should take everyday preventive actions.
People who live in these areas who develop an illness with fever and respiratory symptoms, such as cough and runny nose, and possibly other symptoms, such as body aches, nausea, or vomiting or diarrhea, should contact their health care provider. Their health care provider will determine whether influenza testing is needed.
Even as our responsible journalists lead with calm inducing headlines such as:
Swine Flu Case Count Rising , Swine flu has 'pandemic potential and Mexico Swine Flu Epidemic Worries World
it is important to remember that all seven of the people in the U.S. with confirmed swine flu recovered. Only one patient was ill enough to require hospitalization. The swine flu disease was similar to human flu, except that nausea and diarrhea were more common. But as all forms of flu it would pose special danger to the elderly, the young and those with chronic illness such as diabetes and asthma.
Still the World Health Organization (WHO) is set to name this outbreak an Event of International Concern
While this is a rapidly changing situation the world is presently in phase 3, meaning a new influenza virus subtype is causing disease in humans, but is not yet spreading efficiently and sustainably among humans.
*** UPDATE 7*** CDC reported at their news conference today (26 April) that all of the seven confirmed cases here in the US have recovered and reminded people of basic precautions e.g. handwashing and staying home from work if you are sick) to minimize the spread.
***UPDATE 6*** U.S. officials say the public health emergency is a precaution. Americans are told to prepare for outbreaks but not to panic.
Federal officials today declared a public health emergency involving human swine flu, warning Americans to prepare for widespread outbreaks now or in the future, yet urging them not to panic.
Update to #3 the British Airways pilot DID NOT have the swine Flu
UPDATE 5- Bloomberg:
Obama’s Visit
The first case was seen in Mexico on April 13. The outbreak coincided with the President Barack Obama’s trip to Mexico City on April 16. Obama was received at Mexico’s anthropology museum in Mexico City by Felipe Solis, a distinguished archeologist who died the following day from symptoms similar to flu, Reforma newspaper reported. The newspaper didn’t confirm if Solis had swine flu or not. (more)
8:09PM ***UPDATE 3*** Reports of Swine Flu experiences in Mexico,
Texas state health authorities on Saturday ordered a high school near San Antonio closed indefinitely after a third student showed symptoms of swine flu
British airways pilot being treated in isolation after flight from Mexico
If this thing spreads overseas you can be sure the WHO will elevate its phase level. (see below
4:16 PM***UPDATE 2*** The Kansas Department of Health and Environment has confirmed at least two cases of swine flu in their state, while the New York City Department of Public Health is reporting that at least eight out of an estimated 100 students at a Queens prepatory school who displayed flu-like symptoms likely have the infection. Meanwhile, Imperial County health officials reported that San Diego has yet another case of the swine flu strain that has killed up to 68 people in Mexico.
5:29 PMTotals are now 11 cases confirmed and another 8 possible in NY
1235 CDT ***UPDATE*** The WHO flu experts have met and other than asking countries to keep an eye on things, taken no action.
Phase 4 is characterized by verified human-to-human transmission of an animal or human-animal influenza reassortant virus able to cause “community-level outbreaks.” The ability to cause sustained disease outbreaks in a community marks a significant upwards shift in the risk for a pandemic. Any country that suspects or has verified such an event should urgently consult with WHO so that the situation can be jointly assessed and a decision made by the affected country if implementation of a rapid pandemic containment operation is warranted. Phase 4 indicates a significant increase in risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion.
Original Post
OK- Don't panic. That's the main thing to remember in all of this but its good to be informed. As usual, the biggest weapon against this is simply washing your hands. And doing it right. It also appears that the cases reported in the US are milder than those reported in Mexico.
Also as the WSJ reports, the fact that more and more are being reported doesn't neccessarily mean its spreading faster:
The fact that five more cases have now been confirmed isn’t an indication of the rate at which the flu is spreading; rather, it’s the result of intensive surveillance by the CDC and state health officials to try to figure out exactly what’s going on. And that surveillance is likely to lead to more confirmed cases in the coming days, Anne Schuchat, a CDC respiratory diseases expert, said on a press call this afternoon.
Indeed, the very fact that this strain was identified in the first place is likely the result of the way flu surveillance has increased in the past few years. The first two cases were both detected by special programs — one at a Navy facility that was studying a new kind of flu testing, and another at a project set up to do intensive surveillance around the U.S.-Mexico border.
“We haven’t seen this strain before, but we haven’t been looking as intensively as we are these days,” Schuchat said. (more)
Previous post
Officials at the U.S. Centers for Disease Control and Prevention and the California Department of Public Health said they expected to find more cases in the coming days and weeks.
Little can be done to prevent an outbreak of flu from spreading, health experts caution, but they say common sense measures can help individuals protect themselves.
Number one is hand-washing, they say -- a surprisingly effective way to prevent all sorts of diseases, including ordinary influenza and the new and mysterious swine flu virus. (more)
The first place one should go for information is to government sources such as the Center for Disease Control but it appears that much of the information on the site is on the incidence of Swine Flu up till February 2009 and does not yet address the latest mutant strain of bird/pig/human which has people concerned. The report on the new strain can also be found on the CDC website with some digging or you can go here.
Special guidance has been provided for Texas and California residents. Once again much of this is common sense but very important to prevent spreading the infection:
Residents of California and Texas
CDC has identified human cases of swine influenza A (H1N1) virus infection in people in these areas. CDC is working with local and state health agencies to investigate these cases. We have determined that this virus is contagious and is spreading from human to human. However, at this time, we have not determined how easily the virus spreads between people. As with any infectious disease, we are recommending precautionary measures for people residing in these areas.
Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hands cleaners are also effective.
Try to avoid close contact with sick people.
If you get sick, CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.
Avoid touching your eyes, nose or mouth. Germs spread that way.
There is no vaccine available at this time, so it is important for people living in these areas to take steps to prevent spreading the virus to others. If people are ill, they should attempt to stay at home and limit contact with others. Healthy residents living in these areas should take everyday preventive actions.
People who live in these areas who develop an illness with fever and respiratory symptoms, such as cough and runny nose, and possibly other symptoms, such as body aches, nausea, or vomiting or diarrhea, should contact their health care provider. Their health care provider will determine whether influenza testing is needed.
Even as our responsible journalists lead with calm inducing headlines such as:
Swine Flu Case Count Rising , Swine flu has 'pandemic potential and Mexico Swine Flu Epidemic Worries World
it is important to remember that all seven of the people in the U.S. with confirmed swine flu recovered. Only one patient was ill enough to require hospitalization. The swine flu disease was similar to human flu, except that nausea and diarrhea were more common. But as all forms of flu it would pose special danger to the elderly, the young and those with chronic illness such as diabetes and asthma.
Still the World Health Organization (WHO) is set to name this outbreak an Event of International Concern
While this is a rapidly changing situation the world is presently in phase 3, meaning a new influenza virus subtype is causing disease in humans, but is not yet spreading efficiently and sustainably among humans.
*** UPDATE 7*** CDC reported at their news conference today (26 April) that all of the seven confirmed cases here in the US have recovered and reminded people of basic precautions e.g. handwashing and staying home from work if you are sick) to minimize the spread.
***UPDATE 6*** U.S. officials say the public health emergency is a precaution. Americans are told to prepare for outbreaks but not to panic.
Federal officials today declared a public health emergency involving human swine flu, warning Americans to prepare for widespread outbreaks now or in the future, yet urging them not to panic.
Update to #3 the British Airways pilot DID NOT have the swine Flu
UPDATE 5- Bloomberg:
Obama’s Visit
The first case was seen in Mexico on April 13. The outbreak coincided with the President Barack Obama’s trip to Mexico City on April 16. Obama was received at Mexico’s anthropology museum in Mexico City by Felipe Solis, a distinguished archeologist who died the following day from symptoms similar to flu, Reforma newspaper reported. The newspaper didn’t confirm if Solis had swine flu or not. (more)
8:09PM ***UPDATE 3*** Reports of Swine Flu experiences in Mexico,
Texas state health authorities on Saturday ordered a high school near San Antonio closed indefinitely after a third student showed symptoms of swine flu
British airways pilot being treated in isolation after flight from Mexico
If this thing spreads overseas you can be sure the WHO will elevate its phase level. (see below
4:16 PM***UPDATE 2*** The Kansas Department of Health and Environment has confirmed at least two cases of swine flu in their state, while the New York City Department of Public Health is reporting that at least eight out of an estimated 100 students at a Queens prepatory school who displayed flu-like symptoms likely have the infection. Meanwhile, Imperial County health officials reported that San Diego has yet another case of the swine flu strain that has killed up to 68 people in Mexico.
5:29 PMTotals are now 11 cases confirmed and another 8 possible in NY
1235 CDT ***UPDATE*** The WHO flu experts have met and other than asking countries to keep an eye on things, taken no action.
Swine Flu Info
Over at Effect Measure some good info on the current Swine Flu situation. I would recommend the whole article.
...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. If it turned out that there had been the same number of cases in Mexico but from many different known viruses we might look for another explanation, for example, a change in insurance that changed care seeking behavior so cases were counted that weren't counted before.
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. We'll try to get to some more of these questions in the days ahead, since we have many new readers, but one big thing to know was emphasized by Acting CDC Director Richard Besser at the White House briefing yesterday: 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. (more)
...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. If it turned out that there had been the same number of cases in Mexico but from many different known viruses we might look for another explanation, for example, a change in insurance that changed care seeking behavior so cases were counted that weren't counted before.
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. We'll try to get to some more of these questions in the days ahead, since we have many new readers, but one big thing to know was emphasized by Acting CDC Director Richard Besser at the White House briefing yesterday: 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. (more)
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