Flu Season Getting Underway

The 2010-2011 flu season has been underway for a couple of weeks, but now's a good time to remember to get your influenza vaccines. Not only does this provide protection to yourself, but it reduces the chances of influenza spreading to those you come in contact with, including the elderly, infirm, and young who are most susceptible to the disease and complications that can result in hospitalization and even death.

Large parts of the US are reporting the disease sporadically, but they will become more regionalized in coming weeks.

The 2010-2011 flu vaccine will protect against three different flu viruses: an H3N2 virus, an influenza B virus and the H1N1 virus that caused so much illness last season. Getting the flu vaccine soon after it becomes available each year is always a good idea, and the protection you get from vaccination will last throughout the flu season.

Typically, influenza kills anywhere from 3,000 to 49,000 people a year in the US. The 2009 H1N1 pandemic resulted in more than 12,000 flu-related deaths in the US.

This is nothing to sneeze about; the disease causes a significant economic toll - in lost productivity and the medical costs of dealing with symptoms that sometimes mimic a cold. The vaccination is a low-cost preventative.

Scientists Discover Natural Cellular Antiviral Proteins

Scientists have found a natural antiviral protein that can thwart influenza.

U.S. researchers have discovered antiviral proteins in cells that naturally fight off influenza infections, a finding that may lead to better ways to make vaccines and protect people against the flu.

They said a family of genes act as cell sentries that guard cells from an invading influenza virus, the team reported on Thursday in the journal Cell.

"This prevents the virus from even getting into the cell," said Stephen Elledge of Harvard Medical School and a Howard Hughes Investigator at Brigham & Women's Hospital.

"It is out there fighting the flu all of the time," Elledge said in a telephone interview.

Elledge and colleagues used a new research technique called RNA interference in which they systematically turned off individual genes and then exposed cells to the flu virus.

Using this method, they discovered a small family of flu-fighting proteins called interferon-indicible transmembrane proteins that boost the body's natural resistance to viral infection.

"If you get rid of it (the protein), the virus can replicate 5 to 10 times faster. What that means is your cells have a mechanism that can block 80 to 90 percent of the virus that gets in," Elledge said.

This is a pretty exciting discovery given that up to 25% of the American population gets the flu in any one year, and that the H1N1 swine flu is considered the latest pandemic while the H5N1 variety is considered the riskiest of turning into a pandemic on a scale of the 1918 flu epidemic that killed millions worldwide.

In fact, a specific protein may actually help fight off not only influenza, but West Nile Virus, dengue fever and even yellow fever.

Hopefully this research will pan out and lead to more effective vaccines and cures for these common scourges, particularly in the third world.

Poll Finds 1/3 of Parents Oppose Swine Flu Immunizations

I'm not particularly shocked by this study, which claims that one third of parents oppose immunizing their kids against swine flu. The reasons may vary - from thinking that the swine flu isn't any more dangerous than the regular flu or that the vaccine itself isn't sufficiently tested, but the rationales are mostly due to the lack of information about the vaccine and the threat posed by influenza than objective opposition based on facts about the vaccine.

The AP poll found that 38 percent of parents said they were unlikely to give permission for their kids to be vaccinated at school.

The belief that the new vaccine could be risky is one federal health officials have been fighting from the start, and they plan an unprecedented system of monitoring for side effects.

They note that swine flu vaccine is made the same way as seasonal flu vaccines that have been used for years. And no scary side effects have turned up in tests on volunteers, including children.

On Wednesday, Health and Human Services Secretary Kathleen Sebelius appealed for widespread inoculation against swine flu, vouching unconditionally for the vaccine: "We know it's safe and secure."

The AP poll, conducted Oct. 1-5, found 72 percent of those surveyed are worried about side effects, although more than half say that wouldn't stop them from getting the vaccine to protect their kids from the new flu.

Giving flu shots to schoolchildren is also an idea many parents are still getting used to. It was only last year that the government recommendation kicked in for virtually all children to get it. Seasonal flu vaccination rates for children last year ranged from about 48 percent for toddlers to about 9 percent for teens.

The swine flu vaccine (H1N1) is based on the same seasonal flu vaccine that is updated annually by scientists who make best guess estimates of the top influenza strains that are likely to be spread during the upcoming flu season. The H1N1 vaccine is made using the same processes as the seasonal flu vaccine.

Influenza kills 30,000 to 40,000 people in the US annually. Swine flu was found to be highly communicable, even if the mortality rates weren't different than the seasonal flu in the US. Influenza can affect anywhere from 10-25% of the American public, which means that it can have a serious effect on the productivity of the US economy as well as overburden the health care delivery system. Immunizations can reduce the severity of the influenza outbreaks, and prevent widespread disruptions to school routines, as was the case in New York City last year, where a dozen schools were shuttered because of outbreaks among the student population.

NYS Health Care Workers Question Swine Flu Vaccine Rule

The New York State Department of Health has made it official that all health care workers in the state must take the swine flu shot to continue working. That has got some of these health care workers up in arms over their right to refuse the vaccine.

Healthcare workers in New York are angry and planning to protest a state regulation that requires them to get the swine flu vaccine. They are being given an ultimatum: get vaccinated or get fired, according to a NewsDay.com article on www.drudgereport.com. The healthcare workers who are taking exception to the state’s demand insist that such a requirement violates their personal right and freedom to make that decision, and also puts them at risk of serious health issues and even death.

The vaccine has been fast tracked through the FDA and has not been thoroughly tested. In a previous article, quite a bit of detail was offered about what fast tracking means. In a nutshell, extensive testing is not required. So little is known about the short-term side effects, and no one knows what the long-term effects are going to be. This vaccine is very similar to one used in, 1976 which not only caused some people to get a brain disorder called Guillain-Barre Syndrome (GBS), but the vaccine from 1976 killed more people than the actual swine flu itself.

As for those who aren’t healthcare workers, in spite of the fact that children and pregnant women will be given first priority in receiving the dangerous potion, no studies have been done that indicate what effect the vaccine will have on an unborn child.

These health care workers point to the 1976 vaccine problems, ignoring that the influenza vaccinations made since then have significantly changed, and that the H1N1 vaccination is different from the standard flu vaccines only in that it focuses only on the H1N1 vaccine instead of a cocktail of several different strains.

In fact, it seems that some of this is being driven by the anti-vaccination crowds, and not by hard science on the matter.

These health care workers are on the front lines of any potential outbreak, and if they are sickened and incapacitated, it will put many others in serious harm. Moreover, the Examiner article claims that this is a dangerous potion, when past influenza vaccinations have gotten FDA approval and are produced using the same exact methodologies and processes. The slant on the article is clear; it ignores the actual science.

These workers are already required to maintain proper immunizations against certain other illnesses, but apparently the flu vaccine has pushed this to the forefront.

Already, the flu season is off to a roaring start, with widespread activity in 26 states. That MSNBC chart provides H1N1 deaths, but doesn't tell the whole story - the total killed by influenza, showing that H1N1 continues to play a small but significant role in the overall figure. The CDC map is slightly easier to read, but omits mortality data, particularly from H1N1.

As always, the key is prevention, and taking the flu shot is the first step. Maintaining proper hygiene and constant washing of hands is another. Getting the flu shots is important if you're a care giver or have elderly parents or young children who may be more susceptible to the illnesses due to weakened or still maturing immune systems.

Swine Flu 2009 Watch

The Centers for Disease Control, which is led by former New York City Health Commissioner Thomas Frieden, is set to release a study noting that 10% of New York City suffered from swine flu this past year (800,000 people out of a population of 8 million), and that 47 people died as a result of complications from swine flu (H1N1).

"In New York City, where we had a lot of H1N1 this last spring, the estimate is about 800,000 people - about 10% of New York City residents - got infected with the flu," said Thomas Frieden, head of the federal Centers for Disease Control and Prevention and former New York City's health commissioner.

"That's a lot of people," he said.

Swine flu killed 47 New Yorkers in the spring - less than 1% of those infected.

A report released last week suggested half the country could get sick with swine flu this fall and 90,000 could die.

The actual fatality rate from the swine flu in New York City appeared to be .0005875 (47/800,000). That's a fraction of a fraction of 1%. The 90,000 figure that is being touted is likely a worst case model, figuring that the death rate is much closer to 1% than to the rate seen in New York City this past year. If the rate is unchanged from this year, 1,762 people might be expected to die as a result from swine flu, which is still a percentage of the overall number of people who die annually from the flu - which normally ranges around 40,000 annually.

The warnings are needed because this particular strain appears to be far more virulent than other strains seen recently, and the flu season lasted longer that several prior seasons, which could foreshadow a far more virulent 2009 flu season.

The concern is that this virulent form could mutate into a much more deadly form. That's why the need to be vigilant is an absolute must. Early detection and precautions are needed so that if there is an outbreak, health officials can be ready to provide guidance and assistance.

Swine Flu Outbreak Update

Since cases of swine flu broke out in the NYC metro region, much has been written about swine flu and the deadly consequences. So, it is somewhat reassuring that 127 people have been confirmed to have died of the disease in the US along with 27,000+ confirmed cases.

US health officials estimate that at least one million Americans have been infected with swine flu since the H1N1 virus emerged nearly three months ago.

The number is far higher than cases actually reported to the authorities.

The Centers for Disease Control and Prevention (CDC) said many cases were mild, although 127 people had died.

The CDC based its figures on surveys, rather than laboratory evidence, but the numbers suggest the death rate from swine flu is lower than thought.

"We're saying that there have been at least a million cases of the new H1N1 virus so far this year in the United States," said Anne Schuchat of the CDC.

"Reported cases are really just the tip of the iceberg."

The CDC has based its estimate on mathematical modelling, based on surveys by health officials.

If the figures are correct, it is reassuring news, because it indicates that the fatality rate from swine flu is even lower than thought, says BBC medical correspondent Fergus Walsh.

However, Dr Schuchat warned that swine flu might exhibit higher infection rates than seasonal flu and could return in a more virulent form in the autumn.

However, based on computer models, the true number of people who were infected and got sick from the H1N1 virus was likely above 1 million. That means that the mortality rate for this strain is far less than previously thought.

Recall that in any given year, anywhere from 5-25% of the US population becomes ill from the flu, and 25-40,000 people die of the flu.

The concern is that this strain will give way to a more virulent form that is more dangerous and deadly. Health officials have to remain vigilant to see if there are additional outbreaks.

That means constantly scouring medical reports from hospitals and medical officials worldwide for unusual presentations of influenza, but tracking to see whether there are late outbreaks of H1N1 or other influenzas that might signal that the disease is hanging around into the next flu season.

German Officials Warn H1N1 Mutating?

Reuters is reporting that German officials believe the swine flu, H1N1, is apparently mutating and could be setting up to spread in a far more virulent and dangerous form.

Germany's federal agency for infectious diseases said on Tuesday there were signs the H1N1 swine flu virus had started to mutate and warned it could spread in the coming months in a more aggressive form.

Experts were concerned about how the flu was developing in Australia and South America, said Joerg Hacker, head of the Robert Koch Institute for infectious diseases.

"It's possible the virus has mutated. In autumn the mutated form could spread to the northern hemisphere and back to Germany," Hacker told a news conference in Berlin.

The flu could become far more deadly than the relatively mild strain that we've seen to date, even as dozens of people around the world have died from this strain (annually in the US anywhere from 25,000 to 40,000 die from influenza every year).

It bears watching and public health officials are right to warn that the population should seek vaccination for influenza since it can reduce the spread among the population and vaccine developers are working to prepare the newest flu vaccines to include H1N1 in their mix.

Swine Flu School Closures Continue In NY Metro Region

The New York metropolitan region continues seeing new cases of influenza and 17 schools have been closed in the past few days. The majority were closed following the death of assistant principal Mitchell Weiner, who worked at one of the affected schools. His school was closed days after Weiner and others contracted the illness.

It's also reported that an infant may have died after contracting the swine flu. One can clearly sense the rising fear and apprehension among the public in the area over the swine flu and the media response hasn't exactly helped matters either.

Every year, 36,000 people die of influenza in the United States, but that number doesn't generate the kind of fear that the swine flu and the relatively few cases that have come to light. It's in the absence of information that fear spreads, and school districts are grappling with that lack of information and are going to make bad decisions.

Here's what's known so far:

Education officials said citywide attendance yesterday was at 85.1 percent; last Monday, it was 86.5 percent.

Meanwhile, yesterday:

* The city Health Department said there have been 192 confirmed swine-flu cases in the Big Apple.

The Centers for Disease Control and Prevention said about 100,000 people are likely infected with the new flu around the country. Dr. Anne Schuchat, an interim deputy director, said the 5,123 confirmed and probable cases and six deaths in the United States were "the tip of the iceberg."

Many other flu deaths are likely to be masking the number of swine flu cases and vice versa since the symptoms are indistinguishable from each other.

There is little guidance on how school districts should respond.

Many school officials have shut the doors and had the custodians disinfect the empty buildings.

But that leaves parents confused and frustrated. Those whose schools remain open may fear that their children are in danger, and those with healthy children whose schools close may feel that officials have overreacted, burdening them with day-care costs and denying their young ones an education.

Even guidance from the top is ambivalent.

On May 4, the acting director of the Centers for Disease Control and Prevention, Dr. Richard E. Besser, said “closing schools is not effective” at halting the spread. Previously, the centers had advised schools to shut for up to two weeks if a confirmed case was found.

On Monday, New York City closed four more Queens schools after outbreaks of flu symptoms, bringing the total to 16 ordered shut since last week. In Texas, hundreds have been closed at various times.

“There’s no right answer,” Mayor Michael R. Bloomberg said at a news conference. “I’ve asked the question, ‘What would you do, Dr. Frieden, if you wanted to prevent the spread of flu around the entire student population?’ And the answer is, ‘Closing the schools for a month, prohibit all interaction among kids outside of school, and even then there’s no guarantee that you can do that.’ The bottom line is, case-by-case basis is probably the right thing.”

(Mr. Bloomberg was referring to Dr. Thomas R. Frieden, the city’s health commissioner, who has just been nominated to be chief of the C.D.C.)

Many parents and teachers have been calling local lawmakers wondering if their schools would be closed, said Eric Gioia, a City Council member from Queens who wants parents to be given the results of flu tests at their local schools and daily attendance figures.

Information is the key detail, and on that point Dr. Frieden's ability to disseminate information in a timely manner and maintain perspective on this public health threat hasn't exactly put the public at ease.

One has to wonder whether people are reacting differently to this particular flu outbreak because it was a named flu, rather than the garden variety influenzas that ravage anywhere from 5-20% of the nation every year.

The closure of schools is as much a political decision as a public health decision. The closures may prevent the spread of disease between students, but if infected individuals come in contact with other people, the disease will continue spreading. Also, if officials closed every school where students have flu symptoms there would be no schools open since influenza is a common ailment throughout the school year. Surely, there is no right answer since public health officials have to gauge the merits of keeping the schools open versus closing them and they will not know whether they've made the right decision until after the fact. It's too easy to second guess these officials.

The school closures also don't help parents deal with the fact that their kids are now suddenly home on an extended vacation. What are parents struggling to make ends meet at their jobs supposed to do? Parents can't just stop going to work to care for their kids, and some parents have been sending their kids to school while they are showing symptoms of influenza because they aren't able to stay home to care for their kids.

Some of the affected schools saw dozens of students come to the school nurses seeking medical attention. Reports that kids were nauseous and vomiting in class are prevalent, and it needs to be stressed that parents who see that their kids are showing symptoms must keep their kids home - not only for their own children's protection, but to protect their classmates from becoming ill.

Also, the whole idea of disinfecting schools is useless, as the virus can thrive for up to three days and the moment schools reopen, any infected students will quickly spread the disease among the population. The disinfection of schools is done for show (though it probably is a good idea to improve the hygiene at schools generally).

Still, it is cold comfort to those who are coming down with the flu, and swine flu is suspected in the death of an infant in Queens.

City and hospital officials said it was too soon to tell for sure if the baby succumbed to the H1N1 swine flu virus spreading sickness and death around the world.

"It will take days before the Centers for Disease Control and Prevention can confirm or deny that," said hospital spokesman Dario Centorcelli.

The unidentified infant's parents noticed he had a high fever when they put him to bed Monday night. They brought him to the hospital after he started turning blue, Centorcelli said.

The baby was pronounced dead at 10:20 p.m.

His 3-year-old brother and 1-year-old cousin were also being treated for flulike symptoms at the hospital.

UPDATE:
The CDC notes that about half of the influenza cases being reported are the H1N1 swine flu, with the rest being the normal circulating flu:

"We are now experiencing levels of influenza-like illness that are higher than usual for this time of year," Schuchat added. "We are also seeing outbreaks in schools, which is extremely unusual for this time of year."

New York City Health Commissioner Dr. Thomas Frieden agreed with Schuchat.

"We're seeing increasing numbers of people going to emergency departments saying they have fever and flu, particularly young people in the 5 to 17 age group, " Frieden, who has been named by U.S. President Barack Obama as the new CDC director, told a news conference.

About half of all cases of influenza are being diagnosed as the new H1N1 strain, while the rest are influenza B, or the seasonal H1N1 and H3N2 strains. Flu season in the United States is usually almost over by May.

What has public health experts worried is that there are a larger number of young adults sickened and requiring hospitalization, plus that this is at the tail end of the typical influenza season.

UPDATE:
The infant previously reported as having died from swine flu did not have the H1N1 strain, but further tests are needed. Also, 26 schools are now closed as a result of flu cases being reported.

First Swine Flu Death In NYC Reported

Assistant Principal Mitch Weiner passed away from complications relating to swine flu. He's the first person to pass away from swine flu in New York City.

"We were treating him very aggressively," said Flushing Hospital spokesman Ole Pedersen. "Unfortunately, he did expire at 6:17 p.m. this evening."

The sick man, Mitchell Wiener, 55, an assistant principal at IS 238 in Jamaica Estates, first fell ill more than a week ago, but didn't seek help at the hospital until his symptoms became severe early Wednesday morning.

Since that time, he's been in a medically induced coma, on a ventilator.

My thoughts and prayers go out to his family and friends. My brother in law's school was among the six shuttered by the Board of Education last week in the wake of hundreds of students coming down with flu like symptoms so I know how this situation can hit home.

Mr. Weiner didn't seek care immediately, although there's no way to know whether earlier treatment would have mattered. Still, it's a good idea to see a health professional if you come across the symptoms that may be influenza.

there are other ailments that can have similar symptoms, including the cold. Here's a checklist of symptoms or quiz the symptoms to see whether it fits a classic influenza or the common cold.

Some parents and teachers are complaining that at least one of the schools should have been closed earlier - at IS 238, where Weiner worked. Now, the City is closing additional schools because of suspected flu cases, so as to limit the spread of the disease.

Swine Flu Reasserts Itself In New York City; 3 Schools Shuttered

Just days after saying that the City wouldn't consider shuttering schools that may have been affected by swine flu outbreaks, the City has closed three schools through the end of next week because of several hundred cases of suspected flu.

Just as many New Yorkers were beginning to forget the threat of swine flu, Mayor Michael R. Bloomberg said at a hastily called news conference Thursday evening that swine flu had been confirmed in the sick man, whom colleagues identified as Mitchell Wiener, the assistant principal of Intermediate School 238 in Hollis. He was being treated at Flushing Hospital Medical Center, where he was on a ventilator.

Mr. Bloomberg said Mr. Wiener appeared to have had some health problems that could have made him more susceptible to the virus. His colleagues and friends said he had diabetes and sometimes walked with a cane.

In addition to Mr. Wiener, who is in his 50s, four students at I.S. 238 have been confirmed as having swine flu, officials said, and more than 50 students have been sent home with flulike symptoms since May 6.

The city’s Education Department decided Thursday to close that school, along with Public School 16 in Corona, where 29 students went to the nurse’s office Thursday with influenzalike symptoms, and I.S. 5 in Elmhurst, where 241 students were reported absent Thursday. Officials said the plan is to reopen those schools next Friday.

I have a personal connection to this as my brother in law works at one of the affected schools and he had been telling us that there had been quite a few absences from class of late - far more than a typical day.

The closures mean that the potential transmission between students is thwarted because students wont be in close contact. The City also scaled back its testing for swine flu as it became evident that swine flu is more mild than typical flu. However, as I've repeatedly noted, the regular flu kills nearly 36,000 people and sickens anywhere from 5-20% of the nation every year. The situation gets more attention since a name was placed on this particular strain, which is one of many that circulate around the globe naturally and which evolve on a constant basis.

These three schools were closed because of the unusually high percentage of flu cases.

Meanwhile, a vigil is being held for Assistant Principal Mitchell Weiner, who is suffering from complications of swine flu and is in critical condition at a Queens hospital. Weiner appears to have had a preexisting condition, which made his case more difficult to treat, although the Daily News ominously claims that this may be a mutated version of the influenza (ignoring and/or omitting that the regular flu kills thousands annually).

It's one thing to be cautious, it's quite another to blow things out of proportion. The media needs to keep its perspective on the situation.

UPDATE:
There's some question about the accuracy of reports claiming that Weiner had a preexisting condition. New reports indicate that Weiner had gout, but no other ailments at the time he came down with the flu. Also, his wife claims that the City botched its response to a growing number of cases at Weiner's school in Queens because the principal wasn't given the ability to shutter the school before Weiner came down with the ailment.

Bonnie Wiener, whose husband, Mitchell, is assistant principal of Susan B. Anthony Intermediate School in Hollis, one of three schools closed by the latest swine flu outbreak, said the city health department denied the principal's request to close the school because of suspected swine flu cases there.

"If he [the principal] was allowed to shut the school down, my husband would not be in this condition," she said.

Three Queens schools -- IS 5, the Walter Crowley Intermediate School, in Flushing; PS 16, an elementary school in Corona, and Susan B. Anthony -- are closed through next Friday after hundreds of students were sent home sick this week....

(snip)Bonnie Wiener said her husband called the city Department of Health after meeting with four students at his school who reported feeling ill May 8 with flulike symptoms. He told the department he was concerned the students may have swine flu, she said.

"He was chastised by the [department] of health or someone higher that he was setting off a panic," Bonnie Wiener said. "The man said there is nothing to worry about."

She said the health department official told her husband, "Even if it is swine flu, it is still diluted."

Good News On Swine Flu Outbreak Despite Biden Gaffes

Vice President Joe Biden is warning that people should avoid taking subways, trains, and planes. It's easy to tell everyone to get to work on their own when they don't have a personal chauffeur, which in Biden's case is the United States Secret Service. For everyone else, you're on your own.

Of course, Biden shows his utter ignorance on health issues, which shouldn't be all that unexpected. It also runs contrary to what President Obama and various US health officials have said. There are so many people out there talking about the swine flu that don't have the slightest bit of understanding or knowledge - or worse, know just a little bit and then make dangerous leaps in logic to conclude as Biden has, that people should avoid taking subways and planes.

Of course, the Vice President's staff was quick (but not quick enough) to issue a clarification.

The advice he is giving family members is the same advice the administration is giving to all Americans: that they should avoid unnecessary air travel to and from Mexico.

If they are sick, they should avoid airplanes and other confined public spaces, such as subways. This is the advice the Vice President has given family members who are traveling by commercial airline this week. As the President said just last night, every American should take the same steps you would take to prevent any other flu: keep your hands washed; cover your mouth when you cough; stay home from work if you’re sick; and keep your children home from school if they’re sick.”

Not to minimize the potential hazards associated with the swine flu, but why aren't people more concerned with the garden variety flu that kills 36,000 Americans every single year while sickening anywhere from 5-20% of the nation?

Those figures are from the Centers for Disease Control, which is part of the US government. You'd think that Biden would know that information, or one of his staffers was briefed on the situation.

In fact, you'd think that Biden would have been briefed that scientists think that the swine flu as it is currently configured is a relatively mild strain of flu.

As the World Health Organization raised its infectious disease alert level Wednesday and health officials confirmed the first death linked to swine flu inside U.S. borders, scientists studying the virus are coming to the consensus that this hybrid strain of influenza -- at least in its current form -- isn't shaping up to be as fatal as the strains that caused some previous pandemics.

In fact, the current outbreak of the H1N1 virus, which emerged in San Diego and southern Mexico late last month, may not even do as much damage as the run-of-the-mill flu outbreaks that occur each winter without much fanfare.

Thus far, we've got a handful of swine flu cases relatively speaking with the overwhelming number of cases in New York City as a result of a school trip to Cancun, Mexico. There was one fatality, which was a Mexican toddler who was in the US with her family and apparently seeking care here.

Taken together, that's good news. It also reinforces the point I have been making for the last few days about how getting the flu vaccine may do more to prevent deaths or complications from the annual flu. The hysterics in the media about the swine flu may bring attention to that form, but it's the regular flu that still does the damage around the world annually.

The same precautions apply to all kinds of flu - good hygiene is a plus, and staying home when you're sick so as not to infect anyone else helps limit the spread.

Thus far, this version of the flu doesn't appear to have a higher mortality rate in the US than other flus (Mexico's health care system isn't exactly looking all that impressive if you go by the claims that 150+ have died of swine flu, but the WHO claims there are less than a dozen confirmed fatalities from the swine flu). The Mexican authorities are also doing more to limit public events to limit the spread, as they are at the epicenter of the outbreak. Google has updated and expanded its flu tracking services, to improve Mexico's ability to track the incidences.


It's good to keep this in perspective and to maintain a health respect for the potential harm that the swine flu can bring. Needless hysterics and blatherings from politicians who don't know when to keep their mouths shut only further obfuscate the facts and important information that people should take away from the health situation.

Swine Flu Update: WHO Raises Global Alert Level

Today, we learn that the US has seen the first fatality from the swine flu. It was apparently a 23-month-old Mexican girl who came to the US with her family on a trip. To keep this in perspective, the garden-variety flu that everyone seems to ignore kills 36,000 annually while sickening anywhere from 5 to 20% of the US population.

Swine flu has yet to approach those figures yet, but it bears watching. Caution is the name of the game. Thus far, nearly 2,500 cases were reported in Mexico, with 159 fatalities.

Confirmed U.S. cases, by state: 45 in New York, 11 in California, six in Texas, two in Kansas and one each in Indiana and Ohio, according to CDC and states.

U.S. Food and Drug Administration issues emergency guidance allowing certain antiviral drugs to be used in broader range of population if needed. Public health emergency declared and roughly 12 million doses of Tamiflu from federal stockpile to be delivered to states.

Cuba bans flights to and from Mexico; Argentina suspends flights from Mexico; U.S., European Union, other countries discourage nonessential travel there. Arriving travelers questioned at Mexico's U.S. border and world airports. Cruise lines avoid Mexico ports.

Mexico suspends all schools until May 6. In U.S., some schools closed in New York City, Texas, California, South Carolina, Connecticut and Ohio.

Egypt ordering the slaughtering of entire herds of pigs isn't likely to stop the spread of the disease, especially given that the disease is now being transmitted between people. It was only the initial incidences that included transmission between pigs and people.

France is hoping to get the EU to cancel all flights to Mexico. I think the time for such measures has passed as we're seeing cases pop up all over the world, including in Germany.

Meanwhile, President Obama is basically reinforcing what has already happened in the NYC metro area. He's said that schools where outbreaks have been reported should be shuttered. That's already happened with St. Francis Prep, and it may happen with a nearby school that has seen several cases.

The CDC and health departments across the country have protocols for dealing with communicable disease outbreaks like flu, and they should be followed. There's no reason to panic unnecessarily. While the Obama Administration will take the credit for the response to the outbreak (which still suffered problems from delays in obtaining information from Mexico over the growing epidemic there), once the CDC and other health organizations received that information, they were able to plan and prepare because of the groundwork laid by the Bush Administration, who spent billions preparing for this eventuality.

However, timely and accurate information should be passed on to the public.

What is thus far a most curious situation is that virtually all of the fatalities are in Mexico. That's a question epidemiologists will have to sort out. Is it a comparatively less comprehensive health care system? Access to health care? Or is the particular strain in Mexico more deadly than the version seen elsewhere? It could be a combination of factors.

UPDATE:
Two more schools have closed in Brooklyn:

Two more New York City schools will be shuttered after students came down with confirmed cases of swine flu, an official said Wednesday.

St. Brigid's School and Good Shepherd School, both in Brooklyn, each had at least one child sickened by the virus and will be closed for the rest of the week, a diocese official told the Daily News.

That brings the number of schools in the city closed as a swine flu precaution to four, putting already anxious parents further on edge.

I expect more closures in the NYC metro area as clusters break out in different parts of the city. It would be interesting to see the connections between the various schools and whether there's some common thread. That's likely to come much later. For now, health experts are trying to limit the spread, and the closures reduce the chances that the cases will spread beyond the immediate families of those already sickened.

UPDATE:
A WHO official says that only seven deaths can be attributed to swine flu, not the widely circulated 152. All the fatalities are in Mexico. They also say that there's been only 79 confirmed cases worldwide. Well, don't that beat all when you've got various agencies not talking to each other and getting information from different sources and using different measures to describe the situation.

Compare that with the US CDC, which notes that there are 94 confirmed cases in the United States.

UPDATE:
The WHO has raised the global alert level to 5 out of a possible 6.

WHO Director-General Margaret Chan declared the phase 5 alert after consulting with flu experts from around the world. The decision could lead the global body to recommend additional measures to combat the outbreak, including for vaccine manufacturers to switch production from seasonal flu vaccines to a pandemic vaccine.

"All countries should immediately now activate their pandemic preparedness plans," Chan told reporters in Geneva. "It really is all of humanity that is under threat in a pandemic."

A phase 5 alert means there is sustained transmission among people in at least two countries. Once the virus shows effective transmission in two different regions of the world a full pandemic outbreak would be declared.

WHO has confirmed human cases of swine flu in Mexico, the United States, Canada, Britain, Israel, New Zealand and Spain. Mexico and the U.S. have reported deaths.

Swine Flu Cases Swell

New York City likely has hundreds of cases that have gone uncounted so far, according to NYC Health Commissioner Thomas Frieden. Several of those cases are at a public school not far from St. Francis Prep, which was closed to disinfect the facility after several dozen students came down with the illness after going on spring break in Cancun, Mexico.

Los Angeles suspects that swine flu may be responsible for two deaths there.

Seven countries are now confirmed as having swine flu.

Twenty fatalities have been confirmed in Mexico, and the number of deaths considered likely to have been caused by the flu rose to 152, up from 149 on Monday, according to Mexico’s health minister. The number of people believed to be infected surpassed 1,600.

In the United States, the number of infections stood at 50. Preliminary tests by health officials in New Jersey had identified five “probable” cases — four people who were recently in Mexico and one who had been in California, The Associated Press reported.

Other cases have been reported in Ohio, Kansas, Texas and California. Most of the cases were concentrated in New York, at a high school in Queens where a group of students had recently traveled to Mexico. At least 28 students at the school tested positive, and another 17 were suspected of having the flu, with testing under way. Investigators were also examining between 10 and 15 possible new cases in three counties in upstate New York, all involving people who had recently traveled to Mexico or the southwest United States.

“All of our cases continue to be mild, with spontaneous recovery,” said Richard F. Daines, the New York state health commissioner.In Mexico, state health authorities looking for the initial source of the outbreak toured a million-pig hog farm in Perote, in Veracruz State. The plant is half-owned by Smithfield Foods, an American company and the world’s largest pork producer.

Mexico’s first known swine flu case, which was later confirmed, was from Perote, according to Health Minister José Ángel Córdova. The case involved a 5-year-old boy who recovered.

The part in bold is important to keep in mind. While this is a public health emergency, it's important to keep perspective over the illness and that most of those who are getting sick at present are recovering on their own. The situation becomes far more problematic if the mortality rate increases or the number of cases swells exponentially.

Businesses are being affected all over the place, although the effects are nowhere near as bad as during the 1918 outbreak. Thus far, the worst hit areas economically are the businesses in and around Mexico, and the tourist industry is taking a hit as well. Carnival Cruises has canceled all Mexico port of calls until further notice.

Meanwhile, President Obama has called for another $1.5 billion to spend on swine flu prevention. Slate points out that Mexico's response isn't exactly impressive and the slow response may have allowed additional people to be exposed to the disease.

New influenza cases started appearing in Mexico City on March 18. The first death occurred April 12. But the government dragged its feet, hoping that this was an isolated case. As deaths mounted over the following days, the Calderón administration refused to take decisive action.

It wasn't until half a dozen cases were discovered in the United States that the Mexican authorities sent mucus samples to Canadian and U.S. laboratories for testing. The lab results immediately sent alarm throughout Mexico and the world. But almost a month had been lost.

A more fundamental cause of the late response is the terrible state of Mexico's public health system. Due to years of neglect by the government, the poorest patients normally need to wait for hours or even days to see a doctor. Medicines are scarce. The largest network of public hospitals recently won an "award" as the government agency with the most useless red tape.

A large percentage of the poorest Mexicans therefore do not even bother to go to the doctor when they feel sick. It is more effective to self-prescribe antibiotics or anti-virals, which are easily available over the counter at pharmacies. This leads to serious problems with early detection of new diseases. To make matters worse, Mexican labs do not have the profiling data needed to detect many new viruses.

These kinds of situations bring out the worst in politicians, and this is quite the doozy from Rep. Michelle Bachmann (R-MN), who doesn't quite get the science behind influenza or know her history well.

That's okay, because the stupidity is bipartisan.

Swine Flu Disconnect

The media continues churning out stories about swine flu and the hype appears to be outpacing what we know about the disease, let alone just how dangerous it is. You're still more likely to die of the regular flu than you are of the swine flu (36,000 fatalities in the US annually vs 81 in Mexico among 1,000+ reported cases). It seems every local station and news outlet in New York City has some expert on warning about just how dangerous swine flu might be and the precautions that one should take.

The precautions are all sensible, but one has to wonder why people don't take flu shots more seriously. The regular run of the mill flu hits millions of people annually (5-20% of the nation, depending on the severity of the season) and it kills roughly 36,000 people in the US every year. You'd think that those kinds of numbers would get people to take flu shots more seriously, but it hasn't.

Maybe the swine flu, which sounds pretty bad, will get people to take flu vaccination more seriously, but I doubt it.

What the swine flu outbreak has done is show that the US still needs to work on its national handling of such outbreaks. The Obama Administration still lacks a Health and Human Services Secretary along with several key posts at HHS. The Administration says that those empty posts aren't getting in the way of the response, but US health officials were in the dark about what was happening in Mexico for two weeks.

The delayed communication occurred as epidemiologists in Southern California were investigating milder cases of the illness that turned out to be caused by the same strain of swine flu as the one in Mexico.

In the wake of the 2001 terrorist attacks, the outbreak of severe acute respiratory syndrome (SARS) in 2003 and the more recent emergence of H5N1 bird flu in Asia, national and local health authorities have done extensive planning for disease outbreaks that could lead to global epidemics, or pandemics. Open and frequent communication between countries and agencies has been a hallmark of that work.

Whether delayed communication among the countries has had a practical consequence is unknown. However, it seems that U.S. public health officials are still largely in the dark about what's happening in Mexico two weeks after the outbreak was recognized.

Asked at a news conference yesterday whether the number of swine flu cases found daily in Mexico is increasing -- a key determinant in understanding whether an epidemic is spreading -- Anne Schuchat, an interim deputy director of the Centers for Disease Control and Prevention, said, "I do not know the answer to those questions."

As of yesterday, U.S. officials had reported 11 domestic cases, none fatal. Last night, Mexican health officials reported more than 1,300 suspected cases and 81 deaths "probably linked to the virus."

We're learning that the first fatality in Mexico was a 39-year-old woman who died April 12 of severe viral pneumonia in San Luis Potosi, which is located in central Mexico. Epidemiologists then uncovered additional cases, including several fatalities, that involved unusual respiratory ailments.

UPDATE:
Europe has now issued warnings for travel to the US based on the swine flu outbreak and to postpone unnecessary travel to the US. The CDC says that the move was unwarranted.

Meanwhile, the US stock markets are dropping on concerns relating to the swine flu. Not surprisingly, drug stocks are up.

UPDATE:
The number of cases of swine flu in NYC has increased to 28, as a result of more cases diagnosed at St. Francis Prep School, where many students went to Cancun on spring break.

UPDATE:
Meanwhile, the suspected death toll in Mexico is now 149. Mexican officials have closed schools through May 6, which should help reduce the spread of the flu through direct contact in public places.

He says 1,995 have been hospitalized with serious cases of pneumonia since the first case of swine flu was reported on April 13. The government does not yet know how many were swine flu. Of those hospitalized, 1,070 have already been released.
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Cordova says school at all levels nationwide are suspended until May 6. Schools had already been suspended in Mexico City and five of Mexico's 32 states.

The school closer is part of the government's effort to stem the spread of a deadly strain of swine flu. Earlier Monday, the work week began with pleas to stay home if they have any symptoms of the virus believed to have sickened nearly 2,000.

Officials already canceled hundreds of public events. But as the number of suspected cases and deaths rose again — and millions returning to work — they looked to other measures to control the outbreak.

Labor Secretary Javier Lozano Alarcon said employers should isolate anyone showing up for work with fever, cough, sore throat or other signs of the flu.

Swine Flu Pandemic Possible

Let's see. There was the 1918 flu pandemic. More than 100 million people were killed worldwide.

There was the Hong Kong flu, which killed more than 34,000 in the United States.

Now, we're dealing with swine flu, which is typically categorized as H1N1.

Will this be the pandemic scientists and medical experts had dreaded with what they expected to be the bird flu strain or will it fizzle? No one knows. It's too soon to tell, although there are a few things that mitigate against the kind of mass death that the 1918 flu pandemic saw. For one thing, swine flu, while being extremely easy to transmit and succumb to its effects, is not nearly as deadly as other version, including the bird flu:

Swine influenza, or “swine flu”, is a highly contagious acute respiratory disease of pigs, caused by one
of several swine influenza A viruses. Morbidity tends to be high and mortality low (1-4%). The virus is spread among pigs by aerosols and direct and indirect contact, and asymptomatic carrier pigs exist. Outbreaks in pigs occur year round, with an increased incidence in the fall and winter in temperate zones. Many countries routinely vaccinate swine populations against swine influenza.

Swine influenza viruses are most commonly of the H1N1 subtype, but other subtypes are also circulating in pigs (e.g., H1N2, H3N1, H3N2). Pigs can also be infected with avian influenza viruses and human seasonal influenza viruses as well as swine influenza viruses. The H3N2 swine virus was thought to have been originally introduced into pigs by humans. Sometimes pigs can be infected with more than one virus type at a time, which can allow the genes from these viruses to mix. This can result in an influenza virus containing genes from a number of sources, called a "reassortant" virus.

Although swine influenza viruses are normally species specific and only infect pigs, they do sometimes cross the species barrier to cause disease in humans.

What are the implications for human health?

Outbreaks and sporadic human infection with swine influenza have been occasionally reported. Generally clinical symptoms are similar to seasonal influenza but reported clinical presentation ranges broadly from asymptomatic infection to severe pneumonia resulting in death. Since typical clinical presentation of swine influenza infection in humans resembles seasonal influenza and other acute upper respiratory tract infections, most of the cases have been detected by chance through seasonal influenza surveillance. Mild or asymptomatic cases may have escaped from recognition, therefore the true extent of this disease among humans is unknown.

A pandemic involving influenza has not only been overdue for years, but with the way people can travel around the world, the threat from an outbreak is multiplied and can spread far beyond the initial outbreak area in a matter of hours. It could happen far faster than authorities can react to contain the outbreak to a localized area.

Mexico City is not taking any chances. It has canceled all public events.

The World Health Organization is extremely concerned. More than 1,000 cases have been reported worldwide. It's also been found in the NY metro area as several people at a Queens, NY school have been diagnosed with suspected cases of swine flu. It's a mild version, but experts are concerned it may morph into a more virulent and dangerous form.

The students were among about 100 at St. Francis Preparatory School in Fresh Meadows who became sick in the last few days, said Dr. Thomas R. Frieden, New York City’s health commissioner.

“All the cases were mild, no child was hospitalized, no child was seriously ill,” Dr. Frieden said.

Health officials reached their preliminary conclusion after conducting viral tests on nose or throat swabs from the eight students, which allowed them to eliminate other strains of flu. Officials were also suspicious since some St. Francis students had been to Mexico recently. The samples have been sent to the Centers for Disease Control and Prevention, the only lab in the country that can positively confirm the new flu swine strain — which has been identified as H1N1 strain. Results were expected on Sunday, officials said.

Outside New York, at least 11 swine flu cases have been confirmed in the United States — in California, Texas and Kansas, where two cases were reported on Saturday. There have been no deaths and officials said most of the 11 seemed to be recovering.

The outbreak has killed at least 68 people in Mexico and infected about 1,000 others.

Fearing a panic that might tax local health facilities, Dr. Frieden urged New Yorkers not to go to a hospital if they had typical mild cold or flu symptoms. If they are seriously ill, especially with lung problems, they should seek medial attention promptly, he said, because anti-flu drugs work best if taken in the first 48 hours of symptoms.

Because of fears of the H5N1 avian flu, both New York City and the United States have had detailed pandemic emergency plans in place since 2005, as well as stockpiles of emergency supplies and flu drugs (the plan can be read at www.pandemicflu.gov).

Dr. Frieden said that for such an emergency, the city had extra hospital ventilators, huge reserves of masks and gloves and “millions of doses of Tamiflu,” an anti-flu drug that thus far appears to work against the new swine strain.

In a reaction to the flu outbreak, the World Health Organization convened an emergency meeting of experts on Saturday in Geneva, while public health officials in the United States huddled on conference calls to discuss what steps, if any, to take.

Officials with the W.H.O. were discussing whether to declare an international public health emergency, a move that could involve travel advisories and the closing of borders.

The US has a pandemic flu resource page here and maps outbreaks of all flu cases here.