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Swine flu: here we go again

update below

The news is spreading everywhere: Mexico flu ‘a potential pandemic’. In the next few days we’ll probably have a replay of the bad old bird flu days. Tamiflu! Hide in your house! Shoot the postman! Or whatever level of idiocy we achieve this time.

I did one of my POPs (Pissed Off Posts) on that occasion, and I think it’s time for a rerun. electron micrograph of a flu virus in cross section

First, this newest flu strain, H1N1 (CDC info), sounds vicious. It’s communicable between people (in the US, as of this morning, there were 11 cases with no fatalities) but it’s already killed dozens of people in Mexico. This makes it a far more serious threat than bird flu, which was almost never caught from another person. So being worried about this new flu is not a mark of loopiness in the same way as setting your hair on fire over bird flu. But panic is still an intensely foolish reaction, and the points I’ll run through below are still valid.

Fiction 1: We’re all going to die. It makes for a good movie script, but this is not the way flu works. Even SARS, which had an exceptionally high rate, had about 15% fatalities. Obviously, the only good rate is zero. The point I’m trying to make is that exaggerating risk does not help anyone to deal with it.

Fiction 2. Quarantine will stop the disease. Imagine two different scenarios. You feel the first twinges of something that could be flu. In the first scenario, you go to the hospital, get tested, receive free medication, your whole family and all your contacts are tested and also receive any necessary medication. People who see how you were treated are also alert to any sign of flu and go to get treatment as fast as possible. In the second scenario, you go to the hospital, and get tested. Then you’re quarantined for an unspecified length of time, your family is quarantined and unable to go to work, pay the rent, go to school, or do anything they have to do. The money spent on finding and quarantining you and yours is not available to provide an adequate supply of drugs. Obviously, in the second case you’ll rush to the hospital at the first sign of flu. Not.

Quarantine is useful in some situations that epidemiologists know all about. They’ll tell you when quarantine is necessary. Really, they will. Public hysteria is never useful.

Fiction 3. I’ll take Tamiflu and save myself! No, you won’t. Save yourself, that is. Here’s why.

Flu viruses mutate. Flu viruses mutate a lot. They develop resistance to antivirals incredibly fast, much faster than bacteria do to antibiotics. Way back in 2005, in the bird flu days, this was already a problem, and Tamiflu had barely been invented. Flu viruses are growing resistant to antivirals: “…in a special online edition of The Lancet, scientists at the Centers for Disease Control and Prevention reported that 12% of influenza A strains worldwide have developed resistance to the most widely used flu medications.” (That referred to A-series, not H-series, viruses and not to Tamiflu specifically, but the principle is exactly the same.)

So, by trying to take care of number one, instead of everyone, we’ll end up breeding resistant disease, potentially in a matter of weeks, and we’ll all be defenseless, including the people who took it “preventively.”

When is it sensible to take an antiviral? When it is part of the public health measures to contain an outbreak. On an individual level, it’s prescribed preventively when you or someone you live with has a diagnosed case of flu. This is the main reason why outfits like the CDC don’t stock enough doses of antivirals for “everyone.” We don’t need enough for everyone. We need enough to blanket regions with outbreaks, and we need those viruses not to be already resistant to the only drugs available because people have been using them wrongly.

Another consequence of viruses’ rapid mutation rate is that new lethal strains appear all the time. Case in point, H5N1 bird flu in 2005, H1N1 swine flu in 2009. That’s another reason why quarantine, by itself, doesn’t solve the problem. All you’re doing–if it works!– is putting out brush fires, while the viruses keep pouring on fuel just out of reach.

So, that’s what not to do. What are the sensible things that actually work?

First and foremost: vaccines. Obviously, we don’t have a vaccine for this new strain yet, and it’ll take several months before we do. Once it’s available, that’s the most effective protection and the best way to stop the spread (since the virus can’t hop from person to person as easily).

Once there is a vaccine, there’s a useful priority list as to everyone’s place in the line. It really helps to control the spread if people help with that. The most vulnerable people need to go first because they’re the likeliest to catch it and, therefore, to spread it. That puts everyone in greater danger. The priority is, more-or-less in order, frontline public health workers (nurses, ambulance drivers, and the like); school-age and day care-age children (the main vectors); the elderly, infants, and the immune-suppressed; people who deal with the public a lot (teachers, hairdressers, police, funeral workers, and so on), and, finally, the rest of us.

The next most useful thing is not to spread virus particles around. (I mean, duh, right?) The problem is we still don’t really know how they’re spread. The CDC thinks droplet infection (i.e. by air) is an important route. Other research points to touch as the main route. E. g. a BBC report on a study by Oxford & Lambkin, Journal of Infection, August 2005, pages 103-9.

One proven source of droplet infections is airplane trips. Since air travel is by far the biggest way viruses hop continents and spread long distances, I’d say that forcing the airlines to deal with their bad habits is right up there with vaccination as an important preventive measure. The airlines really are part of the problem. It’s not just a matter of many people in close proximity for a long time. The airlines save money by recirculating air without filtering it well enough, by keeping the air too dry because that’s cheaper, and by keeping its oxygen content too low, likewise because that’s cheaper. Airlines should be kicked, repeatedly, until they do what is necessary for the safety and health of their passengers and flight attendants.

For the rest of us, however, the most effective ways to stop the spread are:

1) Stay home at the first sign of sickness. That, up to the point when the disease peaks, is the time of highest infectivity. (I know. The feeling tends to be, “I’m already sick. I can’t get any sicker. And I’m sure not wasting any days off on this.” Or, “I have an exam. I have to go to class.” It’s another case where worrying about number one makes it worse for everybody, including eventually number one.)

2) Wash your hands or use alcohol wipes after touching doorknobs, phones, toilet handles, and anything else touched by many different people. Basically, you should be cleaning your hands about six times a day. The next most important thing is cleaning and disinfecting surfaces that are touched often (counters, phones, desks, etc.). The virus is activated when virus-laden fingers touch our mouths, nose or eyes. It is truly amazing how difficult it is not to touch one’s face, and how unconscious and automatic the process is. One of the interesting effects of wearing rubber gloves is that you find out how often you touch your face. Most face masks are useless for stopping viruses. Viruses are tiny. They’re just big molecules, after all. Any face mask that is easy to breathe through has a pore size that looks like chicken wire to a virus. However, what face masks can do, and do very effectively, is stop you from touching your nose or mouth.

So, as the hysteria mounts in the next weeks and months (unless we’re lucky and this bout is caught early enough so that it fizzles) remember what you know. There’s no need to shoot the postman. It wouldn’t help anyway. There’s no need for any heroic high noon standoffs at the OK Corral pharmacy for the last magic pills. Just wash your hands and don’t panic. (If you need to do something violent, kick the airlines.) And tell everyone you know to do what works instead of what feels good.

Update April 26, 5 pm: Then again, the BBC has a series of very worrisome comments from a whole series of people in Mexico City and Oaxaca, many of them health professionals. Not good.

Crossposted to Acid Test, Shakesville. Technorati Tags: , ,


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48 Responses

  1. When my son, Peter was an infant we had an outbreak of the Swine Flu – I didn’t want to get the shot but friends told me I ” had to to protect the baby” – ok, so I was guilted into it and have never been the same since – I was strong, healthy, no allergies, but when I got the shot I became very ill – honestly thought I was going to die and leave a motherless child – but since I’ve had a bronchial condition.

    So, I am very hesitant to take any kind of widespread, government sponsored inoculations.

    • I got really sick the one time I had a flu shot. I haven’t taken one since.

    • I developed peripheral neuropathy in my legs after several years of getting flu shots. This condition was extremely painful, like having flame throwers attached to my ankles much of the time, and in more comfortable moments, Bic lighters and Velcro. My arms were also affected, but less seriously. I found my own remedy (a combination of Neurontin and Ultram) on an online message board after any number of medical professionals failed to give me any relief. The discomfort has long been reduced to a faint burning sensation. I’m convinced that the flu shots were implicated and I’ll never go near one again.

  2. Wasn’t it Swine Flu that scared everyone back in 1974 or so? I was a poor student at the time and don’t remember the technical reasons for the worry. Did anyone die of it back then? I don’t think it developed into a serious problem….

    • Yes, Peter was about 4 months old – I don’t remember if anyone died. But I do remember Pres. Ford repeatedly urging everyone to get the shots.

      • the swine flu was in the fall of 1976. Carter had just been elected but hadn’t taken office yet.

  3. Joanelle, how many years ago was that? They used to use live flu vaccine which could, in susceptible people, cause a case of flu. Genetic engineering in the last fifteen years or so has moved the whole vaccination field by a couple of light years. Live flu vaccine issues aren’t there any more.

    Also, it’s not impossible that you may have had some different infection that had nothing to do with the vaccine, except that it happened at the same time. Any chance of that?

    I can’t begin to describe how thoroughly vaccines are tested. The fear of them has really been whipped up by media outlets looking to increase viewership. It’s really that simple.

    And I’m not just saying that as a scientist. One of my degrees is in Naturopathic Medicine. (It was a 3-year, med school-type program in Germany.) I’m *very* sympathetic to alternative medicine. But the vaccine fear really is bogus.

  4. katiebird, swine flu could come in any number of forms. Nothing to stop the 2009 one from being superbad, or the 1974 one from being no big deal. I don’t remember it myself. Wasn’t paying attention, I guess.

    • I guess it could be quixote, I just remember being realllllllly mad :x: because I was fine and with a day or so of getting the shot I was reallllly sick.

  5. Thanks for the post, quixote.

    I was just reading this piece, “Contagion on a Small Planet,” from NYT:

    http://dotearth.blogs.nytimes.com/2009/04/26/contagion-on-a-small-planet/

    I’ve been reading the swine flu news and thinking about how we respond to natural disasters (from hurricanes to pandemics) in densely populated areas. Mexico City’s population is almost 9 million; Los Angeles has almost 4 million. How do we create sound policies in communities so large, with so much movement of people?

    Here’s a quote:

    “Disaster experts have been warning that the world, because of the fast-rising density of human populations, needs to work now to avoid high death tolls in inevitable natural disasters. Public health experts similarly warn that vigilance and speed in tracking and responding to disease outbreaks will be vital to limit the chances of a pandemic.”

    • Here’s a link to a potential “Hog Farm Zero” as the source of this flu outbreak. Smithfiled Farms huge operation in Mexico.

      http://www.grist.org/article/2009-04-25-swine-flu-smithfield/

    • I’ve used homeopathic flu remedies very successfuly for 18 of the 20 years I’ve been in practice. Unlike the flo shots, these products ALWAYS contain the flus that actually go around.
      Heel/Bhi make Flu Plus, Guna make Guna flu and and Bioron has a product occillicoccinum. They are all from the same source, I happen to prefer the larger tablets from Heel

      They may be taken prophylactically or, if you get sick,get on the couch and have a tablet in your mouth constantly until you’re well, about 4 hours.

      • I’ve used Ossillicocinum very successfully over the years. I’m glad to hear that they are good preventives.

        • Is that OTC? I did a pretty good job of knocking out round two of this respiratory flu with a full day of Airbornne every four hours.

  6. I think I read that, at least in Mexico, this virus was mainly hitting those who should be in prime heatlh, i.e. between ages 20 to 40. And then include the h.s. kids in N.Y. So it seems this virus is hitting a group that’s usually not that susceptible to the flu.

    • The Spanish Flu of 1918 had a similar pattern. Most of the deaths are thought to have been caused by “cytokine storms” – an extremely intense immune system response to the infection. As I recall, the Hong Kong flu of 68 and 69 had a similar pattern. That was the only time I caught honest-to-God influenza (rather than the variety of miscellaneous mild viral infections that often get called “flu”). I was 13 and it pretty much wiped me out for 2 weeks or so (and I wasn’t 100% for a good month after that). One high school kid in my town died.

      • One small point — or maybe not so small — about cytokine storms is at this point we have immune system suppressants that might prevent fatalities. They didn’t have those in any of the previous nasty outbreaks.

  7. IIRC it was June when Captain Trips started.

    It wasn’t 100% fatal either.

  8. Not intending this to be taken seriously, but anyone remember reading Stephen King’s The Stand ?

    • Beat ya to it

      • Yep you did!! But I was thinking about it last night when watching news.

        Ever since reading that book (and seeing the movie) whenever they’ve used that term pandemic I think about that book!

    • Heh, The Stand scared the crap out of me. I remember the beginning vividly — how do you do something like just get out of NYC in the middle of a pandemic?

      The Walking Dude was an amazing character.

      • (nodding quickly)

        Those opening chapters were great. The whole book was good. But, the set-up was REALLY good.

        • King did a pretty good job showing how some “good” people can be lured into the service of evil.

          All you have to do is convince them it’s “law and order” that they’re supporting and they’ll torture and murder.

  9. A lot of people believe that the 1918 influenza pandemic started about 100 miles from my house at Camp Funston (part of Fort Riley).

    I think the fact (or assumed fact) that such a thing could develop so close to where I live is one of the reasons I’m always interested in the origin of pandemics.

  10. pardon me if this is redundant…

    10 NZ students in quarantine
    http://news.yahoo.com/s/ap/20090426/ap_on_re_au_an/swine_flu_world

    4 cases reported in Canada
    http://www.google.com/hostednews/afp/article/ALeqM5hc-80Bn2Vjdk0Z0XotES4F_ml8Wg

  11. Last night, there were reports of 8 students here in NYC that were diagnosed with it.

    http://www.cnn.com/2009/HEALTH/04/26/swine.flu.ny/

  12. Thanks for another great post, Quixote!

  13. One thing to remember when seeing media reports of people being diagnosed with flu in NZ, Canada, Timbuktu, and Wherever, is that you want to take them with a grain of salt. There’s “ordinary” flu going around too. Distinguishing that from H1N1 takes very specific tests. People are being super-careful right now, as they should be!, but propbably not everyone with suspected H1N1 is going to prove to have that.

    The CDC site (http://www.cdc.gov/swineflu/investigation.htm) (which I also linked in the post) has the latest numbers, and a link to a WHO site for other countries. That link didn’t work when I tried it, probably because half the planet is hammering their poor server.

    • the Canadian health officials have confirmed the reports. i would assume they performed the correct tests (as they did with the Mexican samples)?

  14. After SARS and the Bird/Avian Flu attempts to terrify the world, it’s hard to take the CDC and the media seriously.

    My cynical view of the media has me wondering what subject they are trying to cover up with this story.

    Wash your hands.

    • (Just to be fair, it wasn’t the CDC who was being gonzo. The media loves to gin up viewership with panics. You really can get good info from the CDC. Honest. I say that as a scientist who can read their statistics and see if they make sense. Well, sometimes I can. Sometimes it’s way beyond me.)

      • Well, I watched a short interview with a CDC official on Friday, I think it was. I was not convinced. We used to be able to get good information from the FDA, too.

        There is enough going on that we, the public, “needs” to be distracted from that I’m just cynical. The flu that’s been going around over the past couple of months in my area has hit every single person I know, and twice. Didn’t raise an eyebrow.

  15. There are 2 confirmed cases here at a local high school (Cibolo – about 20 miles outside of San Antonio), and another kid got sick yesterday.

    They’ve shut down that high school, and we are all waiting to see if it pops up in any other schools.

    • Is that a higher rate of sharing than other flu outbreaks? I work with 3 people, and regularly spend time with 9 others. Every single one of us has had the respiratory flu that has been going around…we didn’t just get it once, we got it twice (so far). It’s miserable.

  16. I just remarked to my husband..” you don’t know whether to believe them or not.” How sad that we feel this way about our government.

  17. Extraterrestrial life makes more sense than flu.

    Galaxy’s centre tastes of raspberries and smells of rum, say astronomers

    http://foxyurl.com/cx

    Astronomers searching for the building blocks of life in a giant dust cloud at the heart of the Milky Way have concluded that it tastes vaguely of raspberries. […]

    Finding amino acids in interstellar space is a Holy Grail for astrobiologists, as this would raise the possibility of life emerging on other planets after being seeded with the molecules.

    In the latest survey, astronomers sifted through thousands of signals from Sagittarius B2, a vast dust cloud at the centre of our galaxy. While they failed to find evidence for amino acids, they did find a substance called ethyl formate, the chemical responsible for the flavour of raspberries.

    “It does happen to give raspberries their flavour, but there are many other molecules that are needed to make space raspberries,” Arnaud Belloche, an astronomer at the Max Planck Institute for Radio Astronomy in Bonn, told the Guardian.

    Curiously, ethyl formate has another distinguishing characteristic: it also smells of rum.

    Last year, the team came tantalisingly close to finding amino acids in space with the discovery of a molecule that can be used to make them, called amino acetonitrile.

  18. If I got the old swine flu shots back as a kid in the 70s, does it give me any coverage?

    • No, unfortunately not. The flu vaccines have to be precisely tailored to the specific strain, and, although I don’t know this for a fact, I’d be amazed if this was exactly the same beastie.

      It’ll take them a few months to come up with the tailored vaccine. 😦

      Meanwhile, a vaccine for a related flu virus (ie any H-series virus probably) will likely reduce the severity of an infection if it does happen.

  19. Dakinicat–I’ve been wondering the same thing. I didn’t find anything about the 1976 swine flu vaccine so far on the CDC site. Didn’t hear any questions asked about it at today’s press conference.

    And, to be truthful, I don’t know if I actually got the shot. I think I did…. I know I had not Guillaume-Barre (sp?) reactions.

    Re: regular flu shots — I’ve been taking them since the early 90’s. After two winters in a row of getting “something” that was awful, which lasted about 6 weeks, then getting something similar again two weeks later, I decided to see if I could at least rule out one possible cause. The first year It didn’t seem to work all that well, but since then I’ve had fewer and fewer bad colds/flus. And, gradually, fewer really prolonged, really bad sinus infections.

    If I have fewer colds/flu incidents, I seem to be able to fend off the really bad sinus infections.

    With the newest generation of wee ones in our family, however, I’ve had more whatevers. Don’t last as long, thank goodness.

  20. I’m also hoping that not everyone who thinks s/he has swine flu is correct. My husband and I had the regular flu in Feb/March, and we each had about five-six days of “feel I could die” before it passed off without any permanent problem.

  21. Jesus, the only flu shot I ever got was in 1995 or thereabouts. Not only did I NOT get the flu, but I didn’t even get a cold for about six years afterwards.

    My immune system is weird.

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