Are you ready for pandemic flu?

[Guest]

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[Wood Fairy Glenda]

 

[TheTatiana]

I've seen many items and comics like that saying essentially "What's the big deal?"  The big deal is not what has happened so far.  It's what can be expected to happen in the near future.  A pandemic IS a big deal, because almost nobody has any immunity to it at all.  It's completely different than regular seasonal flu.  We're very lucky that so far this one has been mild.  The reason it's a big deal is that there's no guarantee it will stay mild, and the sheer numbers of cases during a wave overwhelm any infrastructure set up to handle them.

[karlynwagner]

IS A PANDEMIC A BIG DEAL???

The WHO's askew flu fears
The World Health Organization has apparently redefined 'flu pandemic' to reflect popular angst, as well as its own.

By Michael Fumento
June 14, 2009
The Los Angeles Times

How bizarre! The World Health Organization has declared swine flu a "pandemic," signaling governments worldwide to launch emergency response plans.

The mildest pandemics of the 20th century killed at least a million people worldwide, according to the WHO's data, while old-fashioned seasonal flu strikes every nation yearly and kills an estimated 250,000 to 500,000. As of Thursday, when the pandemic was declared, H1N1 swine flu had killed only 144 people total -- fewer than succumb daily to seasonal flu annually. And in Mexico, where the outbreak began and where it has been the most severe, cases peaked quickly, in just four weeks.

A pandemic declaration will be costly when we can least afford it and could prompt severe restrictions on human activities (think China). Perhaps most important, such a declaration could render the term "flu pandemic" essentially meaningless -- risking lethal public complacency if a bona fide one hits.

So how can the WHO say swine flu qualifies as a pandemic? And why?

The WHO definition for "influenza pandemic" once required "several, simultaneous epidemics worldwide with enormous numbers of deaths and illness." But in 2005, it promulgated a definition that virtually ignores the number of cases and completely ignores deaths. Now it requires "sustained chains of human-to-human transmission leading to community-wide outbreaks" in two parts of the world, with this addition: The cause must be an animal or human-animal flu virus; the latter is known as genetic reassortment.

Thus, under this definition, "community-wide outbreaks" of swine flu in two South American countries and somewhere in China could qualify as a pandemic. No deaths required. And a pure human flu that killed 20 million people would not qualify.

The obvious presumption is that viruses with animal genes pose a greater threat. But that's "a matter of faith more than science," says James Chin, a UC Berkeley epidemiologist who was in charge of surveillance and control of communicable diseases at the WHO in the late 1980s.

Indeed, the science indicates the presumption is false. The WHO first warned of an H5N1 avian flu pandemic in 2004, projecting up to 150 million deaths. Yet a 2007 study found H5N1 -- though detected in 1959 -- was many mutations away from the ability to become readily transmissible among humans.

We're also repeatedly warned that if H5N1 reassorted with human flu, it would produce a combination with the alleged severity of the bird virus and the infectiousness of the human one. Yet a 2006 Centers for Disease Control and Prevention study found the opposite: that a genetically engineered reassortment given to ferrets -- the best animal models for human flu -- produced milder and less infectious flu than did pure H5N1. Reassortment didn't create a "super flu" but rather a 98-pound weakling.

As to human-pig hybrids, a 1976 New Jersey swine flu outbreak in the dead of winter, when flu is most contagious, infected just 230 soldiers, killing one, on a crowded Army base.

At some level, the WHO knows its definition is faulty. The online "WHO Handbook for Journalists" still states: "A pandemic virus can emerge" by adapting "during human infections." And the WHO has warned that one way avian flu could become pandemic is through a purely human mutation.

But it's also true that the worst influenza pandemic in history, the Spanish flu of 1918-19, did involve an animal-human hybrid virus; that episode has become a popular obsession. Never mind that "each subsequent novel flu that sweeps through the world has been milder," Chin observes. "The public health community keeps waiting for the second coming" of Spanish flu, he says.

So, in 2005, the WHO apparently redefined "flu pandemic" to reflect the popular angst as well as its own.

A less generous observation is that the WHO's "when, not if" avian flu pandemic failed to materialize, and it has now put swine flu in its stead. In her pandemic announcement Thursday, WHO's director-general, Margaret Chan, declared: "The world can now reap the benefits of investments over the last five years in pandemic preparedness." Not really. Swine flu, being no more contagious and far milder than seasonal flu, calls for absolutely no actions that wouldn't apply to seasonal varieties.

"I think they're going to have to go back to the drawing board," says Chin of the WHO definition. For now, we'll pay in told and untold ways because the WHO has cried "havoc" and let slip the dogs of pandemic.

Michael Fumento is director of the Independent Journalism Project, where he specializes in science and health issues.

[mejane]

Karen.........  

While influenza should not be taken casually, you have put perspective on this "hype."  Thank you for taking the time to post this valuable information.

Appreciatively,
Jane

[TheTatiana]

Hmmm, to me that article sounds like it was written by someone who completely misunderstands the meaning of "pandemic" which has nothing to do with severity of illness, nor with animal origins, but rather it has to do with whether the flu virus is novel enough that there is little to no immunity in human populations.  This can arise by mutation or reassortment, either one. 

Pandemic flu viruses tend to preferentially strike young healthy people.  Seasonal flu attacks mainly infants and the very old.  Pandemic flu comes in waves of cases, with many cases happening at once, due to the general lack of immunity.  Seasonal flu has sort of a background level of cases, peaking during the flu season (for reasons that aren't understood) but affecting only a small fraction of people at a time. 

If you look at how the numbers of cases have changed over time, the novel influenza A(H1N1) this year still is showing an exponential rise in number of cases, despite the fact that the emphasis in the countries with widespread outbreaks has shifted from counting cases to alleviating the effect of the virus in the community.  So there are likely many more cases than those reported.  This is not how seasonal flu acts.

I totally agree that we've been very lucky so far.  What I disagree with is the idea that there's nothing to fear, and the worries are groundless.  The 1918 pandemic was the worst one of the 20th century, but throughout human history there have been flu pandemics occurring at the rate of several per century.  Some are more severe and some are less so.  There's no trend, long term.  However, human society has changed since 1918 in ways that could make a bad one much worse now, e.g. higher population, more interdependence in the world economy, faster and more frequent world travel, just-in-time inventories at most production facilities, 3 days supply of food in grocery warehouses, fewer home gardens and less home production of food and goods in general, etc.  Disruption is likely, in that event, so it only makes good sound sense to be prepared.   

[Kay]

The big picture: 9 reasons to RE-worry about the (swine) H1N1 flu - and 7 things to do about it

http://www.sfgate.com/cgi-bin/blogs/gurley/detail?entry_id=44301#ixzz0Mp2YPXAJ

[Kay]

WHO warns of severe form of swine flu
http://news.yahoo.com/s/nm/20090829/hl_nm/us_flu_pandemic

By Maggie Fox, Health and Science Editor

WASHINGTON (Reuters) – Doctors are reporting a severe form of swine flu that goes straight to the lungs, causing severe illness in otherwise healthy young people and requiring expensive hospital treatment, the World Health Organization said Friday.

Some countries are reporting that as many as 15 percent of patients hospitalized with the new H1N1 pandemic virus need intensive care, further straining already overburdened healthcare systems, WHO said in an update on the pandemic.

"During the winter season in the southern hemisphere, several countries have viewed the need for intensive care as the greatest burden on health services," it said.

"Preparedness measures need to anticipate this increased demand on intensive care units, which could be overwhelmed by a sudden surge in the number of severe cases."

Earlier, WHO reported that H1N1 had reached epidemic levels in Japan, signaling an early start to what may be a long influenza season this year, and that it was also worsening in tropical regions.

"Perhaps most significantly, clinicians from around the world are reporting a very severe form of disease, also in young and otherwise healthy people, which is rarely seen during seasonal influenza infections," WHO said.

"In these patients, the virus directly infects the lung, causing severe respiratory failure. Saving these lives depends on highly specialized and demanding care in intensive care units, usually with long and costly stays."

MINORITIES AT RISK

Minority groups and indigenous populations may also have a higher risk of being severely ill with H1N1.

"In some studies, the risk in these groups is four to five times higher than in the general population," WHO said.

"Although the reasons are not fully understood, possible explanations include lower standards of living and poor overall health status, including a high prevalence of conditions such as asthma, diabetes and hypertension."

WHO said it was advising countries in the Northern Hemisphere to prepare for a second wave of pandemic spread. "Countries with tropical climates, where the pandemic virus arrived later than elsewhere, also need to prepare for an increasing number of cases," it said.

Every year, seasonal flu infects between 5 percent and 20 percent of a given population and kills between 250,000 and 500,000 people globally. Because hardly anyone has immunity to the new H1N1 virus, experts believe it will infect far more people than usual, as much as a third of the population.

It also disproportionately affects younger people, unlike seasonal flu which mainly burdens the elderly, and thus may cause more severe illness and deaths among young adults and children than seasonal flu does.

"Data continue to show that certain medical conditions increase the risk of severe and fatal illness. These include respiratory disease, notably asthma, cardiovascular disease, diabetes and immunosuppression," WHO said.

"When anticipating the impact of the pandemic as more people become infected, health officials need to be aware that many of these predisposing conditions have become much more widespread in recent decades, thus increasing the pool of vulnerable people."

WHO estimates that more than 230 million people globally have asthma, and more than 220 million have diabetes. Obesity may also worsen the risk of severe infection, WHO said.

The good news -- people infected with AIDS virus do not seem to be at special risk from H1N1, WHO said.

(Editing by Mohammad Zargham)

[Soriak]

Just a note for American Kivafriends: the seasonal flu vaccine should be available in the next few days. Walgreens in NY is offering it starting tomorrow (9/1) for $25.

There's some concern that swine flu and seasonal flu vaccines shouldn't be taken at the same time. So if you're planning to get the flu shot (which you should ), you shouldn't wait too long. That way it will be out of your system again by the time the swine flu vaccine is available, presumably in October. Given how quickly H1N1 is spreading, getting that vaccine makes a lot of sense, I think.

[Bastet]

I still find myself wondering how those of us who've already had the virus once will fare if it does come back to bite us this winter. Thanks to working with kids [I love them, but they're walking disease balls] I had a relatively severe case of the hamthrax - bad enough to have me off work for three weeks and needing chest scans and all the rest.

Guess we'll find out when the snow hits!

[charity]

I still find myself wondering how those of us who've already had the virus once will fare if it does come back to bite us this winter.

If it hasn't mutated your body should be able to fight it off  (http://www.nhs.uk/Conditions/Pandemic-flu/Pages/QA.aspx#twice).    And I would imagine you would have an upper hand either way, since I would think that even if the virus mutated it would be similiar enough that your body could fight it off relatively easily.