Swine Flu outbreak

GreNME said:
All I can say is :rolleyes:

Listen, actual experts on infection are still being circumspect as to the actual threat the flu poses, and are instead focused on diminishing its spread. Complain about appeal to authority if you want, but in this case the authorities trump your Google-fu any day of the week, and their focus is not on the risk of having the infection, it's on the effort to keep it from spreading. The perceived risk out there right now and the actual risk being addressed by authorities are worlds from each other, and I find attempts to reconcile the two more than a little unnecessary and ridiculous.
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Which "authorities" are contradicting what I've said.

What is it about 'not enough data for a conclusion' that you are having a hard time understanding?
 
paximperium said:
It has already met common epidemiological definition of Pandemic.
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I almost think WHO is waiting to make it level 6 because going directly from 4 to 6 would have made it look like either their level designations were not useful or they were late in upping the risk from 4. They are pretending there is actually a 5th step in there. ;)


Think about the following time line and the evidence for how many cases are not in the official count. When this is over there is going to be an incredible amount of epidemiological data to analyze. The public is so expecting instant doom or there must be no threat. They seem to have little clue about the implications of how fast this strain has spread or about what such a pandemic should look like through observation tools never before seen in history.

I've posted links to this data or other people have in past posts so I'm not going to put cites for all the facts here.

The first inkling of this new strain entering the population occurred in early March when a town in Mexico, La Gloria, experienced widespread serious upper respiratory infections and 3 kids died. A small number of samples were recovered after the number of cases subsided and were positive for the new flu strain.

A woman with a job going door to door in the vicinity of La Gloria developed pneumonia with the onset of illness around the first week in April. She eventually died in Mexico City on April 13th.

An amplifying event occurred with a Mexican holiday, Semana Santa, the week of April 5th to the 12th when many people in Mexico travel in Mexico.

A second amplifying event probably took place during Spring breaks for US colleges when lots of students travel to Mexico and return to mix with large clusters of fellow students. This year's breaks began the week of February 16-20. The largest number of colleges were off March 16-20, the second biggest group, March 9-13 and the last break was April 6-10, 2009. Perhaps only the last week or two of travelers were affected.

There is continual travel between Mexico and the US because we have such a large overlapping population.

Swine-Origin Influenza A (H1N1) Virus Infections in a School --- New York City, April 2009
On April 24, 2009, CDC reported eight confirmed cases of swine-origin influenza A (H1N1) virus (S-OIV) infection in Texas and California (1)

On April 23, DOHMH was notified of approximately 100 cases of mild (uncomplicated) respiratory illness among students at an NYC school (high school A) with 2,686 students and 228 staff members. During April 23--24, a total of 222 students visited the school nursing office and left school because of illness. Given initial reports on April 24 of what was later determined to be a large S-OIV outbreak in Mexico, DOHMH decided to rapidly mobilize staff members to go to high school A to collect nasopharyngeal swabs from any symptomatic students. On April 24 (a Friday), DOHMH staff members collected nasopharyngeal swabs from five newly symptomatic students identified by the school nurse and four newly symptomatic students identified at a nearby physician's office.

Four patients reported travel outside NYC within the United States in the week before symptom onset, and an additional patient traveled to Aruba in the 7 days before symptom onset. None of the 44 patients [interviewed by phone] reported recent travel to California, Texas, or Mexico.

Illness onset dates ranged from April 20 to April 24; 10 (23%) of the patients had illness onset on April 22, and 28 (64%) had illness onset on April 23 (Figure). The most frequently reported symptoms were cough (in 43 patients [98%]), subjective fever (42 [96%]), fatigue (39 [89%]), headache (36 [82%]), sore throat (36 [82%]), runny nose (36 [82%]), chills (35 [80%]), and muscle aches (35 [80%]). Nausea (24 [55%]), stomach ache (22 [50%]), diarrhea (21 [48%]), shortness of breath (21 [48%]), and joint pain (20 [46%]) were less frequently reported but still common. Among 35 patients who reported a maximum temperature, the mean was 102.2°F (39.0°C) (range: 99.0--104.0°F [37.2--40.0°C]). In total, 42 (95%) patients reported subjective fever plus cough and/or sore throat, meeting the CDC definition for influenza-like illness (ILI) (2). At the time of interview on April 27, 37 patients (84%) reported that their symptoms were stable or improving, three (7%) reported worsening symptoms (two of whom later reported improvement), and four (9%) reported complete resolution of symptoms. Only one reported having been hospitalized for syncope and released after overnight observation.
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Per WHO's last update, "30 April 2009 -- The situation continues to evolve rapidly. As of 17:00 GMT, 30 April 2009, 11 countries have officially reported 257 cases of influenza A (H1N1) infection."

Now there are a couple important things to point out here. One is the short time span. In 2 months or maybe 2.5 or so this infection went from the first patient to world wide early phase pandemic. That's really really fast.

Compare that to SARS which festered in Guangdong China for 4 months (Nov, 2002 to Feb, 2003), broke out into Hong Kong in March and spread from Hong Kong to 18 countries in April but only Canada and the US had clusters of cases outside SE Asia. The other countries merely had citizens who were infected elsewhere and became ill after arriving home.

In addition, with SARS, most cases could be connected.

The second important thing to consider is how many people are really infected here. The NY school came to the attention of health authorities because so many kids were ill at the same time, ("222 students visited the school nursing office and left school because of illness"). Only 7 were tested, ("DOHMH staff members collected nasopharyngeal swabs from five newly symptomatic students identified by the school nurse and four newly symptomatic students identified at a nearby physician's office") That doesn't mean only 44 of the 222 kids had swine flu. By case definition, most if not all of them met the definition of a probable case.

And these were not kids who went as a group to Mexico. So on April 20th there were 10 sick kids and by 3 days later the total had reached 222 out of a population of 3,000.


To anyone who looks carefully at this evidence and understands the epidemiology we are seeing here, this organism is incredibly contagious. The absence of known exposure sources in many cases suggests many undetected infections. The speed of spread is unusual even for influenza.


We still don't have much of a clue how many serious illnesses we are going to see. It could be that because we have never tracked seasonal flu in this much detail, that there are many more mild cases of influenza during flu season than are typically recognized. To conclude nothing is going to come of this in the way of serious illness is naive.

At a minimum staffing shortages and closed businesses are going to affect lots of people. I wrote a sick leave policy yesterday and I started adding it up and the hospital I was writing it for is going to have some serious issues. If you are exposed to sick family members, you have to stay home. If the schools close some workers will have child care issues. If workers are ill, they can't return for 7 days even if they feel better. This is going to be a mess even if only a few serious cases occur.

There is already a local shortage of both Relenza and Tamiflu if you want to buy some to dispense from your office practice. I'm not sure how the supply is for filling individual prescriptions. Public health is triaging prophylaxis and treatment. If you are seriously ill or have a high risk condition, you get treated. If it's mild or you've been exposed but you don't have specific risks, no prophy for you. I think health care workers can get prophylaxis, but not if there is none to be had. The Feds are being quite stingy. I say they didn't stockpile enough. Hopefully this pandemic will be a nice dry run to see what problems we might encounter when a more lethal phase or strain comes around.
 
WildCat said:
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I'm not inhumane, I'm realistic. Flu happens every year, and unless you're very old or very young or otherwise in poor health it's not going to kill you.....
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Maybe you should take the time to check that fact. Because it is not correct.
 
GreNME said:
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So, yeah, there's cause for concern. But panic? ....
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Not sure what people are doing where you live but I haven't seen any evidence of panic here other than a few extra 'worried well' going to the ED who didn't need to be there.
 
I Ratant said:
Watching the young Hispanic kid puking his guts out into the shrubbery at the Mall this afternoon, while Papa waits for him to finish, so they can continue -into- the Mall....
Is cluelessness a prosecutable crime?
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How many people have you seen out and about with their sick kids in tow? It is certainly not confined to Hispanics.

I would have said something, race wouldn't have been relevant. I'd have said take the kid home, haven't you heard there is a flu outbreak?
 
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alfaniner said:
Guy next to me tonight was talking about how deathly ill he was last weekend, said he didn't bother reporting it because then he knew CNN would be right at his door. I think there may be lot of other cases like that. Of course, he was still hacking so I'll probably be off the Forum in the next few days...
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Interesting. I hope you don't get sick.
 
skeptigirl said:
Maybe you should take the time to check that fact. Because it is not correct.
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Maybe you could offer some facts?

Only case of a death in the US was a 2 year old. Do you have an age/health breakdown of the only other deaths in the entire world, the 7 in Mexico?

I've seen no evidence at all this is any deadlier than any other strain of flu.
 
WildCat said:
Maybe you could offer some facts?

Only case of a death in the US was a 2 year old. Do you have an age/health breakdown of the only other deaths in the entire world, the 7 in Mexico?

I've seen no evidence at all this is any deadlier than any other strain of flu.
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That's because, so far, it's not. On the way to work today there was yet another health department spokesperson being questioned on NPR, and they even pointed out that there is no indication yet that this flu virus is any more severe than seasonal flu, and that what they are concerned with gaining a measure of control over is the spread of the infection (which I already said yesterday).
 
skeptigirl said:
Which "authorities" are contradicting what I've said.
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Um, no. I'm not getting into a semantics game with you again. There is far less cause for concern than is being promoted by many in this thread, including yourself. The main concern is that health professionals take part in the reporting of suspected cases, swabbing when able to send in for testing (and tracking), and for the most part containment of the spread. Neither the CDC nor the HHS are focusing on H1N1 in terms of being deadly, they are focusing on slowing the spread.

skeptigirl said:
What is it about 'not enough data for a conclusion' that you are having a hard time understanding?
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Someday, I hope you learn that not everyone who finds fault in the way you frame things is suffering from a lack of understanding. It not only might greatly improve your worldview, but it would make your posts come off as far less pretentious.

skeptigirl said:
Not sure what people are doing where you live but I haven't seen any evidence of panic here other than a few extra 'worried well' going to the ED who didn't need to be there.
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Here in Dallas everyone is pretty much dealing with it, even taking into account the various school closings. That's a good sign, and it means that the majority of people aren't buying into the fear-mongering from the media or getting too worked up about those seemingly focused on making this infection sound more dangerous than it actually is. The only health-related official I've heard so far today has said essentially what I stated in the previous post (in the text you seem to have ignored):

"The danger in this flu outbreak-- what is making it a pandemic-- is that it's exotic enough that there is not much general resistance to it and people tend to get hit pretty hard and fast when such strains pop up. Combined with the absolute horrid healthcare for people with not-a-lot of money-- and I guarantee you that nearly everyone who dies from this is going to be lower-middle- or working-class-- this means that the fast spread of an exotic virus requires a strong reaction from health control organizations to prevent it from actually becoming dangerous. It's not very dangerous right now, though there are the same risks any bad flu virus has, but if the spreading of this disease is not managed efficiently it has the potential to become dangerous at some point, mostly due to complications and not the influenza itself."

The only part of that quote from my previous post that was not addressed by the health spokesperson (which I found was the CDC's Anne Schuchat) was the state of healthcare, which is a political issue that they rightly steered clear of due to the unnecessary baggage it would carry, and instead focused on the goal of slowing and containing the spread of infection.

For those who want accurate information, simply check out the CDC's site and their Swine Flu and You entry, where they even point out that their goal at this time is to reduce the rate of its spreading. HHS has a similar site at pandemicflu.gov set up with similar question-and-answer pages for people who are trying to figure out how concerned to be. The overall consensus so far from both the CDC and HHS has basically been "be concerned enough to avoid catching the flu, but if you get it treat it like you would seasonal flu, and take care."
 
A theory presented to me by my assistant: that those in the otherwise healthy demographic to have been killed by swine flu in Mexico may have also been suffering from (perhaps undiagnosed) silicosis from working in a textile plant sandblasting denim.

http://www.nzma.org.nz/journal/121-1273/3032/
 
Thanz said:
A theory presented to me by my assistant: that those in the otherwise healthy demographic to have been killed by swine flu in Mexico may have also been suffering from (perhaps undiagnosed) silicosis from working in a textile plant sandblasting denim.

http://www.nzma.org.nz/journal/121-1273/3032/
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Too complicated. Most of the time what happens is that a flu virus hits an otherwise healthy person rather hard, they don't seek medical attention early on (thinking it will pass), and they develop worse conditions like pneumonia or something similar that does them in.
 
WildCat said:
Maybe you could offer some facts?
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I have WC, over and over. But since some people were having a hard time evaluating those facts, I thought perhaps if you tried active learning instead of passive there might be a different outcome.

WildCat said:
Only case of a death in the US was a 2 year old. Do you have an age/health breakdown of the only other deaths in the entire world, the 7 in Mexico?

I've seen no evidence at all this is any deadlier than any other strain of flu.
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So then it should be expected to kill 35,000 people this year.
 
GreNME said:
Um, no. I'm not getting into a semantics game with you again. There is far less cause for concern than is being promoted by many in this thread, including yourself. The main concern is that health professionals take part in the reporting of suspected cases, swabbing when able to send in for testing (and tracking), and for the most part containment of the spread. Neither the CDC nor the HHS are focusing on H1N1 in terms of being deadly, they are focusing on slowing the spread.



Someday, I hope you learn that not everyone who finds fault in the way you frame things is suffering from a lack of understanding. It not only might greatly improve your worldview, but it would make your posts come off as far less pretentious.



Here in Dallas everyone is pretty much dealing with it, even taking into account the various school closings. That's a good sign, and it means that the majority of people aren't buying into the fear-mongering from the media or getting too worked up about those seemingly focused on making this infection sound more dangerous than it actually is. The only health-related official I've heard so far today has said essentially what I stated in the previous post (in the text you seem to have ignored):

"The danger in this flu outbreak-- what is making it a pandemic-- is that it's exotic enough that there is not much general resistance to it and people tend to get hit pretty hard and fast when such strains pop up. Combined with the absolute horrid healthcare for people with not-a-lot of money-- and I guarantee you that nearly everyone who dies from this is going to be lower-middle- or working-class-- this means that the fast spread of an exotic virus requires a strong reaction from health control organizations to prevent it from actually becoming dangerous. It's not very dangerous right now, though there are the same risks any bad flu virus has, but if the spreading of this disease is not managed efficiently it has the potential to become dangerous at some point, mostly due to complications and not the influenza itself."

The only part of that quote from my previous post that was not addressed by the health spokesperson (which I found was the CDC's Anne Schuchat) was the state of healthcare, which is a political issue that they rightly steered clear of due to the unnecessary baggage it would carry, and instead focused on the goal of slowing and containing the spread of infection.

For those who want accurate information, simply check out the CDC's site and their Swine Flu and You entry, where they even point out that their goal at this time is to reduce the rate of its spreading. HHS has a similar site at pandemicflu.gov set up with similar question-and-answer pages for people who are trying to figure out how concerned to be. The overall consensus so far from both the CDC and HHS has basically been "be concerned enough to avoid catching the flu, but if you get it treat it like you would seasonal flu, and take care."
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I repeat, what is it about "not enough data" for any conclusion this is bad or not bad makes you insist I am concluding it is bad?

Just to be as clear as I can, at this point I have concluded:
  • This swine flu strain is highly contagious, widespread and work absenteeism is going to be a significant problem.
  • All influenza disease has the POTENTIAL to kill thousands including less pathogenic strains.

That's it. So quit posting as if I've said anything else regarding a current hazard assessment.
 
Thanz said:
A theory presented to me by my assistant: that those in the otherwise healthy demographic to have been killed by swine flu in Mexico may have also been suffering from (perhaps undiagnosed) silicosis from working in a textile plant sandblasting denim.

http://www.nzma.org.nz/journal/121-1273/3032/
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Is there evidence that those who died of swine flu worked at such a plant?

Seems like it'd be a simple enough matter to eliminate or confirm this theory.
 
skeptigirl said:
I repeat, what is it about "not enough data" for any conclusion this is bad or not bad makes you insist I am concluding it is bad?
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Mainly two things: you're being disingenuous about the data that is available, and the fact that for every poster who says something to the effect of "nothing much to be worried about" you feel the need to swoop in and 'correct' them. In reality, there isn't a great deal to worry about. The CDC just today made a statement pointing out that most of the reported cases have been classified as mild in the US.

skeptigirl said:
Just to be as clear as I can, at this point I have concluded:
  • This swine flu strain is highly contagious, widespread and work absenteeism is going to be a significant problem.
  • All influenza disease has the POTENTIAL to kill thousands including less pathogenic strains.

That's it. So quit posting as if I've said anything else regarding a current hazard assessment.
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And just to correct your disingenuous claims one more time:
  • This strain is no more contagious than seasonal influenza strains. The difference is that it's exotic and few people have a resistance built up.
  • Influenza regularly kills at least a few thousand Americans every year, mostly due to complications and lack of healthcare. The current strain out there has exhibited no greater danger, and in the United States the cases have been comparatively mild on the whole.

There is absolutely no reason to be focusing so damned hard on "potential" risks when the data that is currently available is repeatedly pointing to this outbreak being of a relatively average strength influenza at worst. The focus should be the same as the CDC has been stressing: help to keep it from spreading. For professionals in the medical field, the CDC and HHS are also asking for as accurate as possible recording and reporting. HHS is advising all parents to encourage hand-washing and general infection avoidance for children, but is not encouraging people to run and hide-- and if a child gets sick, the parent is encouraged to bring them to the doctor to help contain the spread. Whether checking the WHO, the CDC, or general HHS press releases, the ongoing consensus has been that it is not the influenza pathology itself that is the primary concern, it's controlling the spread that is the goal. That's why none of those agencies-- WHO, CDC, or HHS-- have condoned travel restrictions and are very careful to not encourage (and have tended to discourage) areas infected to close schools and businesses completely.

To add to the other links I gave earlier from the CDC and HHS, I'll also add the WHO rss feed to the list for those interested. There's plenty of prescriptive information out there.
 
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