Swine-Flu-will-not-end-well

This will not end well

UPDATE 1 September 2009:

There continues to be good news about resistance to this flu among older folks. It is more and more likely that anyone who had the 1956 / 1957 flu will either not get the H1N1 flu (what they have decided to call this now) or will have a very mild case. Where ‘very mild’ is a matter of opinion…

My spouse had a flu a couple of months ago, as did her sister. Both had “fairly normal” flu symptoms. They would have had mild immunity from their mother, who had the 1956/57 flu the year or two before they were born (and recent antibodies are known to be passed from mother to offspring). And now both have had cases of pneumonia (successfully treated with antibiotics). They did not do an antigen test on it, but the odds are that, with H1H1 known to be in the schools here, and them being teachers, that’s what they had. I had the “scratchy throat / slight itch in the nose” that I get when some bug is trying to ‘move in’ and I’m killing it off. I probably have full immunity due to my having had such a strong dose of it in the 1956/57 season.

This is a very big deal, since the older folks are normally hardest hit. With those 50 something and over relatively immune, much of the speed and depth of contagion can be limited. Further, we’ve entered trials for an H1N1 vaccine for the next season AND some reports from China say it looks like it works with one dose (initial reports were that it took two to grant full immunity, why was not explained.) With luck, this will be distributed to all the “first responder” groups (Doctors, nurses, etc.) before the season gets going.

Basically, we are in a race condition between the H1H1 bug and the vaccine industry, and due to the slower than expected rate of spread (probably due to the partial population immunity) the vaccine industry is winning, by a nose ;-)

That folks who have gotten sick can be helped by antivirals has also helped reduce the speed and depth of the pandemic, letting the vaccine guys catch a break and pull ahead.

The one “bummer” in this is that the worst flu will tend to attack the lungs (as did the Spanish flu in 1918). It looks like this one does enough damage to make pneumonia more of a risk as a consequence. So if you do get a flu this winter, watch out for persistent cough afterward and don’t be bashful about asking “Could I be developing early stage pneumonia?”. One is also left with the “issue” that folks who die from a lethal pneumonia as a result of a bad flu case will not be in the statistics of H1H1 flu deaths. The statistics may skew the real risk.

One good note: Thanks to a handi-wipe jug in every car, and my spouse using a face mask as soon as she felt sick, the younger members of the household did not get sick. It is possible to contain this thing with modest measures like face masks and compulsive hand cleaning, along with a bit of pro-active isolation of the sick person to their bedroom during the worst of it.

We are now headed into the northern hemisphere flu season, I’m expecting an outbreak mid-winter; but it looks like we have a fighting chance of dodging the killer outbreak scenario.

UPDATE 11 June 2009: The “WHO” (World Health Organization) have finally declared “swine flu” a pandemic. After a bunch of trying to pretend that this was a more or less normal flu and everyone ought to stop panicking (generally a good idea anyway), they have finally stepped up to the truth. Good.

We have the Summer coming in the Northern Hemisphere (when flu slows down) and we have the possibility that folks who lived through the 1957 era flu may have some resistance, also good. I had that 1957 flu. Not Good. My fever was about 105 F to 106 F and I was hauled off to the hospital (after drinking a bunch of “Cheracol D” which in those days had Codeine in it… I was really spaced out from the fever…) If this flu is like that flu you don’t want it… I remember thinking that if this was what living was like, dying might not be that bad as an alternative. I was a bit spaced out …

It will be worth watching the southern hemisphere to see what happens there. They are off to an abnormally cold start to winter that does not bode well for flu outbreaks.

Update 5/8/2009: Mexico has announced that the acute epidemic is over and the U.S.A. has announce they will treat this just like any other flu. I wonder if this had anything to do with some countries announcing an embargo on U.S. pork and business in Mexico coming to a grinding halt? Nah, it couldn’t just be about the money … The latest figures from Mexico had the lethality rate down to 2% (but who knows how cooked those numbers are). Flu will often ‘take a break’ for the summer then come running back stronger next fall. This is not over by a long shot. The virus is still out there, spreading and mutating. The Spanish flu took a summer pause too… So while I would not be paranoid about it; stay careful. Hope that we get a pause. It could give enough time to get a vaccine made.

OLD: At this time CNN, Fox News, et. al. are reporting about 100 dead in Mexico City from the Swine Flu outbreak. This will not end well. They are reporting about 1600 sickened and about 100 dead so far for a lethality of 1 in 16 or about 6.25% so far.

UPDATE: The present (3 May 2009) statistics have this at closer to a 5% lethality and dropping. Many of the earlier reported deaths were later found to be due to other causes. The U.S.A. lethality is now at 1 out of about 100 mature cases (we have about 200 cases, but many are newly diagnosed and have not run their course.) So we can hope that the lethality will drop to 1% or less in a medically well served population with Tamiflu and related antiviral drugs along with high anti-oxidant levels. (Vitamin E and C help to absorb the free oxygen radicals released in a cytokine storm that is the mode of lethality of the flu. Just taking a couple of grams of Vit C and 400 units of E could well be enough to dampen the citokine storm to sub-lethal.)

Project that world wide (assuming about 6.77 billion population per wiki) and we are looking at about 423 million deaths. Think about that for a minute. Realize that you don’t want to be one of them…

UPDATE: If we can get the lethality down to 1%, this becomes 60 million. Still horrid, but much much better. Possible in the western world. I’m not so sure we can get vitamins, antivirals, and vaccines world wide fast enough. Frankly, folks in places like Somalia and Sudan are probably beyond help.

In the last 2 days, the US presence has moved from a couple of cases in San Diego and a few in Texas to cases in Ohio and New York City as well. We are doubling the number of cities involved each day. While there have been no deaths reported in the U.S.A. so far and the virus is reported to be treatable with a couple of antivirals (Tamiflu is one) there are not enough doses of the drug to treat the world and maybe not enough for the whole U.S. population.

UPDATE: We have now ( 3 May 2009 ) had one death in the U.S.A. The cases in Mexico have slowed down (but they were very proactive in handing out face masks and jumping on the contagion.) Our V.P. had it right with the “avoid enclosed spaces with crowds” comment. Sadly, I saw a couple of our Government Ministers on the news (Health and Human Services?) poo-poo-ing the idea and basically saying “do what you always do, go where you always go, my whole family is taking planes and trains”. Lunacy. They are tossing a bone to the companies that would be hurt by lost business knowing full well that contagion is far higher in large public gatherings. This illness is contagious for about 24 hours BEFORE you have symptoms. The statement that “if you feel sick you ought not to be in a plane” as the “proper advice” from our Minister of Stupidity is just nuts. The goal is to SLOW THE SPREAD so that we can get ahead of the curve with vaccine development and Tamiflu production; not to keep United Air Lines profits intact. FWIW, a school 2 miles from me is shut down due to the flu arriving there…

Update: As of 4/27/09 the states with cases includes Kansas and a suspected case in Michigan. Spain now has a confirmed case while Brazil and New Zealand have suspected cases. In California a single case in Fairfield where a child was sent home not feeling well; now has 40 of their classmates not feeling well. Contagion would seem to be high.

Update 2: A little later on 4/27/09 Canada has joined the list of countries with cases.

The CDC is working on an inoculation, but present vaccines do not provide protection from this flu variation. The bottom line is that the world population is vulnerable, there is a limited ability to treat with post infection medication (and that is only really available to the wealthy advanced nations of the world), the virus is spreading from person to person and is already ‘going global’ with cases in Mexico, the U.S.A., Canada, and locations in Europe. It is a pandemic in the making (though not officially one yet – give it a couple of days…) with WHO and the U.S. health department both declaring a health emergency. Mexico City is basically resorting to quarantine and shutdown of public meetings in an attempt to stop the outbreak. You don’t do that for nothing…

So what can you do?

Think 1918. Wash your hands, any chance you get. Touch a door? Wash. Going to eat? Wash. Want to scratch your nose? Wash (or use a handi-wipe. Or at least use a tissue not your hand…). Why? While someone sneezing on you is probably going to transmit the virus, most of the time transmission will be from hand to object to hand to mouth / nose. If you are going to sneeze yourself, cover your sneeze (inside of the elbow is better than using your hand).

Avoid any gathering of groups of people that you can. When the virus is reported in your city, it’s time to skip church for a few weeks and not go to any movies for a while. Why? I had a bacteriology class some decades ago. It was about a 400 person class and was held in a giant auditorium. One demonstration that was done was that the instructor (a small speck way down there in the front of the auditorium) was giving a lecture on contagion. He had gargled with a somewhat unique, but very benign bacteria, then gave the lecture. Grad students set out petri dishes at the doors at the very back of the auditorium (about 40 feet higher and a hundred or so feet back from the speaker). The next week the lecture was on the immune system. It started with slides of each petri dish that showed every one of them had colonies of the unusual bacteria on them. The bottom line was very clear: If someone in a large group in a room is sick, everyone will be exposed.

Mexico is already banning such meetings. It is a wise thing to do. Even if we don’t follow this lead, it is simply time to be a home body.

So right now, go buy a few weeks worth of food (so you don’t need to go grocery shopping when the bug hits your town) and start figuring out what you can do to avoid groups of people when the time comes. Stock up on those little paper air filters that cover your nose and mouth and when you must go out, and be prepared to wear one. Put a few handi-wipes in your pocket (and put a box of wipes in your car). Start taking some vitamin C and E (both of which improve your resistance to viruses) and avoid things that get you ‘run down’. That is, get your sleep, eat well, and avoid too much stress for a while.

But I’m young and healthy!

The Spanish Flu of 1918 preferentially killed those in their 20’s and 30’s who were in the best of health. Why? That variation of the flu turned the persons immune system on their own bodies. Their own immune system attacked and destroyed their lungs in an attempt to kill the virus. The healthier they were and the stronger their immune system, the worse their symptoms and the more likely that they would have lung damage and die. Initial reports on this virus say it, too, is killing folks in the prime of life. It’s not just old folks and babies who are at risk of death from this flu…

If you have ANY typical flu symptoms (fever, chills, body aches, sneezing, coughing, dizziness, disorientation, etc.) go immediately to see your doctor. The antivirals work best if given early in the process. There are not enough doses to use them as a prevention, so don’t expect to take them to prevent the flu. But if you have any flu symptoms, seek treatment fast. If you have a very high fever, get it down (cold water or wash cloths if needed to stay below the 105-106 F range) and take whatever your doctor prescribes to reduce fever (asprin, tylenol, whatever they tell you). Stay hydrated and wear a face mask to protect others from you. Very high fevers and dehydration are the major problems with auto=immune problems close behind if this is like the Spanish Flu.

Urban Jungle

Unfortunately, most of us now live in major urban metroplex / suburb areas. We can’t just run off to the summer cottage and ignore the world for a few months. We also have a hugh number of airplanes carrying folks around the world each day. Because of this, it is likely that this flu will spread very fast and very far. Expect to see the outbreaks beginning in large urban centers with lots of international flights first. Eventually it will make it even to the small farm towns.

We can only hope that it spreads slowly enough for a vaccine to be developed and for public health measures to limit the spread. If we are very lucky, the person to person transmissibilty will be low enough that we will not have a fast pandemic. (Early reports say that the U.S. cases were in people who had traveled to Mexico or were very close to those folks. Lets hope that holds and that the person to person in the rest of the world is weak.)

The Good News

So far, the cases outside of Mexico have been relatively mild and there have been no deaths. IFF we are lucky, there are two varieties and only the milder variant has gone global (or the folks in Mexico were a particularly susceptible subgroup for this virus). The latest CDC report (per the nightly news) is that the US cases are the same virus as the Mexico cases. We’ll see.

We also do have antiviral drugs now that did not exist just a couple of decades ago. We are no long in a “watchful waiting” mode with viruses, we can hit them with effective drugs. This gives hope that we can avoid a lethal pandemic this time.

In Conclusion

Unless you are well over 50 years old, you have not seen this kind of killer flu. Yeah, flu was miserable , but folks just didn’t die from it. That wasn’t the case in 1918… and may not be the same this time. So don’t fool around with this. If your sick, get treatment fast and don’t try to ‘tough it out’; this isn’t the kind of flu where that will work. In fact, the tougher you are, the more likely things will not turn out well…

So just remember that cleanliness is next to Godliness and it’s OK to be a hermit for a week or two if everyone around you is dropping like flies. Its better to look funny in a little blue mask than to be deathly sick. And fate favors the prepared…

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About E.M.Smith

A technical managerial sort interested in things from Stonehenge to computer science. My present "hot buttons' are the mythology of Climate Change and ancient metrology; but things change...
This entry was posted in Emergency Preparation and Risks, Human Interest and tagged . Bookmark the permalink.

7 Responses to Swine-Flu-will-not-end-well

  1. H.R. says:

    Howdy, E.M.

    I’m not sure how this will play out in the U.S. I just saw the evening news and the number of reported cases had doubled since yesterday’s evening news. Also, three more countries have reported cases today.

    I’m not much of an alarmist but it’s a good thing the press is jumping on this quickly. I’m hoping a higher percentage of people will self-quarantine if they are feeling flu-ish.

    Many companies went through flu awareness and abatement education within the past few years due to bird flu alarmism. Our company did. I’m hoping that it’s been recent enough that good prevention practices are still fresh in mind.

    Thanks for that post.

  2. Jeff Alberts says:

    The relatively high death rate only seems to be in Mexico, where, presumably, living conditions and available health care leaves a lot to be desired.

    Thanks for the scare! I have to get on a plane on Sunday too…

  3. e.m.smith says:

    @ HR: Yeah, we seem to be on a doubling curve where every couple of days the number of people and number of countries doubles. At this point, World Health Org is saying that it can not be contained. It’s already gone global and it will come to a place near you.

    @ Jeff Alberts: There has been a death reported outside Mexico now. Remember that it got here later and has fewer total cases so far. Give it time… The theory so far is that there may be a secondary infection in Mexico that is not elesewhere. We’ll see.

    The bad news is that this has the same lethality profile as the 1918 flu ( and H5N1 type ) in that it preferentially kills the most healthy and robust – folks in their 20’s – by turning their own immune systems against them (usually attacking the lungs).

    The very good news is that both Tamiflu and Relenza work, so at least in the advanced countries we can treat it and avoid most of the bad impacts. That may be part of the difference in U.S. deaths. Most doctors here go ahead and give you tamiflu on the off chance it might do something so we may have semi-accidentally done the right thing.

    We also have the ability to mildly suppress the immune system (though that would be considered an experimental usage for most of the immunosupressant drugs). I would expect that if we started seeing higher mortality we would start seeing more experimental treatments.

    The “bird flu” was an H5N1 variant, like the Spanish flu of 1918, but did not have the needed high contagion rate. This flu has the contagion and may or may not have the lethality in the U.S. / Global variation.

    The 100,000,000 deaths question: Will this flu, like the 1918 flu, start off with a modest flush with lower lethality (like in the U.S.) then 6 months later have a resurgence with astounding lethality. What’s different this time is that we ought to have a vaccine by then… While the present vaccine doesn’t seem to be preventative, a specific H1N1 vaccine ought to work. We’ll see.

    So we have 3 probable scenarios:

    1) Lethal pandemic now. Seems unlikely given tamiflu and the low lethality so far in the non-Mexico cases.

    2) Low-lethal pandemic now (where low-lethal still means a 1 or 2 % lethality, just not the gigantic lethality). Most likely, given that the 3rd world does not have the medicines and public health systems needed to suppress it and the present spread seems to have been a less lethal variant.

    3) Lethal Pandemic in 6 months. Modest probability. There is an existence proof for this pattern. Viruses can pick up other bits of genetic material along the way so the virus spreading now can get “juiced up” after 6 months of cooking in folk around the world. We’re headed into warmer times in the N. Hemisphere when flu often takes a slow summer break before resurgence. I’d bet most on this scenario. With a bit of luck, we can get vaccines produced in less than 6 months.

    There is also the chance of a “never mind” scenario where this flu turns into a garden variety “fever chills unhappy for a week back to work” flu. I would not count on it. The specific antibodies (the H1 and N1 markers) imply a not so mild outcome… So we can ignore this “case 4” as highly unlikely.

    Case 3 can be handled with fast vaccine production and tamiflu for now. Case 2 is something our existing health system can handle, but your odds improve with personal paranoia in washing and face masks, along with a fast run to the tamiflu…

    That just leaves case 1 where we are left with: Be afraid and hope for the best. Not much we can do about it if this case plays out other than get the best medical care you can if you come down with something. (Don’t go sit in the emergency room for 8 hours sharing coughs with everyone, but do call the doctor on the phone and get a tamiflu dose sent over…) If you do get sick (and especially if you are a 20-30 something very healthy person) don’t do things to improve your immune response, but do things to dampen it (like fever suppression – soak in a cold tub if needed to keep that body temp close to normal if at all possible…).

  4. pyromancer76 says:

    Thanks, E.M. Smith, for the clear thinking and good advice. I wonder how much corporate America is responsible for the breeding grounds of the H5N1 Swine Flu Virus — in this instance in the pork empire of Smithfield Foods, based in Virginia but doing the very dirty work of raising 1 million pigs per year in a Confined Animal Feeding Operation (manure lagoon with masses of flies) in La Gloria in agrarian Veracruz State. La Gloria is the place of the first outbreak in mid-February according to John Batchelor (4/28). Sixty percent of La Gloria’s population has sought medical assistance since February. Mexico did not inform anyone until much later.

    The U.S. government only issued a travel warning to Mexico Monday April 27 and the WHO only raised the pandemic threat level to 4 at 4:25 pm et on the same day. The Washington Post reported that U.S. public health officials did not know about Mexico’s protective measures until about a week after they were taken and they did not know about the rare strain of influenza until after Canadian officials did. A question raised by Pundita of The Real Barack Obama is: “Why didn’t the U.S. Department of State inform the CDC of the situation in Mexico?” Where was the President’s Office? the Secretary of State? Congress? the military? the CIA? the DHS? etc. Did anybody know anything or did nobody know nothin’?

    One hopes that there is a serious concerted effort to produce more antivirals and that the research is going fast and furious into vaccines as we blog. With this government’s and this Congress’s worry over our poor earth with its teeming, destructive population, they just might like to decline serious effort.

    There are not too many people alive with the antibodies to the 1918 flu. My husband’s grandmother died from it, leaving his own mother motherless at 18 months of age, along with two other young children. I have read that the mortality rate was a staggeringly high 60% — I don’t know if that is true or not, but…

    How important it is that we follow your advice very carefully and how important it is that we hold our elected officials and bureaucrats responsible for swift and courageous action. They are lying about “climate change” and “global warming” in order to control and impoverish us; how can we trust them with our lives?

  5. E.M.Smith says:

    @Pyromancer76:

    The flu virus has always been highly variable. That’s why it’s still around. There are 3 major and a few minor populations that harbor the flu. The most diverse is the bird group. They also are the vector for global distribution. So a new strain pops up somewhere and hops on a long haul duck or goose to the next continent over… But pigs are more like people than ducks are… and pigs are pretty good at hosting both bird and human flu strains. They are the major mixing pot.

    So historically, the 3 pools were more isolated. (There are also equine flu and a few others, but they are less important to this story…) But 2 of the pools were ‘close’ in that people started to raise domestic pigs. Flu got a helping hand from pigs living with people.

    To the extent you have an operation like Smithfield, you have less problems, not more, since they have a highly automated pig factory with few people (who are sent home if they are ill). To the extent you have a Mexican family farm with pigs and kids together, you get virus swapping (and when you swap viruses, the flu virus picks up bits of other varieties in a re-dealing of the RNA deck). Flu is a retrovirus, so it uses RNA to store it’s genes rather than DNA.

    Now it gets real interesting. Ever wonder why there are so many ‘asian flu’ varieties? Because of the way they grow pigs and ducks. Pig pens are put over ponds. Pig poo drops in the ponds and you get a bloom of ‘duck weed’ and other plants. Fish in the ponds eat the plants, as do ducks farmed on the same ponds. Now we have a real tight cycle.

    Farmer poo (“nightsoil”) is added to the mix so a sick person will infect the pond… or a sick farmer sneezes on the pigs. Pig poo means a sick pig will infect the pond. Ducks on the pond act as a mixing bowl for some of the varieties. Farmers handling ducks get infected with avian varieties. The duck guts are fed to the pigs. Pigs act as a mixing bowl for most varieties. In the end, new virus sorts get a rapid cycle through the the major host types being selected for the most infective and most virulent. Then a visiting duck hits the pond and the New Flu is off to the next country or continent over.

    Darned near every new variety of flu comes out of this stew pot of mixing varieties of flu. Once it’s cooked up a new RNA batch.

    So I would worry far less about our commercial pig growers (I visited one in Indiana where there was one guy who visited the site once per day and most of that time was spent looking in silo’s of feed and making sure the computer controlled air control, shower washers, feed systems, et. al. were functional. Rarely did he actually go near pigs.) You want to worry about the 3rd world style family farm especially if they practice the asian intensive aquaculture / aviculture / swine culture mixed system.

    My guess about CDC not being informed is just the usual stuff where State Dept. figures that it’s not their department nor their job and just doesn’t think about it. “It’s Mexico, that’s not MY job…”

    Per vaccines: They are already cooking them up world wide. The good news is that both H1 and N1 are modestly common and well known antigens. There may be some other variant that needs to be in the soup, but this isn’t an exotic variation. It’s also a benefit that it’s a swine flu, not a bird flu like H5N1. Why? Because the vaccine is grown out in eggs.. Swine flu types grow OK in eggs. Bird flu types tend to kill the egg… That’s why we still don’t have an H5N1 bird flu vaccine. They are trying to find a host for the vaccine that the virus doesn’t kill. So I expect a vaccine in about 3 months. The game now is to delay the spread of this flu as much as possible hoping for a 3 month delay for the vaccine to catch up.

    The 1918 flu was also an H1N1 flu and also had a disproportionate lethality in younger health adults. That’s the most worrisome parallel. The good news is that we have drugs that can dampen the cytokine storms that most likely caused the deaths. See:

    http://en.wikipedia.org/wiki/Cytokine_storm

    The other really good news is that simple antioxidants have shown benefit. Yes, just taking a megadose of vitamin C and E might well keep you alive.

    FWIW, this page:

    http://en.wikipedia.org/wiki/Spanish_flu

    Says that the 1918 flu had a 5% lethality. (Estimated). It had a 50% infectivity. So half the planet got the flu, but only 5% (or so 2% to 10% estimated) died from it.

    So given the tendency for flu to do what it does, I would not be too hard on the government folks about it. I’d spend more time working on getting my vit C &E levels up, stocking up on hand cleaners, and scheduling quality time in my bedroom with the TV and the windows shut :-)

  6. pyromancer76 says:

    Thanks for all the info. You are a walking encyclopedia of wisdom on many topics. I just found out that my great grandmother on my mother’s side also died from the 1918 flu leaving a large number of children. Tragedies on both sides of the family. I await your next WSW.

  7. E.M.Smith says:

    Well, more like siting ;-) BTW, the “next WSW” is up now, and thanks for the compliment.

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