Swine flu: outright lies, hyperbole and grains of salt

Half of what you read about swine flu in the coming weeks will be wrong, and much of the rest you ought to take with a grain of salt.

This doesn't mean you shouldn't be alert, but it does mean the first thing with which you should arm yourself is useful information.

Media are going nuts over this story, and although it's worth the space they're giving it, they're assigning a lot of folks to the flu story who have no understanding of epidemiology and no business writing complicated medical stories.

One thing you'll see is breathless prose about how this is some weird mutant strain of flu virus, a Frankenstein supervirus that combines features of lots of other viruses. Well, no, not exactly.

Here are the exact words of Dr. Richard Besser, acting head of the U.S. Centers for Disease Control and Prevention: “This strain is not unlike other new strains that have emerged. It's an assortment -- it's got genetic components from a number of sources, including human, swine, and avian sources. And that's something that you see with new strains.”

The lead flu story in one of the papers today said health officials “fully expect” deaths. Breathtaking news, but of course there are deaths during every flu season—many, many of them—especially among the very old, the very young, the immunocompromised, those with respiratory ailments and so forth.

As of 11:30 a.m. Eastern Time today, the 30th of April 2009, there was one death and 109 confirmed cases in the U.S. The one death was a toddler with other health problems. That's not to say there won't be lots more. There will be. More than in a bad non-swine flu year? We'll see.

Here's a link with a lot of information: http://www.cdc.gov/swineflu/. That's an important website, and it is probably the safest place to get your information. Check it before acting on anything you hear on the street.

Is this just an outbreak, an epidemic, or even a pandemic? Some sources use these terms interchangeably. Generally, epidemic refers to a fast-spreading disease, and pandemic means it's really widespread.

Flu epidemics aren't unheard-of. In fact, last year's flu season was considered an epidemic for an eight-week period, according to the Centers for Disease Control definitions.

It's early, but this flu seems to be spreading fairly rapidly. The CDC is still calling it an outbreak, but because it's moving quickly, it probably will qualify soon as an epidemic. Not a pandemic, yet, by CDC definitions, but the World Health Organization has in fact designated it pandemic. Most cases are in Mexico and the U.S., but there are also some in Canada, Israel, Spain, Germany, England, New Zealand, Costa Rica and Austria, at this writing.

They call it swine flu, because it originated in pigs, or has some characteristics of swine flu viruses. Pigs get pig flu just as humans get human flu. But influenza is a cagey virus, it can change and suddenly jump across species lines.

So, sometimes, pigs can get human flu, and humans can sometimes get pig flu. Same with birds and avian flu. This swine flu, a form of Influenza A, mutated to also affect humans. It happens. The CDC says nearly a quarter of pig farmers and one in 10 veterinarians have been infected with some variant of swine flu over time.

But at this point, for the most part, the current strain is spreading from person to person. Pigs are not involved in most new infections in the U.S. And you don't get it from cooked pork. A well-cooked laulau is safe—it's the coughing person serving it that you need to be careful about.

We're seeing a lot of pictures of people running around in face masks. Will this protect you? Maybe, maybe not. “Information on the effectiveness of facemasks and respirators for the control of influenza in community settings is extremely limited,” the CDC says.

As woodworkers know, if you take a deep breath through a cheap facemask, the air just sucks in unfiltered through the sides.

Wearing a mask couldn't hurt, and might help, but you're better off adopting a range of precautions, including staying away from anyone who might be sick and getting a little nuts about handwashing.

The primary way most people are getting it is through contact with contaminated droplets of moisture from an infected person's cough or sneeze, or from the moisture on that person's hands after he or she has coughed into it, or from something they've touched.

If the flu gets into your community, then any cough, handshake, doorknob or shopping cart handle is a potential source. If you have touched a possibly contaminated object, keep your hands away from your face until you can thoroughly wash them.

Here are the state Department of Health's guidelines for protecting yourself: http://hawaii.gov/health/FluGuidelines.pdf

If you get the flu, unless you get tested, you won't be able to tell whether it's swine flu or some other flu. Flu symptoms, although they can vary in severity, are generally the same: fever (often quite high), body aches, headache, cough, fatigue, nasal congestion or discharge, and sometimes vomiting and diarrhea.

It's unlikely most humans have any resistance to this flu. The Type A H1N1 swine virus—which is the designation for the one causing trouble just now—is quite different from H1N1 human viruses. So having had the human equivalent doesn't protect you from the swine form.

There aren't any effective vaccines for this one, but the CDC is working on it. There are a few antiviral drugs that can help once you've gotten it. If you think you're sick and it might be swine flu, call your doctor for instructions. Some of the medication must be taken early to be effective, so don't waste time.

© Jan TenBruggencate 2009

Vol. 4: Swine flu: outright lies, hyperbole and grains of salt

As the swine flu (Influenza A H1N1) story settles into the long haul, there are still fascinating diversions to be found in its reporting.

In a man-bites-dog twist, in Canada, they have pigs that have contracted swine flu from humans. In Alberta, a farm worker who got swine flu in Mexico apparently passed it on to Canadian pigs.

There's a bunch of commentators who have used the swine flu issue to prop up their own worldviews, many of them complaining about border security and illegal immigration. Problem is it's legal tourists who have brought most of the cases out of Mexico, not illegal aliens.

A group of New Zealand returning students brought it from Mexico to New Zealand. Spanish beachgoers brought it from Mexican beach vacations. The first Swiss case was a tourist returning from Mexico. Catholic school kids in Queens brought it back from a spring break in Cancun. Most of the Britons with the flu picked it up in Mexico. And so forth.

After panicky reports in the first couple of weeks of the flu outbreak, some reports are now swinging entirely the other way—suggesting that perhaps this is was overblown, a mild flu, perhaps not even as bad as a normal seasonal flu.

The best we can say to that is, be careful.

Flu can come in waves--the first wave relatively mild, and subsequent ones severe. Also, flu can mutate mid-season, and if this one does, it could end up with more severe symptoms, or less severe symptoms, or the mutation could cause other changes in the flu's behavior. Among the clearest descriptions we've found of the murky future is this one:

"Influenza is unpredictable. There are so many unanswered questions. This is a brand new virus. There's so much we don't know about the human infectious with this virus,” said CDC epidemiologist Dr. Tim Uyeki.

Some are arguing that the flu has peaked in Mexico and is on the decline there, but globally, the flu is still adding new countries almost daily. It continues to spread.

How many people have actually had the disease? You see media reports of large numbers, like 1,000 New Yorkers associated with the Catholic schools outbreak there. But as of today, May 3, the the U.S. Centers for Disease Control are confirming just 226 cases in 30 states.

Mexico has reports of 1,300 or more people hospitalized with the disease, but the official number of victims is just a few hundred. The county of people who died from the disease is set at 19 in Mexico, but the unofficial count is between 100 and 200.

What gives?

There have probably in fact been thousands of cases across the U.S. and thousands more in Mexico, but the official numbers include only those that have been confirmed by laboratory tests.

Lab tests are expensive, time consuming, and in many cases not necessary. If your kid comes home from school sick, after being in contact with a confirmed swine flu sufferer in pre-school, and then you and the other kids in the family come down with a flu, and then so do your carpool colleagues, there's no point in testing your family or the carpoolers—it's almost certainly swine flu. So there might be a dozen people there with the bug, but on the CDC list, that would still be just one laboratory confirmed case.

The result is that the actual number of people who've been sick is far, far higher than the official number, like the World Health Organization May 3 report of a total of 787 confirmed cases in 17 countries. To date, the total confirmed worldwide death count stands at 20—19 in Mexico and one in the U.S.

© Jan TenBruggencate 2009

Swine flu on path to match 1957 flu pandemic

The new flu, whether you call it swine or H1N1, is spreading fast and spreading widely.

And while in its current form its symptoms appear to be comparatively mild, the flu is expected to have a significant impact because it will hit so many people across the globe.

"Our early analysis would suggest this is going to be an outbreak comparable to that of 20th century pandemics regarding the extent of its spread - it’s very difficult to quantify the human health impact at this stage, however," said Prof. Neil Ferguson of Imperial College London.

He is a co-author of a paper published in the journal Science, entitled "Pandemic Potential of a Novel Strain of Influenza A H1N1: Early Findings," by the World Health Organization's Rapid Pandemic Assessment Collaboration.

Science normally keeps a news embargo on its reports until the publication is actually released late in the week, but determined that this information is so new and so important, that it lifted the embargo this morning (May 11, 2009).

The paper notes that it's early to be drawing assessments from this flu outbreak, but that preliminary data do provide some clues. It compares this flu to two earlier pandemics, the one in 1918 and the one in 1957.

“While substantial uncertainty remains, clinical severity (of this flu) appears less than that seen in 1918 but comparable with that seen in 1957,” the paper says.

The 1957 flu killed about 70,000 Americans at a time when the nation's population was 172 million. The 1918 flu killed about 675,000 when the national count was about 105 million.

The preliminary data suggest the death rate from this flu (the term used is CFR, for case fatality ratio) is in the range of 3 to 6 per thousand people infected. That's based on deaths suspected to be from H1N1. If only confirmed cases are counted, it's 10 times less than that.

Investigative techniques suggest the first case appeared in a human about February 15, 2009. Genetic techniques suggest the virus evolved to use humans as a host between November 2008 and March 2009.

In early cases in the Mexican community of La Gloria, in Veracruz, young people caught the flu much more readily than older folks. Those under 15 were twice as likely to become affected as those older than that. Does that mean that older folks have some level of resistance, from exposure to a previous flu strain? That's not known, yet.

“The strong age dependence in clinical attack rates seen in La Gloria is intriguing,” the paper said.

There remain lots of questions. Among them, whether the flu will move aggressively to the Southern Hemisphere during its winter flu season, and whether it will then sweep back into the Northern Hemisphere late this year. Also, whether the flu will hit in waves, as previous pandemics have.

“The future evolution of the transmissibility, antigenicity, virulence and antiviral resistance profile of this or any influenza virus is difficult to predict,” the authors write.

The paper's authors, all members of the World Health Organization's Rapid Pandemic Assessment Collaboration, are from a range of research institutions in England, Mexico and Switzerland. They include Christophe Fraser, Christl A. Donnelly, Simon Cauchemez, William P. Hanage, Maria D. Van Kerkhove, T. Déirdre Hollingsworth, Jamie Griffin, Rebecca F. Baggaley, Helen E. Jenkins, Emily J. Lyons, Thibaut Jombart, Wes R. Hinsley, Nicholas C. Grassly, Francois Balloux, Azra C. Ghani, Neil M. Ferguson, Andrew Rambaut, Oliver G. Pybus, Hugo Lopez-Gatell, Celia M Apluche-Aranda, Ietza Bojorquez Chapela, Ethel Palacios Zavala, Dulce Ma. Espejo Guevara, Francesco Checchi, Erika Garcia, Stephane Hugonnet, Cathy Roth.

© Jan TenBruggencate 2009

H1N1 Swine Flu hops to turkeys; threat not clear

Just when you thought it was safe to get a little sniffle, the swine flu virus has taken another potentially scary turn.

This bug known as H1N1, which has pieces of human, bird and pig flu in its genetic makeup, and which jumped earlier this year from hogs to humans, has now jumped again into birds.

In this case turkeys—specifically turkeys at a commercial turkey operation in Chile.

(Image: A Centers for Disease Control map shows Hawai'i has "regional" H1N1 flu, along with the southwestern states and the southeast. Only Alaska and Maine, with "widespread" flu, rank higher. Credit: CDC.)

Just what this means is not yet clear, and it might not be trouble, but it could be a step toward something bad. The Centers for Disease Control and Prevention are monitoring.

Meanwhile, the swine flu virus we're familiar with has continued to spread. It is in all parts of the United States, and 522 people have died—mostly people with other underlying health issues that became fatal when the flu virus was added to them.

This flu has comparatively mild symptoms, but it spreads more readily than normal seasonal flu. One of its interesting characteristics is that it is still around in August, when flu is comparatively rare.

“Most state health officials are reporting local or sporadic influenza activity. Two states are reporting widespread influenza activity at this time. Any reports of widespread influenza activity in August are very unusual,” says the CDC.

Most of the people who catch the flu tend to be younger, suggesting some previous flu bug provided older humans with some level of resistance. And most people who do get the flu are over it in a week.

In the swine-to-turkey story, the infected turkeys don't suffer serious symptoms, either.

International health officials can't seem to decide whether this transmittal to birds is curious or ominous. In the reporting, you get a little of both.

There are a few citations that express fear for a “superflu” which spreads as easily as H1N1 swine flu, but is also more frequently fatal. But while that has always been a possibility, there is no evidence that there's a new bug like that now.

An Associated Press story included this cautious note: "What the turkeys have is the human virus — there is no mutation at all," Deputy Health Minister Jeannette Vega told Chile's Radio Cooperativa on Friday.

Stay tuned.

© Jan TenBruggencate 2009

Vol. 2: Swine flu: outright lies, hyperbole and grains of salt

As the real swine (H1N1) flu spreads across the world, the nuttiness of some reports and reactions continues.

The United Arab Emirates just joined a few other nations in banning pork sales. The problem with this: You don't get flu from pork—if you get it, you're most likely to get it from another human.

“It is not pork-borne,” said U.S. Homeland Security Secretary Janet Napolitano.

Conspiracy theorists are spinning all kinds of unnecessary silliness, from assertions about dead pigs in China (problem: there aren't yet any confirmed H1N1 flu cases in China) to Al Qaeda involvement. In fact, swine flu has moved to humans before, and it doesn't require a conspiracy.

The Associated Press has reported nearly 150 dead of swine flu in Mexico alone, 20 of them confirmed. Meanwhile, in a more recent report, the World Health Organization says there are 8 confirmed deaths--7 in Mexico and the eighth a Mexican child being treated in an American hospital. What's going on? The WHO actually requires proof--the person who died must actually have had the H1N1 strain of flu. Other organizations and nations are not such nitpickers. Another reason to be careful with where you get your information.

News reports have suggested that Mexican officials have identified “patient zero”--the first human who got sick with this flu. Dr. Rich Besser, acting director of the Centers for Disease Control and Prevention, says the first victim has in fact NOT yet been identified.

When you hear frightening numbers about how many people are at risk, keep in mind, as Health and Human Services Secretary Kathleen Sebelius said in a briefing today, that the regular annual flu season in this country makes hundreds of thousands of people sick and can result in 36,000 deaths.

The nation has a stockpile of 50 million antiviral medication doses, states have another 20 million or so, and the military has millions more. Hawai'i has enough on hand to treat 25 percent of its population. The primary compounds are Tamiflu (oseltamivir) and Relenza (zanamivir). This medication helps reduce symptoms.

If a person with H1N1 does sneeze on a hand and the touch something, how long can the virus live and remain infective outside the body?

The Mayo Clinic (http://www.mayoclinic.com/health/infectious-disease/AN01238) reports that they can live as long as two days on surfaces. To protect yourself, you could wipe down with alcohol surfaces like computer keyboards that may have been touched by someone sick, said Dr. Rich Besser, acting director of the Centers for Disease Control and Prevention. Frequent handwashing or the use of alcohol gels continues to be a strong recommendation.

This flu virus is still new, and is not a revival of a previous flu virus. “This strain is very different from any previous strain that we've seen,” Besser said.

Its characteristics will be slightly different from the average, but generally, figure that there's about a seven-day incubation period—the period between infection and symptoms showing up. And symptoms can hang around for a few days to a week.

There are still a lot of questions about the characteristics of this particular virus, and about how it will move through the world's populations.

“This is a dynamic situation. It will change,” Sibelius said.

Places to get good information: http://www.cdc.gov/swineflu/ and http://hawaii.gov/health/FluGuidelines.pdf.

Our previous post on this issue: http://raisingislands.blogspot.com/2009/04/swine-flu-lies-hyperbole.html.

© Jan TenBruggencate 2009

The flu in the first person

We've written at RaisingIslands.com about the H1N1 flu virus in a somewhat detached way, but now it's gotten personal.

I'm just off of what could have been- (by some symptom-reading systems—more on that later) the virus formerly known as Swine Flu.

If it is, let me just say, about that business about it being a “mild” flu? Harumph!

I felt like someone had tenderized me top to toe with a baseball bat, and overdoses of pain killers didn't do a lot of good.

I am old enough to be in that group that's statistically less likely to get it. That didn't help me.

Parenthetically, there is a level of weirdness about being infected by a bug that's a direct descendant of a bug that may have been inside a Mexican pig less than a year ago.

I've had a few flus and to be clear, this one stands out.

Actually, three things stood out.

One was pain. Body aches, headaches, skin aches, joint aches. Lot of aches, and Aleve barely made a dent.

Another was the sensation that someone on speed was messing with the temperature controls. There were fevers and chills, and chills during fevers, and sweats, and covers on and covers off, ad nauseum. That an pretty significant fatigue—didn't get out of the sack much for the first three days.

Finally there was, to put it as pleasantly as possible, significant intestinal distress.

There were not in my case—and I give thanks for this—significant nasal congestion, coughing or other upper respiratory issues. I had a mild dry cough. I had no appetite.

From what I read, and my doctor reported, you can't really tell which flu you have without a blood test, and in the middle of both flu season and the H1N1 event, there are so many people getting sick that they're not testing for it any more.

According to some sources, H1N1 has a reputation of sneaking up on you and hitting hard, although other flus will do that, too.

In my case, at 7 a.m., I was out on the ocean, paddling a canoe and feeling great. At 9 a.m. I was wondering who'd wrapped me in a blanket and pounded on me with lead pipes. It was rapid.

I managed to get in to see a doctor at the end of the day, with a temperature of 101 degrees Fahrenheit and a fraction, and he prescribed Tamiflu, which I started taking immediately. It comes in 10-capsule packets, and you take one morning and one at night. For me, the five-day dose coincided with the worst of the symptoms.

They say Tamiflu will take a day or two off the symptoms. On day five I was feeling reasonably human, weak but okay. On day seven I was ready to go paddling in the ocean again.

During the process, I was very uncomfortable, but alert enough to read. For some reason television was far more annoying to me than normal, so I ploughed through books. My librarian wife brought me a tall stack of paperbacks, and I needed the whole stack. I was feeling ornery enough that I wouldn't put up with authors who cheated, digressed or got silly. Half the books, even by well-known authors, didn't make the cut. I gave them 20 or 30 pages, and if they started wasting my time, on to the next volume.

Saving all my patience, I suppose, for getting through the disease.

The pain lasted about three days. The severe fatigue four days, with moderate fatigue beyond that. The feverishness and/or sweats also four days. The intestinal stuff started about halfway in and then outlasted everything else.

Can I say for sure it's H1N1? No.

There's tons of credible information at the government flu site, www.flu.gov, and lots of interesting information elsewhere on the web—some of it credible and some less so.

Some resources say you can tell the difference by symptoms. Others disagree.

Some assert, for instance, that very rapid onset (bingo!) is a factor in H1N1, and that body aches and tiredness are more severe with H1N1 than seasonal flu. Most reputable sources, though, say you can't distinguish a particular case accurately by these or other symptoms, and that rapid onset isn't exclusive to H1N1.

Here's a site that argues they're pretty much the same, except that H1N1 has more respiratory/sore throat symptoms, which of course mine didn't. The federal government flu site notes that the respiratory issues only occur in a few of the cases.

The upshot, of course, is that even in laboratory-confirmed cases, the symptoms are different in different people. Because of courses, it's not just about the flu, it's also about you.

As for me, if a flu shot appears on my radar, I'm taking it. I may now be immune this particular strain of influenza, whatever it was, but I don't want to go through anything like this experience again anytime soon.

© Jan TenBruggencate 2009

Vol. 3: Swine flu: outright lies, hyperbole and grains of salt

In our continuing series on silliness in the management of, response to and news coverage of swine flu or Influenza A(H1N1), these tidbits:

In an article on the origins of the flu in the New York Times, writer Donald McNeil Jr. makes the strong point high in the story that there's no proof the swine flu originated in pigs.

But after toying with this concept for a while, he concedes that there is only no proof because nobody has finished checking yet.

And fourteen paragraphs into the story, he says, “It presumably is in pigs somewhere, perhaps in Mexico.”

Which is akin to arguing breathlessly that there's no proof humans aren't descended from three-legged aliens from Antares, and then conceding deep in the story that nobody actually thinks there is.

The list of scientifically illiterate countries taking it out on pork is growing. Among them, St. Lucia, Indonesia, Thailand, Honduras, Croatia, Gabon, the Philippines, Kazakhstan, Ukraine, Ecuador and the United Arab Emirates are banning pork sales or pork imports.

Egypt set up farmers' riots by ordering all pigs killed, even though there's zero evidence Egyptian pigs have the flu virus.

And in Australia, the entrepreneurial Australian Crocodile Traders are hoping that fears about pork will lead to surging demand for crocodile meat.

That said, let's be clear: It's people who are spreading the flu now, not pigs. But despite that, pigs are taking a beating.

There's lots of news linking this virus to a specific industrial pig farm in Mexico, and more recently, arguing that this virus is descended from a virus in an industrial pig farm in the U.S. in 1998. There is a fair amount of pushback from the pork industry and others, arguing that this virus is as much a human virus or a bird virus as a pig virus, and that pigs are being unfairly treated.

Said the National Pork Producers Council: “Preliminary investigations have determined that none of the people infected with the hybrid flu had contact with hogs. This virus is different, very different from that found in pigs. The hybrid virus never has been identified in hogs in the United States or anywhere in the world. The hybrid virus is contagious and is spreading by human-to-human transmission.”

Some of that is true, and some is spin. The U.S. Centers for Disease Control and Prevention has concluded that the pig connection is real, even though—just like humans—the virus has a diverse lineage. Asked if the current virus is clearly of pig origin, CDC chief virologist Ruben Donis said, “Definitely.”

As of early today, May 1, the CDC reported that in the United States there were 141 confirmed cases of the flu in 19 states, and one death.

Globally, according to the World Health Organization, there were 365 confirmed cases in 13 countries, and nine deaths—eight in Mexico and the one U.S. victim, who was a Mexican toddler.

Here's a site to check on what's happening on the flu in Hawai'i, where no cases have yet been confirmed: http://hawaii.gov/health/family-child-health/contagious-disease/communications/pandemicflu.html


© Jan TenBruggencate 2009

Tired of hearing about swine flu? The other flu, avian, can be much worse

The threat of swine H1N1 flu is expected to increase as we move into flu season later this year, but swine flu while readily transmitted, doesn't make most people too sick.

The opposite appears to be true with another virus: avian H5N1, which isn't transmitted too readily to humans, but is fatal it 60 percent of the people who get it.

It's not yet in the United States, but has been identified in much of the rest of the world. And over time, it is adopting more and more hosts. If it changes to readily pass from human to human, it could be a far worse epidemic than swine.

Here are some basic facts, from the Centers for Disease Control. http://www.cdc.gov/flu/avian/outbreaks/current.htm.

Most people who get this avian flu get it from poultry—often ducks and geese, but also swans and chickens. It rarely is transmitted human to human in its current form.

Few humans have immunity to it.

“If H5N1 viruses gain the ability for efficient and sustained transmission among humans, an influenza pandemic could result, with potentially high rates of illness and death worldwide,” CDC says.

The strain is resistant to two of the four major antiviral drugs. There are no vaccines.

It has shown up in cats, dogs and zoo animals, suggesting it is gaining a wider range of hosts. “Avian influenza A (H5N1) virus strains that emerged in Asia in 2003 continue to evolve and may adapt so that other mammals may be susceptible to infection as well.”

One caution for travelers, particularly in Asia: Stay out of poultry markets.

This flu was first identified in geese in China's Guangdong Province in 1996. The first human cases appeared in Hong Kong the next year.

In 2003, zoo leopards and tigers in Thailand died after being fed chickens. The next year, a Thailand cat got it after eating a pigeon. The disease has since been identified in Vietnam, Korea, Japan, Cambodia. Malaysia, Laos.

It was found in Russia, Mongolia and Kazakhstan in migratory birds in 2005, and then began moving into Europe, often in migratory birds like ducks and swans.

Cases in humans remain fairly rare, but there are intriguing family clusters, in which multiple members of the same family get the disease. Are they getting it from each other? Is it because of a genetic predisposition to infectability? That's not yet clear.

As of August 31, 2009, the World Health Organization reported 440 cases globally, of which 262 were fatal. http://www.who.int/csr/disease/avian_influenza/country/cases_table_2009_08_31/en/index.html

Most of the deaths have been in Indonesia and Vietnam, but Egypt, Thailand and China are also hot spots.

© Jan TenBruggencate 2009

When pigs fly: Swine flu a laboratory escapee?

The H1N1 swine flu story is about to enter the crazy phase, in which conspiracy theorists begin joyously messing with the narrative.

The latest wrinkle is the suggestion by an Australian researcher that it could have been launched from a laboratory.

Even this researcher himself admits it's a far-fetched idea, and likely to be wrong—but conspiracists won't be worrying about that.

AIDS has gone through the same pattern, in which dark theories abound about secret laboratories, devious motives, government plots, and insane objectives tied to racial cleansing or sexual preference.

Meanwhile, H1N1 is behaving as a normal virus does. While it's certainly possible it formed in a laboratory—and that's far more likely than its delivery in glowing green test tubes by aliens in airborne saucers—it seems more reasonable to believe that it evolved in animals. Flu viruses evolve all the time. Nothing unique about that.

As of this morning, the Centers for Disease control report the new H1N1 virus has been confirmed in 47 states—including 10 cases in Hawai'i—with 4,298 total cases and three deaths nationwide. The only H1N1-free states so far are Alaska, Wyoming, Mississippi and West Virginia.

People are also still getting other flu viruses. Only about half of the flu cases being reported in the U.S. are this H1N1 strain.

The World Health Organization is reporting it's in 33 countries with 6,497 confirmed cases. Those (ass in the U.S.) are just those whose infection with H1N1 has been confirmed by a lab test. There are thousands or tens of thousands more actual cases for which tests were not done, or not deemed necessary.

If you get a mild case—and in many people this strain has comparatively mild symptoms—you might never go to a doctor, but you still might pass the disease on. The World Health Organization reports that this strain, while often mild, is more contagious than normal seasonal flu.

That means it has the potential to spread more easily to people with underlying medical problems—for whom it can be severe and potentially deadly. That's how this flu could be paradoxically both mild in symptom and high in fatalities.

A retired Australian researcher, Adrian Gibbs, 75, has gained publicity in recent hours and days with the suggestion that the new H1N1 could have escaped from virus laboratory. Gibbs is a virus researcher with good credentials.

Lots of folks will latch onto that. Indeed, hundreds of media outlets have breathlessly reported Gibbs' suggestion.

But Gibbs himself is reported as saying he just mentioned it as a possibility because it is, of course, possible, but that nobody else had already mentioned it.

Possible, but lacking evidence.

"One of the simplest explanations is that it's a laboratory escape, but there are lots of others," he said on ABC news.

And he makes no bones about the possibility that his wild-ass theory could be bonkers.

“This is how science progresses. Somebody comes up with a wild idea, and then they all pounce on it and kick you to death, and then you start off on another silly idea,” Bloomberg News reported him saying.

Active researchers are aggressively poo-poo-ing Gibbs' idea, some of them predictably going too far in the other direction, arguing that it's a crazy idea and absolutely impossible.

This theory is neither probable nor impossible, but on the spectrum of likelihood, it certainly seems nearer the latter.

The first question that comes to mind is how an escaped virus from a presumably sophisticated viral research laboratory gets to a remote rural part of Mexico, where the disease was first confirmed, and where there are lots of pigs.

If you want a simple theory, how about this: if you hear an oink and a grunt in the night, is your first suspicion that there's a viral researcher with a test tube in the bushes?


© Jan TenBruggencate 2009

Vaccination against the Delta variant: the newest COVID-19 research

The Delta variant has upended the decline in COVID-19 numbers, but the most recent scientific reports indicate vaccination continues to be dramatically effective against it.

The disease is changing with new variants, and the science is changing as more and more researchers report data reflecting the new dominance of the Delta variant. We reviewed the latest scientific studies, which reflect the presence of Delta. The general conclusions are:

❶ Delta is more capable of overcoming vaccination than Alpha or other variants.  That said, vaccination still provides remarkable protection—far more than half of vaccinated individuals will never experience illness with symptoms that make them feel sick.

❷ Vaccination will make you three times less likely to be infected than not being vaccinated. The COVID vaccines provide strong protection—better than the flu shot does against flu.

❸ Underlying medical conditions still increase the threat of severe infection requiring hospitalization, whether you are vaccinated or not, but vaccination improves your odds of experiencing few or no symptoms.

Here are some of the points in research published within the past three months. I have included hyperlinks so you can look at the original source material.

An Israel study showed that vaccination protection from the Pfizer vaccine dropped from 94 to 64 percent when measured against the Delta variant, the protection for the need for hospitalization only dropped from 97 to 93 percent. Meaning there was an increased chance you might get sick, but you were still extremely unlikely to get very sick. 

An India study similarly showed that while Delta gets through vaccination (which researchers call “breakthrough” infections) a little more effectively than other variants, most vaccinated individuals never get sick. 

An English study done from May to July 2021 found that during the study, earlier variants were completely replaced by Delta. And they found that unvaccinated people were three times more likely to get sick than the vaccinated. 

A Singapore study showed the mRNA vaccines, like Pfizer and Moderna, are extremely effective against the Delta variant. This study found that vaccinated patients who did experience breakthrough infections were much more likely to have no symptoms, while unvaccinated individuals were much more likely to get very sick. 

A Mayo Clinic study in the United States reviewed Moderna and Pfizer vaccines January through July 2021 confirmed that both were generally highly effective, but were less effective against Delta. That said, both are much more effective than the seasonal flu vaccine is against flu. 

A Canadian study found that all available vaccines provide significant protection against all variants. Single-dose vaccination provided some protection but full vaccination (2 doses properly timed) was far better. 

A BMJ (formerly British Medical Journal) article notes that vaccination provides good protection against infection, but that it provides excellent protection (in the 90+ percent range) against being so sick you need hospitalization. 

A Welsh-Scottish-Irish study found that vaccines provide similar or better protection than having actually had the disease. And even if you have had the disease, vaccination increases your protection against reinfection. “Effectiveness of two doses remains at least as great as protection afforded by prior natural infection,” the report says.  

The upshots are these:

Some vaccinated people will still get sick. That is the case with all vaccines--they are not 100 percent effective. As as case counts rise, you'll hear about more of these breakthrough infections, but that doesn't mean vaccines are not working.

All the newest evidence shows that vaccination makes you less likely to get infected with COVID-19, and that even if you do get infected, you are dramatically less likely be so sick that you’ll need hospital care.

Put another way, at this point in the pandemic, if you are not vaccinated,  you and your family are at dramatically higher risk of infection and severe illness.

© Jan TenBruggencate 2021

COVID-19 Fake News: Stuff people are saying about the disease thats just bull

There is lots of information about COVID-19 out there, and some of it is bad information.

Hereʻs some of the stuff Iʻve been hearing thatʻs not true, or not entirely true.

Q. A friend asked whether, once youʻve had the virus, youʻre immune in the future.

A. The answer is, probably, but not certainly. 

Youʻre generally immune to a virus after having gotten it—at least for a while. However, there have been rare cases in which people have appeared to be over COVID-19, and then got sick again. Was it simply a relapse of the original infection or a new one? Thatʻs not yet clear.

There is also indication that the virus has evolved, at least in China, and that there are now at least two versions of COVID-19 out there. If youʻve had one, you might still be susceptible to getting the second. Hereʻs a link to a scientific paper on that.

The Centers for Disease Control says this: "The immune response to COVID-19 is not yet understood. Patients with MERS-CoV infection are unlikely to be re-infected shortly after they recover, but it is not yet known whether similar immune protection will be observed for patients with COVID-19."

Q. Another person said flu goes away in the summer, so this will be gone by mid-year.

A. Donʻt count on it. This disease has not been around long enough to know. Hereʻs what the Centers for Disease Control says about that: 

"It is not yet known whether weather and temperature impact the spread of COVID-19. Some other viruses, like the common cold and flu, spread more during cold weather months but that does not mean it is impossible to become sick with these viruses during other months.  At this time, it is not known whether the spread of COVID-19 will decrease when weather becomes warmer.  There is much more to learn about the transmissibility, severity, and other features associated with COVID-19 and investigations are ongoing."

Q. A co-worker told me he read that if itʻs a dry cough itʻs COVID-19, but if itʻs a wet cough itʻs the flu.

A. Wrong. (Sometimes.) 

As this guide from Johns Hopkins Medicine notes, thereʻs no sure thing with symptoms. A dry cough occurs most often in COVID-19, but not always. Same with fever—some patients have one, some donʻt. Same with soreness and tiredness. Same with shortness of breath. 

A World Health Organization study in Chinaʻs outbreak found that fever occurs 88 percent of the time,  dry cough in 68 percent of cases, fatigue in 38 percent, sputum production in 33 percent, shortness of breath in 19 percent, sore throat in 14 percent, headache in 14 percent, joint pan in 15 percent, chills in 11 percent, nausea or vomiting in 5 percent, nasal congestion in 5 percent, diarrhea in 4 percent, and coughing up blood in 1 percent and  and watery or inflamed eyes 1 percent.

Q. Someone asked, if I get tested, will I know for sure that I am or am not infected?

A. If you have symptoms and a positive test, youʻre infected. The test can confirm that the disease youʻve got is not a cold or flu or other virus and is COVID-19. 

If you have no symptoms and you can get someone to test you, chances are it will be negative. But that doesnʻt necessarily mean you donʻt have it. It could mean you donʻt. Or it could mean youʻre infected but havenʻt been infected long enough to test positive.

A report on a Stanford COVID-19 test said: 

"As with all currently available tests, it’s not yet clear how long a person needs to be infected before testing positive, or whether someone who's infected could be identified by the test before displaying symptoms." 

Q. If I get sick, I can only infect others while I have active symptoms.

A. Wrong. You can infect people a day or two before your active symptoms show up, and you might be able to pass the virus to others for a week or more after youʻve recovered.

 

This German study found active viruses for many days after symptoms disappeared.

© Jan TenBruggencate 2020

Your odds if not vaccinated are worse than drawing to an inside straight

Did you get the flu vaccine but not the COVID-19  vaccine?

How about that decision?

According to the Mayo Clinic: 

In the 2019-2020 flu season, 22,000 deaths among 38 million cases. Somewhat less than 1 in 1,000.

In the COVID-19 epidemic in 2020-2021, 580,000 dead among 32 million cases. Somewhat less than 2 in 100.

If you get the disease, you are 30 times more likely to die of COVID-19 than the flu. And these numbers don’t yet reflect the full impact of the new, more virulent Delta Variant.

Among vaccinated individuals, the death rate drops to less than 1 in 100,000, and most of those deaths are among frail, elderly folks in care homes.

Not getting vaccinated is betting on an inside straight. You might get lucky, but the odds are stacked way, way against it. Less than 1 in 10.

Pacific threats: no strangers for Hawai'i

Our ocean is at risk.

A new study by Stanford University researchers looked at a vast array of previous studies about the Pacific, and concludes that there's trouble in our Paradise.

(Image: The oceans report's cover. Credit: Center for Ocean Solutions.)

Interestingly, for anyone familiar with issues in the coastal ocean around Hawai'i, most of the conclusions won't come as a surprise: big issues include sewage and runoff from the land, habitat destruction, overfishing, invasive species, climate change.

In the Islands, think of clouds of sediment pouring into the sea after a heavy rain. Think of dredged reefs and ships aground. Think of why you can't count on catching dinner on a shoreline fishing trip. And think of the tangles of invasive limu choking Kane'ohe Bay. Think of eroding beaches and dying corals.

The study by the Center for Ocean Solutions is “Pacific Ocean Synthesis: Scientific Literature Review of Coastal and Ocean Threats, Impacts, and Solutions.” The Center for Ocean Solutions is managed by the Woods Center for the Environment, at Stanford University.

Primary report authors are Margaret Caldwell, Tegan Churcher Hoffmann, Steve Palumbi, Jessica Teisch, Chelsea Tu. It is available here: http://www.centerforoceansolutions.org/PacificSynthesis.pdf.

One of the issues with scientific research, of course, is that there are lots of researchers studying different pieces of the elephant, but seldom does anyone step back and view the whole elephant.

This report tries to do that.

It “summarizes and distills the scientific literature and highlights common trends in and around the Pacific Ocean regarding threats, impacts and solutions through the review of more than 3400 scientific articles and reports.”

The lead scientists got together and reviewed their work in Honolulu in August last year.

Among their findings: “a review of environmental threats across the Pacific Ocean shows remarkable similarity between the major problems experienced in poor and rich countries or territories alike, in densely settled areas and in rural zones, in populous countries and on small islands. Across these diverse areas, there are three pervasive and serious local threats: pollution from sewage and land runoff, habitat destruction, and overfishing and exploitation. We classify invasive species, which can be considered under both pollution and habitat destruction, as a fourth threat, in a category of its own.”

The final big one, of course, is climate change, which “imperils all Pacific ecosystems.”

An H1N1 “swine” flu analogy may be appropriate here. Ultimately, when people die of this generally mild flu, it's because its symptoms are piled on top of pre-existing medical conditions. Most otherwise healthy folks can handle a flu.

Same with the oceans.

“When marine life is subjected to multiple stressors, including pollution, habitat destruction, overfishing, and climate change, populations of ecologically and economically important species can collapse, from coral reefs to kelp forests to cold water deep seas. In this sense, global climate change is coming at the worst possible time, when many communities around the Pacific—both human and ecological—are threatened by other major problems,” the report's abstract says.

Its recommendations are to act globally on global issues, like climate change, and locally to create a sustainability ethic for local issues, like runoff and overfishing.

© Jan TenBruggencate 2009

This flu's been around for years: Science

A new report in the journal Science suggests the Type A H1N1 swine flu virus that is spreading around the world is a truly cosmopolitan virus, and may have been present in pigs for a long time before shifting to humans.

The report was released this morning by Science, written by a team of more than 60 researchers, led by Rebecca Garten, of the WHO Collaborating Center for Influenza, Centers for Disease Control and Prevention.

Portions of the genetic material “of this lineage of Eurasian swine viruses were originally derived from a wholly avian influenza virus that is thought to have entered the Eurasian swine population in 1979 and continues to circulate throughout the region,” the report said.

But other portions hail from North America, and still others from Asia. And it is related to a lot of previous flus, since flu viruses regularly swap genetic material.

The first human cases were reported in Mexico only a couple of months ago, but perhaps the newest information is that researchers now believe this virus may have evolved into its current form and been spreading among pigs for a long time before jumping to humans. Because these diseases are not closely tracked among swine populations, it might have gone unnoticed.

“This virus might have been circulating undetected among swine herds somewhere in the world,” the authors said.

They don't know where.

“Several scenarios exist, including reassortment in Asia or the Americas, for the events that have lead to the genesis of the novel A(H1N1) virus. Where the reassortment event(s) most likely happened is currently unclear.”

One of the issues for public health officials today is to keep close track of the virus, to see if it changes again—potentially making moot the work to develop a vaccine to the current form.

“ Worldwide monitoring of the antigenic and genetic properties of the novel A(H1N1) viruses continues for, among other reasons, detecting any changes and thus any necessity for selecting further vaccine candidates.”

© Jan TenBruggencate 2009