I have a handful of comments, mostly about how what you are seeing on the news is unimportant, and one comment about why you actually should worry. Within reason.

The new Swine Flu has now been verified in nineteen US states, with 141 cases. Technically there is 1 death, but since the young girl who died actually caught the flu in Mexico (and came to Texas for treatment) it is hard to say how that should be counted.

WHO characterizes the global spread of the flu as a “rapidly evolving” situation. As of an early morning update from WHO, the swine flu has been confirmed in Mexico (156 confirmed cases) as well as Austria, Canada, Germany, Israel, Netherlands, New Zealand, Spain, Switzerland and the UK. Each of these countries has between 1 and about a dozen cases, except Canada which has 34.

My comments:


1) I’m annoyed at the playing around with the name of the flu. The Israeli Government was wrong to insist on not calling this Swine because of the kosher-pork issue. Nothing about that makes sense. The Minnesota Government led by Republican “I’m not very smart but I won’t raise your taxes” Pawlenty is also wrong in insisting that it be called the H1N1 flu. Pawlenty has stated that we should not call it the “swine flu” because that is disparaging of the pork industry (which is reasonably important here in Minnesota).

That is utterly stupid because you can eat pork chops, ham,and bacon all day, from swine who have the flu, and never get it. There are times when it is appropriate to adjust the name of a disease for various social or political reasons, but it is wrong to do so in response to utter ignorance. Instead, deal with the ignorance. Pawlenty will not deal with the ignorance directly because he is a Republican and, quite honestly, Republicans prefer to foster, and when convenient use, ignorance for their own monetary and political gain.

2) There is no validity whatsoever to the idea that the swine flu is more deadly in Mexico than elsewhere, or that Mexicans are somehow more likely to die of it. Well, the latter may ultimately be true because of health care differences. It may turn out that people in Mexico and Panama will be more likely to die of this flu than people in Sweden and France, owing to disparities in health care across countries. It may also be the case that people in Louisiana will be more likely to die of this flu than people in Minnesota or Massachusetts for the same reason. However, it is also true that the data that are currently available are not sufficient to say anything other than this, and only in a very preliminary way: The current swine flu outbreak seems to have a mortality rate that is roughly similar to the seasonal flu, at present. (But see below.)

3) It s not true, as is reported again and again by reporters who should really stuff a sock in their mouth on waking and keep it there all day, that the swine flu is “mild” in the United States. This misconception and mis statement comes from an illogical extension of number 2 above. This is a serious flu. You get sick as a dog for a week or so, and it can kill you, just like the seasonal flu.

4) Regarding the spread of this flu: More and more people who know what they are talking about are saying that the spread of this flu is similar to that of seasonal flu. In the same way that we can characterize the mortality rate as similar to seasonal flu, we can probably say the same regarding the rate of spread. However, both characterizations are subject to change as data become more available.

ResearchBlogging.orgThere are two separate issues here. On one hand, we have the accumulation and verification of case by case data, and on the other hand, we have the spread of the flu. Over time, the quality of the data will become good enough to make longer term projections and to make assumptions about the missing or lower quality data areas of the world. So, right now, as we see reports of more states in the US or more countries across the world reporting cases for the first time, are we watching the actual spread of the flu, or the improvement of data? Answer: Both, and we can’t separate the two right now with any degree of reliability.

5) Regarding the flu’s virulence and mortality: Good news and bad news. I have one piece of good news and two pieces of bad news.

First the good news: It does seem (see above) that this flu is not extra deadly.

Now the first bit of bad news: The seasonal flu is deadly. This new flu … the swine flu … is like the seasonal flu. It is also deadly. It might be that the currently spreading strain of Swine H1N1 ends up being less deadly, it might end up being more deadly, but if it turns out to be about the same as the seasonal flu and goes though a similar cycle, you can expect several tens of thousands of Americans to die of it.

Maybe thats a good thing. Maybe killing 38,000 Americans twice in one year instead of once will result in a change in attitude towards both the flu and towards vaccination in general. Maybe I’m too cynical. Maybe I’m not.

Now the second piece of bad news, and this is the scary bit. This flu may be worse than a regular flu in that more people will get it … there is not vaccine available now, so it’s initial spread will be unchecked compared to a normal seasonal flu for which vaccines may have been distributed. There is probably not as much of an immunity to this flu as for the seasonal flu (this has yet to be determined but is likely true) so it may be that more people will end up getting this flu.

Fine. But that’s not the real bad news.

The real bad news is that since this is a new flu part of which (flu has different parts that may have different histories) only recently entered the human environment, there might be a slightly higher than we would like to have chance that this flu, while it swaggers around the human population making people sick, will recombine with one or more other flu viruses that are already out there with very nasty results.

This flu could spread around the world as a regular flu, making lots of people sick but not being overly deadly. Then, some time during its spread, or even after it has largely abated, it could mutate through recombination (of some of its parts) and come back as a much more severe flu, causing a truly deadly world wide pandemic.

How possible is this? We have no way of knowing, but that scenario has happened before. From a paper by Taubenberger and Morens:

Historical records since the 16th century suggest that new influenza pandemics may appear at any time of year, not necessarily in the familiar annual winter patterns of interpandemic years…. Thereafter, confronted by the selection pressures of population immunity, these pandemic viruses begin to drift genetically and eventually settle into a pattern of annual epidemic recurrences caused by the drifted virus variants.

In the 1918-1919 pandemic, a first or spring wave began in March 1918 and spread unevenly through the United States, Europe, and possibly Asia over the next 6 months … Illness rates were high, but death rates in most locales were not appreciably above normal. A second or fall wave spread globally from September to November 1918 and was highly fatal. In many nations, a third wave occurred in early 1919 … Clinical similarities led contemporary observers to conclude initially that they were observing the same disease in the successive waves. The milder forms of illness in all 3 waves were identical and typical of influenza seen in the 1889 pandemic and in prior interpandemic years. In retrospect, even the rapid progressions from uncomplicated influenza infections to fatal pneumonia, a hallmark of the 1918-1919 fall and winter waves, had been noted in the relatively few severe spring wave cases. The differences between the waves thus seemed to be primarily in the much higher frequency of complicated, severe, and fatal cases in the last 2 waves.

That paper characterized the pattern of the 1918 flu well, but was written before some key findings in the nature of flu evolution, so I won’t pass on the speculations those authors provide for why this pattern developed.

Taubenberger, Jeffery, & Morens, David (2006). 1918 Influenza: the Mother of All Pandemics Emerging Infectious Diseases, 12 (1)

Comments

  1. #1 eddie
    May 1, 2009

    Hold on…

    …ah ah ahtch-oink!

    Oh dear.

  2. #2 mk
    May 1, 2009

    Once again, the Israeli “government” did not ask the name to be changed. It was one minister and he is an ultra-orthodox Jew. Last I saw, Israel’s Foreign Ministry told the Mexican Ambassador that they were not going to change the name to the Mexico Flu.

  3. #3 jim jacks
    May 1, 2009

    interesting this thing is spreading like wildfire.

    get a load of this scary Report.

    http://forecastfortomorrow.com/Files/swineflu.pdf

  4. #4 Greg Laden
    May 1, 2009

    mk: You are correct that the Israelis backtracked. It was Israel’s deputy health minister, Yakov Litzma, talking about the disease to reporters. Perhaps the Israeli people should avoid having ultra-orthodox crazy people working in important position in their government.

  5. #5 gaby_waby
    May 1, 2009

    This article really downplayed the seriousness of the “flu waves” of the 1918-1919 years. There is a big difference as to the seasonal flu that there is a vaccine for available now and those waves and this h1n1 that is going around now. The fatalities of the 1900′s were not hallmarked by “uncomplicated fluenze infections to fatal pneumonia”, but the succession of waves and their hallmark to this day lies in the form that pandemic killed people. Now according to Wikipedia, and it’s source PBS, the very deadly and virulent (aka aggresive) form of the 1918-1919 flu made it’s hallmark by killing people in what is a cytokine storm.
    “Scientists have used tissue samples from frozen victims to reproduce the virus for study. Given the strain’s extreme virulence there has been controversy regarding the wisdom of such research. Among the conclusions of this research is that the virus kills via a cytokine storm (overreaction of the body’s immune system) which explains its unusually severe nature and the concentrated age profile of its victims. The strong immune systems of young adults ravaged the body, whereas the weaker immune systems of children and middle-aged adults caused fewer deaths”-http://en.wikipedia.org/wiki/Spanish_flu

    This flu, that in your words is no different than the seasonal flu and is comparable to the h1n1 virus of 2009, killed more people off than World War I. Now if that is not a hallmark, I don’t know what is. Unless more people begin to survive it and it’s waves to come, then we are no more likely to survive a Juarez, Mexico, drug fueled attack, than the swine flu. That being said because according to statistics, you have more chances of surviving the Iraqi war than you do Juarez, Mexico.

    Truth be told, we don’t know enough yet to categorize it as mild as the seasonal (that being said, although there have been deaths because of it) and not enough to categorize it as the flu of 1918-1919 (aka the Spanish flu).

    I must mention that in this time of fear it is not fair to pinpoint any specific race to the sole cause of any specific disease. That comes from the ignorant lashing out at immigrants and Mexican’s for being the first to recognize it. That is like blaming homosexuals for HIV. Which is what people do in times of fear. But as you are scared so are us Mexican’s. Well, be wary and stay safe!

  6. #6 Greg Laden
    May 1, 2009

    Gaby: I have not said that the present swine flu is no different than seasonal flu. I pointed out several differences. I have said that the spread rate and mortality rate is currently not distinguishable from the seasonal flu, but that this may be wrong.

  7. #7 mk
    May 1, 2009

    Perhaps the Israeli people should avoid having ultra-orthodox crazy people working in important position in their government.

    No question! Hear-hear.

  8. #8 Jason Thibeault
    May 1, 2009

    Given that we don’t have enough data to determine its mortality rate, but that the media as usual jumped all over this to hype it as some kind of apocalypse (my local radio show had a skit on this morning about Hallmark Cards for people with the swine flu, all of them amounting to “sorry you’re about to die”), I think the fact that we are hearing reports showing people who get the flu and get better are pretty heartening.

    But yes, I’m quite concerned with the idea of something extremely deadly recombining with something as obviously virulent as this strain of swine flu. That’s my biggest concern about the whole deal, in fact. Take a few bad features from some deadly viruses and add them to the bad features of this one (e.g. our lack of immunity, and its transmission rate), and we have a real problem on our hands.

  9. #9 Nathan Myers
    May 1, 2009

    This flu doesn’t need to be less “mild” than seasonal flu to kill many, many people. All it needs is to spread faster and and catch many more people, some smallish fraction of whom will die if they get a flu.

    Maybe that’s what you said.

  10. #10 Andrew
    May 1, 2009

    Perhaps the Israeli people should avoid having ultra-orthodox crazy people working in important position in their government.

    No question! Hear-hear.

    Perhaps the American people should avoid electing crazy religious evangelists (twice) into office, and thereby set their health care research back by a decade.

    Perhaps the Swiss should not ask their scientists to fill in a clause requiring them to protect the dignity of plants they are researching.

    The word Pig is offensive to many Hebrew speakers, and there are no euphemisms in Hebrew. The DHM was simply trying to use, what is in his culture, clean language. I am sure that nobody in English speaking countries would call dysentery the “shit eating disease”.

    Unlike advanced nations such as the US and Switzerland, there are no constraints to health and life science research in Israel. With a health care system that ranks at the top 15 of the WHO index, it may be wise to actually learn something from how they treat the pandemic over there, and not what they call it.

  11. #11 A Lurker
    May 1, 2009

    I do have to say, when you write:

    “he is a Republican and, quite honestly, Republicans prefer to foster, and when convenient use, ignorance for their own monetary and political gain…”

    Your (I hope) hyperbole does not help your case. It is unprofessional, and makes you sound snotty and untrustworthy.

    I look at the current Administration, for example, and I would not think you would want to get into people doing things (say, Barney Frank and Geitner) for their own monetary and political gain.

    Why not leave the politics out of it? Unless you are willing to sling mud in all directions, please. Again, it hurts your cause…unless you are only interested in chatting with people who think just like you.

  12. #12 TLP
    May 1, 2009

    The pork meat industry will be affected. Even though you can’t get sick from eating pork, people are stupid and don’t know this.

    I heard Egypt gave an order to kill all their 300.000 pigs.

  13. #13 Stephanie Z
    May 1, 2009

    And the concern trolls come out? Really?

    Andrew, words are not unclean. Anyone who is so afraid of a word that it hampers their ability to talk about a real problem has another real problem. And dysentery would be the “shit drinking disease.” Details are important.

    Lurker, Greg is generally happy to argue with people who disagree with him, as are an awful lot of the commenters around here. If you want mud slung in a particular direction, why don’t you try it and see whether it sticks instead of just trying to daub some discretely in the midst of your interpretive dance of fragile feelings.

  14. #14 Nathan Myers
    May 1, 2009

    TLP: Modern pig-farming methods are deeply and pervasively unsanitary and environmentally destructive. Eliminating pigs eliminates pig farms, which breed flus.

    See http://www.rollingstone.com/politics/story/12840743/porks_dirty_secret_the_nations_top_hog_producer_is_also_one_of_americas_worst_polluters/print

  15. #15 Andrew
    May 1, 2009

    Andrew, words are not unclean. Anyone who is so afraid of a word that it hampers their ability to talk about a real problem has another real problem.

    Only a request to call the disease Mexican Flu by one official (the DHM has no administrative power) does not seem to hamper the Israeli public health system with dealing with it. None of the mainstream Hebrew newspapers seem to call it anything other than Pig Flu. Like I said, it’s a cultural thing, and all cultures have their funny taboos. As taboos go, this one doesn’t really kill anyone. Denying funding for ESS research or to AIDS programs that advocate prophylactics, or research that might increase crop yield and alleviate hunger (Switzerland) probably does.

  16. #16 mk
    May 1, 2009

    @Andrew…

    So what exactly are Israelis hearing when someone says: Shapaat HaHazirim?

  17. #17 Jason Thibeault
    May 1, 2009

    If you want mud slung in a particular direction, why don’t you try it and see whether it sticks instead of just trying to daub some discretely in the midst of your interpretive dance of fragile feelings.

    This is the best thing I have read all day. You win all my interwebs, Stephanie!

  18. #18 Andrew
    May 1, 2009

    @Andrew…

    So what exactly are Israelis hearing when someone says: Shapaat HaHazirim?

    The secular ones: probably nothing more than what you may hear with “Pig Flu”. As one drifts on the religious scale, the uneasiness caused by the word “Hazirim” grows. Not getting into details, but for many reasons, and not just dietary, Pigs have a special place of infamy in certain parts of Jewish culture. Nobody would think of changing the name of Rabies (literally “Dog Disease”), even though dogs are not kosher wither.

    Funny thing is, I just remembered the word for Mumps in Hebrew is also derived from the word Pig. (If you ever seen a person with the Mumps you’d know why). Then again, nobody gets mumps nowadays. Which just goes to show that this is whole naming thing is a tempest in a teacup.

  19. #19 Serena
    May 1, 2009

    Stefanie,
    Your comment directed at Lurker is priceless. It deserves an award. :)

  20. #20 guest
    May 1, 2009

    “The new swine flu: don’t panic, but there is a very bad WCS”

    What is “WCS”?

  21. #21 Rev. BigDumbChimp
    May 1, 2009

    The word Pig is offensive to many Hebrew speakers, and there are no euphemisms in Hebrew. The DHM was simply trying to use, what is in his culture, clean language. I am sure that nobody in English speaking countries would call dysentery the “shit eating disease”.

    How about Hamthrax?

    A snoutbreak?

    A hamdemic?

    The Aporkalypse?

    Seriously, if people are offended by the name of an animal, I’m not going to worry even a little bit about it.

  22. #22 Greg Laden
    May 1, 2009

    WCS = Worst Case Scenario

  23. #23 Stephanie Z
    May 1, 2009

    Thanks, Jason and Serena. Pissing me off makes me weirdly eloquent sometimes. It’s nice to know someone gets something out of it aside from my vague embarrassment.

  24. #24 melior
    May 2, 2009

    lurker@11:

    Your (I hope) hyperbole does not help your case. It is unprofessional, and makes you sound snotty and untrustworthy.

    Actually: sadly, no! In this case, it makes it clear Greg has been paying attention for the last 8 years. One of the most science-hostile administrations in a generation has just been replaced by an enthusiastic supporter.

    Which party has vehemently denied global warming science, promoted oxymoronic “voluntary self-regulation” laws which brought us melamine-laced pet food, salmonella-laced pistachios, and E. coli-laced groundwater, overrode their own obsession with “states rights” to deny California the right to regulate CO2 pollution within its own borders, misdiagnosed Terri Schiavo by remote viewing, setback regenerative medicine research for decades by limiting cell lines to those that baby jesus isn’t scared of?

    The truth sometimes hurts, but facts are facts.

  25. #25 AJ Cann
    May 2, 2009

    Swine flu replicates in pigs, avian flu replicates in birds, this virus replicates in humans. It’s not swine flu any more and the WHO’s decision to use A(H1N1) as the name is appropriate.

  26. #26 Greg Laden
    May 2, 2009

    AJ: Actually, A(H1N1) is a short cut because it is not unique. Then again, neither is “swine flu”

    My objection is not to a particular name, it is to avoiding “swine” for stupid reasons, and to the stupid itself.

    I originally wanted to cal it the Tex-Mex flu but that has not caught on.

  27. #27 Mike K
    May 3, 2009

    Your comments about Republicans and objecting to calling the virus what it is, H1N1, sounds pretty ignorant. Also:

    Actually: sadly, no! In this case, it makes it clear Greg has been paying attention for the last 8 years. One of the most science-hostile administrations in a generation has just been replaced by an enthusiastic supporter.

    The new administration just appointed an AGW hysteric as science adviser who was last seen predicting global starvation with Paul Erlich a couple of decades ago. Politics is politics, left or right orientation. These folks are no improvement.

  28. #28 Mike K
    May 3, 2009

    By the way, the very high mortality in 1918 was largely due to the ignorance of lung physiology and the errors in treating pleural effusion, the cause of at least 50% of the deaths. Look up the Influenza Commission some time. Evarts Graham figured out the reason why so many died from the 1918 flu. Closed chest drainage resulted.

  29. #29 Nacho
    May 4, 2009

    Great article, many thanks.

    Just a quick question to be sure: does it make any difference if the pork is cooked or not? ‘Cause I read in other (admitedly not so trustworthy) sources that it’s not risky to eat well-cooked pork, but it said nothing about pork in general. You don’t make this distinction here, you just say pork is safe. Maybe all pork is safe for the flu but if it’s not well cooked it can transmit other diseases? Thanks again.

  30. #30 Stephanie Z
    May 4, 2009

    Nacho, the recommended cooking temperature of pork has more to do with parasites than with viruses or bacteria. While those parasites have been almost completely eradicated from the U.S. pork supply, following the recommendations is still very wise.

  31. #31 Greg Laden
    May 4, 2009

    Nacho:

    The virus needs to be from living tissue, and it needs to be packaged up for transmission. So, the only way to get this virus from a pig is if the pig sneezes on you, or if it is very freshly dead and you get bits of its respiratory epithelial tissues from the pig into your respiratory system. (The equivalent of a dead pig sneezing on you.)

    The usual parasites you can get from a pig, as Stephanie points out, have been eradicated from the Western food supply, and are also totally curable.

  32. #32 Nacho
    May 4, 2009

    People tend to undercook sometimes because they like eating “juicy” pork (or whatever meat it is), so the recommendation makes sense I guess, even if it has nothing to do with the new swine flu. They (and by “they” I mean the press and the authorities) could explain that to make things clearer, though. Thanks for clarifying it.

  33. #33 Nacho
    May 4, 2009

    (Didn’t see Greg’s comment)

    Yeah, the idea of catching a flu from a long dead animal looked very strange to me, but as I’m no expert…

  34. #34 Greg Laden
    May 4, 2009

    Personally, I think it is pretty safe to eat pork obtained from reasonable sources that is not totally cooked to death (in a culinary sense to death … the should, of course, be dead).

    BTW, I’m pretty sure that a pig that is sick with the swine flu (or anything else) is not supposed to be slaughtered.

  35. #35 Nacho
    May 4, 2009

    Heh. They cook lobsters to death, literally, so it’s worth the brackets.

  36. #36 Monado
    May 13, 2009

    I saw one item that said pigs with swine flu, once cooked, could be safely eaten; but I don’t know what regulations say about it in various countries. A farmer in Alberta had to slaughter 500 hogs, but that was because the barns were getting overcrowded with the farm quarantined and more hogs maturing.