Fast, Foamy and Furious

H1N1 swine 'flu is coming home, and it is a big hit on campus.

With universities starting, and the weather cooling, the prospect for an early and nasty 'flu season was evident, and, amazingly, proactive measures were taken.

The first signs were the free, stand-alone, water free, hand sanitizer dispensers, appearing in high traffic and food areas.

Then came the Fast, Foamy and Furious!
- signs that is.
In the bathrooms.
Apparently the best way to get people to lather up and scrub is to convince them to sing "Happy Birthday". Twice. Quietly.
Annoyingly enough, this clearly works, since weeks later I can recite the directions from memory.

Still, the 'flu came, and now it is mostly a matter of slowing down the spread and damping down the peak, maybe even long enough for a vaccine to appear.
Students with confirmed 'flu are asked to go home, where they can sneeze at suburban Phillieites instead of senior university administrators.
Those who can't go home are bunked in shared isolation rooms, with little signs on the door.

About 1% of students here are reported infected so far (though, strangely, about 10% of the football team got sick last week - need to work on the Fast, Foamy and Furious thing, lads).

So what?
Well, case rate right here is roughly increasing by a factor of 2-3 per week, from few per week to hundreds per week now.
Good news is that this must inflect and plateau, no more than 3-4 weeks from now, at the current rate of growth; bad news is that this will be because tens of percent of the vulnerable population will have been infected...

It is likely that everyone under 50 lacks immunity, and so rather than maybe 5% of the population getting sick, it will be more like 50% - with a factor of 2 uncertainty or so.
So, it is pretty mild, right?
Well, yes, so far. Unless you are pregnant, have asthma, are immunocompromised or have other vulnerabiltiies. The 'flu still kills, and even with a low death rate, if everyone really gets sick, some people will die. Young people. The conjecture that people born before 1957 have some immunity seems increasingly plausible.

Deaths are also lagging indicators, right now if you get sick and it gets worse you'll get into an ICU and have a respirator, anti-virals will be provided, nursing care is there. People are kept alive.
But, earlier this week, the local ped office was seeing kids with 'flu symptoms after hours, because they were so busy they had to, and because they wanted to bring them in when changes of infecting the regular patients were less - so they schedule the routine appointments early and then overflowed the urgent "kid with fever" appointments, staying as long as it took.
Out here only the ER is doing 'flu typing, I am told, but it was also noted that going there would require staying a long long time, the ER being busy, backed up and triaged.

At some point, as case load increases by a factor of ten or more, the ICU slots, the respirators, the beds run out. As does the staff. Medical staff is as vulnerable and will be getting sick about now. This is not black plague level crisis or anything, but it makes the small percentage of cases that develop complications become more vulnerable as the resources to provide heroic intervention and support run out.

When more than 10% of the population is really sick at any given time, we may start to see degradation in economic services. I think I saw a little of that earlier this month, as it took me 50 hours, rather than the scheduled 10, to travel across the US. Some of the delay was not weather, or mechanical, it was lack of people - no one at the gate to wave in an aircraft; staff at airports and hotels working while clearly and visibly sick.
This is likely to be more at the nuisance level but it will change things.

For example, the college football Bowl Championships Series may well end up depending on contingent timing of cases at individual universities
- makes a difference whether you lose just a few players in any given week, or half your starters;
does the offensive line get sick the week of the off-conference cream-puff game, or the week of the away game at the historic rival powerhouse?
Did your team case rate peak early in the season or late? Will there be a vaccine before your team gets it? We'll see in january.

Trivial, in the greater scheme of things, but the sort of thing people care about.
Oh, and a multi-billion dollar industry.

It will be an interesting month or two.

Oh, and yes, as you might infer, swine 'flu has come home.

So far it is like regular 'flu, from second hand observation: high fever for 2-3 days, combined with complete exhaustion and body aches; abdominal pain, then the extra contagious coughing/sneezing feeling-better and stir-crazy period.
Statistically, I have about 1/3 chance of getting it in the next week or two. Yay.
But, hey, I'll blog it if I do.

Thing to keep an eye out for: fever flaring up again after 3+ days; shortness of breath or tightness in chest; dehydration and coma.
Ok, I could have figued out the "coma" bit for myself.
Real issue seems to be "does it get worse again when you should be getting better"?
Don't know if that is secondary infection concern - the opportunistic pneumonia that kills as with the regular 'flu; or is it capitulation of the immune system and the H1N1 virus resurging. Be interesting to know.

If the true number of cases does include tens of percent of the population, worldwide, in a fairly sharp spike this year, it will be unpleasant.
It will be far more unpleasant in countries with defunct health care systems, vulnerable populations and fragile economies.