Canadian Press (Helen Branswell, with contributions from AP reporters) AP has a piece up about how Mexicans are coping that is worth a read, but we were drawn to this description of how the Mexican authorities first recognized something was amiss:.
Health authorities started noticing a threefold spike in flu cases in late March and early April, but they thought it was a late rebound in the December-February flu season.Testing at domestic labs did not alert doctors here to the new strain, although U.S. authorities detected an outbreak in California and Texas last week.
Perhaps spurred by the U.S. discoveries, Mexico sent 14 mucous samples to the U.S Centers for Disease Control on April 18 and dispatched health teams to hospitals looking for patients with severe flu or pnuemonia-like symptoms.
Those teams noticed something strange: The flu was killing people aged 20 to 40. Flu victims are usually either infants or the elderly.
As recently as Wednesday, authorities were referring to it as a late-season flu.
But mid-afternoon Thursday, Mexico City Health Secretary Dr. Armando Ahued said, officials got a call "from the United States and Canada, the most important laboratories in the field, telling us this was a new virus."
"That was what led us to realize it wasn't a seasonal virus ... and take more serious preventative measures," Health Secretary Jose Cordova said. (
Canadian PressAP)
Bloomberg is reporting that the Health Minister, Jose Cordova, is putting at 81 the number of deaths linked to the virus, up from 68, although the number of laboratory confirmed cases still stands at 20.
Then there's this mind boggling factoid:
The first case was seen in Mexico on April 13. The outbreak coincided with the President Barack Obama’s trip to Mexico City on April 16. Obama was received at Mexico’s anthropology museum in Mexico City by Felipe Solis, a distinguished archeologist who died the following day from symptoms similar to flu, Reforma newspaper reported. The newspaper didn’t confirm if Solis had swine flu or not. (Thomas Black, Bloomberg)
I'm going to bed. Maybe when I wake up I'll find this has all been a (bad) dream.
Addendum (4 AM): At the end of a long day, I may have misjudged the alacrity with which some people will convert an interesting, even mind boggling, factoid into an elaborate conspiracy theory. So, for the record, it is my view that sometimes -- in this case all the time -- a flu outbreak is just a flu outbreak. Nature's bioterrorist is always the overwhelmingly likely explanation for a disease outbreak.
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Wait, what? Please tell me that I'm reading that paragraph wrong and that it doesn't say what my eyes tell me it says.
Revere (and anyone else who cares to comment),
speaking of factoids... what do you make of this?
http://biosurveillance.typepad.com/biosurveillance/2009/04/swine-flu-in…
and this, too:
http://biosurveillance.typepad.com/biosurveillance/2009/04/the-global-r…
which lists this: "physician claims over 200 fatal cases of swine influenza"
WTF? Does this site, or Veratect have any credibility?
Suzanne: I know little about them except they are a for-profit disease intelligence outfit selling their info scraping to businesses. It isn't clear to me how much vetting, if any, they do. It's a bit like the flu forums, probably. Hits and misses. Some of the hits are pretty good. We forget about the misses. Same for all of us. But I wouldn't just take their word for it but check out the source.
:) My inner conspiracy theorist wonders how 4 viruses originating on 2 continents find the opportunity to reassort together without anyone noticing the intervening strains...and to manifest a typical incubation period (3d) before the US President visits?
(human H1N1, bird (N. Am. H5N1?), swine (N. Am), and swine (Europe))
Do we know if the Mexican version of the bug has anything interesting under that H1N1 wrapper, like a particularly nasty avian NS1 from Asia?
Or do we just have a farmer with the flu, in the name of economy, feeding mysteriously dead chickens to his under-the-weather pigs?
Holy f$#$ing crap!
Yes many conspiracy are already on-line... still
One day at the time eh!
We are lucky in whealthy countries to have significant amount of medicines, antivirals and antibiotics.
In the worst case scenario this is the mild first wave that I believe we can cope with, yes I do believe it.
So as The Doctor (Grattan Woodson) said, it granths us few months to developped and produce an efficient response in the Fall.
I know I am again against the Wind but I truly believe we will cope with this first assault.
Snowy
Confident Snowy Owl
Lisa, I'm surprised at you. Tell your inner conspiracy theorist to get a good night's sleep. You know that flu viruses reassort all the time and there is a lot of international travel of goods and people. Pigs are always suspect in the flu world because they have both avian and human receptors in their respiratory tract so are an ideal mixing vessel for flu virus. We didn't see it because no one was looking. There is no systematic surveillance of livestock and no one was running analyses to see if whatever isolates were out there had two different lineages. Human, bird and pig have been seen together before.
As far as not seeing the outbreak, you know enough about surveillance to know how easy it is to miss it without a surveillance system.
Right now we should be figuring out how to manage the consequences of this.
Suzanne: I suspect the 200 deaths comes from this BBC report where they printed first hand accounts from Mexico City. It's not an official number but disturbing none the less. http://news.bbc.co.uk/2/hi/talking_point/8018428.stm
The money quote:
"I work as a resident doctor in one of the biggest hospitals in Mexico City and sadly, the situation is far from "under control". As a doctor, I realise that the media does not report the truth. Authorities distributed vaccines among all the medical personnel with no results, because two of my partners who worked in this hospital (interns) were killed by this new virus in less than six days even though they were vaccinated as all of us were. The official number of deaths is 20, nevertheless, the true number of victims are more than 200."
On a more coherent note, I have a question about alcohol-based hand sanitizers. A nurse recently said that it's only really effective against bacteria... which makes it useful for things like MRSA, but is not at all effective for viruses, like, say, colds. Or flu.
For years, I'd just gone along assuming that rubbing alcohol did kill viruses, since it was always right behind hand-washing on the recommendations for colds and flu. Is that wrong?
caia: DemFromCT said a commenter at his place said the guy died of a heart attack. That doesn't mean he did, or if he did, that it is any less of a mind boggling factoid. I'm not making anything out of it except to say the fickle finger of fate can be really fickle sometimes. I seem to remember Barry remarking that one theory that Wilson was so off at the Versailles peace conference in 1919 is he had sequelae. Unlikely, but thought I'd lighten up the posts after a long day and also toss some fresh meat to the tin foil hats. As if they needed it.
When I saw the Bloomberg article earlier today about Obama and the museum director, Solis, I googled and found this source's different account of events. I'm having trouble capturing the link and I know nothing about this source...but it says:
"U.S. President Barack Obama was in contact with a man who died April 23 from the swine flu, Reforma reported April 25. Felipe Solis, a museum director, met Obama on April 16 in Mexico City, and began to suffer from flu-like symptoms the following day. On April 18 he was admitted to a hospital, where he was diagnosed with a case of pneumonia, which was aggravated by his diabetes. Solisâ glucose levels could not be stabilized, and he died on April 23 from cardiac arrest."
http://www.stratfor.com/sitrep/20090425_mexico_u_s_man_swine_flu_met_ob…
Scary Barack brush. Does anyone know when case studies will be available from Mexico? How many days from now will details trickle in at the level of USA case study details?
This virus may severly impact 2nd and 3rd world nations, which is what makes this virus a potential pandemic. As a US citizen, I am not worried; I live a health lifestyle in a sanitary environment.
Caia: yes alcohol rubs work fine. They don't kill spores like C.Diff (found in poop). Medonyx and Sprixx manufacture a portable pager-like alcohol gel dispensers that would've been ideal for time-pressed nurses and doctors in a pandemic to already have been equipped with. I think Canadian healthcare agencies are waiting for a large clinical trial at U of T to be completed next year before ordering gelFAST. Why they are waiting I have no friggin idea; costs $1-2 a nurse shift.
Brian, I hate to be the one to have to tell you this, but first world citizenship, Purell, and a gym membership are not proof against contagious disease.
DemFromCT said a commenter at his place said the guy died of a heart attack. That doesn't mean he did, or if he did, that it is any less of a mind boggling factoid.
AP is reporting that Solis "had a pre-existing illness and died of pneumonia unrelated to influenza."
Large numbers of people (although far short of the entire US population as was originally planned) got vaccine against "swine flu" in 1977. Anyone know if those people who received that vaccine would have any remaining degree of immunity to this current outbreak?
Xan - It was 1976 and I was one of those at the time who refused the vaccination. No particular reason why...just did not want to have to go get another painful shot. I was young and still feeling pretty immortal back then...
I heard this same question asked on CNN earlier today. The 'expert' (can't recall who) said that it was so long ago, he highly doubted those vaccinated in '76 were still protected...from anything. He also said this new swine flu is probably vastly different from the old.
Thanks Cheetos...I was tasked with researching the question by one who did get the shot back then (was in the military and not given much of a choice in the matter.) It struck me as unlikely too but I am just a rank amateur who reads a lot, not a trained medical person of any sort.
Conspiracy theories, here, are utterly stupid. Period. And I agree with Revere here, Lisa; I am truly surprised at you!
"Revere"
You are more than welcome to check my facts. We work with WHO, OIE, CDC, and a multitude of other international organizations on a daily basis doing nothing but global detection and tracking of infectious disease events, crises, and disasters. We are a multi-source environment. After 12 years of doing this work, our teams have evaluated nearly 100,000 events and were first to report many, many events.
What you see in HealthMap, ProMED, and your blog, of course is not all that happens in this world in all the languages of the earth.
You are more than welcome to contact me anytime- with the caveat you divulge your identity.
PS- My two Congressional testimonies stand. A simple Google check will bring them up.
Should you wish to be kept abreast of the evolving global situation, you may follow http://twitter.com/veratect
"Suzanne: I know little about them except they are a for-profit disease intelligence outfit selling their info scraping to businesses. It isn't clear to me how much vetting, if any, they do. It's a bit like the flu forums, probably. Hits and misses. Some of the hits are pretty good. We forget about the misses. Same for all of us. But I wouldn't just take their word for it but check out the source."
Despite the moniker "for-profit disease intelligence outfit selling their info scraping to businesses", we actually provided early warning to several key organizations, including our own nation's public health infrastructure and the World Health Organization completely free of charge.
Regarding credibility assessments, yes we do that for each source that we evaluate. We have been doing this kind of work for years.
The screenshots Suzanne asked about were live shots taken straight off our operations center portal. The dots correspond to all (not just swine flu or respiratory illness) infectious disease events being tracked at the moment the shot was taken.
And lastly, our role in the timeline of detection and warning of swine flu in Mexico is here:
http://biosurveillance.typepad.com/biosurveillance/2009/04/swine-flu-in…
We stand by these facts. Some have been left out due to sensitivity considerations.
Ah, Revere, I know better, I'm just making light...
I'm hoping that the reported Mexican death rate is a sample-bias due to mild cases going unrecognized, and what we wind up with is an epidemic or possibly pandemic no more severe than seasonal flu, though it might chew on different age groups than usual.
In any case, we knew a flu pandemic of *some* type was coming, and because of H5N1 concerns we're more prepared for it than we might have been, so I'm glad its a (compared to H5N1) mild one.
The other nightmare scenario is if this bug depletes resources and is followed within 2 or 3 years by H5N1 breaking loose. While H1N1 could shake the bugs out of our response plans, it will also consume antiviral resources that cannot be quickly replenished should H5N1 come close on its heels.
thanks Revere, BlendedBlur, & James for the responses.
For what it's worth, my gut reaction is that the Mexico City Dr's statement has the ring of truth to it. Surprisingly, it gives me some relief. I was uneasy with the increasing level of official action in Mexico City, given the slow growth of claimed cases. Didn't seem consistent to me.
This Dr Wilson is for real, if it is him who is posting.
The following link is his testimony:
http://homeland.house.gov/SiteDocuments/20080716143655-63876.pdf
A google search reveals that Dr Wilson is the chief scientist for Veratect, a company that provides early detection of viruses. The Veratect corp. website says "Veratect provides timely and actionable information that supports informed decisions across a broad range of public and private institutions."
Thank you for providing that twitter link Dr Wilson.
add--as far as managing, so far I approve of the way 'the experts' have been touting the need for accurate communications and the media (cnn, anyway) seem to be on the same page.
I do think some of the news anchors need a little better grounding in basic flu science. Also reporting without sensationalizing. Don Lemon today kept referring to the 'deadly swine flu', and I really don't like that as a stock phrase, especially since the mortality in the US, with better public health tracking resources than Mexico, has so far (with our small sample) been unremarkable.
Can we create some kind of conspiracy among scientists making media appearances to refer to this as something other than 'swine flu'--perhaps by its proper name (I'm thinking Mexico City flu--that way if the US strain proves different in its details there's a way to distinguish the two).
Other elements I'd like to see the experts address--coughing into a sleeve instead of a hand, and a clearer message about how to accomplish social distancing. For now, in the context, "It's not yet extensive in the US to require it, but if it does become widespread, we'll need everyone to..." Set expectations early.
Probably a good idea for someone at the CDC or CIDRAP to craft a nice, quotable and memorable way of saying the needed precautions, so people remember it--like the slogans of a political campaign. I'm hearing everyone say pretty much the same things, but because everyone says it their own way, I don't think its going to stick in the minds of those who aren't paying close attention. If you recognized experts can decide on buzzwords for the public I think it will help.
Dylan, my apologies. I didn't expect everyone to take it so seriously.
Brian,
My pleasure. If you go to my blog (http://biosurveillance.typepad.com/biosurveillance/) and click the 'about' link, you'll see I've been on the operational front line for many, many concerning issues. In the fog of war, it is indeed difficult to see clearly and know and to whom you notify if something is going on. And it is damned difficult to understand each person's threshold for considering something to be "relevant".
I have been on-point before trying to convince CDC we may be seeing a translocating strain of A/H3N2 in January 2007. This strain was found on the West Coast followed a week later in the Central and Eastern regions of the US in the ensuing weeks. First detection was six weeks prior to the Northern Hemisphere Vaccine Composition Meeting at WHO Headquarters. As we all know, the US was left with a suboptimal vaccine for the 2007/2008 season. In those early days of warning, it was difficult to convince people to pay attention to social disruption indicators versus lab results. We have just witnessed that again here in the case of swine flu in Mexico. That and the ever-present normalcy bias seen in every decision maker I've ever worked with. This highlights (even after doing this for 12 years) that our professional discipline has not been fully embraced by the public health community.
...That said, it is hard to be a decision maker- those individuals who made the choice during the Ford Administration to vaccinate the American public during the Fort Dix outbreak never forgot they were the ones whose decisions caused many deaths due to adverse reactions. It is easy to forget their burden.
Lisa - how about something like 'Blow it in your elbow'...set to rap, of course.
"Probably a good idea for someone at the CDC or CIDRAP to craft a nice, quotable and memorable way of saying the needed precautions, so people remember it--like the slogans of a political campaign."
Or 'blow it out your (pause)--elbow!'
A bit of whimsy might help calm people's fears...
It would take a few days to get a decent rap written, but you could probably get a big artist to do it as a public service.
I think the immediate focus should be on establishing some stock phrases and buzzwords for folk to use with the media. If all the experts are using similar language for what people need to do, I think it will really help the messages sink in. The message is consistent now, but the words themselves aren't.
"Dylan, my apologies. I didn't expect everyone to take it so seriously."
Apologies are entirely unnecessary, Lisa. We are friends of a longstanding nature.
But, everything is serious, these days, Lisa. We have a clear, incipient pandemic brewing, now (as you are well aware of, I am sure). And this one is not likely to simply go away. Or hide. Or fall short of complete expression. It is not at all what we expected; but it is here, just the same. And this one is a complete mystery. We do not have ten years of experience with the pathogen. It is entirely unique. We know nothing about it. We have less than a full week's experience with it, overall. A lot of us are justifiably worried, about something that has fully manifested itself, only a few short days ago. It is not H5N1, thankfully; but other than that, we have absolutely no idea what it is. Or where it is going.
There is already a campaign on the uni campus I work for regarding safety practices and infectious diseases. i. e. coughing into your elbow & washing hands.
For most people it's a question of making a paycheck. Flu/cold symptoms are nothing in the face of a day without pay. How do we address that?
And therein lies the difficulty in practical implementation of non-pharmaceutical interventions.
One of the things that had been suggested in H5N1-related discussions dealing with lost pay, was for creditors to offer some kind of brief credit amnesty--no penalties for an extra month for bills left unpaid or partially paid, or some kind of extended payment plan, especially for essentials like utilities.
If this virus proves in general to behave more like the small US sample of cases, then one month of gentler credit I think would have sufficed--absent the existing economic disaster. Under todays conditions people are already scrambling...it depends how sick they get and how much work they miss.
The US bug, as I understand, has a rapid incubation but also rapid course, which might make the lost pay/economic disruption issue less severe.
I don't know about you but I'm in the habit of considering H5N1 severity; evidence so far suggests this won't be nearly so bad as the case we've imagined.
One might also imagine a withholding-free federal bailout, in which payroll taxes are not collected for a standardized time period, so that take home pay for the days people *do* work would cover for the days they don't?
Folk on unemployment might need a loosening of the number of jobs they must apply to in order to continue benefits. Can't interview if they have flu or if companies have shut down for flu reasons.
One thing that won't work and would be suggested from certain quarters as a 'solution'--a 'tax credit' in any form that defers cash-in-hand. A write off the following year is not going to help anyone's cash flow in the month they get sick. That is why I suggested a suspension of payroll withholdings instead--the cash is immediately in the hands of those who need it.
Ah, the other thing about suspending payroll withholdings--I do believe that would affect only what's withheld from someone's base salary--it would not relieve taxes on 'bonuses'.
Isn't Veratect the outfit that sent Bruce Willis back in time in 12 Monkeys?
Regarding my response at top to Susan about Versatect, I direct everyone's attention to the additional information from Dr. James Wilson of that company, 12:36 - 12:46 AM. Clarifications appreciated.
With regards the "assassination by flu" conspiracy theory. It is ridiculous to believe anyone designed this strain of swine flu and neglected to add tamiflu resistance.
Dr. Wilson, ordinarily I have great respect for accomplished physicians doing useful work, but--are you always such a thoroughly arrogant, self-important prick? Come to Revere's site and demand he reveal himself for the supposed privilege of talking to you--because you've testified before congress, making you all important-like? Good grief!
This is the web. Anyone can claim anything. It is only natural for people to be skeptical of a stranger's claims until they have time to verify them. You should not be insulted that people wanted to verify the basis of your assertions.
It is very hard to respect the pompous, regardless of their accomplishments.
Anyone notice the story that 20 or so kids in NZ, recently returning from Mexico, through L.A., on a language trip, have the febrile yibbidyyoodle?
Count this as my vote that we officially adopt the moniker "febrile yibbidyyoodle" for this virus.
"Dr. Wilson, ordinarily I have great respect for accomplished physicians doing useful work, but--are you always such a thoroughly arrogant, self-important prick? Come to Revere's site and demand he reveal himself for the supposed privilege of talking to you--because you've testified before congress, making you all important-like? Good grief!
This is the web. Anyone can claim anything. It is only natural for people to be skeptical of a stranger's claims until they have time to verify them. You should not be insulted that people wanted to verify the basis of your assertions.
It is very hard to respect the pompous, regardless of their accomplishments."
Indeed. Everyone out there should question anything you see on the net that does not appear credible. We certainly do on our end.
While I understand your anger and the perception here, I at least have the strength to declare myself publicly and not hide behind pseudonyms.
I challenge you and revere to do the same.
James Wilson: I'm glad you are such a tough and brave hombre. Perhaps one of these days you'll be brave enough to give links on your Tweets (I see someone has called you on this already). The reasons for using a pseudonym are well known and I'm not hiding from you (or anyone, for that matter; I don't know you from a hole in the wall). But let's assume that if you knew my name it would mean nothing to you (maybe, maybe not; I'm fairly well known in my specialty). How would that help with authority or credibility? OTOH, there are more than four years worth of daily posts on this site with which to make a judgment on the competence of the person or persons who write under the name revere or Revere. We also provide links here. If you know what I mean.
Well, aren't you just the cutest altar boy?
Here, have a cookie.
Now as to that cookie: wrong end. Sideways. No lubricant.
To be a bit more polite than the situation requires: people have many reasons for writing pseudonymously. I've been known to do it myself when, for instance, my employers don't deserve to be associated with my public writing -- separation of roles, you see.
While there are pluses and minuses to pseudonymity, there is only one opinion that counts. Guess what: yours ain't it.
It's quite true Dr. Wilson - there are four years of daily posts here, and upon studying them it is likely that you would ascertain not only the credentials and competence of one or more individuals but an identity as well. If you see exposing an identity as a gain, I dare say that most of Effect Measure's readers do not. Please leave that alone.
I have been digging around on this quite a bit the last couple of days, and so has a friend of mine who was an investigator for many years. Another friend of ours apparently is a relative of the doctor in Mexico who reported over 200 deaths in ONE hospital. The doctor and his relative are too afraid to try to get this to the media. There is some kind of very scary consequence for that, or they think that anyway. After learning this, I found the Biosurveillance web site and the image of the list of reported fatalities and so, I believe it. The outbreak does appear to have started in a town with a huge pig farm that is owned by a huge corporation that is a subsidiary of another huge corporation, and most of the heavy dying seems to have happened nearest this town. The vector, they feel, is the swarms of flies that breed in the entrails and manure at the pig farm, and the whole reason it is so much worse in Mexico right now than it is elsewhere could have everything to do with viral load.
I was hoping this was just a ploy to take our attention off getting torturers prosecuted, but, even though I'm sure they like the light diverted, it looks as though there is a real reason to believe this could turn into a pandemic.
One way this particular soup of genes could have mixed "naturally" is that they don't just raise pigs industrially everywhere; they also do it with turkeys. They say they have an edge over others in profitability because they have developed a feed that costs them some huge chunk less than it does for others to produce the same. This would have to be them grinding up the unused parts of their own stock to feed their own stock, would it not? Once again, they are a global operation, and turkey parts and pig parts being shipped from all over to be turned into feed to go back to the farms sounds like the perfect way to come up with this DNA mix in a virus.
Here's the link to the few posts full of links I've done on it. They're kind of willy-nilly scattered messes because I was just posting links with salient information, but some of those links are really good.