Swine flu: flu pandemics -- if you've seen one, you . . .

This is a question for any of the health experts/physicians on this blog.

Can a human have ANY immunity to a novel flu like this? Or is it inevitable that if you are exposed, you will get sick? Generally speaking, if one takes good care of him or herself (i.e., eats well, gets enough sleep, doesn't smoke etc.), one can to some extent reduce the likelihood that he or she will get the flu, and perhaps even mitigate the severity of the virus if he gets it (at least this is what I've been told). Will any of these precautions lessen the likelihood of getting this flu? Or is a novel flu like this one a pure probability game, i.e., if you're in the right place, with the wrong person, and the virus gets "in", you get sick?

this thing definitely has legs on it. can't wait to see how the co-workers (lightly derisive of the whole issue they are) take the closing of a local school in Mira Mesa due to cases. wait and see is my approach for now. interesting regardless.

Revere: I understand a lot is unknown but, generally, what are the prospects for a workable vaccine in a few months from now?

Hume made the point on the nightly news I think it was that there are more deaths from normal flus that affect us on a year to year basis then there is from this swine flu right now. I guess the fear is a redo of the 1918 pandemic from a fast moving strain of a cross spieces bug.

I need to look into it, but I wonder how the markets reacted in 1918 to the pandemic then?

Today I see that the market had a bit of a up tick with some of the consumer confidence data but now it seems to be fading. Even more suprising is what the precious metals have been doing. I was looking at the widget ExactPrice and am surprised to see them all falling over this scare. But people and the markets are weird. Maybe the majority agree with Hume. The only thing to tell will be time like you say.

If we donât start seeing a wide spread âpandemicâ with numbers quickly growing over the next two weeks then I think we will be out of the woods and this scare that the government and EU are somewhat creating of their own will fade.

One things for sure, the mask manufacturing companies are going to see a spike in sales.

Out of curiosity, what about those of us who received the 1976 swine flu vaccine? It would be interesting to track this in the U.S.

Given the time elapsed and the notorious mutability of flu viruses, I certainly wouldn't count on that long-ago shot protecting me, but if more U.S. cases occur, this kind of thing might be worth recording.

How quick can this spread through the US?
Also, I heard that it's better to start getting full face masks as well just in case you have to wear them in the street. What do you think about this? My friends even went ahead and got a few Breath of Life Masks from Technon. Their website is http://www.ProactiveAndPrepared.com . Do you know these? Should we get one?

Ellie,
It's my understanding that since this is a brand new, never before seen strain, that no one is immune. I suspect that is why it is so contagious (easily transmitted = high transmissibility). Yes, you can get it easy.

However, the symptoms you experience are going to depend on many factors, including how much of the virons you inhaled or are contaminated with (wash your hands often); your general health (get 8 hrs sleep a night).

I might add that there is some research that shows that adrenaline stimulates the production of bacterial biofilm production (bacterial pathogens cause secondary infections to flu) and that melatonin (sleep) and serotonin (happy) inhibit the formation of bacterial biofilm. Argh...where's that paper to back this up...later.

In case the store runs out.
Simple respiratory face mask directions
http://www.cdc.gov/ncidod/EID/vol12no06/05-1468.htm#Figure

Revere,

I heard only moments ago, that the Ernst and Young report was NOT accurate. In fact no one has been confirmed or even suspected of having Swine flu at the organization. An email was sent in error to employees.

Perhaps I misinterpreted what I heard. But I heard that moments ago on the radio.

I have a question, maybe someone can answer this for me.

Now, I realize there are always a number of viruses out there that are just a few genetic reassortments away from being a real beast. But it seems to me that even if this virus ends up petering out or is milder than it appears (unlikely as this seems, at the moment), it still presents a significant threat.

It's on its way to becoming widely disseminated among a naive population and the chance of it ending up in a host that has a concurrent infection with an even more virulent influenza strain (and picking up some of those virulence factors) seems subjectively greater to me--a fast track to something just as easily transmissible but even nastier.

Am I way off here? I certainly hope so...

Hi! This is an excellent blog containing the most complete information currently available. Thank you.

I have a couple of maybe odd ideas and questions:

At this point it is still unclear whether H1N1 will eventually cause a full-blown pandemic outbreak, yet we do know that containment is no longer possible. Therefore, WHO has not issued any travel restrictions.

Epidemiologically you cannot keep this virus from spreading. So, it seems that WHO allows it to travel freely while governments still try to control its entry into and spread in their respective countries.

If the spread can be delayed, chances are higher that a vaccine would be available should there be a major outbreak lateron but this would take another 6 months... Can it be possible to keep up current hysteria and controls for so long?

Is it reasonable at all to try to keep the virus from entering a country/from spreading?

Right now, infections outside Mexico have been mild. The virus still responds to anti-viral drugs. This could change. Once the virus mutates and becomes drug-resistant, it could be more lethal.

Won't we ironically consider those who have contracted the disease by NOW, in the early stages lucky - at hindsight, should this really get worse?
Who's sick now, is getting a treatment, a hospital bed and all the attention needed for recovery and he/she will also gain immunity.

Will he/she gain immunity since anti-viral drugs aim at neutralizing the virus?
Are we still able to produce antibodies?

My rationale may sound off target but I still wonder whether it is wise to treat the one flu patient aboard a plane with Tamiflu and also administer it to all others on the plane as a precautionary measure.
Doesn't this speed up anti-viral drug resistance?

Or isn't there any logic (the more drugs there are around, the higher the chances that the virus will learn to "resist"?) that would explain how a virus becomes drug resistant?

Maybe the disease will go away altogether. If not, the virus could mutate further.
Could it be that a vaccine is being developed now that won't be effective to treat the mutated strain six months from now?

Also, I may have read here about an earlier swine flu outbreak in the seventies that led to the vaccination of some 40 Million Americans. The program was stopped because people developed neurological disorders...

Once the H1N1 vaccine will be available, no one can be sure that it will be "safe".

Hello Revere,

Thanks for providing the information you do. Whenever there's a scare about infectious disease I'm glad to be able to come here to see what you're saying.

Can you explain something my husband and I have been wondering about infection rates and eventual immunity in the general population? If only 25 to 30 percent of people are infected (as someone said on the news) when there's a novel virus, how does widespread immunity happen? And does the virus itself change and become less dangerous, or is it just our susceptibility that changes?

Also, if as the picture of this virus emerges it seems about as dangerous as the Asian or Hong Kong flu pandemics, is it better not too try too hard to avoid getting sick, with the idea that you might as well bite the bullet and develop immunity?

Thanks...(I hope those aren't dumb questions!)
PS Whenever there's a new face answering questions on the news, I wonder if it's Revere...

David, I am pretty sure the CDC and WHO don't know how fast this can spread. But early signs suggest it's fast and very transmissible. What to compare this speed with? Um...nothing since last 3 known pandemics? I think that's why they are particularly worried. Think of how many people it takes to move food around the country or run a business. Even if people are sick at home for a few days, multiply it.

Wash your hands. Stay out of crowds for a few days/weeks. Get your sleep. Drink lots of water and fluids (hold the alcohol and sugar). Take care of each other. Watch funny movies.

Think lots of microbes in a petri dish versus two lonely microbes in a petri dish. Which dish will have more reproductive/mixing capacity? Same thing with crowds of people. Why give the critter the opportunity to get nasty?

Bern,

It's called Recombination and unfortunately, you are likely right, although virus "drift" is also likely at work. It's a source of debate which of the two, (drift or recombination) is more important. Henry Niman is a big proponent of Recombinomics. You can find his blog on Reveres sidebar under the blog roll.

Thanks for the reply phytosleuth. I wonder about the transmissibility of a novel flu bug not only for selfish reasons but also because in the (admittedly anecdotal) stories I've read in the media, kids seem to pick this bug up very easily and recover from it quite quickly. Meanwhile, Mom and Dad don't seem to be getting it. Perhaps that is due to environmental factors (e.g., they wash their hands more frequently); perhaps Mom and Dad are incubating it right now; or perhaps this is due to an improper correlation that I'm drawing from what I read. But if this virus is highly transmissible and no individual has any resistance to it, then wouldn't we expect everyone in close contact to an infected individual to get sick to at least some extent? (This is a rhetorical question, no need to answer.)

Interesting blog posting from Science Magazine. http://blogs.sciencemag.org/scienceinsider/2009/04/is-current-flu.html
(Disclaimer - I'm not a scientist, so I have no idea how credible this source is.)

Revere-Any graphics anywhere yet?

Ellie-No. Novel viruses are just that. Never seen before. If its infectious to humans its just flat infectious w/zero resistance. And this will roll around in whole and parts for years to come. Springtime in Ft. Riley KS in 1918 for some, and 1976 Swine Flu light for others. The cup IS half full.

Bryan-That question was raised in this mornings email. They have developed the seed for a vax, but apparently not going to do it unless it starts to turn ugly as it will divert production from the normal seasonal vax...developing.

Julie-Apparently they looked at it. Little or no protection afforded to us by the 76 version vax. Long time too. Probably got as much protection from getting the flu since then.

Lilly-Protocol. Monitor and administer. This is one of the protocols to contain and treat it. Same protocols that were NOT followed in Mexico City or by our own CDC/DHS. Bugs equate to time. If you can contain the spread, in time the bug dies out in the host either as an elimination by the immune system or an elimination of the host by the bug. I think at 100 people hospitalized and then thousands standing in the street to be seen that it should have tipped someone off rather than skiffying samples off to Canada and the US for sequencing. There were no attempts apparently to contain until Tuesday of last week. We knew about it and then we did nothing about it here. NYPH knew those kids had been in Mexico for a week after people sickened and said nothing to the public, nor did they isolate them anywhere but home. Great...Infect the family while you are at it. But they might have been on the trip or already infected from the day to day stuff too. Hard to Monday morning quarterback. But with confirmed cases in San Diego and San Antonio those kids showed up with it. Close the borders or at least the flights from Mexico and have everyone who was in Mexico calling their doctors or P. Health depts for a screening. But it might just end up being mild across the board. Lets hope so.

Sleuthy is right. We have done everything so far that has been against protocols including putting politics into it that we might as well have been doing a table top.

I am vastly underwhelmed by the response so far. H1N1 1918 was as Revere indicated a mildly pathogenic bug until August of 1918. It went high path and that was as they say all she wrote. Watching for case surges now. If it doesnt happen then good. Wait for the next one to come and visit.

Ellie, for most pathogens, general health status makes a huge difference in severity of an infection. That is why the seasonal flu usually kills mostly the young, old, and debilitated.

This novel swine flu seems a bit different in that the mortality is seen among younger, healthy adults. Just like the 1918 Spanish flu. The explanation has to do with a postulated "cytokine storm". Healthy, robust immune systems overreact and pump out cytokines like IL1, IL2, IL6, TNF, and others that do more damage than the virus itself. Whether this flu kills by cytokine storm or not is suspected but not yet known. The 1918 flu has been shown to produce cytokine storms in animal models.

I'd still rather be generally healthy than try to run down my immune system if there is a pandemic.

this scare that the government and EU are somewhat creating of their own will fade.

I've seen a lot of people saying that this entire situation was concocted by governments and the media. That attitude baffles me. We know that pandemics happen, and we know that they can kill lots of people, and we also know that preparedness and coordination are necessary at the governmental level.

But the popular belief that this is a "scare" created by government is too comforting, apparently, to let go of...WHO's performance notwithstanding. It makes people feel sophisticated to imagine that they know the "real" story, I think, and it also downplays the serious threats and responsibilities we face (which people don't like to dwell on, for obvious reasons). It also reminds me of the most naive sort of religious thinking about the constant stratagems of the Devil. On some level, we just can't seem to grow up.

We in the northern hemisphere do have one thing going for us, the wind at our back.

As noted in the post, flu is cold weather seasonal and dies down or out in the summer. Same with other respiratory infections like the common cold and pneumonias.

This is somewhat mysterious. The usual explanation is that people spend more time indoors and exchange bugs with each other. Some claim that the cold and drier atmosphere stresses people so they are more vulnerable, others claim that this is nonsense.

In a best case scenario, we contain and treat patients and the summer comes and it dies out.

This would work if the earth only had one winter. As noted above, the southern hemisphere is just starting their winter season.

In a worst case scenario, it gets into the third world where the medical systems are third world, spends the winter gathering recruits, and comes roaring back next winter here.

As the CDC says, anyone who makes flu pandemic predictions usually goes down in flames. Got to wait and see.

PS Not sure I agree with the CDC and WHO that travel restrictions are useless. They weren't 100% for SARS but IIRC, probably made a huge difference in limiting the worldwide spread. A good thing because we had no vaccine or antivirals for that one, all but defenseless. In any event, I wouldn't be traveling to Mexico right now.

Randolph: "Protocol - monitor - administer". Well, it would be nice, if some protocol had been followed. WHO is looking for data and statistics before raising their pandemic alert level appropriately.

I believe this situation with plenty of unknowns calls for imagination and basic common sense.
People seem to believe we're still safe at level 4 while we should panic (?) at level 5. There isn't enough data available/the world doesn't seem to be prepared enough to make plans (pandemic preparedness) really work.
It's impossible to turn back the clock.

It is clear that the status quo is not clear. The challenge is to respond to an unclear (out of control) situation effectively, should that be possible at all.

I've seen a lot of people saying that this entire situation was concocted by governments and the media.

A lot of denial right now.
1. No one in the USA has died, therefore it isn't dangerous. Of course, it hasn't happened here with 90 cases but 150 are dead in Mexico. What do they think the death rate will be if we do have a pandemic? Millions maybe. Better to stop it now rather than bury people later.

Right, nothing bad can ever happen in the USA because it upsets people.

A lot of lunatic fringe stuff.

The conspiracy nuts were on it immediately. A man made biowarfare agent spread by the Illuminati-Jewish-Catholic-Reptiloid aliens-Elves-Democrats-Obama to thin the world population down to improve the duck hunting and trout fishing. I've read this more times than I care to remember.

The God Smiters.

Just getting warmed up. God is punishing the USA for gays, Democrats, and socialism. Never mind that it so far is mostly in Mexico.

The anti-vaxxers and germ theory of disease deniers.

One clown claims pandemics are past and will never happen again. He has never heard of HIV/AIDS. Several are already warning people that the vaccine is dangerous and not to get it. Of course, the vaccine doesn't even exist yet.

If this pandemic does occur, going to be heaven for the kooks. Maybe even literally.

"Also, I heard that it's better to start getting full face masks as well just in case you have to wear them in the street. What do you think about this?" (URL snipped)

I heard that it's better not to spam other people's blogs with thinly disguised linkwhoring.

Even for a completely novel virus, there is usually some segment of the population that the virus cannot infect.

For example, certain individuals cannot get HIV because HIV (like most viruses)uses certain proteins on a cell's surface to gain access to the cell. There are a few individuals with a random mutation of one of those proteins such that HIV can't get a grip on their cells. So, they can't be infected.

But this kind of immunity is usually a miniscule fraction of the population. In general, people will be susceptible.

Just because a virus causes a pandemic doesn't mean that the severity of illness must be bad. There's two elements to consider--how sick will individuals be, and how many people will be sick at the same time. The former is a concern if you or a loved one catches the virus. The latter is a concern for your likelihood of catching it and for social and economic disruptions.

So:

1. if the virus were 100% deadly to those who catch it, there are individuals incapable of catching it and humanity would survive (the virus, if not the aftermath).

2) if the virus were 100% non-deadly to those who catch it, but did cause illness, we would still have a big mess in a pandemic because so many people would be sick at the same time that businesses would have to shut down.

3. public health officials have reason to 'panic'in either case, because they're the ones who have to make sure that there are enough regional medical resources present in the outbreak areas, *regardless* of how severe the illness is. So it becomes a big logistics headache for them even if the death toll in percent terms isn't impressive.

4. if you have a huge number of people infected with something that has a low death rate, you're still going to stack up a lot of bodies. It is possible that's what happened in Mexico City. Remember they have 20 million people down there!

5. the media likes to hype stuff like this to get more viewers/more ratings/more ad revenue.

6. CNN really needs to abandon their stock phrase 'deadly swine flu'. It creates an inaccurate association.

Last night Dr. Gupta on CNN described what sounded like 'cytokine storm', or at least ARDS (acute respiratory distress syndrome) as the cause of death for the young folk in Mexico. This is believed to be the mechanism that made Spanish flu so deadly. However...it occasionally happens with ordinary seasonal flu too.

Information remains too garbled to know if ARDS or if 'cytokine storm' is going to turn out to be significant or not.

Lilly-If there is going to be panic its going to happen in peoples homes. If it ever gets out onto the streets then all control will be lost. Numbers, numbers, numbers. If its a lot of numbers and mild then its a really bad flu season. You start seeing people dying and with the nanny state we have been in and getting worse those people are going to look to government which hasnt had their game on for years in all the administrations. Politics in a pandemic. Guaranteed to create a conspirator playground for those who think that way. I AM though a bit surprised from talking to a few knowledgeable people about the make up of this thing... But it is novel so anything is possible. I want to know how improbable it is though and they still are about square one point five on what this stuff did, much less will be doing.

Vax- if they make it will have to be fielded untested. Thats a matter of stated government fact. The only reason they would do that is if it would be of utmost importance and again its based in the numbers. If people get sick and are recovering in high numbers then it doesnt make sense to first make it, nor does it make sense to take it.

Its a bug and not a vengeance of God on any particular group. I think if it is he is pissed at us all. I would be number 2 or 3 on that list. Have to take my hits with the others.

Question: Why is it expected that if the virus goes underground for the summer and then comes back in autumn it will be in a more virulent form? That seems contrary to the principles of Natural Selection. What purpose does it serve the virus to kill its host? Wouldn't that increase the likelihood of its own death, as well. Instead, by becoming milder, it increases the host's chance of survival and therefore its own. Apologies is this the a rube question... I'm just a writer, not a scientist.

River, a CFR of say 10% would be very serious for the infected population, but only have a minor effect of viral multiplication. Especially if most of the transmissibility comes before the patient is showing obvious symptoms. I think the correct answer for whether a second wave will be more or less virulent than a first is "we don't know", it could be more, it could be less. Obviously the former case is the one we need to prepare for.

Thanks for the reply, Patch. I was hoping I was wrong, however...

Tom, Very helpful response! Thanks so much!

Could the CDC Mexico ground crew plz report evidence of cigarette smoking among pneumonia dead. This isn't hard to do at all.

A "Wishful Thinking" question: if the Swine Flu turns out to be one of the less-fatal pandemics, what then of H5N1? I know pandemics don't have to be spaced at a 20-30yr. interval, but does one pandemic in some way or other have any effect on how soon another one is likely to arrive?

The 1918 flu, had three main waves, that were well separated in time.
1918 flu waves

One could postulate about mutations causing the later waves to be worse than the original. Can we do better than speculate? I believe that the virus has been sequenced from samples preserved in corpses. Do we have any information about the genomic differences (if any) of the different waves?

Good question BigTom.

Hi.
I wrote last night but when I checked my email it wasn't working. My 3 year old house bird died. She was in the prime of her life and super healthy. I feed the highest quality pelleted diet along with fruits, vegetables and the best vitamins on the market. I examined her thoroughly only to find nothing wrong with her. No egg binding or swelling in the eyes, nose or mouth. Seems like she died of nothing. She was healthy only hours before she died. When she started acting sick she died within an hour. She went to the bottom of her cage and fluffed up like they do when they are sick only she was acting dizzy.

My neighbor has geese and other birds that like to hang out with my chickens, guinneas and peafowl. All of these birds run free. I also have a very large aviary (32' feet) with more quaker parrots than I can count. Preditory birds fly over my pasture almost constantly in hopes that one of my birds will leave the shelter of my back porch. My birds are quite fond of humans and end up hanging out on all of my porches and decks and where there are birds there are droppings.

A few hours after my house pet bird died I started not feeling my best. Not terribly sick or anything but a cough and sore throat and the worst headache I've ever had. Although I don't usually get headaches so it's difficult to measure how bad it was. Enough to take a pain pill.

My housemate who handles the bird that died is a janitor at a very large and very busy mall here in Oregon. He's in bed right now. There are four of us in this house surrounded by birds and I'm worried about the other two getting sick.

The geese worry me the most but they aren't mine to lock up. Am I overreacting or should I be concerned?

None of us ever get sick so this is really weird for two of us to be sick. Not terribly sick but at the least uncomfortable. Hopefully it's just a cold.

Please let me know if we are in danger and if my housemate should keep going to work at the mall.
Thank you!

As a former cheerleader who who once made love twice in the backseat of an Audi, I know a thing or two about this so-called pig virus. I have had it and I survived. I'm a survivor. The T.V. show might not think so but I am, and more. I recently have had implants and now I'm a triple D, if you ignore all the fat. Beyond that, I'm still available, all you studs.

tickletiels, call your doctor or urgent care center for guidance.

In 1918, there were millions of men shoulder-shoulder in trenches across Europe. In such conditions, a virus could develop with extreme morbidity because it could easily spread to the next poor sod over even if it killed the original poor sod with great speed. And no one was rushing out of the trenches. Are there such immobile populations today? Prisons, perhaps? Or maybe we're safer.

Also, in 1918, tuberculosis was far more common.

My housemate dredged up a factoid that the mortality from tuberculosis was lower than expected after the flu. Co-morbidity may have boosted the death rate.

We now have: IV fluids, oxygen, antibiotics, anti-virals, and maybe even vaccines.

Dj, the slums of Mexico City alone probably contain the same population/living conditions as the entire 1918 Western Front. Both dwarve the size of the small USA military base where it is suspected the Spanish Flu originated (at least that's where first recorded cases originated I thought, but maybe I'm wrong and there are references to Western Front Europe origination).

This just out:

http://news.theage.com.au/breaking-news-national/only-7-confirmed-swine…

79 confirmed cases and 7 confirmed deaths only.

Anyone have any idea who Vivienne Allan is? I can't find anything that would suggest she is involved with influenza at the WHO. I wonder if the WHO even knows she's commenting on this.

The fact that the fatalaties are less frequent among those over 50 suggests that an H151 virus came through about 50 years ago.

The 1918 'Spanish' flu virus was a type of H1N1. It's milder progeny remained as the normal seasonal flu until 1957, when H1N2 flu took over. Thus, anyone born before 1957 has a reasonable chance of having encountered wild-type H1N1 flu infection before. Whether any immunity remains after so many years is unknown.

To the person with the birds: this is not an avian flu, so what you have is probably unrelated. However there are many other viruses and bacteria that can infect both humans and birds. You sound like you feel sick enough to justify a visit to the urgent care clinic.

vpr report on officials' conference on preparedness here:

http://www.vpr.net/news_detail/84819/

i am not reassured by this story. do the vt nurses know what they are doing?
when would the lt. gov. consider it necessary to follow "guidance" even if it is "a little problematic from a reality standpoint"?

i have called his office for clarification. but if anyone can take the time to check out this story, i'd really like to know if i'm overreacting or have cause for concern. and if so, what can i best do, given limited time, and my limited energy (due to immune system issues)?

thanks.

Pssst! Lisa. H2N2 in 1957. But you knew that. Don't want anyone to get confused. Maybe you could do a short primer on the manner in which a pandemic strain becomes the dominant ubiquitous strain, until it is ultimately displaced, too?

To Concerned in Vermont:
Please note that schools have allowed (as per Times Argus newspaper, today) students who travelled to Mexico over spring break, and who returned over the weekend, to attend school all this week.
Since many scientists are positing a 1-2 day incubation period, and none that I've seen have posited an incubation period of more than five days, cases should have appeared by now. So far, I believe, so good.
That said: Was this really a wise decision, when the returned students could have stayed home for observation until five days were up? What does anyone think?

Dylan--sometimes I get impatient typing, even at 85 wpm. Oops!