Influenza treatment
revere | March 30, 2010There is a good Canadian Press by Michael Macdonald about the often long time it takes to make a full recovery from flu. A full blown case of classical influenza can really lay you low for days or weeks. People often report never having felt so sick. But once you are "recovered" and back to work or your daily activities you aren't necessarily fully recovered:
Marga Cugnet thought she knew what she was in for when she came down with swine flu last October.
But the health administrator from Weyburn, Sask., said she was annoyed and somewhat dejected when the potent H1N1 virus left her with…
revere | March 26, 2010We continue to learn a great deal about influenza infection as researchers harvest information from the recent swine flu pandemic. The pork producers don't like to call it "swine flu" but it may well be that its long sojourn in that animal since 1918 (did we give Spanish flu to pigs or did pigs give it us?) may hold an important clue to why older people suffered less than younger ones. It seemed fairly likely that the difference was related to immunity, but since H1N1 came back in 1977 after being absent since 1957, it wasn't clear why younger people born after 1977 would be as immune as…
revere | March 19, 2010As predicted, the pandemic of 2009 is beginning to yield more data, some of it directly applicable to pressing practical questions. The answers are still preliminary, and, as with all science, subject to revision. But it's what we have at the moment, and a letter that just appeared in the CDC sponsored journal Emerging Infectious Diseases, addresses an important question. During a flu outbreak, can hospitalized patients contract influenza from blood transfusions? Since people getting transfusions already have compromised health (else why would they be getting a transfusion?), they are at high…
revere | March 6, 2010Two days ago I went with my daughter to the pediatrician to check out her 20 month old who had a fever and rash. Viral origin, probably. Also an ear infection. Pretty much par for the course at this time of year. But lots of little ones and their older sibs weren't so lucky this flu season. As we've had too many occasions to mention, the severity of the 2009 pandemic has yet to be gauged, but trying to compare it to seasonal flu is misleading as its epidemiology is very different. Nowhere is this seen more clearly than in the melancholy figures for pediatric deaths.
Since the beginning of…
revere | February 26, 2010It is becoming conventional wisdom that the 2009 H1N1 pandemic was not as severe as a bad seasonal flu year. That might be true, although I don't find it much comfort because a bad seasonal flu year is no less bad for being more familiar. But I am not yet willing to assent to the conventional wisdom yet. I don't think we have had sufficient time to collate all the information that would enable us to make that kind of judgment, which sometimes takes years to evaluate. However bad it was or wasn't, the pandemic flu strain could kill you just as dead as any other flu. CDC has just released…
revere | January 21, 2010In my regular science trawling I noticed a fascinating paper in Nature (epub ahead of print) that I haven't seen anything about in the news. It seems to me it's worth a discussion, if for no other reason than it uses a relatively new approach, small interfering RNA (siRNA), to dissect the functions in the host cell the virus needs for the only thing it wants to do, make a copy of itself. It also lets me try out on you a new analogy I cooked up for a short talk on flu for high school students and their parents and teachers. It turns out that parts of it will be useful to explain the new siRNA…
revere | December 28, 2009It's the end of the calendar year and the traditional time the media looks back on "the biggest stories of the year." There are websites about almost any subject (even one on a particular model of running shoe, I am told), but those of us who write specialized blogs (as opposed to ones about politics or current events) rarely expect our subject matter to show up on one of those lists. We've been writing about flu for over five years, here, and while re recognized the possibility our subject would come into vogue -- that's indeed why we were writing about it -- it still took us and everyone…
revere | December 26, 2009This week the Proceedings of the National Academy of Sciences (PNAS) published a paper about a new antiviral drug that fully protected mice against virulent bird flu virus (H5N1). I don't usually pay a lot of attention to papers announcing new flu antivirals that work in animals. It's a long way from there to use in humans. But this drug, called T-705 (also known as favipiravir) seems different in several respects. The work was mainly supported by the Japanese government (with some support from the US NIH) and was led by Yoshihiro Kawaoka, one of the world's leading flu scientists (University…
revere | December 25, 2009So far the pandemic of 2009 has been bad enough but not anywhere near as bad as one could imagine. Let's hope it stays that way. While winning new knowledge from actual disease and sickness is not anyone's favorite strategy, it is likely we will learn a great deal about influenza in the years to come as we begin to mine the wealth of data it is producing. Science, even at its most urgent, is still a slow, methodical process, but this pandemic and the resources devoted to tracking it and the tools being developed to analyze it is a watershed event in flu science. Dogmas will fall and probably…
revere | December 13, 2009Red wine has been touted for its health benefits but these don't seem to extend to warding off swine flu. The virology laboratory in Bordeaux in the southwest of France tested via RT-PCR over 1200 nasopharyngeal swabs between May 1 and the first week in October and found 186 positive for the new pandemic strain. They looked at five of these cases more closely, monitoring them for duration of viral shedding. Two of the five kept shedding for 2 to 4 weeks (paper in Eurosurveillance by Fleury et al., v. 14, #49, December 10, 2009).
The first case was a non-obese previously healthy male in his…
revere | December 12, 2009We complain when there isn't enough swine flu vaccine and we complain when our health departments don't count all the cases. It's probably good so many people are out of work and can't eat in restaurants, because they aren't getting inspected because all available staff are trying to deal with the flu pandemic:
The current swine-flu wave may have peaked, but thousands of public health workers are trying to vaccinate millions of people against the new disease, fearing that another wave could emerge in the new year. Yet recession-driven budget cuts have thinned their ranks so far that they are…
revere | November 27, 2009It seems swine flu is full of surprises that turn out not to be surprises. Or so it's claimed. Or not. Here is CDC's Dr. Anne Schuchat, the agency's chief health officer and spokesperson on swine flu, responding to NPR's Melissa Block's question about what has been her biggest surprise:
Dr. SCHUCHAT: I shouldn't have been surprised, but I have been surprised about this disproportionate toll that it's taking in pregnant women. I think I'd never lived before a pandemic before, and I actually hadn't seen the really sorry and just the tragic stories of healthy pregnant women coming down with such…
revere | November 21, 2009The Norwegian Institute of Public Health is reporting sporadic occurrences of a mutation in a portion of the flu virus that is involved with the process by which it attaches to cells. I use the word "sporadic" because at this point there is no evidence that the cases where the genetic change has been found are epidemiologically linked. Therefore we don't see it spreading from person to person but rather arising in people after they have been infected. At least that's how it appears from reports, but we have only preliminary information at this point. According to WHO, the mutation has been…
revere | November 19, 2009The Director of Loyola University Medical Center's clinical microbiology laboratory is reported as saying that rapid flu tests are a public health risk. Here's some of what he said and then my explanation as to why it is misleading or just plain wrong:
Rapid influenza diagnostic tests used in doctors' offices, hospitals and medical laboratories to detect H1N1 are virtually useless and could pose a significant danger to public health, according to a Loyola University Medical Center researcher.
"At Loyola, we determined four years ago that the rapid tests for influenza detected only 50 percent…
revere | November 10, 2009Nursing homes (Long Term Care Facilities, LTCFs) are a favorite hunting ground for respiratory viruses, including flu. They are open to the general community, where visitors and employees mingle freely with the residents. The residents are usually of an advanced age, have other sicknesses that make them vulnerable and often have less active immune defenses. So when the swine flu pandemic began at the end of April, the Public Health Laboratory at Ontario's Agency for Health Protection and Promotion ramped up their respiratory infection outbreak registration system with the prospect that LCTFs…
revere | November 9, 2009We only just got to the surgical/N95 mask article in the Journal of the American Medical Association (JAMA). We've been traveling and haven't been able to keep up with what others were saying, but we're sure it's been well covered by the usual suspects. So we'll just add our take here, for what it's worth.
As most readers here know, what kind of mask (if any) will best protect a health care worker or anyone else at high risk of exposure to people infected with influenza virus is a difficult question. We still remain unsure whether flu is transmitted mainly by large or small droplets. If most…
revere | November 4, 2009It's being described as a "dramatic settlement" that will set a pattern for the nation. Let's hope so, because the agreement reached yesterday by the California Nurses Association/National Nurses Organizing Committee (CNA/NNOC) and hospital player Catholic Healthcare West (CHW) sounds like just what the doctor ordered. It covers 32 CHW facilities in California and Nevada, where CNA/NNOC represents 13,000 registered nurses.
Some details:
A centerpiece of the agreement is the creation of a new system-wide emergency task force, comprised of CNA/NNOC RNs and hospital representatives following…
revere | November 1, 2009When swine flu began there was a hue and cry in some quarters to shut the border to prevent the virus from taking root in the US. It seems fairly clear, now, that by the time we detected the virus, in late April, it had already situated itself in the US -- assuming that it didn't start here in the first place. We don't really know where the jump from pigs to humans occurred, although the best guess is Mexico. Closing the borders would have done no good and would have stranded thousands of students and other tourists in Mexico. Since the US has more world travelers than Mexico, it was in fact…
revere | October 31, 2009Statins for influenza are in the news again, this time because of a paper given at the Annual Meeting of the Infectious Disease Society of America (IDSA). We'll get to it in a moment, but first a little background.
Statins are cholesterol lowering drugs that are taken by tens of millions of people (including me; I take 20 mg of generic simvastatin a day). The statins are a group of drugs that competitively inhibit an enzyme, 3 hydroxy 3 methylglutaryl coenzyme A reductase (HMG-CoA reductase). They are quite effective in lowering cholesterol and have an excellent safety profile (not perfect,…
revere | October 26, 2009CDC is again warning parents not to send your children to a swine flu party. The idea is to provide them with immunity, like used to be done with chickenpox parties. It's pretty hard to believe this is a live issue and CDC admits it doesn't have evidence that any have actually occurred. When it came up in the spring, during the first wave of H1N1, we and all other flu experts said it was a very bad idea, but at least one could understand the reasoning then. Since there was no vaccine and the worry was that swine flu might come back in the fall in altered and worse form during flu season, it…