Webdiary - Founded and Inspired by Margo Kingston

The New Scientist reports:

THE first case of swine flu resistant to Tamiflu raises questions about a policy in some countries of giving low, "prophylactic" doses of drugs to those who have come into contact with infected people.

On 29 June, Denmark's National Board of Health announced the first known case of H1N1 swine flu resistant to the most popular antiviral drug. The woman was in contact with an infected person and was put on low-dose Tamiflu as a precaution, but she developed flu anyway.

She has now recovered after taking the antiviral Relenza, and the drug-resistant strain appears not to have spread. The State Serum Institute in Copenhagen assumes resistance emerged during treatment with Tamiflu, as low doses can favour the emergence of resistant strains.

If health authorities continue to hand out prophylactic treatments, further resistant cases are likely to emerge. As many countries have stockpiled Tamiflu, and a specific vaccine is unlikely to be available in time for the next wave of swine flu, this could prove disastrous.

Thanks, Fiona. I do still look in from time to time.

Novartis announced on June 12th it had produced its first batch (10 litres) of influenza A(H1N1) vaccine using new cell-based, rather than egg-based techniques, which have sped things up. Clinical testing is to happen in July, and they are expecting to be granted marketing approval in the northern hemisphere autumn (ie. a bit too late for our major flu season).

"...still true that Australia is one of the very few countries that is actually testing everyone with flu symptoms to find out whether they have H1N1 A"

Hi all,

This seems to have been updated yesterday, the day of the 5th Australian death. So I thought I should point out that Australia's number of cases is an under-estimate too. With the severity comparable to the usual seasonal influenzas, in the "Protect" phase, doctors are no longer testing everyone with flu symptoms. H1N1 is being treated like other influenzas except that, as we have no vacccine yet to protect them, the vulnerable are being treated with antivirals.

The drugs need to be given in the first 48 hours to make much of a difference to the course of the illness. So if you are in a vulnerable group (immunosuppressed, asthmatic etc) it's probably a good idea to get to a doctor at the first signs of flu symptoms. Lots of people will get it but, unless it mutates into a more severe form, for now it looks like it will be a mild illness for most.

Fiona: Good to see you back on Webdiary, Robyn. Do you have any insight as to when a specific H1N1 vaccine might be available? I vaguely remember hearing something a few days ago, but haven't had the chance to follow up.

Two reasons: the first is reading the New Scientist reports - particularly, for some reason, the sentence that runs "Pandemics vary enormously, so history is a poor guide, but the last time this family of flu viruses went pandemic, in 1918, there was a four-month gap between the first, mild wave of illness and the big attack.". [my emphasis]

Second, and less amorphous, the knowledge that the UK has both secondary and tertiary infections: "The latest school to be shut down is Alleyn's, in Dulwich. A pupil at the fee-paying school who visited the US during the Easter holidays had already been diagnosed with swine flu. Now five more pupils, off sick on Friday, have been confirmed as having contracted the virus."

So, some worried real scientists, and a cluster none of whom have been to Mexico, including several second-order transmissions, which brings us to a full set of my "what would worry you" list. Still not buying stocks of staples - not least because even in the worst-case scenario they'll probably reach their use-by date before the worst reaches here - but it is beginning to look way less of a beat-up.

I suspect that the media will now trumpet the lowering of restrictions in Mexico as being time to stop worrying, and it will all go quiet for a few months. If we're lucky, it will stay that way. If we're unlucky, there will be an unreported build-up of cases, mostly mis-identified as seasonal flu (panic over, no need to test), and a re-explosion in the northern winter.

Our "best elders" offer the most invaluable resource: experience.

A weapon in the "right" hands, incalculable, in all it's good. A weapon in the 'wrong" hands, so damaging.

My biggest fear as a parent is transferring my fears, hopes, aspirations, and fights onto my children - as my parents worried before me. It's a constant battle; yet, a battle worth fighting.

As an elder I want to be remembered as a mentor, not an abuser of trust.

The result may well justify the means, yet, we must also accept, we own the result, even when it fails!

John Pratt: “Nothing wrong with a good panic. It makes us act before reason kicks in. Sometimes that can save your life.”

Sometimes it can kill you. The twentieth anniversary of the Hillsborough Disaster has just passed – and that’s only one of many, many stampedes and panics.

Oh yes, I do remember the advent of HIV/AIDS. I remember the way that health workers, school children, sports people etc who were believed to be homosexual or HIV positive were ostracised. To suggest that millions of Australians did not die of AIDS because we panicked is quite frankly absurd. We were lucky enough to have a well-resourced, proactive public health system that produced a practical and non-hysterical program of public education, as a result of which Australia has one of the lowest rates of HIV/AIDS in the world.

With the greatest respect, I don’t think that doctors in Australia are panicking. I suspect that Dr Young’s comment was taken out of context and sensationalised by the press (how unusual). I suggest that the following observations by Dr Michael J. Selgelid, who is Deputy Director of National Centre for Biosecurity at the ANU – so probably someone who knows what he’s talking about, are far more typical of the sensible attitudes of health professionals in Australia:

On the one hand, influenza can be quite an ordinary disease — we all suffer from the flu every now and then. Pandemic flu is somewhat different. Pandemics are worldwide epidemics that periodically occur because the influenza virus is changing constantly as a result of the fact that it is particularly prone to genetic mutation. When an animal — usually bird or pig — version of the virus mutates into a form that makes it transmissible between humans, the resulting virus is more dangerous. We have less immunity against it because we have never been exposed to it — or its nearest flu relatives — before.

On the other hand, even pandemic flu is not plague. One of the biggest dangers associated with pandemic flu is that the media, the public, and policy makers will over-react to it. New infectious diseases often lead to unnecessary hysteria — and hasty, irrational, and overly-draconian policy responses.

Though estimates range widely, the 1918 flu is commonly thought to have killed 40 million people. That would be roughly (only) 2 percent of the population at the time. It is true that many of these people were young and healthy — but many were also old or already sick with other illnesses.

The bottom line is that even if the next flu pandemic is as deadly as the worst flu pandemic in history — which is unlikely based on statistical probabilities — a large proportion of people will become infected, but only a small proportion of the population will die or suffer permanent harm.

At the end of the day, even pandemic flu is still just flu. Influenza is simply not the kind of disease that wipes out populations — as the Black Death eliminated one third of the European population between 1347 and 1350.

When it comes to flu, therefore, perhaps the only thing to panic about is panic itself. And panic should not arise if policy makers and public health officials do a good job communicating to the public about the nature of the disease and the measures that can be taken to reduce chances of infection — and if they avoid unnecessarily resorting to draconian public health responses such as isolation and quarantine enforced by the military or other security forces.

– emphasis added.

It’s also worth remembering that the Spanish flu pandemic occurred when medical science was far less advanced. In particular, there were no antibiotics, and I wouldn’t be surprised if many of the deaths attributed to Spanish flu were instead caused by secondary, bacterial infections that these days would be effectively treated with antibiotics – unless, of course, all those panic merchants who insist on being prescribed antibiotics for viral infections have managed to render antibiotics useless by promoting the evolution of antibiotic-resistant bacteria.

Succumbing to panic may also harm – even kill – other people. If stocks of Tamiflu and Relenza are snapped up by people who do not ultimately contract flu (of whatever type), there might not be anything left to help cure those people who do come down with the infection.

Be alert, assess the situation properly, take an evidence-based approach, but don’t panic.

Let me tell you a little secret, John. I am going to die. So are you. It might be the result of a meteor, a tsunami, influenza of whatever kind, old age, or sheer boredom, but sure as eggs is eggs, it will happen.

There is much written about anxiety and panic attacks. Why? - because they are an essential part of being human. Panic attacks and anxiety are abilities that have kept us safe for millions of years, allowed us to survive, evolve and succeed as a species. When the world was a dangerous place, without anxiety and panic attacks we would not have carefully scanned the environment for danger and so may have died out as a species. And this is why.

An ancient legacy lives on

Nothing wrong with a good panic. It makes us act before reason kicks in. Sometimes that can save your life.

Forget swine flu, don't blame it on the pigs. The WHO has renamed swine flu as influenza A H1N1.

Thank God for that. I was almost going to give up eating pork.

The Spanish flu, also known as La Gripe Española, or La Pesadilla, was an unusually severe and deadly strain of avian influenza, a viral infectious disease, that killed some 50 million to 100 million people worldwide over about a year in 1918 and 1919. It is thought to be one of the most deadly pandemics in human history. It was caused by the H1N1 type of influenza virus

Can I panic now?. The H1N1 flu killed 50 to 100 million people last time around.

I promise not to panic until Fiona gives me the nod.

For those who like a little panic, watch the disease spreading around the world.

It seems that about 2 per cent of those who get it die.

The score so far 478 cases and 13 confirmed dead.

No wonder the doctors are panicking!

If 5 million Australians get the flu about 100,000 Australians could die.

The state's chief health officer, Dr Jeannette Young, says while there are no confirmed cases of swine flu in Australia to date, steps should be taken to minimise its spread.

She says Queenslanders should consider stocking up on tinned food and frozen vegetables.

"If someone needs to be quarantined in their home ... if this pandemic arrives, if this new strain arrives in Australia and circulates widely and causes problems, then ... people (need to consider) not doing the shopping as frequently as they might normally," she said.

"So maybe only doing it once a week to just decrease the numbers of people in our shops."

She said people would be asked to keep a distance of one metre away from others if the virus reached here.

Now that is a real reason to panic, if my wife doesn't go to the shops every second day we will know we are in trouble.

Mexico is a country of great inequality, with high rates of malnutrition and diabetes in a crowded population, making its people highly vulnerable. In the neighbouring US, which has 64 confirmed cases and hundreds suspected, no one has died yet. One cannot discount the risk of a pandemic, and people's fear of the unknown is powerful. Yet when Prime Minister Kevin Rudd talks about swine flu being a "serious international concern for public health" and vows to use all available resources to counter it, one has to wonder why the world's really big preventable killers barely register.

Each panic about relatively minor or remote risks diverts attention and resources from tackling threats that we know will kill millions year after year. According to the WHO, nearly 2 billion people — a third of the world's population — are infected with tuberculosis. About 5 to 10 per cent go on to develop full-blown TB, which kills about 2 million people a year. AIDS has infected more than 33 million people, including 2.5 million children, and killed about 2.1 million in 2007. In low to middle-income countries, fewer than one in three HIV-positive people receives antiviral therapy. Malaria causes about 250 million cases of fever and about 1 million deaths a year. Even the simple tragedy of diarrhoea as a result of poor sanitation and malnutrition kills about 1.8 million a year. Each day, about 25,000 children die of infectious disease and hunger.

These are not potential pandemics; they are happening now. Even run-of-the-mill flu infects 3-5 million people and kills 250,000 to 500,000 in a typical year, including about 2000 in Australia. Yet none of these threats causes alarm in Australia.

This, from John Watson’s opinion piece in yesterday’s Age, is the most sensible commentary about swine flu that I have come across so far in the print media.

Federal Health Minister Nicola Roxon and Queensland Health's chief medical officer are at odds over whether people need to stockpile food in advance of a possible swine flu outbreak.

Queensland Health's Dr Jeannette Young has urged people to stockpile food to reduce the number of times they have to go to the shops in case there is an outbreak.

"Have it in your house ready just in preparation - some stocks of tinned food and frozen vegetables in the freezer, that sort of thing," she said. "There's no need to stockpile water."

This puts me in mind of the Twilight Zone episode where the aliens put a town into a state of hysterical panic by turning the town's electricity supply on and off.

Next thing, a UFO panic...

John Pratt, maybe you should consider a small investment.

Talk about a thousand monkeys on one's back, sheesh.

One expert says even a mild pandemic could cost $330 billion to global GDP, with governments already stretched by efforts to combat the economic downturn.

 

Just what we need on top of the biggest global down turn in 60 years.

A perfect storm indeed.

It's very hard to know whether this is another bout of media driven hysteria, promoted by pharmaceutical companies and governments needing to sell their huge stock piles of going out of date flu drugs, or a coming reality. There's lots of people who die from some form of influenza every year, or related pneumonia. Would you call a heat wave or cold snap when hundreds die a pandemic, or an act of nature?

So far there's a lot of hysteria and mask wearing, but a least that will go a long way to slowing it's progress down. I believe if you are associating with the public and have a viral infection, it should be mandatory to wear a mask. You can always drink your beer or coffee through a straw.

Corporatism is good:

Able to respond rapidly and relatively effectively to events. Identification of disease, communication, planning and testing of control measures, border control, antiviral medicines, vaccine manufacture and distribution….

True, transmission is speedier due to modern corporatism, but in previous centuries, global transmission still occurred with deadlier effects. Sewage treatment and public health measures severely limit or have cut out water or rodent-borne pandemics.

Corporatism is bad:

Hype: This is corporatism exaggerating for the sake of promoting corporate power. Annual US deaths by influenza are currently 36,000 per year, and we live with it. With modern medicine, even without all this running around, this strain is unlikely to be much worse. The hype is causing more damage than good.

Humanity is overpopulated. We need to stand back and let nature’s controls work.

Corporatism is ugly:

The health industry (and their investors) is making money out of society’s misfortune.

What do you think?

The World Health Organisation (WHO) has raised its pandemic flu alert level to five, signalling that the world is officially suffering from a swine flu pandemic.

This morning the WHO said the alert level hike was a signal to governments, pharmaceutical industry and the business community to take action.

Nearly a week after the threat of the pandemic emerged in Mexico, that country remains the hardest hit, with up to 159 people killed - although the number of confirmed deaths in Mexico sits at seven.

A toddler in Texas in the United States has become the first confirmed death outside Mexico from the new H1N1 swine flu strain.

It is not as if we don’t have enough on our plate.  What with Climate Change, Peak Oil and a Global Economic Crisis all we need is a pandemic.

According to the (WHO), a pandemic can start when three conditions have been met Emergence of a disease new to a population. Agents infect humans, causing serious illness. Agents spread easily and sustainably among humans. A disease or condition is not a pandemic merely because it is widespread or kills many people; it must also be infectious. For instance, Cancer is responsible for many deaths but is not considered a pandemic, because the disease is not infectious or contagious.According to the World Health Organization, it is inevitable that the world will face another influenza pandemic. While there is no certainty about when the next one will occur, Australia must be prepared. An influenza pandemic could devastate a nation's health system and our health sector must be equipped to respond to minimise the impact on the health of all Australians and on the health system itself. Is Australia prepared for a pandemic? 

With most of our hospitals already operating at near capacity how will we cope if a pandemic comes to Australia?

The burden of an influenza pandemic could overwhelm a nation's health system. An influenza pandemic also has the capacity to cause economic and societal disruption on a massive scale. For these reasons, the World Health Organization (WHO) encourages all countries to draw up and implement national preparedness plans for an influenza pandemic.

There is no certainty when the next influenza pandemic will occur but according to the WHO, 'there will be an influenza pandemic, sooner or later'. In recent history, two to three pandemics have been recorded every century.

How rapidly the next pandemic will emerge is unclear but it could emerge very quickly with little warning. Currently there are influenza viruses with pandemic potential circulating widely in animals. These viruses occasionally infect humans. This situation could continue for some time, and while this situation remains, there is a risk that a pandemic may develop. We may just have run out of time.

A perfect storm is heading our way.

Ed DR: The confirmation this morning of human to human transmission in Spain makes it technically Phase 6, so expect that later. But, for all the reasons stated above, I still don't think this is yet a storm, let alone a perfect one.