If it's a "mild" flu isn't that better? Well, isn't it?

Some food for thought.

CRUNCHING SOME SWINE FLU NUMBERS
By Leva Cygnet

I've been seeing comments around the blogosphere to the effect of "it's a mild flu" and "only 150 out of a population of 110,000,000" are dead in Mexico. I thought I'd do some analysis on the reported swine flu numbers regarding what they might be showing, and what you can infer from them.

First off, Mexico is reporting that there are 157 suspected fatalities and 7 confimed. For ease of argument, I'm going to round this down 150. And yes, I know it's likely some of those suspected fatalities died of other things, and equally likely that Mexico is so disorganized and overwhelmed that they're under-reporting matters. I'm going to take the number of "150" and stick with it for this article for math purposes. You can do the same math yourself on any number you chose to play with.

We cannot calculate a case fatality ratio (CFR) from those 150 dead because we don't know how many are sick. Lots of people are, or have been, hospitalized but it's highly probable that many more people are recovering at home. Swine influenza seems to be behaving exactly like one would expect a new influenza to act, and it is not Ebola or Captain Tripps the Death Flu. This means most people will recover just fine in a few weeks on their own and no doctors need be involved.

What we can do is apply various CFRs to the number of dead to figure out how many people might be sick.

Here's some examples:

The 1918 pandemic had a CFR of around 2.5%. (Though this seemed to be highly dependent on personal genetic resistance and the capriciousness of viral mutation; it would make some people mildly ill and, elsewhere, wiped out entire communities.)

Taking a CFR of 2.5% gives us 150 dead and 6,000 total infected.

That, alone, is unstoppable. 6,000 people are way beyond the ability of any city to manage, even one as big as Mexico City. To stop the flu at that point you'd need to identify every single one of those 6,000 people, put them in isolation, and -- assuming no one was infected with a mutated Tamiflu resistant version of the flu -- shove Tamiflu down the throat of anyone who'd been in the same breathing space as the sick person during the period they were potentially infectious.

Flu is infectious for 24 hours before symptoms to as long as 7 days after. If even one of those people took a crowded subway, went to a sports game, or went to a busy night club, during a period that they were infectious ... well. Game's up. Flu is entirely contagious enough to have added scores of new victims just from one subway trip. It's airborne.

At just 6,000 sick people, my logic tells me the flu would be nigh unstoppable.

If the CFR was lower -- if the disease is less lethal -- there will be more sick, of course. A CFR of .5% gives us 30,000 sick. A CFR of .1% gives us 150,000 sick.

Note that a lower CFR is not necessarily a good thing. The way I see it, either we have a disease with a relatively high mortality rate that is spreading and probably unstoppable in the human population, or we have something that doesn't kill very many people, but is so contagious that it's infected tens or hundreds of thousands of people in several weeks. Either isn't a very good scenario.

The second scenario, a wickedly infectious flu that doesn't kill a lot of people, is problematic on several fronts. One, it will kill some, as demonstrated by the numbers coming out of Mexico. And it would really suck to be one of those people, or their friends or family.

If you take a city the size of, say, the Phoenix metro area (two million) and half are infected and .5% die, that's still 5,000 people dead. For the entire US, with roughly 304 million, if half are infected and .5% die, that is 760,000 people. Worldwide, assuming eight billion people, twenty million could die. Odds are, however, that influenza's going to tear through the Third World with a lot more savagery than it hits modern nations, so the global CFR may be worse than what we're seeing now. Mexico may have a lot of poor, but it's nothing like Congo or Somalia or Haiti.

Secondly, aside from the dead, there will be many people who are sick enough to need medical care. If a "mild" but extremely contagious flu strikes, the number of ill could overwhelm the hospitals. Even a mild flu can be devastating to someone with preexisting health problems, or who is young, healthy, and unlucky enough to have an immune system that goes into overdrive. (We're already seeing this in Mexico city -- they have armed guards at the doors of public hospitals who are turning patients away.) There could be shortages of medication, supplies, and hospital beds.

Some quick calculations, using Phoenix for an example: Two million people. 10% sick at the same time gives you 200,000 sick. If just 5% need hospitalization that is 10,000 people. (How many of those 10,000 will die if they don't get the hospital care they need?)

This affects not just flu patients, but everyone for falls ill or is injured for any reason. If all the ventilators are being used and you're in an auto accident and have a chest injury and need one, you're up a creek. You'll die. The equipment wouldn't be available to save you. Plus, anyone who goes into a hospital would potentially be exposed. It would really suck to develop, say, have a treatable heart attack and then die of influenza complicated by your heart disease.

Thirdly, "mild" flu is only mild until you're the one who's sick. Flu is miserable. A mild, uncomplicated case of influenza will knock you flat for a week and, while it might not kill you, it will make you wish you were dead. If tens or hundreds of thousands of people are sick in a city, it can bring normal life in the city to a screeching halt and disrupt things in spectacular ways. (Mexico City is currently experiencing runs on grocery stores. People are panicking and they are literally running out of food.)

Finally, flu viruses have the capability of swapping genetic material with other strains. That's how swine flu was lborn -- likely, a pig was simultaneously infected with avian, swine, and human viruses. The viruses had virus sex and swapped some genetic material and their nasty little lovechild was born. Then some unlucky person caught that new flu virus, and an epidemic began.

During a pandemic, with lots of people sick, we can assume there will be lots of particles of swine flu virus floating around out there. However, seasonal flu isn't going to go away, and seasonal flu and swine flu could swap genetic code and then swine flu could learn some nasty new tricks, like Tamiflu resistance or increased virulence. It could also meet up with something really unpleasant, like avian H5N1 flu, which isn't really adapted well to humans (yet), but which has some genetic code that kills about 60% to 70% of people who are so unfortunate as to catch it from birds.

We really don't want any human-adapted flu to reassort with H5N1. The same thing that happened with the afore-mentioned pig could happen with H5N1 and if H5N1 retained its lethal nature That Would Be Bad.

On the other hand, if the CFR is higher, 150 dead gives us fewer patients. It's not spreading as fast. However, you can calculate the rate of spread of a virus by how many people each person, on average, infects. If each person infects greater than an average of one other person, the outbreak is growing and has pandemic potential. (AIDs, for example, has a very low rate of spread but it's definitely not dying out -- the rate of spread is greater than "1".)

A slow rate of growth, despite a higher CFR, may make swine flu more manageable. It would be easier to implement social controls such as quarantines of the infected, closing public places, and discouraging travel, to reduce the rate of growth even further. Slow the spread enough, and the hospitals don't become overwhelmed. While getting the rate of spread below "1" would be unlikely, it might be possible to keep it from growing in exponential leaps and bounds. Eventually, a vaccine will be created, and we can bring the pandemic to a standstill -- at least in those areas of the world where a vaccination is possible. (The toll that pandemic flu will take on certain third world countries will be appalling.)

However, slowing down the spread of the flu will require communities to accept restrictions that they will find highly unpalatable: schools, movies, restaurants, malls, ball games, parks, public pools, libraries, and more, all restricted or outright closed for business. Travel will be frowned upon and perhaps limited. All this will create massive financial strain on the people whose jobs are affected, with ripples spreading out throughout the economy.

I'm predicting that, if a large-scale pandemic does materialize, it will shake the western world's perception of itself to its core. Many people will die. Normal life will be disrupted on a large scale in ways that haven't happened in decades. The economy will be at the bottom of an outhouse before all is said and done. We will learn we are vulnerable to disasters of this scale, despite our assumptions to the contrary.

Stay tuned. The next few months will be very interesting ...

First US swine flu death (UPDATE)

A 23 month old baby in Texas has died from swine flu. This is the first US, non-Mexican death. The Center for Disease Control Acting Director Dr. Besser extended his sympathies to the family.

Swine flu has been confirmed in Germany and Austria and London overnight.

Will it stay mild? Is this the first wave? Only God knows.

UPDATE: CHILD WHO DIED OF SWINE FLU IN TEXAS WAS MEXICAN WHO TRAVELED TO US FOR MEDICAL TREATMENT -HOUSTON HEALTH OFFICIAL

Swine flu facts and the Model State Emergency Health Powers Act

Mexico has closed all public functions and schools, restaurants too, through Cinco de Mayo, until May 6 and beyond. Other countries are following suit with various travel restriction bulletins or other warnings.

The military is monitoring the outbreak, something they would naturally do since the CDC invoked the "declaration of public health emergency." Doing so can invoke the Model State Emergency Health Powers Act (MSEHPA) which in turn (depending on which state you are in that has passed it) use the military.

Under the Model State Emergency Health Powers Act, upon the declaration of a "public health emergency," governors and public health officials would be empowered to:

1. Force individuals suspected of harboring an "infectious disease" to undergo medical examinations.
2. Track and share an individual's personal health information, including genetic information.
3. Force persons to be vaccinated, treated, or quarantined for infectious diseases.
4. Mandate that all health care providers report all cases of persons who harbor any illness or health condition that may be caused by an epidemic or an infectious agent and might pose a "substantial risk" to a "significant number of people or cause a long-term disability." (Note: Neither "substantial risk" nor "significant number" are defined in the draft.)
5. Force pharmacists to report any unusual or any increased prescription rates that may be caused by epidemic diseases.
6. Preempt existing state laws, rules and regulations, including those relating to privacy, medical licensure, and--this is key--property rights.
7. Control public and private property during a public health emergency, including pharmaceutical manufacturing plants, nursing homes, other health care facilities, and communications devices.
8. Mobilize all or any part of the "organized militia into service to the state to help enforce the state's orders."
9. Ration firearms, explosives, food, fuel and alcoholic beverages, among other commodities.
10. Impose fines and penalties to enforce their orders.

Considering that Executive Order 51, signed by President Bush last May allows the President to establish an "enduring Constitutional Government" under which the Executive Branch alone has authority and powers, (martial law) and considering that Rahm Emanuel, chief of staff for President Barack Obama is on record as saying that "you should never want a serious crisis to go to waste... an opportunity to do things you think you could not do before..." and considering that CDC and Homeland Security shared the podium at yesterday's news conference (well, you connect the dots as to the next steps in this public health emergency.

The CDC reports that it has spread to six states with 64 confirmed cases. When a swab comes in for testing, they first test for Influenza-A, then go forward if positive for sub-set testing to conform the swine variation. However, that two-step process is slowing down the testing considerably, so California announced that "From now on when we are unable to sub-type Influenza-A virus, we have been directed to conclude the test has, in fact, detected swine flu," and New Zealand declared the same. At the same time, the WHO declared that containment is no longer possible and they just want to slow the spread.

CDC's list of US cases is up to 40 , 50, 64 cases. If it gets to 80 today that is a doubling since yesterday and certainly worth noting.

FYI, New York Times also has a world map-flu tracker here.

There are many reasons that local and national governments, the CDC, and WHO are concerned. Even though there have been no deaths in the US or elsewhere yet, there are items to consider about this particular version of the flu:

waves: pandemics occur in waves. The second wave is more fatal than the first. In the case of this 2009 outbreak, scientists fear that the first wave may have largely gone undetected, allowing wide spread virus transmission.

"In the 1918–1919 pandemic, a first or spring wave began in March 1918 and spread unevenly through the United States, Europe, and possibly Asia over the next 6 months (Figure 1). Illness rates were high, but death rates in most locales were not appreciably above normal. A second or fall wave spread globally from September to November 1918 and was highly fatal. In many nations, a third wave occurred in early 1919." source

Scientists are concerned because they are not sure if they are seeing the first or the second wave. If it is the first, this disease will seem to have died down and then in the fall it would reappear with devastating results. So...pray!

recombinant "Although the airborne virus is called swine flu, it is a recombinant mixture of DNA segments from pigs, birds and humans. The virus is a new genetic strain, which medical experts say could mutate into an even more dangerous variant of potentially pandemic proportions, since no one would have immunity to it." source. It is what makes the second wave so deadly: the virus re-adapts.

cytokine storm: As it was in the 1918 flu pandemic, it attacked adults in the demographic of 25-55 year olds, with healthy immune systems. The normal flu attacks young children and the elderly first. The difference is that in 1918 as it is now with this version of the swine flu, it causes a cytokine storm. When the immune system is fighting pathogens, cytokines signal immune cells such as T-cells and macrophages to travel to the site of infection. In addition, cytokines activate those cells, stimulating them to produce more cytokines. Normally, this feedback loop is kept in check by the body. However, in some instances, the reaction becomes uncontrolled, and too many immune cells are activated in a single place." The immune system gets overswamped, and you die.

Interestingly, scientists cannot figure out why the flu is lethal in Mexico and has not been anywhere else.

Are we really at pandemic level 4?

Looking at the google map of confirmed swine flu cases and looking at the WHO's rules for pandemic levels, it looks to me like we are actually at level 6 not level 4...but that's just me.

Here are WHO's rules for phases of pandemic level:

Phase 1: In nature, influenza viruses circulate continuously among animals, especially birds. Even though such viruses might theoretically develop into pandemic viruses, in Phase 1 no viruses circulating among animals have been reported to cause infections in humans.

In Phase 2 an animal influenza virus circulating among domesticated or wild animals is known to have caused infection in humans, and is therefore considered a potential pandemic threat. Below: WHO regions

In Phase 3, an animal or human-animal influenza reassortant virus has caused sporadic cases or small clusters of disease in people, but has not resulted in human-to-human transmission sufficient to sustain community-level outbreaks. Limited human-to-human transmission may occur under some circumstances, for example, when there is close contact between an infected person and an unprotected caregiver. However, limited transmission under such restricted circumstances does not indicate that the virus has gained the level of transmissibility among humans necessary to cause a pandemic.

Phase 4 is characterized by verified human-to-human transmission of an animal or human-animal influenza reassortant virus able to cause “community-level outbreaks.” The ability to cause sustained disease outbreaks in a community marks a significant upwards shift in the risk for a pandemic. Any country that suspects or has verified such an event should urgently consult with WHO so that the situation can be jointly assessed and a decision made by the affected country if implementation of a rapid pandemic containment operation is warranted. Phase 4 indicates a significant increase in risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion.

Phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short.

Phase 6, the pandemic phase, is characterized by community level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in Phase 5. Designation of this phase will indicate that a global pandemic is under way.

Protecting Your Family From an Influenza Pandemic

Protecting Your Family From an Influenza Pandemic

"The emerging threat of the Asian Avian Flu Virus (AAV H5N1) brings into sharp focus the vulnerability of modern, highly mobile and technological societies to viral or bacterial infectious diseases. The last major Asian flu outbreak, (H2N2 in 1957, which killed 69,800 people in the United States) took five months to reach the United States. With the advent of global jet travel, it is now likely that highly virulent disease strains will be transmitted to population centers around the world in a matter of just a few days."

We have seen the spread of this flu from Mexico City to Canada to New York to New Zealand to Israel in just a few days. It's out there. One iteration of the virus seems more mild, those in NYC and New Zealand are comfortably recovering. The Canadian who returned from Mexico was in hospital for 11 days, and the Mexicans are now suffering with a virulent iteration that kills.

* This new strain of influenza has shown it can spread easily from person to person.

* It has been found in several places and among people who had no known contact. This suggests there is an unseen chain of infection and that the virus has been spreading quietly.

* This can happen because respiratory illnesses are very common and doctors rarely test patients for flu. People could have had the swine virus and never known it.

* At least in the United States, it has so far only been found in people who had mild illness, another factor that would have allowed it to spread undetected.

* World Health Organization director Dr. Margaret Chan has said the new strain of H1N1 has the potential to become a pandemic strain because it does spread easily and does cause serious disease.

From the article: "Here are the key things that you need to do to protect yourself and your family, and to help restore order during a pandemic:"

A.) Raise Your Immune Resistance
B.) Be Ready to Fight the Illness
C.) Avoid Exposure.
D.) Stockpile Key Logistics.
E.) Be Prepared to Dispense Charity From a Safe Distance

Read more at the link. The most important things are to cover your mouth when you cough and to instruct kids to cover their mouths. Coughs are weapons. Also, frequent hand-washing is a must, with warm water and anti-bacterial soap or alcohol hand sanitizer. Reducing or eliminating attendance at large-scale events is also a strongly recommended preventative.

Anyway, that is some information or you and I highly recommend reading the article!

wow, alleged Athens GA shooter: manhunt goes nationwide

I hope and pray for his kids, and him, and his wife's family...

Article here

A nationwide search is underway for a University of Georgia professor who police say shot and killed his wife and two men early this afternoon at an Athens theater gathering. George Zinkhan, 56, is still at large, Athens-Clarke police said.
[Athens-Clarke police Capt. Clarence] Holeman raised the possibility that the shooting could be a crime of passion. “I can only speculate,” he said. “Some people are saying it could be a love triangle or something like that.” Zinkhan appeared to target Tanner, Teague and Bruce, said Rick Bedell, an actor with the Town and Gown Players, but he did not know why. "It was deliberate,” Bedell said. “He shot these three people specifically and walked out.“They were good people, and I have no idea why (Zinkhan) went nuts,” he said.

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so sad!

Athens Georgia shooting

Just when you think 'it could never happen here', it does. A University of Georgia Professor allegedly shot and killed three young adult student at an off-campus theatre. (UPDATE, AP at 8:53 pm: Authorities say a University of Georgia professor suspected in the deaths of his ex-wife and two others outside a community theater near campus had left his children in the car when the shooting happened.) One was close range, unfortunately. Three additional students were injured. The alleged shooter- Professor got in his car and drove away. Manhunt on now...Police are looking for George M. Zinkhan III, a professor in the Department of Marketing and Distribution and have searched his house with a SWAT team....

NYTimes article

AP article

AJC article

Swine flu very latest

LA Health Dept says new strain of swine flu is likely already affecting residents in LACounty, although no cases confirmed...

Crisis units have been activated in Brasil, France, Colombia, Chile and Nicaragua to monitor the swine flu outbreaks in the US and Mexico...

Possible Swine Flu Outbreak At NYC Prep School, New York City health officials say that about 75 students at a Queens high school have fallen ill with flu-like symptoms and testing is under way to rule out the strain of swine flu that has killed dozens in Mexico...

Mexico City closes museums, libraries, theaters

Mexico City closes museums to stop flu outbreak

MEXICO CITY (AP) — Mexico's federal government has closed museums, libraries, and state-run theaters as well as schools in its overcrowded capital to stop a swine flu outbreak authorities say may have killed as many as 60 people.

The government already shut down schools across Mexico City Friday in hopes of containing the outbreak that has sickened more than 900 people. World health officials worry a global flu epidemic could spread from the city of 20 million.

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Mexican officials have pushed back the deadline for filing national taxes for one week.

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Also, CA has opened its joint operations center to combat the flu in California

Swine flu outbreak: update/latest. CDC to hold presser

Authorities rush to tackle killer multi-strain swine flu in Mexico, US

MEXICAN and US officials have taken emergency measures to contain outbreaks of a new multi-strain swine flu blamed for scores of deaths in Mexico and seven infections in the United States. Mexican authorities confirmed the swine flu outbreak ...

The World Health Organisation in Geneva said 60 people have died from suspected swine flu in Mexico, and Mexican Health Minister Jose Angel Cordova said officials are probing 45 deaths and 943 possible infections.

The US cases included five in California and two in Texas, in three clusters, WHO spokeswoman Fadela Chaib said. [ED. NOTE: with another potential cluster in Ottawa]

The WHO, which has identified swine influenza as a potential source of a human flu pandemic, activated its global epidemic operations centre.
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CDC to hold press conference today at 2:30pm.