...but you should probably keep an eye on China, just in case. Quartz explains what's so troubling about this newest mutation, which so far has claimed seven lives:
The most worrying part is that authorities don’t know how these people were infected. There’s no evidence so far that any of the patients interacted with each other, a sign that the bird flu hasn’t mutated into a virus that can jump between humans rather than just from animal to human–the basis for a global pandemic. Yet, most of the patients were not in close contact with birds (one woman was a poultry butcher and the woman in Anhui had some contact with live chickens.) Moreover, the mysterious illnesses are being disclosed within six weeks of over 16,000 carcasses of mysteriously killed pigs and 1,000 ducks floating in waterways near Shanghai and Sichuan province.
(This post provided the opportunity for me to dust off the long-comatose "SNOUTBREAK" tag. The archives for that tag make for an interesting look at the last time a global pandemic struck. If this bird flu spreads, hopefully we can learn from our Snoutbreak's mistakes.)
Health officials confirmed Saturday that he was suffering from H1N1 virus, commonly referred to as swine flu.
Although Aaron was in and out of hospitals for most of his short life, his parents, Elizabeth and Benito Lopez, said Wednesday that they were surprised swine flu ultimately caused his death.
Aaron was born in May with two holes in his heart and had surgery on his heart when he was 6 weeks old. Complications from that procedure affected his kidneys and brain, his mother said. Other illnesses followed.
"There were serious underlying health conditions, but that does not make the loss any easier for the family or the child's loved ones," said Dr. Larry Jecha, Benton-Franklin Health District officer.
Some parents—ingenious, brilliant parents—are holding swine-flu parties to expose their kids early, hoping that'll work like a vaccine. Says the good Dr. Thomas Sandora of Children's Hospital in Boston:
"Intentionally exposing your child to a potentially fatal infection is never a risk worth taking."
In other afflictions, Irish prisons are preparing for Purell parties. Prisoners don't have access to alcoholic gels now, but they will if an outbreak begins:
"Prisoners here have shown ingenuity in the past—so if and when the authorities bring the raw materials in for them, they do not pass up the opportunity," said a senior officer.
"This gel is practically pure alcohol and the rumours circulating are that it can be diluted with fruit, water and sugar to give it a reasonable taste while retaining the buzz."
After about 100 people were sicked with (possible) swine flu at the Penny Arcade Expo last weekend, the hamdemic also appears to have spread the University of Washington campus.
Early this morning, UW sent out this email to students and faculty:
While a diagnosis has not been confirmed, the first apparent cases of novel H1N1 influenza have been reported to Hall Health Center from a sorority at the University. Sorority rush is beginning and many of the houses are active with returning sorority members and new students. Two cases of probable H1N1 flu have been identified in one house. The students were advised to return home and other members who may have been exposed have been advised to take necessary precautions, which include hand washing and use of hand sanitizers. They have also been advised to watch for symptoms of the flu and report cases to Hall Health.
More information will be forthcoming in the coming week as we approach the start of the school year. This is the leading edge of what we anticipate during the fall quarter.
Jean Haulman, M.D. Medical Director Campus Health Services
PULLMAN, Wash. — Washington State University officials say more than 2,000 students have been sickened by swine flu during the first two weeks of classes on the Pullman campus, though none have required hospitalization, according to WSU Health and Wellness Services.
Saturday's football game between Stanford and Washington State will go on as scheduled.
"Public health officials believe that attending the game and sitting in the stadium poses almost no risk to attendees," WSU said.
"We'll have hand sanitizers at all concession stands," said Bill Stevens, a spokesman for the football team, adding that 13 WSU players have shown flu symptoms at some point.
From Hampocalypse to hand sanitizer in six months.
According to the King County Department of Health, only 11 patients being treated for swine flu worldwide have become resistant to the antiviral drug Tamiflu. However, two of those 11 patients with superpowered swine flu just so happen to be in King County.
From the the county:
The two patients, one a male teenager and the other a female in her 40’s, had no links to one another and these infections are not believed to be related. Both patients had compromised immune systems, a condition that has previously been shown to raise the risk for prolonged seasonal influenza virus infection and development of antiviral resistance during treatment. One patient is currently no longer ill from the influenza virus infection and the other has ongoing symptoms and is being treated with the antiviral medication zanamivir.
There is no evidence that health care workers or other contacts of these two people became infected with a Tamiflu-resistant virus. The risk of infection to the general population is very low from these cases, but as a precaution, local and state health officials are working in collaboration with the CDC to conduct enhanced monitoring for antiviral drug resistant influenza in the community.
Yeah, yeah. I'm being an alarmist. Whatever. We'll see who's still standing when the Hampocalypse arrives.
At least 1 million Americans have now contracted the novel H1N1 influenza, according to mathematical models prepared by the Centers for Disease Control and Prevention, while data from the field indicates that the virus is continuing to spread even though the normal flu season is over and that an increasing proportion of victims are being hospitalized...
The normal seasonal flu virus has virtually disappeared from this country, as would be expected. But the novel H1N1 virus is continuing to spread, and now accounts for 98% of all cases.
"So far, it doesn't look like transmission is declining at all," Finelli said.
The World Health Organization has (finally) declared swine flu to be a full on pandemic, raising the global pandemic alert to its highest level.
The World Health Organization has told its member nations it is declaring a swine flu pandemic — the first global flu epidemic in 41 years, news services reported.
The move came after an emergency meeting with flu experts here that was convened after a sharp rise in cases in Australia, which reported 1,224 cases on Wednesday, and rising numbers in Britain, Japan and elsewhere.
In a statement sent to member countries, the W.H.O. said it decided to raise the pandemic alert level from phase 5 to 6, indicating a global pandemic outbreak, The Associated Press said, attributing the information to health officials from Scotland, Indonesia and Thailand. An official announcement of the change was due at 6 p.m. Geneva time on Thursday (noon in New York).
Just in case there was any doubt, the Center for Disease Control has confirmed nine cases of swine flu in Washington. It's not yet clear how many samples from Washington have been tested by the CDC.
So far, the state health department lab has tested nearly 300 samples of suspected swine flu and found 45 probable cases. The state has been forwarding the suspect viral samples to the CDC in Atlanta for confirmation.
If you're still freaking out about swine flu—in spite of the fact that it appears to be a fairly mild strain—you can keep up with the state health department running case tally here.
It's starting to seem that, at least from a Seattle perspective, "yawn" might have been the most correct answer during this definitive series of online swine flu panic polling.
But when, exactly, did swine flu stop being a terrifying calamity for all of humanity and turn into a much less panic-inducing (but perhaps still Purell-selling) problem?
Did you know that it was imminently played out on Wednesday, April 29, when the World Health Organization upped the global threat level to 5, declaring an imminent pandemic? Or on Thursday, April 30, when Joe Biden started telling people to stay off planes and suspected swine flu turned up in Seattle? How about Friday, May 1, when Madrona elementary was closed because of one student with suspected swine flu and the number of confirmed U.S. cases stood at 141? Or was it on Saturday, May 2, when the number of suspected cases in the Seattle area kept rising even as the WHO said there was no sign of the flu spreading outside of North America and Mexico said its number of real cases could end up being half of what had been suspected? Perhaps it was Sunday, May 3, when it was increasingly pointed out that the vast majority of cases in the U.S. are mild? Or maybe it was yesterday, Monday, May 4, when the number of probable swine flu cases in the Seattle area continued to rise somewhat but officials announced that all nine closed schools in the region would reopen? Or was it today?
Well? When did you know? Because you knew before everyone else, right?
Last Friday, I talked to Metro general manager Kevin Desmond about how his agency plans to respond in the event of a swine flu outbreak. The answer, in short: They're putting up signs and asking people not to cough on each other. "We're following the advice of county department of health and the CDC ... and watching very carefully how things are evolving," Desmond said. "The basic recommendation from the department of health is for people to practice protective hygiene: Don’t touch your hands to your eyes, mouth, or nose and wash your hands a lot; don’t go out in public if you're sick; and cough or sneeze into a tissue or sleeve and not your hand." If you ride the bus, you'll probably see new signage with those recommendations sometime later this week. Desmond says Metro has no plans to step up its bus-cleaning schedule, adding that it would be a "huge undertaking" to try to sanitize every bus every day.
Desmond says Metro wouldn't shut down unless ordered to by authorities—a scenario he calls a "huge financial emergency," because Metro would still have to pay people despite drastically reduced revenues—but it might reduce service, as it did during last year's snowstorms.
As a pathogen, influenza is the cat's pajamas; influenza puts the ortho in orthomyxovirus, the segments in its RNA genome and the misery in sneeze droplets everywhere.
Let's unpack H1N1 and H5N1. The 'N' in both stands for neuraminidase, a fancy way for saying "snot eating enzyme." The virus needs to get to the juicy cells at the back of the throat. Our bodies pour out copious amounts of snot in defense, forming a sticky wall of doom for all manner of pathogens. Stuck on the outside of every flu virus is a sea of this neuraminidase enzyme. The enzyme gobbles up the snot, allowing the virus to reach the cells lining our throat. In comes the 'H' or hemagglutinin protein, also located on the outside of the virus. Hemagglutinin binds the salicylate receptors located on the outside of almost all cells (salicylate is a special way of saying aspirin), dragging the virus into the cells. Once inside, you're infected. Huzzah for our little virus. Go team!
Influenza has been around for a while—co-evolving with many other species beyond man. As a result, different versions of the H and N enzymes have split off over time. The numbers after H and N in a flu virus name indicate the rough genetic heritage of a given flu's enzymes. H1 and H5 are like Montagues and Capulets—alike in kind if not kin. A given H (or N) is accomplishing the same task, but in slightly different ways.
In comes the home team. If the B-cells in our immune system can make antibodies against the neuraminidase and hemagglutinin, blocking their function, we can stop the virus. Making antibodies takes time. While we're waiting, CD8 T-cells (cytotoxic T-cells) come in and kill any of our own cells that are infected with virus, a sort of controlled Kamikaze mission in defense of the Home Islands. (Dead cells can't make more copies of the virus; once you're infected, brother cell, it's too late to save you.) With each kill, the CD8 cells release a little bit of activating cytokine and become a bit more bold. This self-death is a large part of the misery of the flu. You are sore because your body is literally killing itself in battle. It takes a week or two for the B-cells to start pumping out antibodies to a new(-ish) virus, at which point the CD8 cells are told to lay off, and take a break.
What we have here is the co-evolution of a host and parasite. My favorite! This sort of host-pathogen interaction is an evolutionary saddle-point, with two possible resolutions:
An exchange I had with Slog commenter "I Got Nuthin'" this morning (edited for space):
I boarded the 271 to Bellevue at the UW. A gentleman (25 - 30 years old) was already on the bus, sitting about half way back on the driver's side. The bus was maybe at 25% of capacity with people spread out as one would typically find on any bus in the city.
As soon as I got seated, the aforementioned gentleman immediately caught my attention because of an incessant and deep hacking cough. I estimate that he coughed—2 or 3 coughs at a time—every 30 seconds for the duration of the half hour trip that we shared. Of course, this being Seattle, everybody just sat and endured it. No eye contact, no suggesting that maybe he shouldn't be out in public, no reaction from the bus driver. At one point I did spend several seconds studying the cougher and I have to say that he looked like death. His cheeks and forehead were all rosy. He was clearly congested and appeared to be in a generally miserable condition physically.
Which leads me to my questions:
1. Would it have been appropriate for someone to suggest to this person that maybe in light of the "swine" flu pandemic and associated fears, that he shouldn't be out in public, well alone on the bus? 2. What role does the bus driver have in protecting his riders? 3. Has Metro published any guidelines regarding situations like this?
And my response:
As far as I know, Metro doesn't have any specific guidelines about people riding the buses while sick. When I talked to Metro GM Kevin Desmond last week, he said their basic policy was to advise people not to ride the buses while sick, to cover their coughs, and to be mindful of other passengers. Obviously, this guy wasn't doing that, and I'm not sure what their advice would be in that situation—I have a call in to their PR person to find out if there's any kind of actual policy.
In general, though, I think passengers would be in the right asking the coughing guy, politely, if he was OK and whether he should be out and about. Given that Metro's a public accommodation, and coughing doesn't violate the agency's code of conduct, I don't think the driver would be able to make him leave. But I'll let you (and Slog) know what I find out.
I haven't heard back from Metro yet, but I did take a closer look at the code of conduct, and it's pretty clear that you would have been in the right at least saying something to the driver or the passenger. From there, it would be the driver's call whether to ask the passenger to leave or continue to ignore him. Specifically, the code of conduct prohibits causing "safety problems," and advises passengers to call 9-1-1 if they see a medical emergency. (Hilariously, the code of conduct also prohibits both "spitting" AND "expectorating.") The bottom line is, you shouldn't have to put up with a gross hacking cougher on the bus—particularly during a possible epidemic—but there's only so much you can do. The rest depends on the driver and the consideration of the cougher.
Pigs might have spread the current strain of influenza to humans, attracting worldwide attention, but new Canadian-led research suggests that we might have given pigs the flu in the first place, during the 1918 Spanish flu pandemic.
My great-grandfather (allegedly) died in that Spanish flu epidemic—an Irish prisoner sent to Nova Scotia prison camp to make shoes for British feet. He (allegedly) got out, went to New York City, met my great-grandmother, married her, made a baby, and promptly died before my grandfather was born.
Why all the "allegedly"s? Because that story always seemed like a convenient lie.
My grandfather was raised by his mother—and the Irish priest she took up with, as a "housekeeper," after "John Kiley" (the most generic Irish name possible) "died." Which raised the eyebrows of subsequent Kiley generations. Those subsequent generations were promptly and thoroughly scolded for "even thinking about it."
But maybe, just maybe, we're descended from that priest1. Or from some Lithuanian sailor great-grandma met one night. (Shut my mouth!) Or maybe "John Kiley" really existed and died of Spanish flu.
In which case, it is perhaps my destiny to die of swine flu, which descended from Spanish flu just as I descended from "John Kiley."
Either way, I'm going to have a drink.
1A remarkable man, really, who served as a trench priest during WWI and, once he came to America, fought off the anti-immigrant, anti-Catholic KKK (small as it was) in New York state. There's one story of him facing down a posse of hooded Klansmen who'd gathered in the yard of a terrified Italian family one night. Father Riley brought along a spiky bludgeon of some kind and stood his ground while the Klansmen slinked away.
When he was in his 70s, a man broke into Father Riley's small home in the middle of the night. Father Riley got up and beat the holy hell out of that burglar, who had to be removed from the house on a stretcher. Not a bad man to claim as a great-grandfather.
With the World Health Organization declaring a swine flu pandemic “imminent,” the Seattle School District is asking teachers and administrators—who receive some training—to monitor kids for possible infection at most schools, instead of relying on trained medical staff.
According to data received from the Seattle School District, about 80%—or 74 of Seattle's 95 schools—don't have full-time nurses on staff. Nurses generally work two or three days a week, leaving teachers and secretaries to take temperatures and monitor kids for behavioral shifts, which could indicate illness.
The school district, naturally, is a bit defensive about the lack of nursing staff in the district. “Parents should be [monitoring] as well,” says Seattle School District spokesman David Tucker. “It’s not just the school district’s job." When I pointed out to Tucker that some teachers aren't comfortable diagnosing their students, Tucker says the district is "not looking for teachers to make diagnoses.”
While the school district is downplaying the importance of nurses in schools, at least one swine flu case appears to have been spotted by a school nurse. New York City school nurse Mary Pappas is being is being credited with spotting a swine flu outbreak at her school and contacting the health department.
It was her call to the New York City Health Department last Thursday morning that prompted the city to send samples from sick students to Atlanta for testing, and resulted in the first eight confirmed cases of swine flu in New York State on Sunday, triggering a nationwide response.
It’s possible that the nurses really aren’t necessary, and that vigilant parents and doctors will be enough. But it seems that they could also be a helpful resource to have in place at a time when schools are closing because of the fear of widespread illness. Unfortunately, the district doesn’t see it that way.
According to district records, about 50 of Seattle’s 95 schools don’t have a nurse on staff today.
There is not a pure fund of soapmakers, but you can definitely buy stocks that would benefit from soap and alcohol gels, and face mask, sales. I would think Netflix would get a pop in sales if there was a widespread shutdown, and probably internet porn, and airlines would be slaughtered.
Soap: Proctor & Gamble makes Ivory soap, ticker PG.
by Dan Savage
on Fri, May 1, 2009 at 3:27 PM
Is it just me or... does it seem silly to close schools one at a time after a confirmed case of swine flu is found? If the threat is serious enough to close schools after a single case of swing flu is discovered, wouldn't it make more sense to close the schools—all of them, all at once—before another student population is exposed?