ButAsForMe 

Striking parallels between the influenza of 1918 and new ’swine flu’ through a historical comparison

by admin on April 25, 2009 · 0 comments

in Uncategorized

Influenza is an ancient disease. It is first described by Hippocrates in 412 BC, though the term “influenza” would not be coined until the 14th century. (”Influenza” is Italian for “influence,” as the prevailing idea of disease causation at that time was the influence of the stars). In 1580, a disease originating from Asia and thought to be influenza swept through Europe, Africa, and the Americas on trade routes. While these cannot be confirmed as influenza, a better handle on the symptoms of the disease makes it likely that several influenzapandemics occurred in the 1800s: in 1833, 1836, 1847 and 1889.

From a historical perspective, this is very serious.

The worst influenza pandemic in recorded history took place in 1918-1919. At least 40 million, and likely closer to 100 million deaths worldwide have been attributed to the virus, most of them occurring in the 16-week period between September-December 1918.

In large U.S cities, more than 10,000 deaths per week were attributed to the virus. It is estimated that as many as 50% of the population was infected, and ~1% died. To compare, in “normal” (interpandemic) years, it is estimated that between 10-20% of the population is infected, with a .008% mortality.

The fact the current ’swine flu’ has shown to be contagious is alarming. So far the virus has shown to have a 6% 6.3% mortality rate. It may not seem like much, but please consider the following: The deadly influenza panic in 1918 had a mortality rate of under 1%.

This virus went on to kill tens of thousands of healthy people a day in large cities and up to 100 million people world wide.

Viruses, like this strain of swine flu, kill their host by over-stimulating active immune systems that are robust and healthy. That is why the victims in Mexico were between the ages of 20 and 45.

Some have said that no one in the United States have died from the virus, so we need not worry. Experts say it is only a matter of time. The virus is not prevalent enough to reach statistical significance in the United States, with only a  handful of confirmed cases.  93.7% of all Mexicans with the virus recovered.

More cause for worry: The 1918 virus started off ‘mild’ before it mutated into a raging storm. It also does not mean we will see millions of deaths. It is too early to draw sweeping conclusions.  Nevertheless, there is potential for a disastrous pandemic. If 50% of Americans catch this flu in the next two years, and the mortality rate stays at 6.3%, we would witness 20+ million deaths.

Still much to learn

Despite its popular name of the “Spanish flu,” it’s uncertain where the 1918 pandemic originated. (During World War I, Spain was one of the few countries who did not censor media, so reports of the state of the epidemic in that country were widely circulated). Scientists and historians have put forth points of origin in China, Vietnam, India, France, Great Britain, and the U.S. (Kansas).

Contemporary reports of the pandemic contain imagery that harkens back to the 14th century Black Plague. Morgues were overwhelmed; dead were buried in simple pine boxes, as the supply of caskets was quickly depleted; public activities were cancelled; spitting on the street was criminalized. The death toll made the casualties as a result of World War I pale by comparison. The virus struck hardest in the young and healthy, whose rapid immune response actually became their downfall. Enough young people died that it dramatically decreased the average life expectancy in that year (see figure below, from Nature Medicine 10, S82 - S87 (2004)).

Typically, influenza causes death due to a secondary bacterial pneumonia. Bacteria are able to take advantage of the host’s compromised immune status and damaged lung cells, establishing a potentially deadly infection. However, during the 1918 pandemic, a greater percentage of the deaths in the 20-45 age group were due to primary pneumonia: pneumonia caused by a combination of the influenza virus and the host response, with no bacterial invaders involved. In some patients, this occurred within a matter of hours from the first symptoms. A Pennsylvania medical student documented the phenomenon:

As their lungs filled, the patients became short of breath and increasingly cyanotic. After gasping for several hours, they became delirious and incontinent, and many died struggling to clear their airways of a blood-tinged froth that sometimes gushed from their nose and mouth. It was a dreadful business.

Though serological studies carried out in the 1930s had already identified the virus as a serotype H1N1, it was long thought that was the end of the potential information that could be found about the virus. However, in the mid-1990s, a group of researchers led by Jeffrey Taubenberger at the Armed Forces Institute of Pathology found samples of lung tissue from soldiers who had died of the 1918 virus in the archive at that institute. Additionally, pathologist Johan Hultin provided an additional sample from the lungs of an Inuit woman in Alaska who had died during the pandemic. These samples have been sequenced in an effort to determine what it was that made the 1918 virus so virulent. Though these questions are still being investigated, the preliminary data suggests that the virus was a human-avian reassortant which had entered the human population a short time before the pandemic (likely 6-12 months).

Though the 1918 pandemic has been the most dramatic example of the killing potential of influenza, there have been 2 other pandemics in the last 100 years. In 1957, a H2N2 virus appeared in China. This “Asian flu” quickly swept through the population, replacing the previously-circulating H1N1 virus and killing 70,000 in the U.S. Similarly, in 1968, an H3N2 virus emerged from Hong Kong to replace the H2N2 virus. This pandemic resulted in 34,000 American deaths. The H1N1 serotype re-surfaced in 1977, and currently, H3N2, H1N1, and reassortant H1N2 viruses circulate in the human population.

The H1N1 caused an additional scare in 1976. In January of that year, a private at Fort Dix, New Jersey, collapsed and died following a march. It was determined that he died of “swine flu,” serotype H1N1. Although he was the only death at the fort, health officials were highly concerned. Secretary of health F. David Matthews stated that

there is evidence there will be a major flu epidemic this coming fall. The indication is that we will see a return of the 1918 flu virus that is the most virulent form of flu. In 1918, half a million people died. The projections are that this virus will kill one million Americans in 1976.

With hindsight, we can see that a proclamation with this level of certainty is folly, but at the time, it was thought that influenza cycled in a fairly regular pattern, varying between very high pathogenicity strains and lower pathogenicity strains. It was thought that the world was overdue for another high pathogenicity strain, and that the “swine flu” virus just might be the one. In March of 1976, President Ford announced that he would ask Congress for funds to produce enough vaccine “to inoculate every man, woman, and child in the United States.” Of course, this epidemic never materialized, and actually dealt a blow to the influenza vaccine campaign, as reported side effects of the vaccine included Guillain-Barré syndrome, a debilitating neurologic condition.

Looking back, one can certainly draw parallels between the scare and build-up to vaccination in 1976 and today with H5N1. However, just because that pandemic never materialized does not mean that the same thing will happen with today’s flu. At this point, we just don’t know, but it behooves us to hope for the best, but prepare for the worst.

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DR. GITTERLE

It has come to our attention that a viral e-mail concerning the swine flu has made rounds on the Internet. Unfortunately, most e-mails in circulation have been modified for selfish reasons (to promote a certain herbal remedy — You can see an example of a fake e-mail in the comments section of this post.)

While the e-mail has a large element of truth, the modifications need be addressed. We will post a detailed explaination soon.

FACTS

What is Swine Influenza? Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza virus that regularly causes outbreaks of influenza in pigs. Swine flu viruses cause high levels of illness and low death rates in pigs. Swine influenza viruses may circulate among swine throughout the year, but most outbreaks occur during the late fall and winter months similar to outbreaks in humans. The classical swine flu virus (an influenza type A H1N1 virus) was first isolated from a pig in 1930.

How many swine flu viruses are there?

Like all influenza viruses, swine flu viruses change constantly. Pigs can be infected by avian influenza and human influenza viruses as well as swine influenza viruses. When influenza viruses from different species infect pigs, the viruses can reassort (i.e. swap genes) and new viruses that are a mix of swine, human and/or avian influenza viruses can emerge. Over the years, different variations of swine flu viruses have emerged. At this time, there are four main influenza type A virus subtypes that have been isolated in pigs: H1N1, H1N2, H3N2, and H3N1. However, most of the recently isolated influenza viruses from pigs have been H1N1 viruses.

Can humans catch swine flu?

Swine flu viruses do not normally infect humans. However, sporadic human infections with swine flu have occurred. Most commonly, these cases occur in persons with direct exposure to pigs (e.g. children near pigs at a fair or workers in the swine industry). In addition, there have been documented cases of one person spreading swine flu to others. For example, an outbreak of apparent swine flu infection in pigs in Wisconsin in 1988 resulted in multiple human infections, and, although no community outbreak resulted, there was antibody evidence of virus transmission from the patient to health care workers who had close contact with the patient.

How common is swine flu infection in humans?

In the past, CDC received reports of approximately one human swine influenza virus infection every one to two years in the U.S., but from December 2005 through February 2009, 12 cases of human infection with swine influenza have been reported.

What are the symptoms of swine flu in humans?

The symptoms of swine flu in people are expected to be similar to the symptoms of regular human seasonal influenza and include fever, lethargy, lack of appetite and coughing. Some people with swine flu also have reported runny nose, sore throat, nausea, vomiting and diarrhea.

Can people catch swine flu from eating pork?

No. Swine influenza viruses are not transmitted by food. You can not get swine influenza from eating pork or pork products. Eating properly handled and cooked pork and pork products is safe. Cooking pork to an internal temperature of 160°F kills the swine flu virus as it does other bacteria and viruses.

How does swine flu spread?

Influenza viruses can be directly transmitted from pigs to people and from people to pigs. Human infection with flu viruses from pigs are most likely to occur when people are in close proximity to infected pigs, such as in pig barns and livestock exhibits housing pigs at fairs. Human-to-human transmission of swine flu can also occur. This is thought to occur in the same way as seasonal flu occurs in people, which is mainly person-to-person transmission through coughing or sneezing of people infected with the influenza virus. People may become infected by touching something with flu viruses on it and then touching their mouth or nose.

What do we know about human-to-human spread of swine flu?

In September 1988, a previously healthy 32-year-old pregnant woman was hospitalized for pneumonia and died 8 days later. A swine H1N1 flu virus was detected. Four days before getting sick, the patient visited a county fair swine exhibition where there was widespreadinfluenza-like illness among the swine.

In follow-up studies, 76% of swine exhibitors tested had antibody evidence of swine flu infection but no serious illnesses were detected among this group. Additional studies suggest that one to three health care personnel who had contact with the patient developed mildinfluenza-like illnesses with antibody evidence of swine flu infection.

How can human infections with swine influenza be diagnosed?

To diagnose swine influenza A infection, a respiratory specimen would generally need to be collected within the first 4 to 5 days of illness (when an infected person is most likely to be shedding virus). However, some persons, especially children, may shed virus for 10 days or longer. Identification as a swine flu influenza A virus requires sending the specimen to CDC for laboratory testing.

What medications are available to treat swine flu infections in humans?

There are four different antiviral drugs that are licensed for use in the US for the treatment of influenza: amantadine, rimantadine, oseltamivir and zanamivir. While most swine influenza viruses have been susceptible to all four drugs, the most recent swine influenza viruses isolated from humans are resistant to amantadine and rimantadine. At this time, CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with swine influenza viruses.

What other examples of swine flu outbreaks are there?

Probably the most well known is an outbreak of swine flu among soldiers in Fort Dix, New Jersey in 1976. The virus caused disease with x-ray evidence of pneumonia in at least 4 soldiers and 1 death; all of these patients had previously been healthy. The virus was transmitted to close contacts in a basic training environment, with limited transmission outside the basic training group. The virus is thought to have circulated for a month and disappeared. The source of the virus, the exact time of its introduction into Fort Dix, and factors limiting its spread and duration are unknown. The Fort Dix outbreak may have been caused by introduction of an animal virus into a stressed human population in close contact in crowded facilities during the winter. The swine influenza A virus collected from a Fort Dix soldier was named A/New Jersey/76 (Hsw1N1).

Is the H1N1 swine flu virus the same as human H1N1 viruses?

No. The H1N1 swine flu viruses are antigenically very different from human H1N1 viruses and, therefore, vaccines for human seasonal flu would not provide protection from H1N1 swine flu viruses.

How does swine flu spread among pigs?

Swine flu viruses are thought to be spread mostly through close contact among pigs and possibly from contaminated objects moving between infected and uninfected pigs. Herds with continuous swine flu infections and herds that are vaccinated against swine flu may have sporadic disease, or may show only mild or no symptoms of infection.

What are signs of swine flu in pigs?

Signs of swine flu in pigs can include sudden onset of fever, depression, coughing (barking), discharge from the nose or eyes, sneezing, breathing difficulties, eye redness or inflammation, and going off feed.

How common is swine flu among pigs?

H1N1 and H3N2 swine flu viruses are endemic among pig populations in the United States and something that the industry deals with routinely. Outbreaks among pigs normally occur in colder weather months (late fall and winter) and sometimes with the introduction of new pigs into susceptible herds. Studies have shown that the swine flu H1N1 is common throughout pig populations worldwide, with 25 percent of animals showing antibody evidence of infection. In the U.S. studies have shown that 30 percent of the pig population has antibody evidence of having had H1N1 infection. More specifically, 51 percent of pigs in the north-central U.S. have been shown to have antibody evidence of infection with swine H1N1. Human infections with swine flu H1N1 viruses are rare. There is currently no way to differentiate antibody produced in response to flu vaccination in pigs from antibody made in response to pig infections with swine H1N1 influenza.

While H1N1 swine viruses have been known to circulate among pig populations since at least 1930, H3N2 influenza viruses did not begin circulating among US pigs until 1998. The H3N2 viruses initially were introduced into the pig population from humans. The current swine flu H3N2 viruses are closely related to human H3N2 viruses.

Is there a vaccine for swine flu?

Vaccines are available to be given to pigs to prevent swine influenza. There is no vaccine to protect humans from swine flu. The seasonal influenza vaccine will likely help provide partial protection against swine H3N2, but not swine H1N1 viruses.

Is this swine flu virus contagious?

CDC has determined that this swine influenza A (H1N1) virus is contagious and is spreading from human to human. However, at this time, it not known how easily the virus spreads between people.

What are the signs and symptoms of swine flu in people?

The symptoms of swine flu in people are similar to the symptoms of regular human flu and include fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and vomiting associated with swine flu. In the past, severe illness (pneumonia and respiratory failure) and deaths have been reported with swine flu infection in people. Like seasonal flu, swine flu may cause a worsening of underlying chronic medical conditions.

How does swine flu spread?

Spread of this swine influenza A (H1N1) virus is thought to be happening in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing of people with influenza. Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose.

How can someone with the flu infect someone else?

Infected people may be able to infect others beginning 1 day before symptoms develop and up to 7 or more days after becoming sick. That means that you may be able to pass on the flu to someone else before you know you are sick, as well as while you are sick.

What should I do to keep from getting the flu?

First and most important: wash your hands. Try to stay in good general health. Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food. Try not touch surfaces that may be contaminated with the flu virus. Avoid close contact with people who are sick.

Are there medicines to treat swine flu?

Yes. CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with these swine influenza viruses. Antiviral drugs are prescription medicines (pills, liquid or an inhaler) that fight against the flu by keeping flu viruses from reproducing in your body. If you get sick, antiviral drugs can make your illness milder and make you feel better faster. They may also prevent serious flu complications. For treatment, antiviral drugs work best if started soon after getting sick (within 2 days of symptoms).

How long can an infected person spread swine flu to others?

People with swine influenza virus infection should be considered potentially contagious as long as they are symptomatic and possible for up to 7 days following illness onset. Children, especially younger children, might potentially be contagious for longer periods.

What surfaces are most likely to be sources of contamination?

Germs can be spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth. Droplets from a cough or sneeze of an infected person move through the air. Germs can be spread when a person touches respiratory droplets from another person on a surface like a desk and then touches their own eyes, mouth or nose before washing their hands.

How long can viruses live outside the body?

We know that some viruses and bacteria can live 2 hours or longer on surfaces like cafeteria tables, doorknobs, and desks. Frequent handwashing will help you reduce the chance of getting contamination from these common surfaces.

What can I do to protect myself from getting sick?

There is no vaccine available right now to protect against swine flu. There are everyday actions that can help prevent the spread of germs that cause respiratory illnesses like influenza. Take these everyday steps to protect your health:

  • Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
  • Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.
  • Avoid touching your eyes, nose or mouth. Germs spread this way.
  • Try to avoid close contact with sick people.
  • If you get sick with influenza, CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.

What is the best way to keep from spreading the virus through coughing or sneezing?

If you are sick, limit your contact with other people as much as possible. Do not go to work or school if ill. Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick. Put your used tissue in the waste basket. Cover your cough or sneeze if you do not have a tissue. Then, clean your hands, and do so every time you cough or sneeze.

What is the best way to keep from spreading the virus through coughing or sneezing?

If you are sick, limit your contact with other people as much as possible. Do not go to work or school if ill. Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick. Put your used tissue in the waste basket. Cover your cough or sneeze if you do not have a tissue. Then, clean your hands, and do so every time you cough or sneeze.

What is the best technique for washing my hands to avoid getting the flu?

Washing your hands often will help protect you from germs. Wash with soap and water. or clean with alcohol-based hand cleaner. we recommend that when you wash your hands — with soap and warm water — that you wash for 15 to 20 seconds. When soap and water are not available, alcohol-based disposable hand wipes or gel sanitizers may be used. You can find them in most supermarkets and drugstores. If using gel, rub your hands until the gel is dry. The gel doesn’t need water to work; the alcohol in it kills the germs on your hands.

What should I do if I get sick?

If you live in areas where swine influenza cases have been identified and become ill with influenza-like symptoms, including fever, body aches, runny nose, sore throat, nausea, or vomiting or diarrhea, you may want to contact their health care provider, particularly if you are worried about your symptoms. Your health care provider will determine whether influenza testing or treatment is needed.

If you are sick, you should stay home and avoid contact with other people as much as possible to keep from spreading your illness to others.

If you become ill and experience any of the following warning signs, seek emergency medical care.

In children emergency warning signs that need urgent medical attention include:

  • Fast breathing or trouble breathing
  • Bluish skin color
  • Not drinking enough fluids
  • Not waking up or not interacting
  • Being so irritable that the child does not want to be held
  • Flu-like symptoms improve but then return with fever and worse cough
  • Fever with a rash

In adults, emergency warning signs that need urgent medical attention include:

  • Difficulty breathing or shortness of breath
  • Pain or pressure in the chest or abdomen
  • Sudden dizziness
  • Confusion
  • Severe or persistent vomiting

How serious is swine flu infection?

Like seasonal flu, swine flu in humans can vary in severity from mild to severe. Between 2005 until January 2009, 12 human cases of swine flu were detected in the U.S. with no deaths occurring. However, swine flu infection can be serious. In September 1988, a previously healthy 32-year-old pregnant woman in Wisconsin was hospitalized for pneumonia after being infected with swine flu and died 8 days later. A swine flu outbreak in Fort Dix, New Jersey occurred in 1976 that caused more than 200 cases with serious illness in several people and one death.

Can I get swine influenza from eating or preparing pork?

No. Swine influenza viruses are not spread by food. You cannot get swine influenza from eating pork or pork products. Eating properly handled and cooked pork products is safe.

Related Post:

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{ 2 trackbacks }

Bioinformatics of Swine Flu « Aurametrix’s Blog

April 28, 2009 at 3:08 PM

Swine Flu: A Historical Note on Influenza @ Helian

May 25, 2009 at 10:51 PM

{ 8 comments… read them below or add one }

X April 25, 2009 at 8:05 PM

What happened to http://www.birdfluupdates.org/?

William Paolini April 26, 2009 at 11:22 AM

I have a degree in Microbiology. Although I did not work with viruses, I know a bit about Influenza.

Somehow I stumbled on this site during a search yesterday. I did not see an authors name so whoever wrote this, I found this article a fairly complete summary. Got me up to speed quickly.

The term that is used when the immune system over reacts is called a Cytokine Storm. It is usually fatal if not treated and yes, the young with healthy immune systems are the ones that are most effected. During this “Storm” over 150 inflammatory mediators are released. This would account for the high mortality rate in 1918-19.

CDC confirmed this morning 20 cases in five states.

unabashedlib April 26, 2009 at 2:22 PM

Right on! The information of birdflu-updates.org is reflected in the major post here on the 1918 flu comparison. The author of that blog is knowledgeable about pandemics and preparation. Hope to see more information from that author because John Q. Public shouldn’t be kept in the dark and we need all the expert information we can get since government officials are fairly mute on this subject.

Sam April 26, 2009 at 4:07 PM

This strain of virus is more potent and more deadly than the virus that hammered the world in 1918 and 1919. Viruses come in waves. There are striking similarities to this virus and the virus that killed up to 100 million people in 1918. The first wave is historically more mild than the later waves.

In addition to this virus becoming more severe, it is mutating faster than previous virus that we have seen. In addition, this virus is nothing like we have ever seen before because it combines features from viruses natural in different parts of the globe. We are in uncharted territory.

If it follows the same path as the 1918 flu, we will see very damaging results. However, we must remember we are a global society now and the virus can spread quicker than we have ever witnessed in history. This is very concerning especially since the drugs we have now seem resistant.

While there have been no deaths in America, it is shadowed by the fact the common variable among the deaths seem to be age. While most American cases have involved the very young and very old (under 10 and over 50) the Mexican cases that ended fatally involved the robust and healthy (over 20 and under 45).

This virus kills the host by over-stimulating the immune system. The term that is used when the immune system over reacts is called a Cytokine Storm. It is usually fatal. During this “Storm” over 150 inflammatory mediators are released. This would account for the high mortality rate in 1918-19.

Soli April 29, 2009 at 3:38 PM

does this mean people with weaker immune systems eg. older people, babies, and those who happen to be severly immunocomprimised will, in general, have a higher survival rate if infected because of the lack of a powerful “Cytokine Storm” which would be found in an other wise healthy patient?
I also saw a baby died as a result of this, its always unfortunate to hear such incidents.

Sarah April 29, 2009 at 5:29 PM

@Soli
In general most of the death would logically follow the healthier and more robust immune systems. However, like all flu viruses, the symptoms are still there. If a baby or an older person gets it, they can still die if they cannot deal with the symptoms of the flu. A baby or an older person that have other conditions would not fare well. it is sad. also if a baby or older person has a particular healthy immune system they may suffer as well. There are so many variables.

But the fact young people are dying is something not normal with regular flu viruses. Usually the old and young die from the flu. Remember 36,000 people die from the regular flu each year.

However, this is different because of the number of healthy adults in the prime of their life have died. It something we have never seen before or witnessed since 1918. and that is the true cause for deep concern.

Julie May 1, 2009 at 10:45 AM

I’m commenting about your “Plain Stupid” remark above.

Unless people go through the trash and dig out infectious items, which is hard to imagine, I don’t see the threat here. Your assumption of “an incubus of viral plague” is inaccurate. It sounds like you are trying to pin the responsibility of airport trash cans on President Obama. Am I to assume that you think that the government is control of and responsible for the airports now? Oh, I guess in an emergency you want the government to be held responsible for every minor detail. But, otherwise you don’t want the government to be involved in much at all, right? (unless it’s convenient so that you can blame them)

The airlines can purchase these biohazard containers if they feel it is necessary. At this point, all businesses around the world are more worried about the economical impact of this crisis, (greed always seems to prevail.) I’m sure additional measures will be taken at airports should this escalate and more deaths are reported.

But, If the government were telling people what they can and cannot do right now, I’m sure you would be saying that “this is all a way for them to try to take away our rights” or “Mexico is trying to destroy the US” other such nonsense. It sounds to me like you are trying to blame President Obama for whatever may happen, When really, no one knows what’s going to happen.President Obama is doing a remarkable job.

On another note. I am impressed with his site. Very informative and interesting. I have used this link to help inform people. Thank you.

I want to paste something here and I want you to tell me what you think. I received an email from my sister this morning. She lives in TX and is a counselor at a middle school. So, this isn’t something that kids are passing around or anything like that. Here it is:

Swine Flu Update from Dr. Marc Gitterle

Dr. Marc Gitterle is head of ER at Christus Santa Rosa Hospital in New
Braunfels, TX (formerly named McKenna Hospital).

Update from Dr. Marc Gitterle

After I returned from a public health meeting yesterday with community
leaders and school officials in Comal County, Heather suggested I send
an update to everyone, because what we are hearing privately from the
CDC and Health Department is so different from what you are hearing in the
media. Some of you know some or maybe all of this, but I will just list
what facts I know.

The virus is infectious for about 2 days prior to symptom onset. The virus
sheds more than 7 days after symptom onset (possibly as long as 9 days).
This is unusual.

Since it is such a novel (new) virus, there is no “herd immunity,” so the
“attack rate” is very high. This is the percentage of people who come down
with a virus if exposed. Almost everyone who is exposed to this virus will
become infected, though not all will be symptomatic. That is much higher
than seasonal flu, which averages 10-15%. The “clinical attack rate” may be
around 40-50%. This is the number of people who show symptoms. This is a
huge number. It is hard to convey the seriousness of this.

- The virulence (deadliness) of this virus is as bad here as in Mexico, and
there are folks on ventilators here in the US, right now. This has not been
in the media, but a 23 month old near here is fighting for his life, and a
pregnant woman just south of San Antonio is fighting for her life. In
Mexico, these folks might have died already, but here in the US, folks are
getting Tamiflu or Relenza quickly, and we have ready access to ventilators.
What this means is that within a couple of weeks, regional hospitals will
likely become overwhelmed.

Some of the kids with positive cases in Comal County had more than 70
contacts before diagnosis.

There are 10-25 times more actual cases (not “possible” cases — actual),
than what is being reported in the media. The way they fudge on reporting
this is that it takes 3 days to get the confirmatory nod from
the CDC on a given viral culture, but based on epidemiological grounds, ws
know that there are more than 10 cases for each “confirmed” case
right now.

During the night, we crossed the threshold for the definition of a
WHO, Phase 6 global pandemic. This has not happened in any of our lifetimes
so far. We are in uncharted territory.

I expect President Obama will declare an emergency sometime in the next
72-96 hours. This may not happen, but if it doesn’t, I will be
surprised.

When this happens, all public gatherings will be cancelled for 10 days.

I suggest all of us avoid public gatherings. Outdoor activities are not as
likely to lead to infection. It is contained areas and close
contact that are the biggest risk.

Tamiflu is running out. There is a national stockpile, but it will have to
be carefully managed, as it is not enough to treat the likely number of
infections when this is full-blown. I don’t think there is a big supply of
Relenza, but I do not know those numbers. If I had to choose, I would take
Relenza, as I think it gets more drug to the
affected tissue than Tamiflu.

You should avoid going to the ER if you think you have been exposed or are
symptomatic. ER’s south of here are becoming overwhelmed — and I mean that
– already. It is coming in waves, but the waves are getting
bigger.

It appears that this flu produces a distinctive “hoarseness” in many
victims. The symptoms, in general, match other flu’s; namely, sore throat,
body aches, headache, cough, and fever. Some have all these
symptoms, while others may have only one or two.

N-Acetyl-Cysteine — a nutritional supplement available at the health food
store or Wimberley Pharmacy — has been shown to prevent or lessen the
severity of influenza. I suggest 1200 mg, twice a day for adults, and
600 mg twice a day in kids over 12. It would be hard to get kids under 12
to take it, but you could try opening the capsules and putting it on yogurt.
For 40 pounds and up, 300-600 mg twice a day, for less than 40
pounds, half that.

Oscillococinum, a homeopathic remedy, has been vindicated as quite effective
in a large clinical trial in Europe, with an H1N1 variant. You can buy this
at Hill Country Natural Foods, or the Wimberley
Pharmacy.

I will try to keep everyone posted if I have any new information.
Meanwhile, don’t be afraid just avoid infection. The fewer people
infected the easier it will be for our public officials to manage it.

Dr. Marc Gitterle
Head of ER
Christus Santa Rosa Hospital
New Braunfels, TX

admin May 2, 2009 at 4:52 AM

@Julie
The news update section contain feeds from all sources. I wish I had a link for that one, but it was on CNN TV and cannot find a link on their website. In terms of protecting the citizens, the government should do what is required to establish domestic tranquility.

It’s plain stupid because we are not lacking in government resources at airports with the NSA. The CSS also has a large presence in the airports. It would cost very little to remove the trash threat. Most airports have bio-hazard bags and have been doing this, but not all.

In addition, “an incubus of viral plague” is accurate — saliva from the mouth is more than enough for the virus to survive.

It’s not an Obama putdown. Rather we are trying to protect the public. Obama has a huge brand and is broadly influential. He said there is nothing to worry about. But the situation is more complex than his message eludes.

First, people have their attention on this subject. He should use the time to promote provident living instead of saying all is well — use this opportunity to explain to people how they can better prepare for pandemics or any other calamity for that matter.

Second, while it is true this virus is relatively mild — However, I fear by only saying this send a message that people do not need to worry about the potential of this virus. Those knowledgeable about history know viruses come in waves. The pandemic in 1918-1919 first started off very mild. We expect this virus to move to the southern hemisphere for flu season; and there is a huge possibility it will return stronger and more deadly.

Third, the structure of this virus is showing signs of mutating with a certain type of virus and the WHO has some evidence is combining with HIV. This would not be good.

—

As for that e-mail message: I have the original. And I can tell you the e-mail you have is very different. I will post the e-mail, but I can tell you my initial thoughts right now:

I think someone took the original e-mail that made rounds on the Internet and modified it to promote certain natural remedies. While it may be these remedies work as claimed, it is completely unethical to use this doctor’s name and e-mail to promote these products.

Again, we will publish the original e-mail. But first we have to blacken out some of the contact information before we publish. We also have expert sources that will offer their opinion on this email. These sources are more qualified than I am to judge as they work directly with the people who are advising top officials. They have asked to remain anonymous, and to that we hold.

Thank you for your comments, and your visit to our site. You are important to us. Your comments were great. And even if we have certain disagreements, our hope is we can both learn from each other and move closer to truth.


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