Swine Flu got Legs
This could be the big one.
Health alerts have spread through Australia’s government institutions, in particular hospitals, advising of the risk of Swine Flu. It affects young adults, has a high probability of mortality, and is described by the World Health Organization as an emergency having the potential to reach pandemic proportions rapidly. In Mexico, it is said that over 1000 people at the present time have been infected, of which over 60 (27/4/09 – now 80) have died – a fatality rate of (roughly) 6%. Schools, museums and other public gathering places have been closed to try to prevent further spread. The virus has already spread to California, Texas, with at least seven confirmed infections.
The number of fatalities outside of Mexico currently equals 1, a 23 month old in the US.
Specifically, the virus belongs to the H1N1 group of influenza A viruses. This particular strain is novel; its discovery occurred as recently as 2 days ago (23/4/2009). Its genetic profile is such that the conventional flu vaccines offered to hospital workers and the community are unlikely to offer protection. It is said to be sensitive to the drugs zanamivir (Relenza, owned by GSK) and oseltamivir (Tamiflu, owned by Roche). Supplies of this drug in Australia are probably adequate to manage the early stages of an outbreak, but clearly, in developing countries, this is definitely not the case.
The lethality of this infection is similar to that during the Spanish Flu pandemic (1918-1920) which had a mortality rate of 2 to 20%. It too was a subtype of the H1N1 influenza A virus.
One of the most common questions being asked by the public are about the presentation of the illness and how to avoid getting infected. In general, the symptoms and signs of the infection are nothing out of the ordinary. They include:
- All the usual flu symptoms, such as fever, lethargy, lack of appetite and coughing (respiratory tract), sometimes runny nose and sore throat.
- Other body systems can also be involved, such the gut (nausea and vomiting, diarrhoea)
These are the same symptoms that can happen in pneumonia, the common cold, even urinary tract infection in some people. This is not very helpful, because it can now be expected that, very often, a person with even the slightest runny nose, or food poisoning or whatever, will think he or she has swine flu. The rule of thumb is, if you are more sick than your usual, see a doctor. If you have a reason to avoid being sick at all (such as being on drugs which decrease your immunity), see a doctor.
As for avoiding infection, well there are more myths than facts around. If you managed to avoid catching a cold over the last five years, then you are doing something right, but the fact is that most people are forced to go to public places, shop, go to school, work and so forth. Like every virus, the flu will have an incubation period (even if it’s just a couple of days) where a person is infected, is infectious, but is feeling perfectly well.
Of the few things that have been proven to work, careful and consistent hand washing after human contact, isolation of the sick, vaccines (by no means a panacea), and being otherwise healthy, well slept and well fed, are the best thing. If you are worried about dying, but smoke, drink too much, go to fast food restaurants and drive too fast, then fix those before you worry about the flu!
The coming weeks will reveal whether this virus manages to spread faster than the ability of researchers to design a vaccine in order to produce herd immunity, especially in major cities. In the meantime, governments around the world will be placing their institutions on alert for symptoms and putting in place treatment protocols and the like. There is no doubt that everybody will do whatever is feasible to curtail the spread of this organism.
There are oddities about this organism, however, as reported in the Wall Street Journal:
The flu virus mutates promiscuously, and this strain is no exception: Officials said that, in addition to genetic material associated with North American swine flu, the strain has gene segments associated with European and Asian swine flu, North American avian flu and human flu.
Three strains in one! It’s not unreasonable to ask questions about just how probable (or improbable) such a mutation is in the wild. In laboratories, however, mixtures of multiple viral RNA fragments can be combined to yield a successful result. Biological weapons research has not ceased either, but has continued quietly out of the public limelight. We can expect to hear of many different explanations about this particular virus.
It is useful to keep an open mind about the outbreak. It is currently assumed that the virus is a natural occurrence. Indeed, there have been warnings about this for years now. The thing is, though, that warnings do not change the probabilities. Many people are rightly wondering whether the virus was engineered in a laboratory or is merely a coincidental mutation among a herd of pigs. If it is a man-made virus, then its release into the wild could represent the greatest act of mass murder in history. This question, therefore, is not to be shirked at and must be answered.
The influenza viruses, however, are known for their unstable genetics and rapid rate of mutation, hence the tendency for new strains to emerge each year, and even during a seasonal outbreak. It would be interesting to tease out the probabilities that this particular strain would have spontaneously emerged. Also, we can expect this outbreak, if it does spread as predicted, to rapidly mutate into multiple strains, making containment even more difficult.
On the topic of containment, it needs to be said that ordinary surgical masks do little to prevent the spread of influenza. It’s all just for show. During the first few minutes of wearing a surgical mask, the device performs to manufacturer specifications, but after that the mask is damp and warm and cannot offer the same protection. A paper mask cannot form a tight seal around the face so that air is always entrained on inhalation. If you are sneezed on, or are in contact with an infected person, you are going to get infected. Mask wearing is by and large a waste of time – as good as placebo. But people will do it anyway, of course.
Whatever its origins, this virus is already showing an ability to spread extremely rapidly. Within days we will know whether this is indeed the flu pandemic of the century.