Pandemic Flu Watch

From simple to stupid

2009-05-23T05:47:00.003-04:00

Epidemic: from the Greek, epi- (upon) + -demos (the people)

Pandemic: from the Greek, pan- (all) + -demos (the people)

Pandemic (according to the WHO): from external pressure and internal weakness, highly-virulent + "justified" panic + all + the people

The definition of a pandemic used to be simple: a worldwide outbreak of disease in excess of what would normally be expected (a global epidemic).

The WHO even came out with a definition of worldwide spread (community transmission in 2 or more WHO regions).

But now, apparently, the WHO intends to change the definition of a pandemic from simple to stupid.

Bowing to pressure from member nations, the WHO is (according to the New York Times) going to change the definition to include the severity of disease, and will probably do so in such a way that the current H1N1 outbreak will never count as a pandemic (unless it becomes more virulent, which it very well might).

Now, you may remember that we've had three pandemics in the last century, one in 1918, one in 1957 and one in 1968... or, at least, that used to be true. If this new definition goes into effect as described, we'll have to erase those last two from the list, because they were no more severe than this new H1N1 strain appears to be right now.

Whether a given outbreak is a pandemic or not is a separate question from how severe that pandemic is.

If the WHO thinks a severity scale would be useful, then by all means they should create one. There are some good arguments against using a severity scale (flu viruses evolve so quickly, severity varies between and within countries, etc.), but it's possible a severity scale would help countries and communities to better plan for and respond to a pandemic... but the role of a severity scale should be to better describe an existing pandemic, not to determine whether an outbreak is a pandemic.

If the WHO goes through with this, there will be two definitions of a pandemic: One used by epidemiologists and other public health professionals, and one used by the WHO --because the WHO's new idea for a definition doesn't make any rational sense. By setting up such a situation, the WHO will be undercutting its own credibility in a time when its ability to lead is more important than ever.

Instead of caving to the pressure of politicians from the member nations who feel that declaring a pandemic would cause "unjustified panic," the WHO should be using this as a teachable moment, to educate the public about what a pandemic is, what can be done about it, and why panic is never a justified reaction regardless of severity.

Obesity and H1N1

2009-05-20T05:02:00.006-04:00

The Washington Post just ran a story with the headline "Survey finds link between obesity and flu severity." Now, I'm usually a big fan of The Post, but that turns out to be completely inaccurate.

The study in question, entitled "Hospitalized Patients with Novel Influenza A (H1N1) Virus Infection --- California, April--May, 2009," was published online as an early release by the CDC's Morbidity and Mortality Weekly Report (MMWR), and there is nothing in that study to indicate that obesity is a risk factor for severe disease with H1N1. Nothing at all.

The authors don't interpret their findings that way in the paper, and the simplest of math shows that such a conclusion makes no sense on the basis of this data.

As the wonderful XKCD t-shirt my wife got for me says, "Stand back, I'm going to try SCIENCE!"

The prevalence of obesity among the 30 hospitalized cases in California was 4/30 = 13.33%

The prevalence of obesity in California (in 2001) was about 20.9%

13.33% is less than 20.9%

Now, you shouldn't take that to mean that obesity is protective against the H1N1 virus. (The numbers are just too small for statistical stability.) But there's absolutely no reason on the basis of this data to conclude that obesity "obesity may raise risk for flu complications," as the Post's running title for this piece reads. Which is why the authors make no such assertion.

Does that mean the same thing as "there's absolutely no reason at all to conclude that obesity is a risk factor for severe disease with H1N1?" No, it does not. Thirty cases are too few to draw definitive conclusions. And, in fact, the article goes on to say:

"We were surprised by the frequency of obesity among the severe cases that we've been tracking," said Anne Schuchat, one of the CDC epidemiologists managing the outbreak. She said scientists are "looking into" the possibility that obese people should be at the head of the line along with other high-risk groups if a swine flu vaccine becomes available.

And it is entirely possible that there's something to that, though the article gives us no direct evidence to support it.

But if any such evidence exists, it certainly isn't to be found anywhere in the MMWR paper. And the paper's authors make no claim that it is, so don't blame them for the inaccuracy.

Swine flu + Japan = Karaoke boom?

2009-05-19T08:18:00.004-04:00

Apparently, a lot of students at Japanese high schools that have been shut down due to the H1N1 outbreak haven't been staying home; instead, they've been going out for karaoke.

As someone who discovered firsthand that karaoke microphones make good fomites (someone shared a nasty cold with me once, by way of a karaoke mic), I'd like to point out that this is a Very Bad Idea. --All the more so, since a lot of the karaoke venues in Japan include smallish private rooms, where the ratio of students to square feet (and, therefore, the opportunities for large droplet spread) can be quite high.

Is this an argument for not shutting down schools, then?

Probably not.

Unless a very high percentage of students from these closed schools are crowding into the karaoke joints or other venues where there is a relatively high risk of transmitting the flu, school closings are still likely to be more effective than not in slowing the spread of the virus.

Another edition of "Complete Rubbish"

2009-05-15T06:01:00.006-04:00

Adrian J. Gibbs, a retired plant virologist recently claimed that the H1N1 "swine flu" virus must have originated as the result of a laboratory accident.

According to the New York Times, his theory (or, rather, his poorly thought out hypothesis) has now been debunked by the WHO.

A brief excerpt from the article:

Dr. Gibbs, who had studied the gene sequences of the swine flu virus posted on public data banks, argued that it must have been grown in eggs, the medium used in vaccine laboratories. He reached that conclusion, he said, because the new virus was not closely related to known ones and because it had more of the amino acid lysine and more mutations than typical strains of swine flu.

His theory was reported by Bloomberg News on Tuesday. Even though scientists at theCenters for Disease Control and Prevention were skeptical and some prominent virologists openly derisive, news outlets have repeated and magnified the theory, adding speculation about bioterrorism that even Dr. Gibbs repudiated. He was also interviewed Thursday on the ABC News program “Good Morning America.”

Dr. Fukuda said a W.H.O. panel of experts had concluded that “the hypothesis does not really stand up to scrutiny.” The lysine residues and mutation rates were typical, he said, and many swine flus seem unrelated because not enough pigs are tested each year.

The article went on to make some astute points about the damage that misinformation like this has caused in the fight against diseases like AIDS and polio.

This is why the cultural expectation in science is that you publish, then pronounce. Or, in cases where the early dissemination of your research could save lives, that you at least get your work through the peer review process before typing up your press release.

Because science matters. Getting it wrong matters. Reducing the public's trust in the people working to protect them matters.

Dr. Gibbs should have known better.

Bogus bioweapon claims for H1N1 Swine Flu

From the comments: Is the bioengineering theory really rubbish?

Disturbing results of a recent survey

2009-05-14T10:05:00.009-04:00

According to a new poll by Zogby / University of Texas:

Only 30% of Americans would get a vaccine against the H1N1 "swine flu" virus, if one were available.

This shows that we aren't getting the message across to the majority of Americans: This virus may appear relatively mild right now, but we can't trust it to remain so. The first wave of infections caused by the 1918 pandemic flu virus was also mild... and then it went on to kill tens of millions of people in a world of only 1.8 billion. We don't know that the same thing will happen with this virus, but we also don't know that it won't. If a protective vaccine becomes available, take it. Immediately.

A whopping 38% of those surveyed managed to combine ALL of the following: Not vaccinated against the flu, not practicing good hygiene, and not restricting travel or mall shopping.

Now, I'm not too concerned about that last part at the moment. Healthy people aren't being encouraged to curtail their social interactions right now. But unvaccinated people who practice poor personal hygiene (e.g. they don't wash their hands regularly) aren't only putting themselves at risk: they're gambling with everybody's health. By making choices that make them more likely to become infected, they are also increasing the risk that they'll pass that infection on to someone else.

Which is why the next bullet is so striking:

"The same was true of 25% of health care workers polled, 28% of caregivers in nursing homes and 33% of those whose children are vulnerable due to asthma, diabetes, or HIV. Particularly concerning is that only 48% of these children were vaccinated." (emphasis added)

Now, you might be thinking: "Yes, but maybe these people would vaccinate if there were an H1N1 vaccine; this is just how they react to the 'regular' flu, after all."

To which I respond:

These people all provide care to those who are at high risk of severe complications (including death) from "regular" seasonal flu.
Are you forgetting the poor hygiene issue? Handwashing, good cough/sneeze etiquette, and the like are not just for special occasions. They save lives every day.

These groups have a special responsibility as care providers to ensure that they are not putting their patients (or high-risk children!) in danger through their own negligence. Some of those parents may not know any better, but none of the healthcare workers / nursing home caregivers have that excuse.

No amount of good advice from the government can take the place of personal responsibility. Do your part: cover your mouth when you cough or sneeze (preferably with a tissue or the crook of your elbow); wash your hands regularly (try for at least five times a day, for at least 20 seconds); get a flu shot* if you're medically fit to do so (especially if you provide care to people who are at high risk of complications), and vaccinate your kids*, unless your healthcare provider tells you not to.

*The current flu vaccine won't help against the H1N1 "swine flu" virus, so when a vaccine for that strain becomes available (hopefully by this fall), roll up your sleeve and take it. And make sure your kids get it, too.

Pandemic Partners - A way to help each other during a pandemic

2009-05-10T11:55:00.003-04:00

During a pandemic, we all know a lot of people are going to get sick.

Whether they get treated in a hospital or recover at home, a lot of those who get sick are going to need some help... and not just with their illness. Even the seasonal flu can knock you onto your back for a week or more, and a pandemic flu virus is likely to to be worse. So a lot of people who get sick will also need some help managing their day-to-day lives until they're back on their feet, simple things like:

Making sure there is food in the house
Contacting healthcare providers
Helping provide care for children or other dependents
Helping provide care for pets
Contacting family members
Picking up medicine from the pharmacy

But in today's society there are many of us who could fall off the map without anyone noticing right away. In many cases, it's all too possible for a person to be home sick for weeks before anyone thinks to check on them, and this will be even more true during a pandemic.

Because the same social distancing measures that will help to protect us from the flu (staying away from other people as much as possible, working from home if you can, etc.) will also reduce social interaction to the point that even those who would ordinarily be missed after a very brief illness will be at risk of falling through the cracks.

To help fix this problem, people can pair up with people they trust (friends, neighbors, family members, co-workers, members of their place of worship) to keep track of one another during a pandemic and help each other as needed.

The Reveres over at Effect Measure mentioned one program to do just that, a faith-based initiative called Flu Friends.

A similarly-alliterative initiative called Pandemic Partners is also under development to help people help each other through a pandemic. Right now, it mostly consists of a set of forms people can use to share the information their "pandemic partners" will need to be able to assist them.

Copies of the form are available as a Word Document: Pandemic Partners.doc

or PDF: Pandemic Partners.pdf

The forms are a work in progress, so if you have any suggestions for improving them, let me know and I'll pass them along.

FDA Q&A on PPE (especially N95 respirators)

2009-05-08T19:25:00.005-04:00

With a title like that, I can't help but feel as though I'm back in the Army. It's the only organization in the world that would take a nice 3-letter word like "job" and expand it into "military occupational specialty," just to abbreviate it with the 3-letter acronym MOS...

Anyway, here is the latest and greatest from the Food and Drug Administration (FDA) on the use of FDA-regulated personal protective equipment (PPE) for preventing infection with the H1N1 flu virus.

Some of the questions it addresses are regulatory clarification issues that are unlikely to be of much interest to the general public, but they also include some excellent basic advice on PPE, including things like "What is the difference between a face mask and an N95 respirator?" and "Is it OK to re-use or share a disposable N95 respirator?"

You can also find the original version here.

The FDA and Personal Protection Equipment for the 2009 H1N1 Flu Virus

Questions and Answers

Q: What are facemasks and N95 respirators?

A: Facemasks and N95 respirators are devices that when properly worn may help prevent the spread of germs (viruses and bacteria) from one person to another.

Facemasks and N95 respirators do not provide complete protection from airborne germs and other contaminants. They are one part of an infection-control strategy that should also include frequent hand washing, social distancing, and staying home when sick.

Facemasks and N95 respirators should not be shared. Facemasks and respirators may become contaminated with germs (viruses and bacteria) that can be spread between people.

It is important to understand that if you are exposed to infectious material while wearing a facemask or N95 respirator, it should be considered contaminated. After you remove it and dispose of it properly, wash your hands thoroughly.

Q: What’s the difference between a facemask and an N95 respirator?

A: A facemask is a loose-fitting, disposable device that creates a physical barrier between the mouth and nose of the wearer and potential contaminants in the immediate environment.

If worn properly, a facemask is meant to help block large-particle droplets, splashes, sprays or splatter that may contain germs (viruses and bacteria) from reaching your mouth and nose. Facemasks may also help reduce exposure of your saliva and respiratory secretions to others.

While a facemask may be effective in blocking splashes and large-particle droplets, a facemask, by design, does not filter or block very small particles in the air that may be transmitted by coughs, sneezes or certain medical procedures. Facemasks also do not provide complete protection from germs and other contaminants because of the loose fit between the surface of the facemask and your face.

An N95 respirator is a respiratory protective device designed to achieve a very close facial fit and efficient filtration of airborne particles. In addition to blocking splashes, sprays and large droplets, the respirator is also designed to help prevent the wearer from breathing in small particles that may be in the air.

To work as expected, an N95 respirator requires a proper fit to your face. It is designed to fit tightly over your mouth and nose, with no gaps. And gaps will allow air to pass around and reach your nose, mouth, and lungs without being filtered.

The ‘N95’ designation means that when subjected to careful testing, the respirator blocks at least 95 percent of small test particles. If properly fitted, the filtration capabilities of N95 respirators exceed those of face masks. However, even a properly fitted N95 respirator does not completely eliminate the risk of contracting illness through airborne viral particles.

N95 respirators are not designed for children or people with facial hair. Because a proper fit cannot be achieved on children and people with facial hair, the N95 respirator may not provide the expected protection. Also, people with chronic respiratory, cardiac, or other medical conditions that make it harder to breathe should check with their healthcare provider before using an N95 respirator because the N95 respirator can require more effort to breathe.

FDA has cleared the following N95 respirators for use by the general public in public health medical emergencies:

* 3M™ Particulate Respirator 8670F

* 3M™ Particulate Respirator 8612F

* Pasture Tm F550G Respirator

* Pasture Tm A520G Respirator

These devices are labeled "NOT for occupational use.”

Q: Do N95 respirators reduce the chances of contracting the 2009 H1N1 flu virus?

A: When worn properly, N95 respirators help reduce your exposure to airborne germs. They do not provide complete protection from airborne germs and other contaminants, however. They are one part of an infection-control strategy that should also include frequent hand washing and staying home when sick.

Q: Is it OK to use one disposable N95 respirator for a long time?

A: Disposable N95 respirators are not intended to be used over long periods of time. If the respirator is damaged, torn or soiled, or if it becomes difficult to breathe while wearing it, remove it and replace it with a new one.

It is important to understand that if you are exposed to infectious material while wearing an N95 respirator, your respirator should be considered contaminated. After you remove it and dispose of it properly, wash your hands thoroughly.

Additional references on this can be found at the following:

U.S. Centers for Disease Control and Prevention

“Recommendations for Facemask and Respirator Use in Certain Community Settings Where H1N1 Flu Virus Transmission Has Been Detected”

http://www.cdc.gov/swineflu/masks.htm

“The Department of Health and Human Services Guidelines for the Use of Facemasks and Respirators in Non-Occupational Settings during an Influenza Pandemic”

http://www.pandemicflu.gov/plan/community/maskguidancecommunity.html

Q: Is it OK to re-use or share a disposable N95 respirator?

A: Disposable N95 respirators are not intended to be used more than once. They should also never be shared. Their protective capabilities cannot be assured when they are reused either by yourself or another person. Perhaps more importantly, by sharing, one may inadvertently be exposing another person to infectious material.

Q: What other personal protective equipment does FDA regulate?

A: Personal protective equipment (PPE) is any type of face mask, glove, eye shield, or specialized clothing that acts as a barrier between infectious materials and the skin, mouth, nose, or eyes (mucous membranes). When used properly, PPE can help prevent the spread of infection from blood, body fluids, or respiratory secretions.

The U.S. Department of Labor's Occupational Safety and Health Administration (OSHA) requires employers to provide appropriate PPE for workers who could be exposed to blood or other infectious materials (bloodborne pathogens). OSHA may also require employers to provide PPE to protect against other hazards at work. Although OSHA requires the use of specific equipment, it does not regulate the marketing of these devices nor grant claims of disease prevention. For more information, go to http://www.OSHA.gov.

The U.S. Centers for Disease Control and Prevention (CDC) gives recommendations for protecting yourself from infection, including swine flu. For more information, go to http://www.cdc.gov/h1n1flu/.

The National Institute for Occupational Safety and Health (NIOSH) has established certification requirements for various respiratory PPE, which are found at 42 CFR part 84. NIOSH tests products for compliance with these regulations and issues a certification for products that comply. NIOSH certification evaluates the performance of respiratory protection equipment in functional terms and not in terms of claims for use in preventing disease. Employers subject to OSHA and the Mine Safety and Health Administration (MSHA) regulation may be required to provide NIOSH-certified respiratory protection equipment to satisfy their OSHA and MSHA requirements.

Q: Where can I find additional information on personal protective equipment (PPE)?

A: For more information on Personal Protective Equipment (PPE), go to:

http://www.fda.gov/cdrh/ppe/

Q: What is the purpose of the FDA's Emergency Use Authorization for certain N95 disposable respirators?

A: The FDA issued an Emergency Use Authorization (EUA) for certain disposable respirators known as N95 respirators. This EUA permits the deployment of these products, accompanied by fact sheets with information for use during the 2009 H1N1 flu virus emergency, from the Strategic National Stockpile for use by the general public to help reduce wearer exposure to airborne germs during this emergency. The term "general public" in this EUA is broad and includes people performing work-related duties.

Q: Does the FDA’s Emergency Use Authorization for certain disposable N95 respirators cover only products in the Strategic National Stockpile?

A: The FDA’s EUA for certain disposable N95 respirators for use by the general public during the 2009 H1N1 flu emergency is limited to only those products deployed from the Strategic National Stockpile (SNS) before or after the signing of the EUA on April 27, 2009. The specific products covered by the EUA are identified by manufacturer and model number (see http://www.fda.gov/cdrh/emergency/N95-authorization.html).

Q: Does the FDA’s Emergency Use Authorization for certain disposable N95 respirators permit them to be re-used in health care settings?

A: The FDA’s EUA for certain disposable N95 respirators for use by the general public does not permit the re-use of N95 respirators.

Q: Does the FDA’s Emergency Use Authorization for certain disposable N95 respirators cover health care employees?

A: Yes, the term "general public" in this EUA is broad and includes people performing work-related duties, for example in occupational health care settings. However, this EUA does not affect Occupational Safety and Health Administration (OSHA) requirements. If respirators are used for people in occupational settings, employers must comply with the OSHA Respiratory Protection Standard, (29 CFR 1910.134), which can be found at http://www.OSHA.gov.

Q: Does the FDA’s Emergency Use Authorization for certain disposable N95 respirators lift the fit-testing requirements?

A: No, the EUA does not waive fit testing and other OSHA requirements that apply when respirators are used for people performing work-related duties.

The FDA’s EUA and accompanying fact sheet can be found on the FDA’s Web site at: http://www.fda.gov/cdrh/emergency/h1n1influenza.html. For further information on OSHA requirements, go to http://www.OSHA.gov.

2009-05-07T20:03:00.004-04:00

The experts (and I do mean experts) at Effect Measure have posted an excellent discussion of why "swine flu parties" are a really bad idea.

I'd like to thank them for doing so. Not only does this post get out an important public health message that will help people make better decisions about how to keep themselves (and their families) safe... but it also saves me some work!

Hong Kong Quarantines: No proof they were effective

2009-05-07T18:38:00.005-04:00

Once again, our friends at the Wall Street Journal are a bit confused by the H1N1 outbreak, and public health principles in general.

In a story on the Hong Kong quarantines today entitled Flu Lockdown Spurs Quarantine Debate, Peter Stein gets it wrong when it comes to the evidence for/against the effectiveness of the quarantine measures, saying:

"No new cases of the A/H1N1 virus, also known as human swine flu, have emerged in Hong Kong since officials ordered nearly 300 people quarantined at the Metropark Hotel Friday, apparently vindicating the policy."

He is right in noting that no new cases of the virus occurred... but he neglects to mention the fact that this means none occurred in the people who were quarantined, either.

That means is that none of these people who were locked away from their lives for days on end could have transmitted the virus to anyone.

The lack of new cases that Mr. Stein puts forth as evidence of the quarantine's apparent effectiveness is exactly the same thing that would have happened had there been no quarantine at all.

Update: Suspected H1N1 case in Indonesia tests negative

2009-05-06T19:27:00.004-04:00

Did I say it's the place to turn for the latest news, or what?

The Bird Flu Information Center is now reporting that the patient with the suspected case of H1N1 in Indonesia has tested negative for the virus.

Suspected H1N1 in Indonesia

2009-05-06T18:43:00.003-04:00

Apropos of my last post:

The Jakarta Post is reporting the first suspected case of H1N1 in Indonesia.

The patient was identified by thermal scanning in the airport at Surabaya after arriving from Hong Kong, and is being treated in an isolation unit at a nearby hospital. H1N1 infection has not yet been confirmed.

Indonesia is epicenter of the H5N1 epidemic in humans. Not only is it the country with the most H5N1 infections to date, it is also home to the deadliest version of the virus. The most recent official numbers* from Indonesia are 115 dead out of 141 cases, for a case fatality rate of 81.6%.

*As you can see here, the WHO hasn't received official reports of any cases at all this year, despite the fact that we know the disease continues to occur in Indonesia, so any recent changes that might be occurring in the spread or virulence of the virus would not be reflected in these numbers.

If you're interested in (necessarily) unofficial reports of suspected cases and the latest news on H5N1 avian influenza in Indonesia, check out Bird Flu Information Center.

H1N1 + H5N1 = ?

2009-05-05T07:26:00.003-04:00

Until the surprise outbreak of what the CDC is now calling "novel influenza A (H1N1)" a couple of weeks ago, if you had asked which strain of flu virus was most likely to cause the next pandemic, most experts (and even news-consuming lay people) would have told you the same thing: H5N1

The H5N1 flu virus is either a panzootic in birds (a panzootic is just like a pandemic, but for animals), and has shown the ability to infect a number of other species in a more limited way, including the friendly neighborhood tom cat... and yes, the occasional human.

And we've been quite lucky that it's only been the occasional human, because of the 421 confirmed cases we've seen over the years, 257 have been fatal. That's a case fatality rate (CFR) of just over 61%. It's a mean and nasty bug.

So, at this moment when much of the world is learning about recombinant flu viruses for the first time, it's not surprising that a lot of people (or at least a lot of the people who post comments in blogs and bulletin boards) are wondering whether the H1N1 virus and the H5N1 virus could combine to create a virus far more lethal than H1N1 and far more capable of human-to-human transmission than the H5N1 virus.

The bad news is that, yes, it's possible.

The good news is that it's not terribly probable, because -while the H5N1 virus is capable of infecting humans and a broad range of animals- for the most part it continues to be a disease of birds. It typically doesn't reproduce very well in pigs at all, and humans seem to be a dead-end host for the virus so far.

The Novel Influenza A/H1N1 virus, of course, is mostly a disease of humans (though it is apparently willing to move back in with the pigs too).

In an interview with Science Insider, virologist Yi Guan of SARS fame shared his thoughts on the possibility:

Discussing the our inability to predict whether the H1N1 virus will become more virulent....

Q: It depends on further mutations?

Y.G.: It depends on mutations and whether the virus further reassorts with other viruses—like H5N1. That could be a super nightmare for the whole world.

Q: You’re talking about the Armageddon virus?

Y.G.: The chance is very, very low that these two viruses will mix together, but we cannot rule out the possibility. Now, H5N1 is in more than 60 countries. It’s a panzootic, present everywhere except North America.

Q: If the nightmare comes true?

Y.G.: If that happens, I will retire immediately and lock myself in the P3 lab. H5N1 kills half the people it infects. Even if you inject yourself with a vaccine, it may be too late. Maybe in just a couple hours it takes your life.

Sounds pretty scary, and it could be... but you'll recall that he said the chance of it happening is very, very low.

This is a good illustration of the difference between a hazard (something that can cause harm) and a risk (the likelihood of that harm actually occurring).

An H5N1/H1N1 recombinant virus represents a serious hazard, but the risk of it actually happening is thankfully rather low.

That doesn't mean we can afford to take our eyes off the ball, however. The H5N1 virus is no less of a threat today than it was before the H1N1 outbreak began, and we ignore it at our peril. President Obama says that the President of the United States needs to be able to walk and chew gum at the same time, and he's right. Here's to hoping the global public health preparedness community can do the same.

Some statistics from today's CDC H1N1 Swine Flu Briefing

2009-05-04T17:55:00.007-04:00

The following information comes from today's press conference with Dr. Besser, Acting Director of the CDC.

Stats for the United States:

279 confirmed cases in 36 states
> 99% of probable cases so far have tested positive
> 700 probable cases in 44 states
Median age of confirmed cases: 16 years old
Age range for confirmed cases: 3 months to 81yrs
62% of confirmed cases are in patients < 18 years old
The most recent confirmed case occurred on May 1st
35 known hospitalizations
1 known death

Because probable cases are so likely to be confirmed when they are tested, they provide us with a more clear and timely picture of where we stand in the way of actual infections right now than the number of confirmed cases.

No matter what the situation, the "confirmed" number will always lag behind reality, but right now it's lagging even further behind because of the significant backlog of samples to be tested. This is inevitable when a novel pathogen emerges and a new test has to be invented to deal with it; the CDC's public health laboratory scientists have exceeded any rational expectations in the speed and the quality of their response.

Dr. Besser said that the CDC intends to start reporting probable cases on its website the near future.

He also said that the number of probable cases is likely an underestimation of the real number, as well, because the CDC's definition of a probable case requires that a person have flu-like symptoms and test positive for Influenza A, but negative for the H1 & H3 subtypes --and we know this testing is not happening for every person with influenza-like illness (ILI).

The CDC is now rolling out H1N1 Swine Flu test kits to the states, so state public health laboratories will be able to test for the virus. Over time, this will help to reduce the backlog for confirming cases, but states will still not be able to test all possible or even probable cases.

That's okay, though, because the point isn't to ensure that we confirm all cases of the disease, it's to ensure that we know where, when, and in whom the virus is spreading. --That's the data we need to make sure we're taking the right steps in the right places to protect the public.

Egypt's ham-fisted, pigheaded ploy leads to riots

2009-05-03T14:26:00.009-04:00

In Egypt today, Coptic Christian shantytown residents rioted over government attempts to slaughter all pigs in the country. The government's action was ostensibly undertaken as an attempt to prevent the introduction of the H1N1 swine flu virus into the country. However, as the story linked above (from the Telegraph) says:

"The Egyptian authorities have admitted since ordering the slaughter last week that it was mainly a pretext for carrying out a reorganisation of the country's pig farms, which are used to supply the country's Coptic Christians, ten per cent of the population."

The goal, apparently, is to ensure that pigs in the country are no longer raised in small, "unhygienic" holdings, for instance by trash collectors who feed their hogs with the trash they collect.

A story by Reuters opines that:

"...culling swine, largely viewed as unclean in Muslim Egypt, could help quell any public panic in the most populous Arab country."

So far, the only known case of this H1N1 Swine Flu strain actually being found in pigs occurred in Alberta Canada when a farmworker who had recently visited Mexico passed the virus on to his porcine charges. That's right, human-to-swine spread, not swine-to-human. (The pigs are all expected to recover, by the way.)

There have been no cases of the disease identified in Egyptian swine (or any other beyond that one farm in Alberta). There is certainly no epidemiological justification for slaughtering an entire nation of uninfected pigs.

Both the World Health Organization (WHO) and the Food and Agriculture Organization (FAO) have issued statements condemning the action, but Egypt is clearly not as interested in the science of the situation as they are in the propaganda value of being seen to do something (especially if that something only hurts a powerless minority group).

So far, the only Swine Flu-associated casualties in Egypt aren't cases of the disease, but 13 to 15+ civilians and police who have been injured in the rioting. Let's hope it gets no worse.

Morbidity vs. Mortality

2009-05-02T19:31:00.005-04:00

A Wall Street Journal article by Ron Winslow and Avery Johnson opines that a deadlier strain of flu virus would overwhelm the US healthcare system.

Sadly, it won't even take a deadlier strain to accomplish this. Even if every single person who gets the virus recovers, a pandemic will cause a surge in the number of people sick enough to require hospitalization. And that alone will wreak havoc on our healthcare infrastructure.

We have, essentially, zero excess capacity in our healthcare system tpday. I was involved in a full-scale emergency response exercise a few years ago and the local ambulance company did not expect to have any ambulances to spare for use in the exercise. (They did eventually manage to find exactly one, but the real response to such a disaster would have called for many more.)

When I was helping the same health department with their pandemic response plan, we polled the local nursing homes to see what they had in terms of excess beds and respirators. The answer was, "none to speak of." --And hospitals are the same way.

Severe economic pressures force these organizations to grow leaner and leaner all the time, to trim excess capacity wherever they find it. And we haven't developed any worthwhile incentives to reverse that trend.

So people don't have to die in large numbers in order to overwhelm our healthcare system; they just have to get sick enough to require care. Indeed, the sad truth is that those who die during a pandemic may use up fewer "bed days" than those who get sick, but pull through.

Most hospitals right now couldn't deal with the results of a bus crash by themselves. In order to meet the needs of an influx of patients like that, hospitals rely on their ability to transfer (or divert) patients to other nearby hospitals. During a pandemic, however, this won't be an option, because those nearby hospitals will be equally overwhelmed.

Like many others who are looking at this problem for the first time, the authors of this article are putting an undue emphasis on mortality (death) versus morbidity (sickness) when it comes to the effects on the healthcare system. In many ways, mortality is the most important thing about a pandemic. It's certainly what worries me the most on a personal level. But when it comes to the healthcare arena, it takes a back seat to morbidity.

Because the thing that's going to transform the healthcare infrastructure from a moderately well-oiled machine into just a greasy pile of slag isn't the number of people who die, but the wholly unmanageable number of people who get sick.

First Cases Identified of Swine Flu in Pigs

2009-05-02T17:04:00.002-04:00

The Canadian Press is reporting that an official announcement will soon be made that the epidemic strain of H1N1 Swine Flu has been found in pigs in Alberta, Canada. The pigs are thought to have been infected by a farm worker who became ill after traveling to Mexico.

Too soon to say

2009-05-02T07:09:00.006-04:00

Suddenly, stories like this one abound, implying that the outbreak of H1N1 Swine Flu may not be such a big deal after all.

Of course, we all hope it turns out not to be a big deal, but as they finally got around to mentioning in paragraph 5 of the new article, it's "...too soon to be certain what the swine flu virus will do."

We are so early in this outbreak that we really don't know much about the epidemiology of this virus at all.

How many people have the disease?
How many people have died?
How readily is it transmitted from person to person?
What risk factors are there for infection (does it spread well among people crammed into the same airplane for several hours, but poorly in more open settings; are smokers or the elderly or some other group more likely to catch it)?
How lethal is the virus to those who catch it?
Who is most at risk of severe disease?
When it does kill people, is it the flu infection itself (primary viral pneumonia) that causes death or is it secondary bacterial pneumonia that moves in after the flu virus is gone?

And it will be awhile before we have many of the answers. In the UK, they are waiting for the results of more than 600 tests for the virus. Mexico has a backlog of over 35,000 samples waiting to be tested, and their total number of confirmed cases shot up by nearly 250 overnight to 397 as a result of additional testing (not necessarily correlated to any new cases). In the US, it's taking 4 days to get test results, which -with a virus that has only a 24 to 96-hour incubation period- means that our picture of confirmed cases here at home is far behind the times, as well.

And all that only goes to the epidemiological situation now. The situation is likely to change over time, as the virus mutates. In the case of the 1918 Pandemic, for instance, the first wave of infections spread around the world in the spring, and it was pretty mild. It wasn't until the fall, when the next wave of infections struck, that the virus became so frighteningly lethal.

So I'm very pleased that the CDC, the Department of Health and Human Services, and the Department of Homeland Security are all continuing to take the situation very seriously and are doing an excellent job of letting the public know what we do and don't know.

Dr. Besser, Acting Director of the CDC, has done a particularly good job of communicating the expectation that the government's response, the guidance to the public and the guidance to healthcare professionals will all continue to change as the situation evolves --and that that's a good thing.

Yesterday's webcast on the swine flu outbreak

2009-05-01T16:47:00.005-04:00

Here is yesterday's webcast from the Department of Health and Human Services and the Department of Homeland Security.

Dr. Besser, Acting Director of the CDC, Secretary Sebelius of the Department of Health and Human Services, and Secretary Napolitano of the Department of Homeland Security did an excellent job of answering questions from the public.

More on face masks

2009-05-01T09:47:00.004-04:00

I just ran across a very helpful article on the use of face masks to prevent the transmission of influenza-like illness in the home. The researchers asked parents who had children with respiratory illness to wear either surgical masks, non-fit tested P2 masks (= N-95 masks), or no mask to see if the masks protected them against infection.

The key findings were:

"We estimated that... the relative reduction in the daily risk of acquiring a respiratory infection associated with adherent mask use (P2 or surgical) was in the range of 60%–80%." (emphasis added)

"Adherent" in this context means that the people actually wore the mask most or all of the time. And...

"... [less than] 50% of those in the mask use groups reported wearing masks most of the time."

You can't win if you don't play, folks. The take home message here is: Masks help... but only if you use them consistently.

Interestingly, the authors also found no significant difference in adherence between P2 (N-95) mask users and surgical mask users, despite the widespread opinion that N-95 masks are more uncomfortable than surgical masks.

From the Comments: Disinfection

2009-05-01T08:04:00.003-04:00

Disinfecting surfaces in your home and workplace is an important way to protect yourself against the flu (including this H1N1 strain). Pay particular attention to places you're likely to put your hands, like doorknobs, keyboards, mice (the computer kind), faucet taps, countertops, etc.

Don't forget: Be careful not to mix different kinds of cleaners (i.e. bleach-based and ammonia-based) or you'll have definite toxic fumes to deal with, instead of possible swine flu.

john said...

can you tell me about disinfections techniques. In particular are anti-bacterials good against flu virus thanks

APRIL 28, 2009 6:49 AM

PanFluWatch said...

Yes, thankfully the flu virus is easier to kill than bacteria, so any disinfectant designed to kill bacteria (antibacterial disinfectants) should also protect you against the flu.

For more useful information on this topic, see these pages from www.pandemicflu.gov:
http://www.pandemicflu.gov/plan/healthcare/influenzaguidance.html
http://www.pandemicflu.gov/plan/individual/panfacts.html

APRIL 28, 2009 7:20 AM

Catch it, bin it, kill it

2009-05-01T07:09:00.004-04:00

A very good public service ad from the UK's Department of Health: Catch it, bin it, kill it.

In addition to giving advice to the "sneezer" depicted in

the video, this also illustrates why it's so important to

wash your hands frequently during this outbreak --even

when you're not aware of having gotten anything on them.

Reality wins

2009-04-30T08:32:00.002-04:00

Yesterday, the WHO moved to increase the Pandemic Alert Level to Phase 5 (defined below).

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.

I'm glad they have finally chosen to acknowledge reality and follow their own guidance. We will need the WHO to be a credible player if we are to have any hope of coordinating a global response to the pandemic.

Edging closer to Phase 6, an Official Pandemic

2009-04-29T11:42:00.012-04:00

The BBC just reported that there has been a confirmed case of human-to-human transmission in Spain.

Here is the definition of Phase 6:

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.

"Community level outbreaks" are "sustained disease outbreaks in a community," and that criteria hasn't been met by this case; we'd need to see more than one generation of human-to-human transmission before we could call it a sustained disease outbreak in this community, but hope is swiftly waning that this outbreak will fail to become a pandemic --especially since we haven't been able to contain it in the Northern Hemisphere, where the flu season is coming to an end.

Today also saw the first confirmed death from the H1N1 strain in the US, a toddler from Texas. My heart goes out to the parents and to the families of all of those who have died in Mexico, already. I hope that not too many more of us will have to face what they've been through.

From the comments: Is the bioengineering theory really rubbish?

2009-04-29T05:53:00.004-04:00

Doxocopa writes:

"Complete rubbish???

For a start... still, not yet a SINGLE PIG INFECTION was reported, as far as I'm aware. Could you please answer two things?
1 - If no pigs seem to be affected at all, how on earth a pig flu virus turned suddenly to a human airborne disease? - First human cases from other species Flu virus begun by direct contact with the infected animals
2 - This virus is indeed a genetic chimera; independently of what people think about its origins, so probably can infect humans, pigs and birds, so how can it survive in Nature without an epidemiological reservoir?"

Hi Doxocopa,

Thanks for commenting. Yes, actually: it's complete rubbish. But I can certainly understand why the situation would be confusing to someone who hasn't studied the flu... especially because this strain was unfortunately saddled with the misnomer "swine flu." What we're really all paying attention to right now is a HUMAN flu with swine-, avian- and human-flu progenitors.

This flu has four grandparents, if you will: two from different regions of swinelandia, one from birdlandia, and one from humanistan –and it LIVES in humanistan: really, it’s a human flu, even if it is an immigrant.

So, to answer question 1:

What does it mean that we haven’t seen any cases in pigs yet? It could mean any one of a number of different things:

1. The virus may cause asymptomatic infection in pigs or cause only very mild symptoms. That is, they might get infected and be able to spread the disease (both to humans and other pigs) without showing any sign of having the disease.

2. It may be that the cases in pigs have simply been missed, even if the disease was severe. There are a number of diseases that cause illness in pigs, including “normal” swine flu, and the affected farmers may not have recognized that anything new was happening. We can’t be sure yet where the virus first emerged, but there may simply not be a very robust veterinary public health surveillance infrastructure in the country of origin.

3. The recombination may have occurred a human, instead of a pig. We are also capable of being infected by human, swine and avian flu strains.

4. Even if the recombination DID occur in pigs, that doesn’t mean that the new virus was best-suited to reproducing in pigs vs. humans. Remember, the pig in question would have been infected by 2 or more strains of flu at the same time; its immune system was likely compromised. A compromised immune system may be the reason it was infected by more than one flu strain in the first place. Even if not, the infections, themselves, would have worn down its immune response. (Secondary bacterial pneumonia is what usually kills most people who are killed by seasonal influenza.)

If this is true, even if the virus was better-suited to humans than pigs, the virus may have reproduced sufficiently in this one pig to infect a human handler and enter into circulation in the human population. It might never have been, and might never be, primarily a disease of pigs.

As for question 2:

What is the “epidemiological reservoir?” Humans appear to be the primary host species for this virus. That’s why I saw “swine flu” is really a misnomer. As far as anyone knows right now, this is solely a disease of humans, and WE are how the virus is “surviv[ing] in nature.”

What's more, this virus would be a profoundly stupid bioweapon. No one would benefit from it.

Phase 4 Pandemic Alert - Is this the right level?

2009-04-28T04:39:00.007-04:00

Yesterday, the World Health Organization (WHO) in an emergency meeting raised the pandemic alert level to Phase 4 (statement here).

The practical difference in the US was pretty much nil, since we have active cases to contend with already, but in some countries this is likely to lead to a stepped-up response.

Because the WHO's pandemic alert level is written into some national pandemic flu plans as a trigger point for specific actions, it is a relevant issue and it's worth considering whether Phase 4 is the right level at this time.

Here is the definition for Phase 4:

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.

We certainly seem to meet this criteria with the outbreaks in Mexico, but let's take a look at Phase 5:

We meet this criteria, as well, with the outbreak in Mexico and laboratory-confirmed human-to-human transmission from husband to wife in Kansas. Both countries are in the Americas Region.

We don't yet meet the criteria for Phase 6 --or at least we can't confirm that we do:

As they said over at Effect Measure, "... [the] WHO has been timid and slow" in responding to this crisis, and with this decision it seems they're continuing in that pattern.

I realize that there are political and economic costs attached to moving to Phase 5 and that, with the world economy in shambles, this is an especially difficult time for the global community to have to face those costs. But what does it do for the credibility of the WHO when anyone who can read can plainly see that we should be in Phase 5 by the agency's own definition?

The World Health Organization does a tremendous amount of good in the world and they have an important role to play in managing this outbreak. It's time for them to refocus and re-emerge with the courage to do this job as only they can; they should start by following their own guidelines.

Bogus: Bioweapon claims for H1N1 Swine Flu

2009-04-27T21:03:00.011-04:00

Some segments of the blogosphere are all atwitter (pun intended) with the theory that the H1N1 Swine Flu must be the work of some nefarious group of bioengineers because the virus contains segments from 4 different progenitor viruses --2 different swine flu viruses, an avian flu virus and a human flu virus. Some even seem to imply that US government researchers working on the 1918 pandemic flu virus (which was also an H1N1 virus, though very different) might have been involved in weaponizing it.

Much of this seems to be driven by a story written by Wayne Madsen of Online Journal:

It turns up all over the place, at PrisonPlanet.com, Know4Life, InTheseNewTimes, and elsewhere.

Jeff Denmark at Drudge Retort quotes the article:

"According to two mainstream media journalists, one in Mexico City and the other in Jakarta, who spoke to WMR on background, they are convinced that the current outbreak of a new strain of swine flu in Mexico and some parts of the United States is the result of the introduction of a human-engineered pathogen that could result in a widespread global pandemic, with potentially catastrophic consequences for domestic and international travel and commerce."

And goes on to say: "WMR has been informed that the CDC and U.S. Army dug up the body of an Inuit woman who died in 1918... from an outbreak of Spanish flu. . . . . WMR has been told the genetic material recovered by the U.S. government from the corpse of the Inuit woman provided the basis for the development of the H5N1, or bird (avian), flu strain at the U.S. Army Medical Institute of Infectious Diseases (USAMRIID) laboratory at Fort Detrick, Maryland, the point of origin for the Ames strain of anthrax used in the 2001 bio-war attacks against the U.S. Congress and the media."

This is, as they say in Jolly Olde England, complete rubbish.

"How, then" you may ask "did a brand new virus that's made up of four different viruses suddenly spring into being and spread all over the world? Doesn't it have to be the result of bioengineering?"

...Actually, no.

This is exactly the sort of thing we've been expecting for years.

If more than one strain of flu virus infects the same cell, the two strains can mix up their genes, leading to what is called a recombinant virus. That simply means that the genes from the two (or more) viruses have recombined to create a new strain. In effect, it's a lot like sexual reproduction in humans; parents mix up their genes with the result that a child might have her mother's hair and her father's eyes.

This recombination happens especially easily in pigs, because they can be infected by swine flu viruses, avian flu viruses and --you guessed it-- human flu viruses. The pig as a "mixing vessel" scenario is something we've long known to be a threat when it comes to pandemic flu. In fact, this is believed to be what caused the last two pandemics, in 1957 and 1968, as this figure illustrates.

This is perfectly natural and expected. That doesn't make it good, of course, but there's no hidden conspiracy behind it. The virus arose naturally and the epidemiological evidence seems to show pretty clearly that it's spread so quickly because of air travel --something else we knew to expect-- not because it's being used as some kind of very inefficient bioweapon.

We humans are all on the same side on this one.

Protecting yourself

2009-04-26T16:58:00.003-04:00

Although things aren't looking good so far, it's still too early to say for certain whether the swine flu outbreak will mushroom into a pandemic. But it's a good idea to start giving some thought to how you can protect yourself and your family from infection, if the virus should continue to spread.

Here are some evidence-based protective measures you can take to help prevent infection:

1. Wash your hands

...then wash your hands some more. In fact, one of the studies examined in the relevant Cochrane Review showed that simply washing your hands at least 5 times a day cuts the risk of coming down with a respiratory infection by almost 50%.

Handwashing is one of the most important things you can do both to keep from getting the virus and to keep from spreading it, if you happen to be infected. --And it's important to understand that you may well be contagious for 24 hours before you show any symptoms. That's one of the reasons why influenza is so much harder to control than the SARS epidemic was.

Most people, even those who have the training to know better, don't wash their hands correctly. For instance, did you know that every time you wash your hands, it should take you 20-30 seconds to scrub them thoroughly (long enough to sing the alphabet song once or the "happy birthday" song twice)? For more on how to wash your hands correctly, see the CDC's video "Put Your Hands Together."

2. Stay away from infected people (and stay home if you're infected)

This is called "social distancing" and it sounds pretty obvious, but it's one of the hardest recommendations to stick to. That's because during a pandemic simply going to work, going out to buy groceries, going to a doctor's appointment or going to school could put you in contact with infected individuals or put others at risk if you're infected.

And, as I mentioned above, people (yourself included) can be contagious for 24 hours before showing any symptoms. When it comes to a flu pandemic, the fact that people feel well or look well is not a reliable measure of the risk they pose to others.

If this does become a pandemic, the safest thing you can do is stay home and avoid contact with others as much as possible.

3. Use personal protective equipment (PPE) when you might come into contact with infected individuals

Masks

There has been a lot of talk over the last few years about the use of N-95 particle respirators as a way of avoiding infection, and they have been shown to work pretty well when used correctly... but the Cochrane Review I mentioned earlier found that there was no statistically significant difference between their performance and that of simple surgical masks. Another study found that using nylons (AKA pantyhose) to hold the surgical mask tighter against your face improved their performance even further. This is a more foolproof form of protection than the N-95 mask, which must be correctly fitted and it may be more comfortable, as well, which has implications for compliance. --Paper masks were not shown to be effective.

Goggles

Eye protection (in combination with masks) was also shown to be effective by the Cochrane Review. It's not clear whether this is primarily because goggles protected users from airborne droplets or because it prevented them from rubbing their eyes and thus introducing infectious material from their fingers into their eyes, but either way they made a difference.

Gloves

The same Cochrane Review showed that gloves were highly effective in preventing infection. The studies on this topic took place in a hospital setting, where healthcare providers changed their gloves after seeing each patient, so wearing the same pair of gloves all day isn't likely to help. It's also very important to understand that wearing gloves does not eliminate the need for handwashing.

Gowns

Protective gowns (e.g. surgical gowns) were also shown to significantly reduce infection. Again, this was in a hospital environment, but it highlights the importance of clothing as a possible fomite (an inanimate object that can transmit infection). Surgical gowns may not end up seeing much use in day-to-day interactions outside the hospital, but this finding implies that it might be worth changing your clothes after coming into contact with someone who may be infected.

All of the above, plus handwashing

Not surprisingly, the most effective intervention was a combination of all the forms of personal protective equipment above plus frequent and thorough handwashing.

4. Thoroughly disinfect surfaces where you live and work

Doorknobs, computer keyboards and mice, telephones, tables, kitchen counters and other surfaces can all transmit infection. Thoroughly cleaning these surfaces with disinfecting agents can help reduce the spread of a flu virus.

5. Use a humidifier

This study (and a few others) suggest that humidifying indoor air may reduce the risk of flu transmission. The evidence is fairly limited here, but the argument seems sound to me.

6. Practice good cough and sneeze etiquette

Don't cough or sneeze into your hands. If you don't have a tissue available, cover your cough or sneeze with the crook of your elbow instead of your hands. That way, you won't be spreading germs to everything you touch. If you do have a tissue available, you can cough or sneeze into that, then throw it away and wash your hands as soon as possible.

7. If you have children, make sure they do all of the above

Children are especially good at transmitting the flu virus, which is why schools are likely to be closed down during a pandemic. Making sure that your children learn to take the above precautions (especially frequent and thorough handwashing) can help to keep them safe... along with everyone around them.

Swine Flu Map

2009-04-26T12:13:00.001-04:00

Update: The map has been re-designed to be easier to read and continues to be updated frequently. The link for the map has changed, and the link listed below is the latest version.

---------------------------------------------------

This site maps confirmed and suspected cases related to the swine flu outbreak and gives information on mortality, along with reports of suspected cases that turned out not to be swine flu:

tinyurl.com/swinemap09

It's a useful tool for visualizing the outbreak and because it links to the news reports that back up the data it's mapping, you can assess the reliability of the information yourself. So far it's being updated very frequently, despite (or perhaps because of) the fact that we're in the middle of the weekend, so keep an eye on this site for the latest.

Time to update your pandemic flu plan

2009-04-26T11:48:00.000-04:00

With the H1N1 “swine flu” outbreak unfolding across the globe, the threat of a flu pandemic is higher than it has been in decades. We don’t yet know whether this new virus will become the next pandemic or (as we all hope) simply fizzle out, but now is a good time for families everywhere review their plans for coping with a pandemic and make sure they’re up to date.

What is a flu pandemic?

A flu pandemic is caused by an Influenza A virus, the same type of virus that causes the seasonal flu we deal with every year. The difference is that a pandemic flu strain makes a lot more people sick than the seasonal flu and that it doesn’t just occur during the regular flu season. –A pandemic may last 18 months or more. One other important difference is that, unlike the seasonal flu, which is normally only dangerous to infants and the elderly, pandemic flu strains often cause severe illness among teenagers and young adults, as well. This is a pattern we’re seeing in the preliminary data from the swine flu outbreak, which is cause for concern.

Three conditions must be met in order for a flu virus to cause a pandemic:

It’s new to humans so that we have little or no pre-existing immunity to it
It readily causes significant disease in humans
It spreads easily from person to person

“Swine flu” is a flu virus that normally infects pigs, and most swine flu viruses only meet the first of those three criteria: we’re not immune to them, but they don’t easily causes disease in humans (and such diseases are usually mild when they do occur) and they are rarely ever transmitted from person to person. While the virus implicated in this outbreak is causing significant disease in humans and, based on early reports, is probably spreading from human to human, it is too early to say whether it is doing so at a level that could cause a pandemic to occur. But whether this is the start of the next pandemic or not, it’s an important reminder about the importance of having a plan in place for keeping your family safe when a pandemic does strike.

How should you prepare?

The website www.pandemicflu.gov is the federal government’s one-stop source for pandemic flu-related information, and it offers useful advice on how to prepare. The following checklist comes from that site and will help you to make a good start toward doing what you can to keep your family safe:

1. To plan for a pandemic:

¨ Store a two week supply of water and food. During a pandemic, if you cannot get to a store, or if stores are out of supplies, it will be important for you to have extra supplies on hand. This can be useful in other types of emergencies, such as power outages and disasters.

¨ Periodically check your regular prescription drugs to ensure a continuous supply in your home.

¨ Have nonprescription drugs and other health supplies on hand, including pain relievers, stomach remedies, cough and cold medicines, fluids with electrolytes, and vitamins.

¨ Talk with family members and loved ones about how they would be cared for if they got sick, or what will be needed to care for them in your home.

¨ Volunteer with local groups to prepare and assist with emergency response.

¨ Get involved in your community as it works to prepare for an influenza pandemic.

2. To limit the spread of germs and prevent infection:

¨ Teach your children to wash hands frequently with soap and water, and model the correct behavior.

¨ Teach your children to cover coughs and sneezes with tissues, and be sure to model that behavior.

¨ Teach your children to stay away from others as much as possible if they are sick. Stay home from work and school if sick.

3. Items to have on hand for an extended stay at home:

Examples of food and non-perishables

¨ Ready-to-eat canned meats, fish, fruits, vegetables, beans, and soups

¨ Protein or fruit bars

¨ Dry cereal or granola

¨ Peanut butter or nuts

¨ Dried Fruit

¨ Crackers

¨ Canned juices

¨ Bottled water

¨ Canned or jarred baby food and formula

¨ Pet food

¨ Other nonperishable foods

Examples of medical, health, and emergency supplies

¨ Prescribed medical supplies such as glucose and blood-pressure monitoring equipment

¨ Soap and water, or alcohol-based (60-95%) hand wash

¨ Medicines for fever, such as acetaminophen or ibuprofen

¨ Thermometer

¨ Anti-diarrheal medication

¨ Vitamins

¨ Fluids with electrolytes

¨ Cleansing agent/soap

¨ Flashlight

¨ Batteries

¨ Portable radio

¨ Manual can opener

¨ Garbage bags

¨ Tissues, toilet paper, disposable diapers

How can you help?

If you are interested in helping your community prepare for and respond to a possible flu pandemic, consider volunteering through your local Medical Reserve Corps unit. You don’t need to be a medical professional to join; you just have to be willing to help. You can find out more about the Medical Reserve Corps and how to contact your local unit at www.medicalreservecorps.gov.

You can also volunteer through the American Red Cross (http://www.redcross.org/en/volunteertime), your local Community Emergency Response Team (CERT) (http://www.citizencorps.gov/cert/) or any of the national, state or local Voluntary Agencies Active in Disaster (VOADs) found here: http://www.nvoad.org/.

Take home message

There’s no need to panic. Right now, we don’t know whether this new swine flu virus will become a pandemic or just fizzle out. It’s just too early to tell. But either way, now is a good time to review your plans for keeping your family safe during a flu pandemic. Make sure you have two weeks worth of non-perishable food and water at home. Make sure you have a continuous supply of any medications you rely on. Keep up to date with the latest information and advice at www.pandemicflu.gov, and consider volunteering to help your community in the event of a public health emergency. Because even if this isn’t the next flu pandemic, eventually there will be one. Being prepared before it strikes could make all the difference for you and your family.