Sobering news indeed.
The Boston Globe reports that “of the 86 children who have died since the new swine flu arose last spring, 43 deaths have been reported in September and early October alone, the Centers for Disease Control and Prevention reported. That’s a startling number because in some past winters, the CDC has counted 40 or 50 child deaths for the entire flu season — and no one knows how long this swine flu outbreak will last.”
Ok, ok, I am trying to be a little less of an alarmist lately, and there have been a lot of positive developments. For example, it is being reported that there will be enough of the H1N1 vaccine for everyone and that it will be available earlier than expected. However, and this is the thing that keeps bugging me: The chief infectious disease pathologist at the CDC, Dr. Sherif Zaki, said the new virus had burrowed into the lungs of the 90 or so people he examined after they died, and they had huge amounts of the virus in their blood.
This in turn caused what is known as acute respiratory distress syndrome — an often fatal development that leaves patients gasping for breath.
“This is almost exactly what we see with avian flu,” Zaki said. “This looks like avian flu on steroids.”
Zaki said 90 percent of the fatalities he looked at had some condition that would predispose them to serious disease. They had a median age of 38 and one victim was a two-month-old infant who died within a day of getting sick.Nearly half — 46 percent — were obese, many had fatty liver disease, 27 percent had heart disease and 22 percent had asthma, he said.
So, in the vein on not being an alarmist, this guy only examined 90 people. And this still has not surpassed the 30,000 + deaths in the U.S. from seasonal flu. And no one really knows what will ultimately happen with the life of this H1N1 virus.
Or, in the words of Arrested Development, “No touching!” This works perfectly for me, as I have an extremely large area of personal space I expect others to stay out of.
An advisory panel is recommending a major step up in protection for health workers dealing with patients suspected or confirmed to have H1N1 influenza.
The Institute of Medicine said Thursday, in recommendations requested by the CDC, said loose paper masks are inadequate because the workers could still breathe in the virus.
Instead, health workers should switch to N95 respirators that form an airtight seal around the nose and mouth.
If properly fitted and worn correctly, N95 respirators filter out at least 95 percent of particles as small as 0.3 micrometers, which is smaller than influenza viruses, the report notes.
However, it is important to remember that “there is a lot we still don’t know about these viruses, and it would be a mistake for anyone to rely on respirators alone as some sort of magic shield.”
“This virus travels at an unbelievable, almost unheard of speed,” World Health Organisation Director General Margaret Chan told France’s Le Monde daily in an interview.
“In six weeks it travels the same distance that other viruses take six months to cover,” Chan said.
“Sixty percent of the deaths cover those who have underlying health problems,” Chan said. “This means that 40 percent of the fatalities concern young adults — in good health — who die of a viral fever in five to seven days.
“This is the most worrying fact,” she said, adding that “up to 30 percent of people in densely populated countries risked getting infected.”
I had a mild heart-stopping moment just now when I was reviewing the WHO’s update on H1N1, published today on their web site, which hints at the real possibility of impending doom:
Severe respiratory failure
Perhaps most significantly, clinicians from around the world are reporting a very severe form of disease, also in young and otherwise healthy people, which is rarely seen during seasonal influenza infections. In these patients, the virus directly infects the lung, causing severe respiratory failure. Saving these lives depends on highly specialized and demanding care in intensive care units, usually with long and costly stays.
During the winter season in the southern hemisphere, several countries have viewed the need for intensive care as the greatest burden on health services. Some cities in these countries report that nearly 15 percent of hospitalized cases have required intensive care.
Preparedness measures need to anticipate this increased demand on intensive care units, which could be overwhelmed by a sudden surge in the number of severe cases.
Vulnerable groups
An increased risk during pregnancy is now consistently well-documented across countries. This risk takes on added significance for a virus, like this one, that preferentially infects younger people.
Data continue to show that certain medical conditions increase the risk of severe and fatal illness. These include respiratory disease, notably asthma, cardiovascular disease, diabetes and immunosuppression.
When anticipating the impact of the pandemic as more people become infected, health officials need to be aware that many of these predisposing conditions have become much more widespread in recent decades, thus increasing the pool of vulnerable people.
Obesity, which is frequently present in severe and fatal cases, is now a global epidemic. WHO estimates that, worldwide, more than 230 million people suffer from asthma, and more than 220 million people have diabetes.
Moreover, conditions such as asthma and diabetes are not usually considered killer diseases, especially in children and young adults. Young deaths from such conditions, precipitated by infection with the H1N1 virus, can be another dimension of the pandemic’s impact.
Higher risk of hospitalization and death
Several early studies show a higher risk of hospitalization and death among certain subgroups, including minority groups and indigenous populations. In some studies, the risk in these groups is four to five times higher than in the general population.
Although the reasons are not fully understood, possible explanations include lower standards of living and poor overall health status, including a high prevalence of conditions such as asthma, diabetes and hypertension.
According to a study that polled over 2000 Hong Kong health workers, about half would refuse the swine flu vaccine. Those who would pass on the vaccine say they are concerned about potential side effects. So far, the effects have been mild, such as soreness at the injection site.
It is unlikely any rare side effects will pop up until the vaccine is given to millions. That might include things like Guillain-Barre syndrome, a temporary paralyzing disorder, which was seen after the 1976 swine flu vaccination campaign, and happens fewer than once every 1 million vaccinations.
Researchers at the University of Hong Kong surveyed doctors and nurses in public hospitals this year from January to May, asking them if they would get a pandemic vaccine based either on bird flu or swine flu. About 35 percent of health workers were willing to get a bird flu vaccine, versus 48 percent for swine flu.
Experts were surprised so few of Hong Kong’s health workers were willing to be vaccinated, since the city was hit hard during the 2003 outbreak of SARS, or Severe Acute Respiratory Syndrome.
Paul Chan of the Chinese University of Hong Kong, one of the study authors, thought the results would be similar elsewhere. Fewer than 60 percent of health workers in most countries get vaccinated against regular flu, thought to be a reliable indicator of whether they might get a swine flu shot. In the U.S., about 35 percent of health workers get a regular flu shot, while in Britain, only about 17 percent do.
Annas said health workers were ultimately like everyone else when it comes to getting vaccines. “Like the lay population, they assume they won’t need the shot because they don’t think they will get the flu.”
The H1N1 flu virus could cause up to 90,000 U.S. deaths, mainly among children and young adults, if it resurges this fall as expected, according to a report released Monday by a presidential advisory panel.
The report says 30,000 to 90,000 deaths are projected as part of a “plausible scenario” involving large outbreaks at schools, inadequate antiviral supplies and the virus peaking before vaccinations have time to be effective.
Up to 40,000 U.S. deaths are linked to seasonal flu each year, with most of the fatalities occurring among people over 65. With seasonal flu and H1N1, this fall is expected to bring more influenza deaths and place “enormous stress” on intensive care units nationwide, which normally operate near capacity, the report says.
An H1N1 resurgence may happen as early as September, at the beginning of the school year, and infections may peak in mid-October, according to the report. However, the H1N1 vaccine isn’t expected to be available until mid-October, and even then it will take several weeks for vaccinated individuals to develop immunity, the report says.
From The Telegraph:
American officials rushed out a vaccine in 1976 following an outbreak of swine flu in military barracks. Around 40 million people received the vaccine but doctors reported an increase Guillain-Barre and 25 people had died before the immunisation programme was stopped…
“Guillain-Barre syndrome has long been identified as a potential adverse event that would require enhanced surveillance following the introduction of a pandemic vaccine but there is no evidence to suggest there is an increased risk of Guillain-Barre syndrome from this vaccine.”
He said there was also no increased risk of the syndrome associated with the seasonal flu vaccine.
“Establishing enhanced surveillance on Guillain-Barre syndrome has always been part of our pandemic plan because there is an increased risk of this disease after a flu-like illness…
However critics have said the fact doctors are being told to report cases of Guillain-Barre syndrome is evidence that the authorities are concerned.
Jackie Fletcher of the campaign group, Jabs, added: “What we’ve got is a massive guinea-pig trial.”
Guillain-Barre Syndrome attacks the nervous system and can cause paralysis and death. More information can be found here.
A 26-year-old from the Cape and islands with no history of underlying medical problems has died from swine flu, the 11th death in Massachusetts attributed to the novel virus, state public health authorities announced this morning.
