Severe Respiratory Failure

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.

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Would Health Workers Reject the Swine Flu Vaccine?

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.”

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It’s Coming….Get Scared!

From CNN:

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.

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Jewish Mysticism to Ward Off Swine Flu

From BBC News:

A group of rabbis and Jewish mystics have taken to the skies over Israel, praying and blowing ceremonial horns in a plane to ward off swine flu.

About 50 religious leaders circled over the country on Monday, chanting prayers and blowing horns, called shofars.

“We are certain that, thanks to the prayer, the danger is already behind us,” added Mr Batzri was quoted as saying.

Television footage showed rabbis in black hats rocking backwards and forwards as they read prayers from Kabbalah, a form of Jewish mysticism.

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