More Scary News!

“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.”

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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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Looming Swine

A new round of the swine flu, which has been exploding in the Southern Hemisphere, could be making its way to the Northern Hemisphere in a matter of weeks.  There will be deaths,  but there are always deaths as a result of the flu.  As Marc Lipsitch, a professor of epidemiology at the Harvard School of Public Health who has been helping the CDC project the severity of the upcoming wave noted, “It’s fair to say there will be tens of millions of illnesses and hundreds of thousands of hospitalizations, and tens of thousands of deaths. That’s not atypical. It just depends on how many tens of thousands.”

The Washington Post provides a good summary, noting that:

Perhaps more important, in every country where the virus has spread, it has continued to affect children and young adults much more commonly than typical flu viruses.

“In a pandemic where a greater fraction of illness and deaths occur in kids and young adults, that will be clearly noticeable to the public. There will be a sense that this is a greater severity of illness even if fewer people die overall,” the CDC’s Bresee said.

Most of those who have developed serious illness and died have had other health problems. But those include many common conditions, such as diabetes, asthma and obesity. Pregnant women appear to be especially at risk. And the virus can cause severe illness and death in otherwise healthy people in perhaps a third of cases.

In the Southern Hemisphere, the virus has been more intense in some places, including those with few resources.  Countries with fragile health care like India and South Africa could be quickly overwhelmed if the swine flu starts infected a large number of people.

I guess we will have to wait and see.  Preferably with suspenseful music in the background.

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“Germ Factories”

By now you may have heard that swine flu could infect up to 40% of the United States. Health officials say flu cases are likely to explode once school begins and serve as “germ factories.”

“The estimates are based on a flu pandemic from 1957, which killed nearly 70,000 in the United States but was not as severe as the infamous Spanish flu pandemic of 1918-19. The number of deaths and illnesses from the new swine flu virus would drop if the pandemic peters out or if efforts to slow its spread are successful, said a CDC spokesman.”

“The World Health Organization says as many as 2 billion people could become infected in the next two years — nearly a third of the world population.”

“Swine flu has been an escalating concern in Britain and some other European nations, where the virus’ late arrival has grabbed attention and some officials at times have sounded alarmed.”

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Puzzling and Troubling

The W.H.O. quietly announced today that it would stop tracking swine flu cases and deaths worldwide.  This move was said to have baffled experts.  Certainly, it cannot be because those numbers have been declining:

“The last W.H.O. update, issued on July 6, showed 94,512 confirmed cases in 122 countries, with 429 deaths.

Many epidemiologists have pointed out that, in reality, millions of people have had swine flu, usually in a mild form, so the numbers of laboratory-confirmed cases were actually meaningless. And performing the tests has overwhelmed many national laboratories.

The briefing note said countries would still be asked to report their first few confirmed cases. It also said countries should watch for clusters of fatalities, which could indicate that the virus had mutated to a more lethal form.”

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