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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“Full Pandemic Potential”

Now that’s certainly an exciting phrase.  I find it helpful to remind myself that “pandemic” refers mostly to the extent of the spread of the virus, and not necessarily the severity.

Researchers are estimating that 1 in 3 people who come into contact with someone infected will become infected themselves.  (I watch too many zombie-flu movies, because every time I hear “the infected” I think of the “rage” virus in 28 days later…not a pretty sight.”) Anyhow, researchers think the H1N1 virus will “go global” in the next 6-9 months. The “analysis of Mexico’s swine flu outbreak suggests that the H1N1 virus is about as dangerous as the virus behind a 1957 pandemic that killed 2 million people worldwide.”

Prof Ferguson from the WHO’s emergency committee for the outbreak, says:

“This virus really does have full pandemic potential. It is likely to spread around the world in the next six to nine months and when it does so it will affect about one-third of the world’s population.

To put that into context, normal seasonal flu every year probably affects around 10% of the world’s population every year, so we are heading for a flu season which is perhaps three times worse than usual – not allowing for whether this virus is more severe than normal seasonal flu viruses.”

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Swine-Bird-Zombie Mix!

What happens if the current strain of swine flu (H1N1) bumps into its friend, the bird flu (H5N1) and they mingle together to create a new virus?

“The current swine flu strain…has sickened more than 2,300 people in 24 countries. While people can catch bird flu from birds, the bird flu…does not easily jump from person to person. It has killed at least 258 people worldwide since it began to ravage poultry stocks in Asia in late 2003.

The WHO reported two new human cases of bird flu on Wednesday. One patient is recovering in Egypt, while another died in Vietnam — a reminder that the H5N1 virus is far from gone.

Experts have long feared that bird flu could mutate into a form that spreads easily among people.

An infectious disease specialist said while flu experts are discussing the scenario, he has yet to see specific evidence causing him to think it will happen.

“Everything with influenza is a huge guessing game because Mother Nature holds all the rules, and we don’t even know what they are, so anything’s possible,” he said. “We don’t have any evidence that this particular reassortment is that much more likely to pick up H5N1 than any other reassortment out there.”

So.  To recap:  Nobody knows what’s going to happen.  There will another deadly pandemic at some point (everyone keeps saying “we are due for one”), because that’s just the way these things work.  But we don’t know where or when or how or what animal!  Also, I think there needs to be more research on potential reassortment of the swine, bird, and zombie flu.

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More on Infected Zombies

Salon has a good article on “plague movies” and how they relate to our panic over the swine flu.  Some of my favorite excerpts that articulate my crazy fears better than I would:

“What most if not all of these movies share is a gloomy atmosphere of isolation and paranoia. The culture so carefully built by man over the centuries has either completely disappeared or is vanishing rapidly. Stores are closed and, very likely, have been looted. Our traditional means of law and order have disappeared. There’s no more garbage pickup. The military and the government are usually somehow involved — ostensibly, they’re trying to keep order, but mostly they’re  just leading people to their doom.

These movies do more than just lay out chilly what-if scenarios. Some of them are steeped in biblical morality: How do we react when we see fellow human beings in pain? When we see someone in danger — a feverish individual, say, who may or may not be a zombie — do we stop to help if doing so threatens our own safety, or do we opt for self-preservation? In most plague movies, there’s deep mistrust of “the other,” the outsider who may be infected (and it’s often an outsider who started it all). Those kinds of stark divisions raise even bigger questions, sometimes amounting to a kind of civics lesson: What is it that keeps a society together, even if it’s just a society of a dozen or so healthy (that is to say, uninfected) people?

And maybe that’s why a real-life virus scare and a wholly fictional movie elicit the same response in us: Both make us think about coming face-to-face with our own sense of aloneness.”

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Happy Friday!

Confirmed cases are now at 331.

Hong Kong and Denmark have their first cases of confirmed swine flu.

Mexico is beginning their 5 day shutdown in hopes of slowing the spread of the virus.

Sometimes I feel like I’m in a real-life version of 28 Days Later, mainly due to the terminology: confirmed cases, shutdowns, confinement, PHASE 5,  etc. but without the zombies.

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