The outbreak of H1N1 recombinant influenza seems to have inspired quite a range of emotion, from racist rants by Michelle Malkin and Michael Savage(http://www.alternet.org/immigration/138859/michelle_malkin_and_michael_savage_use_swine_flu_crisis_to_peddle_their_xenophobia/) against Mexican immigrants, to disturbing theories of artificial origin (http://www.waynemadsenreport.com/) and a hilarious send-up by John Stewart. Leftists seem to have their own brand of sneering dismissal.
The question is whether the current situation has the potential to cause widespread misery and death, and it is a little comparable to having been shot in the leg by an unknown assailant; although it is very relevant to ask who has perpetrated the crime, the first thing to do is to take action to save one's life, to stop the bleeding and call an ambulance. In order to develop a political and historic analysis of the flu outbreak, it is necessary to look at global, journalistic, and scientific sources, as well as comprehensive examinations like John M. Barry's book The Great Influenza. By coincidence, if you believe in that sort of thing, I picked up a copy of that book this February, purely out of curiosity. The account it tells of the 1918 outbreak is quite disturbing.
Here is a quote:
"No medicine and none of the vaccines developed then could prevent influenza. The masks worn by millions were useless as designed and could not prevent influenza. Only preventing exposure to the virus could Nothing today can cure influenza, though vaccines can provide significant--but nowhere near complete--protection, and several antiviral drugs can mitigate its severity."
John Barry also wrote: "...the closing orders that most cities issued could not prevent exposure; they were not extreme enough. Closing saloons and theaters and churches meant nothing if significant numbers of people continued to climb onto streetcars, continued to go to work, continued to go to the grocer. Even where fear closed down businesses, where both store owners and customers refused to stand face-to-face and left orders on sidewalks, there was still too much interaction to break the chain of infection."
Consider that, and consider the photographs in the news of people going about Mexico City with their face masks. They have been closing schools and stadiums too, and it is clear that if the virus is contagious enough, if it is like the 1918 virus in that regard, they will ultimately gain little from these precautions, and neither will we. We can wash our hands until the cows come home, and a sufficiently transmissible virus will still find its way into our bodies. The advice is to wear a mask and to avoid touching the eyes and mouth--but if you really think you can avoid touching your eyes unconsciously, try putting habanero pepper juice on your fingers, letting it dry, and try to go for eight hours without touching your eyes. You will touch your eyes. So, again, the question is whether the pandemic is likely to turn deadly.
The issue here is not how many people have died so far--a small number indeed compared to the world population or even to annual flu deaths--but rather what sort of process has been set into place. The experts are not sanguine.
NYT/Denise Grady 4/29/09
"A global swine-flu pandemic is likely, the World Health Organization (WHO) said Wednesday as it raised its alert level to Phase 5, the next-to-highest level in the worldwide warning system.
Phase 5 never has been declared before. Phase 6 means a pandemic is under way. WHO said its decision was based on the continuing spread of swine flu in the United States and Mexico, particularly the increasing numbers of unexplained cases."
What details can be gleaned from research scientists?
The following information is gleaned from a partial transcript I made last night from an interview on WPXI with Dr. Henry Niman, who holds a medical Ph.D. from the University of Southern California, and has worked with the prestigious Scripps Clinic, and also at the University of Pittsburgh and with Harvard University research teams.
In the WPXI interview earlier this week, Dr. Henry Niman pointed out that an influenza virus markedly similar to the current outbreak in its transmissibility, timing, and immune-refractory characteristics left 20-50 million people dead in 1918, at a time when the World population was a third of today's. A third of world's population was infected at that time, he said. If--and he points out that this is a big if--if it follows the 1918 pattern, it could 'kind of disappear,' or rather become less threatening over the Summer, and then reappear with greater violence this Fall. Adding to the list of 1918 similarities, Niman points out that most of the influenza deaths in Mexico are in a tight age group, 25-44 year olds.
Existing vaccines won't work, Niman says. An effort to produce a new vaccine will now get under way. The fact that there are few fatalities in the US at this time is probably a timing issue, he says; there would be a similar level of deaths if the number of infected persons rises to levels currently seen in Mexico. Within a month, the US flu-tracking map will "be covered in dots."
[This would seem to be echoed by a doctor in Mexico, Justino Regalado Pineda, an epidemiologist with the Health Ministry, who was cited in the Washington Post today:
"He speculated that one reason people have died in Mexico as opposed to the United States is that the life span of the virus could have been longer in Mexico. "]
Whereas the state of the pandemic is still mild even in Mexico, the number of actual cases, Dr. Niman says, are likely 10 or 100 times the reported number; most of these persons will experience a "mild course" similar to seasonal flu, because of the initial nature of the virus.
Counteractants will include tamiflu, an antiviral drug; however, Niman said, influenza generally is already resistant to one such drug, amantadine. He said seasonal flu is already resistant to tamiflu, so as the flu interacts with victims(recombines), there is a "good chance that that resistance will transfer to the swine virus" on the N gene; hence virus emerging in Fall might be resistant to Tamiflu.
It is still early in the pandemic process, so there is no guarantee that the disease will ebb in the Summer. Niman noted ruefully that there has been an announcement that testing is to stop on milder cases, to concentrate on severe symptoms. The new recombinant flu is widespread, Niman said; in the next week or two most cases will be from those "returned from Mexico," but that will change. An intensive vaccine effort will ensue, along with a "major effort" to monitor the virus; there will be no border closings, however, because the virus has already moved about --[as President Obama said last night].
The risk group for fatalities will be healthy adults, because of the "robust immune response.... that ends up killing the patient," similar to 1918. Commenting on the general threat level of the virus, Niman said that it is still early, and the virus might not sustain itself --but the number of people infected in Mexico militates against that forecast. He pointed out that earlier this week, one or two dozen students returned to the US who had gone to Mexico; days later, 150 were infected, 45 confirmed, and now parents are infected.
There is a lot more surveillance now than in 1918, Niman noted, so we can see the pandemic unfold at its early stages; but it is unlikely the virus will burn itself out, paradoxically because it is mild at this point, and is not eliminating the population. "People have a tendency to go to work, go to school, take public transportation," he said, thereby providing the opportunity for the disease to spread.
See kboo.fm/presswatch or theresaspresswatch.blogspot.com for the video URL of the interview.
Niman's comments on the similarities with 1918 may be borne out by breaking reports, such as this one from El Manana Nacional (and several other sources) in Mexico City:
One 24-year-old man started with a stomach ache and chills; he was initially treated by a private doctor, but the situation rapidly grew worse, and by the time he was taken to the hospital he was unconscious and having difficulty breathing. He died; "it began with cough and temperatures of 39 (102.2F) degrees, pain in the throat, diarrhea, vomiting, discomfort, and nausea."
This would be further underlined by a report in the Washington Post today (4/30/09), which said in part:
"Most of the fatal cases involved extensive lung damage, requiring doctors to prescribe mechanical breathing assistance. Exactly what caused the lung damage is not known."
The influenza outbreak in Mexico has been associated with numerous cases of "atypical pneumonia" although specifics seem to be hard to come by so far (http://www.washingtonpost.com/wp-dyn/content/article/2009/04/29/AR2009042904911.html). John M. Barry wrote in his NYT bestselling book The Great Influenza [pp. 242-243] "It was the lungs that had attracted attention from pathologists first. Physicians and pathologists had many times seen lungs of those dead of pneumonia. Many of the deaths from influenzal pneumonia did look like these normal pneumonias. And the later in the epidemic a victim died, the higher was the percentage of autopsy findings that resembled normal pneumonia, bacterial pneumonia.
Those who died very quickly, a day or less after the first symptoms, however, most likely died of an overwhelming and massive invasion of the virus itself. The virus destroyed enough cells in the lung to block the exchange of oxygen. This alone was unusual and puzzling. But the lungs of the men and women who died two days, three days, four days after the first symptom of influenza bore no resemblance to normal pneumonias at all. They were more unusual, more puzzling."
Note, then, this report of a rapid death from the Las Cruces Sun/News, New Mexico, by Ashley Meeks, seeming to bear out Niman's warning already:
April 29th 2009
"LAS CRUCES - A 6-year-old student in Las Cruces died Tuesday afternoon after being sent home from school sick that day with nausea and a fever, according to the Doña Ana Sheriff's Office.
By Friday, preliminary autopsy results should determine whether Columbia Elementary School first-grader Cody Scarborough had contracted swine flu, said Sgt. Joe Reynaud, who said the death had originally seemed to be caused by a heart attack.
"It's out of the ordinary to have a death of a 6-year-old. It could be anything from carbon monoxide to a birth defect," said Reynaud, who said Scarborough's mother had picked him up from school with a fever. "The child did not exhibit any symptoms previous to yesterday.""
If this sort of incident gains in frequency, it might be an indicator of the 'cytokine storm,' , the hyper-immune response that apparently killed many in 1918.
Doctor Henry Niman does not represent unanimous opinion in the scientific community, however:
Reuters reports "Masato Tashiro, head of the influenza virus research center at Japan's National Institute of Infectious Disease and a member of the WHO emergency committee, told Japan's Nikkei newspaper it appeared the H1N1 strain was far less dangerous than avian flu.
"The virus is relatively weak and about the same as regular influenza viruses passed on via human-to-human contact. I don't believe it will become virulent," he was quoted as saying.
"The threat to health from the avian influenza and its fatality rate is much greater than the new flu," he said.
"I am very worried that we will use up the stockpile of anti-flu medicine and be unarmed before we need to fight against the avian influenza. The greatest threat to mankind remains the H5N1 avian influenza.""
Tashiro's confidence is interesting in view of the fact that the virus has been reported to be composed of avian influenza as well as swine flu and H1N1 genetic components; due to intense pressure from corporate farmers, the disease may be renamed anyway.
If hand-washing, quarantine, and public closures are to be of no use, what can one do? But it is still, frustratingly, too early to determine if we are facing a November full of the reek of death and disease, or clear sailing to the next outbreak. Perhaps some strategem can be devised to defeat the influenza. Or maybe we're all just meat animals in a factory farm, waiting for the time of slaughter.