When swine flu kills

Paul C. Hébert MD MHSc
Editor-in-Chief of Canadian Medical Association.
http://www.cmaj.ca/earlyreleases/31aug09_editorial.shtml

He is against the Canadian Vaccination Program

Then comes the McGill University of Montreal warning
Dr. Brian Ward and Dr. Michael Libman, both of McGill University in Montreal, said H1N1, formerly known as swine flu, has exposed a major weakness in the rating system that must be fixed: the failure to articulate a real sense of the gravity of the flu outbreak, and how much of a public danger it really is.
Libman agreed, saying there was growing recognition among experts that some changes have to be made.

"To be useful, the rating has to have relevance to the actual danger that is present," said Libman, director of the division of infectious diseases at McGill.

"It is recognized now and there is some movement to look at how to revise this type of scheme so it has more relevance to the public."
http://www.vancouversun.com/health/P...177/story.html

Finally but not the least the implication on ICU on much more frequent ARDS with H1N1 than seasonal flu
The direct mortality of H1N1 by ARDS would be one hundred times more than seasonnial flu
http://www.flutrackers.com/forum/showthread.php?t=122927&highlight=ARDS…

More coordination has indeed to be done, Communications, ICU medical respirators, Personal to handle this and more beds.

Snowy Owl

Sorry I forgot to add Helen Branswell article

Via the Toronto Sun, a CP story from Helen Branswell: Lung damage in fatal swine flu cases similar to bird flu: expert.

http://www.torontosun.com/news/canada/2009/09/03/10734186.html

Snowy

It's worth noting that seasonal flu too occasionaly causes the same type of severe viral pneumonia/ARDS, even in otherwise healthy young adults.
The difference, however is that with seasonal flu this happens only in about one in a million cases, but in about one in 1000-10000 cases for pandmic H1N1 (and for almost all cases in H5N1).

Furthermore it is puzzling that the spectrum of disease, while extremely "broad" is at the same time not very continuous. This bi-modal clinical spectrum looks like two completely different diseases but caused by the same virus.

So the question is which host and/or environmental factors are responsible for the dramatically different outcomes.

And the answer is probably not given by the usual "underlying conditions" explanation for two reasons:

1. The conditions mentioned such as "high blood pressure", "asthma", "obesity" are so highly prevalent in the general population that their occurence (even if slightly increased) in the sub-group of severe H1N1 cases does not have much explanatory power.

2. Almost 50% of all fatal cases did not have any known "underlying condition" at all, as has been uniformly reported from every affected country in the world.

So it would make sense to put more scientific effort in identifying the "real" risk factor in order to a much more percisely targeted treatment/prevention to those 1000 at-high-risk-but-yet-unidentifiable people out of a million who really need it.

Swine flu raises ICU-overload concerns
CBC News
http://www.cbc.ca/canada/manitoba/story/2009/09/03/mb-swine-flu-winnipe…

A Winnipeg intensive-care specialist hopes an international conference taking place in the city will find ways to deal with the flood of patients that hospitals could see this fall during a second swine flu pandemic.

Dr. Anand Kumar worked during the first wave of the swine flu, or H1N1 influenza A, crisis in the spring.

"Quite frankly, professionally, it was the most frightening experience of my life," he said. "We simply didn't know if we would have sufficient beds in three to four days because we were getting six patients a day. We were fortunate, because the epidemic abated within three to four days of when we would've overloaded."

At one point, there were 60 patients with proven or suspected H1N1 infection in a city with only 70 ICU beds, Kumar said. Most people will not need hospitalization if they get infected with H1N1, but for those who do, about 15 per cent will require ventilators in the ICU, he said.

"It will not just be ventilators [of concern]. Hopefully, we've put into place preparations for medications that might be short â sedatives is one large group of those," Kumar said.

'Quite frankly, professionally, it was the most frightening experience of my life.'
âDr. Anand Kumar"Then most importantly, manpower. One of big chokepoints is nursing and respiratory tech manpower

A Winnipeg intensive-care specialist hopes an international conference taking place in the city will find ways to deal with the flood of patients that hospitals could see this fall during a second swine flu pandemic.

Dr. Anand Kumar worked during the first wave of the swine flu, or H1N1 influenza A, crisis in the spring.

"Quite frankly, professionally, it was the most frightening experience of my life," he said. "We simply didn't know if we would have sufficient beds in three to four days because we were getting six patients a day. We were fortunate, because the epidemic abated within three to four days of when we would've overloaded."

At one point, there were 60 patients with proven or suspected H1N1 infection in a city with only 70 ICU beds, Kumar said. Most people will not need hospitalization if they get infected with H1N1, but for those who do, about 15 per cent will require ventilators in the ICU, he said.

"It will not just be ventilators [of concern]. Hopefully, we've put into place preparations for medications that might be short â sedatives is one large group of those," Kumar said.

'Quite frankly, professionally, it was the most frightening experience of my life.'
âDr. Anand Kumar"Then most importantly, manpower. One of big chokepoints is nursing and respiratory tech manpower

It is time to turn around. Live a simple, guilt-free lifestyle that does not depend on meat for sustenance, for we humans as a species can survive on plant-based diet.

Swine flu is not a pandemic disease awaiting scientific solution. It is a bad karma caused by incessant killing of animals for food. It is a moral problem with a simple ethical solution.

Change your heart. Change your mind. Be virtuous, be merciful. Change to a vegan lifestyle.

Swine flu is not a pandemic disease awaiting scientific solution. It is a bad karma caused by incessant killing of animals for food. It is a moral problem with a simple ethical solution.

Speaking as a vegan, let me be the first to point out that you're completely out of your mind.

Revere: When patients are so critically ill, as reported in the article, is it safe for us to assume that such patients would have been well-screened for any âextraâ--and perhaps nastier viruses or bacteria? I mean--once the seriously ill and/or dying test positive for H1N1, do the doctors continue to do cultures and such? Or, once they know it is H1N1, do they just stop testing?

I guess my broader point is--in an environment in which a huge percentage of the population is infected H1N1--wonât it be easier to miss other infectious diseases? (diseases that are even worse than H1N1--like pneumonic plague, or something in that category of horrible?)

Phila:

You're saying this person is completely out of her/his mind when he/she says
"be merciful?"

melbren: One you are in ICU and under the care of critical care docs they are looking at everything. Remember, this is a very small number of people at this point. But getting cultures and doing tests on critically ill people is often difficult. But they are looked at very hard and thoroughly.

ssal:

Get real. It is obvious that Phila's comment was in response to the quoted text - in which "Meat is POISON" was "completely out of [his/her] mind" when saying "Swine flu is not a pandemic disease ... [but] a bad karma ... a moral problem."

(BTW, the rest of us would appreciate it if you and "Meat" would stay on topic.)

You're saying this person is completely out of her/his mind when he/she says "be merciful?"

Of course not. I'm saying that swine flu is not caused by "bad karma."

And personally, I don't consider it "merciful" to try to mislead or misinform people about the causes of disease. Even if it's done to advance a cause I happen to support, like veganism.

It's interesting that they are finding co-infections with strep. My interest in flu originated from an experience with canine influenza H3N8 which had at that time recently been recognized as a novel virus. Now some years later there has been more investigation of canine deaths associated with that flu, and what they are finding is frequent co-infection with a bacteria called strep zoo. The co-infected dogs die very quickly from hemorrhagic pneumonia. In several outbreaks in different parts of the country canine flu & strep zoo are being found together as co-infections. Same scenario - canine influenza can be a mild disease or in a percentage of dogs it is a killer.
It sure looks to me like there is a pattern of flu virus somehow operating in conjunction with strep - maybe both in canines and humans.

Mary: This connection is classical and has been known for a long time. Strep pneumoniae used to be called Diplococcus pneumoniae or pneumococcal pneumonia, so it is just a renaming (2974a0 of a long known secondary bacterial infection with flu. It is also a major cuse of middle ear infection in kids and sinusitis.

Two features reported here are that 90% of this particular series of fatal cases (not necessarily representative of all fatal or severe cases) had underlying medical conditions (most prominently morbid obesity but also high blood pressure, chronic heart disease and asthma); and that a third involved secondary bacterial infections, both antibiotic sensitive and resistant varieties.

Every one of the conditions noted here is one I've previously read is correlated to deficiency of serum calcidiol (25-hydroxy-vitamin D3). The reported or rumored greater severity of illness suffered by blacks and hispanics can also be understood with reference to vitamin D3 deficiency, as can the broadly annual periodicity of the flu.

These points don't add up to proof of a causal role for vitamin D3 deficiency, but they do seem to be grounds for further investigation. I wish to hell that someone would just start checking patients' serum calcidiol.

Chirp:

Merciful treatment of animals is something about which there should be no misunderstanding. I honestly thought there was a possibility Phila was also referring to that, and so I asked. And let me assure you I would try to seek clarification again if a similar situation should occur.

Phila:

Thank you for responding and making it absolutely clear you weren't referring to treatment of animals.

Also, I believe there is such a thing as Universal justice, and personally I cannot rule out the possibility that the treatment of other animal species by the human species is a significant contributing factor, i.e. "karma," to whatever happens. But I can't begin to be able to prove that there is such a thing as karma, and therefore would not try to insist that anyone else believes it. If either you or Chirp feels you can prove that there is no such thing as karma, I request we move to a different site and discuss it. (You choose the site.)

Doug:

Is hypertension that is under control through the use of drugs still considered an "underlying condition?" in the pandemic flu picture?

Also, there's a pretty good discussion of the Vitamin D matter in a thread over on the Flu Wiki:

http://newfluwiki2.com/showDiary.do?diaryId=3530

Hi,

I would just like to say that good health comes from good eating habbits. We should abandon the meat and all meat products in our lives. It is very clear and becoming more clear day by day that the pandemic swine flu, bird flu etc are indirectly or directly the result of our support of the killing machine. aka primary pork producers.

Meat has been linked to colon cancer, pancreatic cancer, prostate cancer, diabetes, heart attack, hypertention, obesity and countless other diseases, not to mention SARS, avian flu, human-bird-swine flu, BSE, strep aureus, etc etc.

Meat is POISON. Ban meat and stop supporting the meat industry. Meat is killing our young and pregnant people alike.

Change your heart. Change your mind. Turn to the organic vegan solution.

Be Veg. go Green. Save the planet

Because of their overall behavior toward people who do not totally agree with, it seems to me:

Fundamentalist Christians have the net effect of turning people away from Christianity.

Fundamentalist atheists have the net effect of turning people away from atheism.

Fundamentalist vegans have the net effect of turning people away from considering becoming vegans.

The list could go on ...

Meat is Poison; Phila; ssal; Chirp: before you move to another site, I believe there is a well-established *scientific* possibility that you are observing, but identifying as a metaphysical problem (Karma) and, as it turns out, your proposed solution (veganism), could indeed represent a very practical, and accurate solution, none of which is âcrazy,â but possibly, less informatively identified.

The metaphysical prism through which you perceive the causative factor resulting in the development of new viral strains, is indeed related to the increasing world-wide consumption of animal protein: the corresponding development and intensification of *industrial agriculture* to meet this increasing demand (not an original idea on my part).

This is such a perversion of manâs original (and more humane) techniques of husbandry, that the cruel conditions in which animals are now being âraisedâ and slaughtered (facilitating contagion and mutations/reassortment of new viral strains), could reasonably be seen as form of Karmic justice, i.e., an observably related situation of cause and effect: cruelty to animals resulting in blow-back to humans.

A related example of such âKarmaâ is the feeding of animal protein to cattle, to enhance their bulk (feeding the increasing human demand for animal protein), leading to prion caused Creutzfeldt-Jakob syndrome.

Paul:

I'm not sure I understand everything in your first paragraph (that's not to say I disagree with anything in it). But the rest of what you said seems very close to my own thinking.

Thanks for your comment.

Coming from a legal background, not medical, you would be surprised at the prevalence of staph infections in our hospitals, especially ICUs.

Because of the ARDS complications, with H1N1 more people are being put on respirators and having other invasive procedures. Could a great number of these deaths be because of hospital-acquired co-infections? This is not something the doctors & hospitals would especially want to reveal IMO.

I would love to see a study on how many people who have died had staph as a complication. Sometimes there is a simple answer.

Influenza has a cure - Its Affluence

http://www.theglobeandmail.com/news/technology/science/influenza-has-a-…

I would be great Reveres to share your opinion on this article, a must read IMHO.

Snowy

Southbound: CDC Director Frieden was asked this exact question at the presser on Friday. He said that in the case of the 36 pediatric deaths, the children with co-infection presented to the hospital with the combined infection and didn't pick it up there. I got the impression from the report of the Winnipeg meeting that some of the long stay cases (on vents for seeks at a time) had hospital acquired infections. That's all the info I have at this point. So the answer is probably not simple.

Paul:
Your erudite exposition of a complex spiritual truth known as the Law of Karma in clinically accessible terms is much appreciated and admired. For lesser minds, such an abysmal jump to the impetuous proclamation that Meat is POISON would have raised the irk of many.

While scientific principles necessitated the dichotomy of the observer and object as two distinct, independently functioning and disjoint units in the observerable universe, regardless of whether the subject of study is the microscopic swine flu virus or the decomposing steak on the dinner plate, which per chance belonged to the body part of a once alive and well, but nameless, edible animal species, it is important to note that there exists superior spiritual beings who through the process of sublime meditation is able to grasp abstract metaphysical truths easily without the heavy encumbrances of left brain logic.

From such metaphysical mystics' viewpoints, the observer and object are one and the same, which means to say what you do when you kill the animal in order to get the food, you actually killed a part of yourself.

While engaging in laudible scientific inquiry in your attempt to understand swine flu, and to provide a plausible solution to save the world, please also bear in mind the words of Supreme Master Ching Hai, who said, "You don't have to die to save the world, just be vegan !!"

Thanks, all, for two interesting threads peacefully co-existing. Didn't SARS gain momentum in those markets in southern China, with animals caged in horrific conditions? My sentiments with you, ban-meat poster, but perhaps keep your emphasis on the inhumane and cruel, not the metaphysics. You'll reach more people.

Hundreds of thousands of school children are poised to be vaccinated for seasonal flu, and then, if enough supplies, H1N1. Will this mass inoculation reduce the annual sweep of flu(s) around the globe next year, and year after, and then on (if repeated annually) or is it a shot in the dark?

At the same time, should children with a familiar history with strep (ear infections, sinus infections, strep throat, etc.) be vaccinated with the pneumococcal shot?

I did go back and read Revere's June 11 post on this. If the vaccination is a one-shot, why are not more children getting it? Because parents don't know to ask?

Parents know how to ask for the pneumonia shot for their kids but most pediatricians won't give it, at least in my experience and those of my friends. For one thing the pediatric docs don't usually carry the vaccine; if the doc is in a larger family practice, they have the vaccine but generally won't give to a child under 12.

Reasons docs give vary: the CDC hasn't called for it to be used, there are side effects and, my favorite, we don't just vaccinate to vaccinate, there has to be a reason.

When I pointed out that 30 percent of kid deaths were attributed to bacterial pneumonia, the kind this vaccine targets, I was told the the number of deaths were tiny, this is a very mild virus, the chances of my child getting it and getting seriously ill were minute -- and that the risk of side effects from the pneumonia vaccine was greater than the risk of dying from swine flu!!!

Pediatricians are some of the hardest working docs there are, but in this instance, I truly think they don't know or haven't been educated about the pneumonia vaccine and what it can do relative to its side effects.

Will this mass inoculation reduce the annual sweep of flu(s) around the globe next year, and year after, and then on (if repeated annually) or is it a shot in the dark?

Nope.

Exposure to the flu each year gives lots of people resistance anyway, regardless of the vaccine - vaccine is better, of course, since it doesn't come with the bad stuff. Point being that flu already lives with cycles of resistance, it's just a matter of how many people die each year to get there.

Each strain of flu then buggers off, cycles around for a bit, and comes back with a different hairstyle. Previous defences don't recognise it and wave it through the checkpoint. Which is why we're pretty much constantly making a new vaccine - there is always a new variation coming along that last years' vaccine can't touch.

Hi downeast,

Many thanks for remembering the lessons of SARS. Indeed, people eat all kinds of horrible, unmenionable "things", in this case, it is the eating of civet cat that caused SARS to be spread around the world. You wouldn't think of eating your cats and dogs, but some people will do the unimaginable thing... Animals are our friends, they are not our FOOD..

Science needs spirituality, because spirituality offers wisdom, which is absent in science. Wisdom enables one to do the righteous, courageous thing, such as for instance, turn to the vegan lifestyle due to compassion for the miseries the world is facing right now.

So it is timely to marry science with spirituality, because without wisdom and love, science will be groping in the dark, consistently doing the wrong things, the most hurtful things to humanity and the planet despite the best intentions of the scientist.. examples ? GMO, industralized cage farm operations, etc. etc.

It is assumed that the well read and well informed audience in this forum would have known about animal cruelty and man's inhumanity to animals. PETA.org is the most comprehensive site for such education. Also recommended is the EARTHLINGS DVD narrated by Joaquim Phoenix.

Here's a simple test of your human(e)ity. Watch the EARTHLINGS DVD for the full 90 minutes. If at the end of it, you are still the same person as before watching the movie, then you have failed to be human(e)...

Some facts:

About 36,000 people in the US die annually from seasonal influenza, and more than 200,000 are hospitalized, according to the CDC.

As of mid-June, almost 30,000 cases of H1N1 infections and 144 related deaths have been confirmed in 74 countries around the world

Less then 10 percent of its victims require hospitalization, very few of them die, and most recover quickly

In fact, according to the U.S. Center for Disease Controlâs (CDCâs) Pandemic Severity Index, the current swine flu barely qualifies as a category one event, on the CDCâs rising scale of one to five. Its current case-mortality rate is low, and its illness rate as a percent of our population is very low.

By way of comparison, the bird flu (H5N1) virus, to date has about a 60 percent mortality rate for the confirmed global cases

1918 influenza pandemic caused at least 675,000 U.S. deaths and up to 50 million deaths worldwide

1957 influenza pandemic caused at least 70,000 U.S. deaths and 1-2 million deaths worldwide

1968 influenza pandemic caused about 34,000 U.S. deaths and 700,000 deaths worldwide

So it seems that the US has a continuing flu pandemic occuring every year with a greater severity than the 1968 pandemic - 36K vs 34K deaths.

To date, the H1N1 has killed ~3400 people worldwide since it was ID'd in April.

Run away!!

HarryB: You know as much about epidemiology as foreign affairs. Congratulations on this achievement.

Revere-

If strep bacteria is known to occasionally tag along with a flu virus, could yersinia pseudotuberculosis or one of its subspecies tag along with a flu virus? When I commented above on this thread--I was just picking an infectious disease out of the air-I wasn't actually serious about (yersinia pestis.)

Since then, however, I have been thinking.

I am the obsessive mom who has been commenting here since my 21 year old daughter, a student at a university in Northern California, was ultimately sent to an E.R. last March with a mysterious I.L.I.--which I have suspected since the official outbreak was actually 2009 H1N1. Since the mystery illness, my daughter has begun to exhibit rheumatologic symptoms. I was researching âreactive arthritisâ yesterday and stumbled upon the description of y. pseudotuberculosis--of which y. pestis is a subspecies. Y. pseudotuberculosis perfectly matches the description of my daughterâs âMarch mystery illnessâ--particularly if her present issue turns out to be reactive arthritis.

Apparently, y. pseudotuberculosis can be, initially, food-borne. (Perhaps an infected California vole made his way into the carrot shredder at the organic farm that supplies the campusâ highly-touted, extensive, organic salad bars?)

And, in reference to Helen Branswellâs article, specifically regarding the surprisingly ravaged lungs of the swine flu fatalities, I am wondering if it is conceivable that we could be starting to see some sort of sub-clinical y. pestis (or y. pseudotuberculosis) hanging out with H1N1? Are we positive that our infectious disease surveillance would spot it right away, if this were the case?

I would also like to know how related are the âyersiniasâ-- pestis and pseudotuberculosis--to TB? (A great deal of TB research is conducted at the laboratory affiliated with my daughterâs university; so they are probably hyper-vigilant about it--but they tested over 200 students and professors for TB around the time of my daughterâs illness. There was at least one active TB infection--and there were a lot of students with a cough.) TB and the âyersiniasâ may not be related to each other in any consequential way--but I couldnât find the answer through my own googling.

But I did learn--and was surprised by the fact that the first well-documented y. pestis outbreak in North America occurred 100 years ago, in the same location as the university where my daughter attends--the San Francisco/Oakland area. And, according to the stateâs recent vector-borne illness surveillance--about 10% of the wild life that is routinely and randomly tested in California tests positive for y. pestis. Interestingly, and admittedly--probably not important, 5% of California ground squirrels test positive for y. pestis; the ground squirrel population on my daughterâs campus is significant--and âoverly-friendly.â (Yikes--I even fed one of them last time I visited!)

The same report indicated that the California ferrell pig population tested negative for y. pestis. But just the mention of âswineâ and ây. pestisâ in the same sentence made me uncomfortable.

I do not have access to many of the scientific articles that sound pertinent to this subject; many of the articles that I am able to access seem to require far more IQ points than I have at my disposal. But I am getting the general impression that y. pestis and y. pseudotuberculosis are more closely related than previously thought. And this has prompted me to question the possibility of an emerging y. pseudotuberculosis subspecies that may not quite be y. pestis, but maybe something akin to it. (And, to question the possibility that it has become fond of certain H1N1 flu-infected hosts.)

As a lay person, one of the most important public health lessons that I will take away from the 2009 H1N1 outbreak is a much clearer understanding of the limitations in infectious disease diagnosis, surveillance, and testing. (Budgetary, logistical, practical, political, as well as scientific limitations.) I didnât know how much we donât know.

Perhaps the influenza virus and yersinia pestis bacteria do not regularly hang out together--but isnât it possible---over the course of a few million years--that they occasionally bump into each other and get along?

melbren: Y. pestis is plague. It is endemic in many areas amongst small rodents and other animals. It is not endemic in humans. Strep is a common resident bug in humans. The reasons why flu predisposes to secondary bacterial infection aren't completely understood although we know something about it. Suffice to say, it makes it easier for existing resident organisms to take hold when they wouldn't under usual circumstances. I don't know much about Y. pseudoTB, but it has nothing to do with regular TB except for being part of the species name. Yersinia bugs and Mycobacteria (the TB bug) are completely different.

Snotty lot aren't you. Paul?

The statistics of epidemiology are as malleable as those in any field - GIGO.

A Causal relationship or a casual one? Roman cohort or case-officer control? Incidence or coincidence?

I guess we'll have to settle for giving the Taliban (that should cover the "foreign affairs" jibe)the adjuvant vaccine and hope for the best.

HarryB:The statistics of epidemiology are as malleable as those in any field -
GIGO.

I guess you'd know. But I guess that means you don't ever rely on numbers for anything. What do you use? Your malleable imagination? Or do you mean that whatever the field, you know garbage when you see it? You must be pretty smart. Or something.

Revere-

I know--I was afraid to use the âp-wordâ again. My first comment showed up on a google search that included that word. I felt sort of irresponsible for (someone like me) throwing it around so casually!

But thanks for the info. I just this moment read that y. pseudotuberculosis was only given that name because its symptoms look like TB. (So, apparently 200 kids at her school sounded like they had TB last April, but did not--it truly may have been an early H1N1.)

There seem to be some interesting articles about y. pseudo tuberculosis in the scientific magazines that I cannot access--even a couple recent ones in Nature. (And one of the journals "teased" a possible vaccine for y. pestis via its less virulent ancestor, y. pseudotuberculosis?) Maybe you could give us your take on it someday! In your spare timeâ¦.

Thanks for the âoffice hours.â So many questionsâ¦so few Reveres!

Rude bugger you are, you cheeky lad.

It's a crime what some people do with statistics. (Thanks, Arnold)

Freakonomics or Freedonomics?

For CA - at what elevation is the college? What are the coyotes (non-human variety) up to? Any O. montana bites or O. hirsuta?

I'll stick to my grays and becquerels, you stick to being some form of...something.

HarryB: Fine with me. Pick your own Poisson (I assume that will click with you).

Isn't that some kind of mustard? Any probability of becoming a "distributor"? but I "regress", I mean digress.

Au revoir.

Love,
Cherenkov

HarryB-
I don't understand blog etiquette--I think you meant me when you referred to "CA." And I can't tell if you and Revere are actually mad at each other or not. Please don't be mad at each other--I might need you both!
I'm just a mom who is sort of freaking out. And I have no background in science or medicine. The school is UC Berkeley--it's sea levelish, but there are hills nearby that are probably at about 500.
My daughter is in a club that went camping in early February--somewhere near there. In late February they camped at a nearby beach. I had not even thought about those two possible interactions with wildlife until your suggestion. She became ill with flu-like symptoms in early March. She ended up becoming really ill by March 11, and was sent to the E.R.
I have the video from a forum that her club hosted that week; so many kids were coughing that it distracted the speakers. Several kids that I spoke with that night were not feeling well, but none were as sick as my daughter. She gradually seemed to recover over the next several weeks. My daughter began to have swollen, painful ankles in May/June.
I googled the bugs you mentioned, and I don't like what I saw. But--I don't fully understand what I saw, either. Please understand, my concern is not only for my daughter. I don't know what to do. If I did, I wouldn't be reaching out to complete strangers. Any direction would be appreciated.

I was wondering how the facts (see HarryB, 9/8) got lost in all this fear & hysteria. H5N1 is more lethal on a case by case basis than H1N1 however the media & their fear-mongering surrogates have too much invested in the H1N1 story to back off. Unfortunately many theorists & academic communicable disease specialists have bought into the "panic" which is very unscientific of these "former" scientists. I suppose it's the old: "..if it bleeds, it leads!", and the boring facts & logic do not sell. Magpie (9/7) also makes a good point regarding resisitance & immunity. Despite the media frenzy, this risk & potential morbidity needs to be put in perspective. I will continue to worry more about CV discase, cancer (and their associated life style behaviors) & the risk of driving to work, rather than H1NI taking me out.
An ED physician