swine flu

The Reveres have been around a long time and we know a lot of public health people in different states. Recently we were talking with a colleague about the problem of hospital surge capacity -- the ability to handle a sudden demand for services -- and she described her first job working for a state health department in the early 1980s. Her job was to compile a health resources report, essentially a yearly compilation of licensed and operating beds for all manner of health facilities, including hospitals, nursing homes, psychiatric facilities, outpatient clinics, rest homes, group homes and…
Yesterday CDC announced it would no longer report confirmed and probable swine flu cases. This will likely cause consternation in some quarters, but the reasons make sense. First, it should be said that the real pressure to stop counting is coming from the states, where resources are stretched so thin and the value of the numbers so meager they no longer could afford to do it. The data, like most notifiable disease data, comes from state health departments, not the CDC itself. It is also recognition of what everyone knew from the earliest days of this outbreak: the "official" numbers did not…
Yesterday CDC's Morbidity and Mortality Weekly Report (MMWR) carried an a note about neurologic complications in children with swine flu. Central nervous system effects -- seizures, encephalitis, encephalopathy, Reye syndrome, and other neurologic disorders -- are known to occur with seasonal influenza in children, but whether they are more or less common with the swine flu variant is unknown at the moment. The MMWR reports four cases from Dallas County, more as a reminder that these kinds of complications can occur and should be considered whenever a child with influenza-like illness (ILI)…
There have been three reported oseltamivir (Tamiflu) resistant isolates of H1N1 swine flu (added: and now a fourth in Canada) but with those exceptions all others have been sensitive to this oral antiviral. This is in marked contrast to the other H1N1 strain, the seasonal variety which is almost entirely resistant. The spread of Tamiflu resistance in the seasonal strain happened with dramatic suddenness in the winter of 2007 - 2008 and came as an unhappy surprise. People assume that a rapidly mutating virus would inevitably become resistant, but based on several laboratory studies there were…
The reaction to our post on Sunday about preparing for the ongoing flu pandemic was mixed. Some thought it was right on target while others expressed dismay over what was perceived as minimizing the possible effects, especially as we have been talking for well over four years about the potentially pervasive nature of widespread absenteeism. Still others thought we had retreated to a narrow view focused on the pressure on the health care system while neglecting what might happen in the wider world. There is some truth to all these perceptions, but we didn't take this tack because we changed…
With flu season in the northern hemisphere looming and H1N1 cutting a nasty swath through good portions of the southern hemisphere's current flu season, attention is being turned to the non-existent but hoped-for vaccine against swine flu. Yesterday we discussed the problem of pinning pandemic planning on a vaccine. That's planning for the best, not hoping for the best. There are a lot of uncertainties regarding whether an unadorned egg-based vaccine -- the bulk of the vaccine now in development -- will be sufficient, available in time or even effective. But those problems just scratch the…
We've been talking about the possibility of a flu pandemic here for four and a half years. The cliché during much of that time was that the right way to think of a flu pandemic was not "if," but "when." As long as no pandemic materialized, however, there was great scope for what it would look like and hence what to plan for. The hoary adage, "Hope for the best, plan for the worst" made sense but left a great deal of scope for different approaches to planning. What, after all, was the worst we could expect? We had two models, one historical, one hypothetical but plausible. The historical one…
Back in May there were some stories on the wires and flublogia regarding a new study about arsenic exposure and risk of flu. I didn't write about it at the time for purely arbitrary reasons (I was writing about other things), but I noticed it and in fact I know the senior author and his work fairly well. For reasons having nothing to do with flu I revisited the paper the other day, along with a bunch of others on arsenic toxicity from the same group up at Dartmouth (the senior author, Josh Hamilton, has now moved to the Marine Biological Laboratory at Woods Hole, Massachusetts, but I think…
Data from the Emerging Infections Program (EIP), one of the component parts of the CDC national influenza surveillance system, is showing that for some segments of its population the US did indeed experience a second flu season. The segment of particular concern are children between the ages of 5 to 17 years old, and to some extent adults between the ages of 18 and 49. The EIP counts only laboratory-confirmed hospitalizations in 60 counties located in 12 metropolitan areas in 10 states (if you are wondering, the 12 metro areas are San Francisco CA, Denver CO, New Haven CT, Atlanta GA,…
I hate to take off on the press. I do it every once in a while, but not often. The slow and agonizing demise of the main stream press has major consequences for keeping the public informed about issues both big and small. It's also a personal tragedy for many dedicated professional journalists. Still, while newspapers-as-we-knew-them aren't dead yet, they are at least moribund, and like the famous definition of a statesman as a successful politician who is dead, there is more than a bit of a tendency to endow the working press with some virtues it doesn't have now and in general never did.…
Yet another paper testing the current swine flu pandemic virus in animals appeared in Nature yesterday, covering much the same ground as two published July 2 in Science and with similar findings. All three of these papers show the pandemic virus more likely to infect tissues deeper in the lung than seasonal flu viruses used for comparison. But each of these papers had a slightly different author spin. This one is even being construed as suggesting that we may be confronting a virus much like the 1918 monster. We discussed the first two, one from Holland and one from the US, in this post a…
... or is obesity simply Yet Another Risk Factor in severity of this illness? Probably the latter, but health officials seem interested in the developing data. From CTV: ... in a report released Friday, health officials detailed the cases of 10 Michigan patients who were very sick from swine flu in late May and early June and ended up at a specialized hospital in Ann Arbor. Three of them died. Nine of the 10 were either obese or extremely obese. Only three of the 10 had other health problems. Two of the three that died had no other health conditions. This hardly settles the question of…
I am thinking out loud here. Since that's never a pretty sight, you might wish to avert your eyes. With that merest of advance warning, the school closure problem has gotten me to think more generally about social distancing. The term itself is a kind of oxymoron. "Social" emphasizes togetherness, intercourse between people, relations. "Distancing" is negation of the social. We have examples: canceling school, prohibiting mass gatherings, telecommuting, but the underlying idea is straightforward. With a contagious disease that passes from person to person (details still to be worked out, of…
Had a busy day at work yesterday (the pesky day job problem) but did get a chance to see bits and pieces of the Flu Summit video streamed at Flu.gov. This was aimed at state and local folks, and the parts I saw didn't provide much new information if you have been following this for years. I'll bet, though, it was sobering for many state officials who haven't had the chance or inclination to consider the myriad ways widespread absenteeism can affect our intertwined and interdependent modern way of life. One aspect vividly on display in the opening months of the current swine flu pandemic was…
Both Mind Hacks and Jonah Lehrer took interesting note -- Jonah's the longer, and a pretty nice summary itself -- of the fascinating NY Times piece on ultramarathoner Diane Van Deren, who began running long distances after brain surgery removed much of her right temporal lobe. This gave her a great advantage: the lack of memory of the run behind her, and thus of any dread of the punishment still to come. Downside: significant memory problems, and she can't read a map. Speaking of memory ... Newsweek has a good piece on unconscious plagiarism -- that is, how genuine lapses in "source memory…
I'll soon be at the end of my career, funding-wise, although I plan to continue as an active scientist for as long as my neurons will process information in a logical order. I mention this so you won't take this as special pleading. I'm not going to benefit from it. But if we want to continue to make advances in science and health (as well as other things), we're going to have to invest more heavily in basic research. And when we do, we'll have to do it smarter than we've done it before. Notice I didn't say anything about competing economically as a nation, although any nation that fails to…
A risk factor for swine flu complications is pregnancy. Yet one of the few venues specifically for healthy people in modern health care facilities is for pregnant and postpartum women, the in and out patient portions of the obstetrics department. And what of the newborn whose mother gets the flu? Infants are also at greater risk from influenza complications. This is a tough problem. CDC has just issued some interim guidance regarding swine flu and obstetrics settings. The guidance is "interim" because CDC is quite frank that there is a great deal we don't know about the probabilities and…
I'm not qualified to say if science and health reporting has gotten worse in recent years. Maybe I'm just paying more attention to how bad it often is now. My impression is that some reporters today are as good or better than we've ever had but there are fewer of them on the beat. This is compensated for by the fact that the ones still in there writing superb pieces can now be read and appreciated by many more of us, thanks to the very medium, the internet, that is killing their business model and their livelihoods. Exceptional science journalists aside, news outlets are continuing to do…
Flu virus is opportunistic. It takes advantage of any weakness. Seasonal flu picks on the very old and the very young, but pandemic flu has found us old folks tough and the younger amongst us quite tasty. No natural resistance seems to be a flavor enhancer. And pre-existing medical conditions? Quite delectable. So how full is the menu in the prime age range? CDC has just released one of their Quickstat summaries based on household interviews with a sample of the civilian, noninstitutionalized, adult U.S. population. The question the sample was asked was whether a doctor or other health…
I have a lot of respect for civil servants. It's a noble task, nobler than what most of us do. But there are times when I just want to shake my head. The UK government has not exactly distinguished itself in the swine flu area, first putting pressure on WHO to hold off declaring a pandemic, then looking the other way when cases started to skyrocket in their backyard, and now . . . well, it just makes me want to shake my head: Health minister Andy Burnham told the House of Commons yesterday that over the last week a “considerable rise” in H1N1 with several hundred new cases every day. “Cases…