WHO Officially Declares Swine Flu a Pandemic

The World Health Organization (WHO) raised its alert level for Swine Flu / H1N1 to Phase 6 (out of 6), officially classifying the outbreak as a 'global pandemic underway'.

Don't freak out just yet, though; WHO is categorizing the outbreak as 'moderate' in severity and released a statement outlining three main reasons for that categorization:
* Most people recover from infection without the need for hospitalization or medical care.
* Overall, national levels of severe illness from influenza A(H1N1) appear similar to levels seen during local seasonal influenza periods, although high levels of disease have occurred in some local areas and institutions.
* Overall, hospitals and health care systems in most countries have been able to cope with the numbers of people seeking care, although some facilities and systems have been stressed in some localities.

A key stat to keep in mind is that out of approximately 30,000 confirmed cases of Swine Flu worldwide, there have been 150 deaths. That's a death rate of about 0.5%, with many of the fatal cases including other contributing. However, the real concern about the outbreak is what happens this fall and winter, as discussed previously. Hopefully a safe vaccine will be available by then.

Swine Flu Shot

Health officials report that if production and testing continue on schedule, a swine flu shot could be ready by this October.

With more than 13,000 confirmed cases in the U.S. which have resulted in 27 deaths, a vaccine is anxiously awaited. The number of cases continues to rise and will continue to do so until a shot has been created. As discussed previously, while there the current outbreak has not be particularly deadly, researchers are concerned that this winter, when flu viruses can spread much more quickly, swine flu could become a serious problem.


The CDC's Dr. Anne Schuchat said that her agency has been providing samples of the virus to drug makers and will monitor the progress of their work over the coming weeks.

U.S. passes Mexico in Confirmed Cases

In the U.S., according to the CDC, there have 4,298 cases in 47 states with 3 deaths (AK, WY, WV, MS are the only states with any cases). This total passes Mexico's confirmed cases count of 2,446 and is more than half of the total confirmed cases across the world (7,520).

U.S. 4,298
Mexico 2,446
Canada 389
Costa Rica 8

Argentina 1
Australia 1
Austria 1
Brazil 8
China 4
Colombia 7
Costa Rica 8
Cuba 1
Denmark 1
El Salvador 4
Finland 2
France 14
Germany 12
Guatemala 3
Ireland 1
Israel 7
Italy 9
Japan 4
Netherlands 3
New Zealand 7
Norway 2
Panama 29
Poland 1
Portugal 1
Republic of Korea 3
Spain 100
Sweden 2
Switzerland 1
Thailand 2
United Kingdom 71

By State:

Alabama 9
Arizona 187
California 221
Colorado 44
Connecticut 33
Delaware 54
Florida 58
Georgia 8
Hawaii 6
Idaho 3
Illinois 592
Indiana 70
Iowa 55
Kansas 23
Kentucky 10
Louisiana 33
Maine 6
Maryland 23
Massachusetts 107
Michigan 134
Minnesota 31
Missouri 18
Montana 1
Nebraska 21
Nevada 21
New Hampshire 17
New Jersey 8
New Mexico 44
New York 211
North Carolina 12
Ohio 11
Oklahoma 22
Oregon 74
Pennsylvania 22
Rhode Island 7
South Carolina 32
South Dakota 3
Tennessee 57
Texas 293 (2 deaths)
Utah 72
Vermont 1
Virginia 17
Washington 176 (1 death)
Washington, D.C. 9
Wisconsin 496

Update: The State of the Outbreak

In our last post from Sunday, we gave an update on what was known about Swine Flu. Since then, there have been a few more developments;

Swine Flu Continues to Spread

Swine Flu / H1N1 is acting like other flu viruses and continues to infect more people. In the U.S., there are now 2,600 confirmed cases across 44 states and 3 confirmed deaths.[1] Around the world, there have been more than 4,694 cases across 30 countries[2] and it shows no signs of stopping it's growth. While it appears, H1N1 is not a particularly deadly form of flu, there are two main concerns at this point:

Will the virus mutate and become more deadly this fall/winter ?

As discussed in a previous post, it's current form does not seem to be very severe, H1N1 has the potential to mutate and become a real problem epidemic.

Why are the deaths disproportionally young ?

Another issue that continues to concern scientists is the fact that those dieing from H1N1 have tended to be young and the number is only skewing younger as time goes on.[3] Acting Director for the CDC, Dr. Richard Besser, said during a news conference that the severe cases of H1N1 were "younger than what you would see in seasonal flu. In seasonal flu you tend to see a predominance of burden of disease in the elderly and in the very young, and here we are seeing it more in the younger population... That is something that raises concern."

As this chart shows, this is a concern because this was the patterned followed by the devastating Spanish Flu. However, it's only something researchers are keeping their eye on and want to understand better. The sample size is still not very significant with relatively few deaths at this point.

[1] http://www.cdc.gov/h1n1flu/
[2] http://www.who.int/en/
[3] http://www.ajc.com/health/content/shared-auto/healthnews/cdc-/626829.html

CDC Map of Confirmed Cases

The CDC has created a map of the swine flu / H1N1 confirmed cases in the U.S.



http://www.cdc.gov/h1n1flu/update.htm

WHO says infected pork a concern

The World Health Organization said Wednesday that meat from pigs infected with H1N1 should not be eaten by humans and those animals should be kept out of the food supply. "Meat from sick pigs or pigs found dead should not be processed or used for human consumption under any circumstances," Jorgen Schlundt, director of WHO's Department of Food Safety, Zoonoses and Foodborne Diseases.

WHO clarified their stance, writing on their website, "Swine influenza has not been shown to be transmissible to people through eating properly handled and prepared pork (pig meat) or other products derived from pigs. The swine influenza virus
is killed by cooking temperatures of 160°F/70°C, corresponding to the general guidance for the preparation of pork and other meat."

Links:

WHO Swine Flu FAQ (.pdf)
CDC's Swine Flu Key Facts
Reuters WHO casts wary eye on meat...

Is swine flu a threat ? Summary of what we know

Mexico reported no new deaths from swine flu last night[1] and researchers continue to debate how serious a threat swine flu is[2], at the same time the World Health Organization is still at pandemic level phase 5 and officials say it's 'imminent' they'll go to phase 6 (their most serious level; reserved for true pandemics).[3] And it's clear from watching #swineflu on Twitter, that the public is still freaking out about it. Where does this leave us ? Here are the facts we know, with citations from credible sources:

Swine Flu / H1N1 is Real and Spreading

Swine flu is a real strain of the flu, has infected 160 people in the U.S. so far[4] and has reached Europe and Asian. It continues to infect more people and the earliest a vaccine could be ready is sometime this fall, as it will take months to create and then manufacture large quantities[5]. The virus itself is a new, unusual strain of the flu with components of the normal North American Flu, avian flu, and swine flu mixed together and therefore few people have a natural immunity to it (as they would for typical strains). This, combined with the fact that it killed a number of young, healthy victims in Mexico are what caused great concern for WHO, the CDC, and other health organizations. Each continues to take it very seriously; the CDC is recommending anyone who has had contact with someone who has the virus within the past 7 days to get tested and, if infected, treated with antiviral drugs oseltamivir (Tamiflu) or zanamivir (Relenza).[6]


Researchers are cautiously optimistic it's not a nasty virus

As covered before (read article), initial reports indicated that a high percentage of young and health victim were dieing, which mirrored the Spanish Flu outbreak of 1918. And that's where the cause for the concern is; if swine flu kills at a similar rate as the Spanish Flu, we have a real, nasty pandemic that could kill millions. However, if it turns out to be no more deadly than the normal flu, then there will be some deaths, but not significantly more than die each year from the flu normally (which, in the U.S. is about 36,000).[7]

A good sign is that the only deaths so far have been in Mexico, so it's possible that other factors besides H1N1 contributed to those deaths and the virus itself is not the threat it was feared to be. Based on it's behavior so far and from doing DNA analysis, it does not look H1N1 poses a significant threat,[8] however, the virus does seem to be targeting younger people, with the CDC reporting "very few cases of people over 50" in the U.S.[10]. In addition, there is a chance that it could mutate into a more deadly form, which is why health officials continue to take it very seriously and make preparations including creating vaccines. However, given there have not been observed mutations so far, it is increasingly unlikely it will become a significantly more serious threat than the normal, seasonal flu.

Initial Outbreak

Unfortunately, there is also concern that the initial outbreak will peter out and then this winter, during the cold weather (when the flu virus is transmitted more easily), it will come back stronger. This is the pattern the 1918 Spanish Flu pandemic followed.[9]


H1N1 does not currently seem like a big threat, but, given how bad it could be in the unlikely chance it does turn out to be more deadly than currently thought, it's prudent to take it seriously.


[1] - http://www.google.com/hostednews/ap/article/ALeqM5gzz357patY4-QaJFvo9O95zMM_EQD97U7BH00
[2] - http://www.kansascity.com/444/story/1174048.html
[3] - http://www.bloomberg.com/apps/news?pid=20601124&sid=ab1UPXgmE538&refer=home
[4] - http://www.cdc.gov/h1n1flu/
[5] - http://abcnews.go.com/Health/Healthday/story?id=7470044&page=1
[6] - http://www.cdc.gov/h1n1flu/recommendations.htm
[7] - http://www.cdc.gov/flu/keyfacts.htm
[8] - http://www.irishtimes.com/newspaper/world/2009/0502/1224245838739.html
[9] - http://en.wikipedia.org/wiki/1918_flu_pandemic
[10] - http://uk.reuters.com/article/usTopNews/idUKTRE54229K20090503

HHS and CDC Webcast

Health and Human Services Secretary Kathleen Sebelius and Homeland Security Secretary Janet Napolitano is hosting a webcast to answer questions on H1N1 / swine flu / #swineflu. They're joined by Acting Director of the Centers for Disease Control and Prevention, Dr. Rich Besser.

Let's not overreact: Some Swine Flu Facts

The incubation period for the flu is 2-5 days.[1] This means that if you went to Mexico two weeks ago and have not shown symptoms, you do not have the flu. If a co-worker went to Cancun over Christmas, she does not have Swine Flu.

You can not catch swine flu from eating pork.[2] Cooking pork kills the swine flu virus.

There are drugs to treat swine flu patients.[2] Four drugs are used to treat the flu: amantadine, rimantadine, oseltamivir and zanamivir. The recent strain of swine flu has been resistent to amantadine and rimantadine, oseltamivir or zanamivir seem to be effective.

In the U.S. alone, 36,000 people die each year of (non-swine) flu and about 42,000 die of car accidents.[3][4] With one confirmed death in the U.S. so far and 159 in Mexico, swine flu is still very low on the list of things likely to kill you.




[1] - http://www.webmd.com/cold-and-flu/news/20031205/raise-your-flu-iq
[2] - http://www.cdc.gov/swineflu/key_facts.htm
[3] - http://www.cdc.gov/flu/keyfacts.htm
[4] - http://www-fars.nhtsa.dot.gov/Main/index.aspx

Video: US Health and Human Services news conference on H1N1

U.S. Health and Human Services news conference update on swine flu:

Spanish and Swine Flu Targets 25-35 Year Olds

One of the key differences of the Spanish Flu which killed 50 to 100 million people in 1918/1919 was the fact that young, healthy victims died at a much higher rate due to the way it attacked the body. The virus causes one's immune system to go into a feedback loop called a "Cytokine Storm" in which T-Cells, which normally fight the infection, are produced at a tremendous rate and cause the victim's body to shut down. In many cases the inflammation would severly obstruct the lungs causing the face to have a blue tint. Young adults, with strong immune systems, would succumb to the flu in a matter of days, whereas, children and older adults died at a much smaller rate.



Initial reports of the Swine Flu from Mexico indicate a similar pattern of it targeting young adults as the Spanish Flu of 1918 did. This is a large part of the reason why the response from government and health officials has been so strong.

Swine Flu Google Map

A biomedical researcher from Pittsburgh has put together a great Google Map of the currently confirmed Swine Flu cases.

Links and Stats from CDC's Investigation

The CDC has posted a page about their ongoing Swine Flu investigation.

Confirmed cases as of April 26, 2009 9:00 AM ET:

• California - 7
  
• Kansas - 2
  
• New York City - 8
  
• Ohio - 1
  
• Texas - 2
  
• Total U.S. Count - 20
  

Some good news is that, according to the CDC, lab tests have shown that the swine flu virus (H1N1) does respond to antiviral drugs oseltamivir (Tamiflu) and zanamivir (Relenza).

What is swine flu ?

Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza that regularly cause outbreaks of influenza among pigs. Swine flu viruses do not normally infect humans, however, human infections with swine flu do occur, and cases of human-to-human spread of swine flu viruses has been documented. See General Information about Swine Flu.

From December 2005 through February 2009, a total of 12 human infections with swine influenza were reported from 10 states in the United States. Since March 2009, a number of confirmed human cases of a new strain of swine influenza A (H1N1) virus infection in the U.S. and internationally have been identified. An investigation into these cases is ongoing. For more information see Human Swine Flu Investigation.

(from U.S. CDC)

First Hand Accounts from Mexico

The BBC is publishing first hand accounts of the swine flu outbreak in Mexico.

http://news.bbc.co.uk/2/hi/talking_point/8018428.stm

The reports are definitely concerning. For example:

I'm a specialist doctor in respiratory diseases and intensive care at the Mexican National Institute of Health. There is a severe emergency over the swine flu here. More and more patients are being admitted to the intensive care unit. Despite the heroic efforts of all staff (doctors, nurses, specialists, etc) patients continue to inevitably die. The truth is that anti-viral treatments and vaccines are not expected to have any effect, even at high doses. It is a great fear among the staff. The infection risk is very high among the doctors and health staff.

There is a sense of chaos in the other hospitals and we do not know what to do. Staff are starting to leave and many are opting to retire or apply for holidays. The truth is that mortality is even higher than what is being reported by the authorities, at least in the hospital where I work it. It is killing three to four patients daily, and it has been going on for more than three weeks. It is a shame and there is great fear here. Increasingly younger patients aged 20 to 30 years are dying before our helpless eyes and there is great sadness among health professionals here.

Antonio Chavez, Mexico City

Public Health Emergency Declared

The U.S. government has declared a public health emergencyover Swine Flu. I've setup this blog to capture relevant, factual information.

A public health emergency isn't necessarily something to raise concern. It primarily allows different government agencies to coordinate a response.