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Tuesday, April 28, 2009


containment unlikely

following on the first media reporting of the swine flu outbreak that retrospectively began in mid-march around mexico city -- the bbc is reporting the comments of dr. keiji fukuda, a WHO influenza expert.

The swine flu virus first detected in Mexico can no longer be contained and countries should focus on mitigating its effects, a top UN official said.

World Health Organization deputy chief Keiji Fukuda was speaking as the WHO raised its alert level to four, or two steps short of a full pandemic. ...

Alert level four means the virus is showing a sustained ability to pass from human to human and is able to cause community-level outbreaks.

Mr Fukuda said this was a "significant step towards pandemic influenza" but a pandemic should not be considered inevitable.

Experts did not recommend closing borders or restricting travel, he stressed.

"With the virus being widespread... closing borders or restricting travel really has very little effects in stopping the movement of this virus," he said. ...

The number of flu cases under observation in Mexico has reached 1,614. Swine flu was confirmed in 20 of the 152 deaths.

Health Minister Jose Angel Cordova said all of those who had died were aged between 20 and 50. Infections among young healthy adults are a characteristic of past pandemics.

Mr Cordova said the first suspected case of swine flu had occurred in the southern state of Oaxaca but stressed that nobody knew "the point of origin or dissemination" of the virus.

He noted that the number of new cases reported by Mexico's largest government hospitals had declined during the past three days: from 141 on Saturday to 119 on Sunday and 110 on Monday.

Schools nationwide are to remain closed until 6 May as the country grapples with the outbreak.

In almost all swine flu cases outside Mexico, people have been only mildly ill and have made a full recovery.

hopefully the fairly radical steps taken by the mexican government to close schools, sporting events and other mass gatherings will minimize the outbreak.

some early assessments:

-- the fatality rate looks huge. of the first suspected 2000 or so cases there are over 150 deaths, a rate of 7%. data is partial and incomplete, though, deriving primarily from mexico at this point and will likely be heavily revised. the death rate of the spanish influenza of 1918-19 (the last pandemic outbreak of the A/H1N1 virus) was estimated to be just 2.5%. it did, however, infect up to 50% of the global population (then about 2bn), resulting in the deaths of somewhere between 20mm and 100mm people.

-- a widely-cited similarity to past pandemics is the demographic preference for those who are normally least vulnerable to influenza. cytokine storms are poorly understood but may play a critical role in killing those who would normally be thought of as the healthiest hosts. this seems to be happening in mexico.

UPDATE: here's the CDC's mainpage. last i checked, i think yesterday, there had been eight kids in new york thought to have contracted the flu while in mexico. earlier today the caseload had been in the twenties. CDC is now reporting 45 in the city alone. if this is the real deal, it will be in the hundreds very shortly.


In 1918:

In large U.S cities, more than 10,000 deaths per week were attributed to the virus. It is estimated that as many as 50% of the population was infected, and ~1% died. To compare, in "normal" (interpandemic) years, it is estimated that between 10-20% of the population is infected, with a .008% mortality.

The fact the current 'swine flu' has shown to be contagious is alarming. So far the virus has shown to have a 6% to 6.3% mortality rate. It may not seem like much, but please consider the following: The deadly influenza panic in 1918 had a mortality rate of under 1%.

This virus went on to kill tens of thousands of healthy people a day in large cities and up to 100 million people world wide.

Viruses, like this strain of swine flu, kill their host by over-stimulating active immune systems that are robust and healthy. That is why the victims in Mexico were between the ages of 20 and 45.

Some have said that no one in the United States have died from the virus, so we need not worry. Experts say it is only a matter of time. The virus is not prevalent enough to reach statistical significance in the United States, with only a handful of confirmed cases. 93.7% of all Mexicans with the virus recovered.

More cause for worry: The 1918 virus started off 'mild' before it mutated into a raging storm. It also does not mean we will see millions of deaths. It is too early to draw sweeping conclusions. Nevertheless, there is potential for a disastrous pandemic. If 50% of Americans catch this flu in the next two years, and the mortality rate stays at 6.3%, we would witness 20+ million deaths.

This strain of virus is more potent and more deadly than the virus that hammered the world in 1918 and 1919. Viruses come in waves. There are striking similarities to this virus and the virus that killed up to 100 million people in 1918. The first wave is historically more mild than the later waves.

In addition to this virus becoming more severe, it is mutating faster than previous virus that we have seen. In addition, this virus is nothing like we have ever seen before because it combines features from viruses natural in different parts of the globe. We are in uncharted territory.

If it follows the same path as the 1918 flu, we will see very damaging results. However, we must remember we are a global society now and the virus can spread quicker than we have ever witnessed in history. This is very concerning especially since the drugs we have now seem resistant.

While there have been no deaths in America, it is shadowed by the fact the common variable among the deaths seem to be age. While most American cases have involved the very young and very old (under 10 and over 50) the Mexican cases that ended fatally involved the robust and healthy (over 20 and under 45).

This virus kills the host by over-stimulating the immune system. The term that is used when the immune system over reacts is called a Cytokine Storm. It is usually fatal. During this “Storm” over 150 inflammatory mediators are released. This would account for the high mortality rate in 1918-19.

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So far the virus has shown to have a 6% to 6.3% mortality rateju, i would only say that data quality is a big issue right now. this rate is probably much too high because many cases which were not lethal never were diagnosed.

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