The novel swine flu has affected its one millionth American. The first death in England has been recorded (a 9 year old girl). Yesterday, the first Brazilian death was recorded. When we look at the map of the disease, note that many regions of Africa are totally devoid of cases. Just so you know … this is not some special African immunity. This is simply because the global health network has failed Africa and we have no clue what is going on there, and never have had a clue.
A new wrinkle in the process for North Americans, possibly with parallels elsewhere, is the summer camp phenomenon. This is where we take children from multiple communities, only some of which have some dreaded disease, or perhaps just an annoying meme, and we ship them all to one location either every day for the whole day, or for weeks at a time overnight. In this way, the diseases or annoying memes can spread among them and all the children can bring them home!
Despite rumors to the contrary, the novel swine flu is roughly as deadly as the regular flu. I’m still seeing people, even experts, indicate that it is relatively mild. It is not. It is typical.
The novel swine flu seems to be affecting younger individuals in part because of an immunity found in older individuals, presumably from exposure to a similar flu in the past. This is interesting news if confirmed. This touches on another area of confusion. The 1918 pandemic flu was famous for being extra deadly for healthy individuals. This was for a very specific medical reason. The current flu seems to be affecting ‘healthy’ individuals more as well. This is for a totally different and utterly unrelated reason, probably.
This is subject to revision, but here’s the story:
The 1918 pandemic flu killed healthy people more because healthy = stronger immune system. These people were killed by the way their immune system reacted to the flu. A person with a strong immune system would be more strongly affected by the flu, possibly fatally.
The novel swine flu appears to be affecting healthy people more because healthy = younger than a certain age. That age cut off separates individuals (older) who have an immunity from prior exposure to a similar virus from younger individuals who don’t.
Again, this is subject to revision. This is subject to revision in two ways:
1) The assertion I make above about the 1918 flu is very likely true and well demonstrated, but the assertion I make about the novel swine flu is speculative at this time; and 2) the phenomenon seen in the 1918 pandemic flu, while apparently not happening with the current novel swine flu, could develop later on during the pandemic.
Why do I say that? Because that is what happened in 1918. The flu went around the world ‘off season’ (as the current flu is doing) and was typical in virtually every way but its timing. Then it went around the world again with this extra glitch of killing people with their own immune system.
The fact that the 1918 flu did this has flu experts worried, and they should be. However, I have yet to see a biological argument for why this flu should follow the same pattern in regards to this specific feature.
What is going to happen next? In late (?) September (+/-) there will be a flu vaccine available for the regular flu. Get one.
Later, maybe in October (?) there may be a vaccine available for the novel swine flu. This may be a two dose vaccine. Get it, get them both if there are two. There will be instructions as to who should get it and when. But since those instructions will be filtered through the usual sources, be careful what you pay attention to. The little people sitting at the colorful desk on the news show will not be giving you useful information. They never get this stuff right. You should rely on the blogosphere this time around, I think.
(People who have gotten the novel swine flu already seem to be immune but unless you know you had it from a clear test, I would not assume that.)
And speaking of people getting it all wrong … have you heard about any of the flu woo scams going around regarding the flu? There is a treatment in which photons are passed into your cells to kill the virus. There is an anti-flu vaccine. There is a ‘do it yourself’ flu vaccine kit, which involves you sending in your credit card number but then never hearing back from them.
Obviously, don’t fall for that.
I have a handful of comments, mostly about how what you are seeing on the news is unimportant, and one comment about why you actually should worry. Within reason.
The new Swine Flu has now been verified in nineteen US states, with 141 cases. Technically there is 1 death, but since the young girl who died actually caught the flu in Mexico (and came to Texas for treatment) it is hard to say how that should be counted.
WHO characterizes the global spread of the flu as a “rapidly evolving” situation. As of an early morning update from WHO, the swine flu has been confirmed in Mexico (156 confirmed cases) as well as Austria, Canada, Germany, Israel, Netherlands, New Zealand, Spain, Switzerland and the UK. Each of these countries has between 1 and about a dozen cases, except Canada which has 34.
Here is a brief summary of what we seem to know now.
Continue reading The Tex-Mex Flu: Current Situation
Well, at some level, you should be worrying now. This is serious. But there are a lot of other things you should be worried about as well, such as the nuclear threat and, if you live in tornado alley, tornadoes. But when do you have to start paying attention to current information, bulletins, and so on, and to perhaps start planning to alter your behavior (like, not going to Mexico, or wearing around a mask and staying in the house, or perhaps something in between)?
For the last couple of decades, perhaps beginning around the time of the publication of Laurie Garret’s excellent thesis (The Coming Plague: Newly Emerging Diseases in a World Out of Balance) on disease and politics and continuting through Gina Kolata’s “Flu: The Story Of The Great Influenza Pandemic” there has been increased attention on the 1918 flu virus and pandemic, as well as subsequent outbreaks. This interest has probably been fueled by increased knowledge of (or incidence of?) tragic and highly newsworthy outbreaks of Ebola, SARS, and so on. More recently, the perception has grown that the Bird Flu is a’comin’ any time now to ultimately replace the Great Pandemic of 1918 as well as the mud shark in our mythology.
If you read the better done public-oriented literature of this period, you will learn that the nature, cause or origin, and pattern of the 1918 epidemic has been very mysterious. The same level of mystery (but with only a few victims) arose in connection with the Swine Flu threat of the 1970s (see expecially Garret’s book for how this event links to current attitudes as well as public policy regarding vaccines).
This brings us to some time last year or so, when key papers were published (and I presume presented at conferences) regarding what may ultimately be seen as the most important single step in the history of understanding the way the flu vaccine works, and thus, how to combat it. (See this to explore one of those key moments in research history.)
The new knowledge is essentially an improved evolutionarily and developmental understanding of how influenza virus strains change over time. To put it very simply, these viruses are made of chunks that come apart in the host and then recombine. If there are multiple ‘strains’ (think species, more or less) of influenza in an individual, these genetic chinks, each representing a huge percentage of the influenza genome, can and do re-combine to form entirely new strains.
That is in a sense macro-evolution of a pathogen in situ, in the host. What is an immune system to do!?!!?!?? Not much, really. This can be very fatal.
It is now understood that these epidemic or pandemic influenza outbreaks arise from these recombination events. If you now look back at the quirky data, the odd logic influenza seemed to be patterned by, the epidemiological dead ends that seemed to confound everyone through the lens of knowledge of these genetic chunks, called “reassortants,” things suddenly become much much clearer.
A paper has just come out in PNAS reporting research using a primate model to explore immune response and associated pathology under the influence of a recombinant influenza virus, and this research is a direct outcome of this new way of looking at the flu. I offer it here without comment largely because you can get the article yourself, since this one is an OpenAccess piece from the normally not OpenAccess PNAS. Here.