April 26, 2009
Posted by Jim Macdonald at 10:30 PM * 280 comments
What with headlines reading “U.S. prepares for possible swine flu epidemic as global cases rise” and “Swine Flu Confirmed in New York Students,” it’s time to talk about the disease a little more.
We’ve addressed flu before:
Why is “How To Wash Your Hands” a flu post? Because hand washing is the #1 public health measure you can take. Here’s the full list:
- Wash your hands
- Cover your mouth with a tissue when you cough or sneeze
- Stay home when you’re sick
- Avoid touching your mouth, nose, or eyes with your hands
- Avoid close contact with sick people
- Exercise, get lots of rest, eat nutritious food, and drink plenty of water
The #1 public health measure the authorities can take is close the schools.
The CDC have put up a page about Taking Care of Yourself: What to Do if You Get Sick with Flu; another page about Taking Care of a Sick Person in Your Home; and a What’s New on the Swine Flu updates page.
The CDC also has a big thing about Emergency Preparedness Kits. It’s a good starting point. A far better list is posted at Filling A Much-Needed Void.
If you want a crystal ball, I recommend The Great Influenza: The Story of the Deadliest Pandemic in History by John M. Barry. It also has a great deal of fascinating history of nineteenth and early-twentieth century medicine, and the men and women who pretty much created medicine as we know it.
Now let’s talk a little more about influenza.
The flu is a funny bug. As you know, Bob, it’s a virus, and a virus isn’t really alive. A virus is just a strand of nucleic material in a capsule or shell. It needs to find a living cell. It injects its nucleic material into the cell, and the cell (taken over by pirates, as it were) gets to work making lots more viruses.
I discussed the immune system in Why We Immunize, but I’m going to go over it a bit more here.
You must know that proteins have shapes, and those shapes are how you can tell one protein from another. Your cells are covered with protein, viruses have protein capsules, it’s all protein on the molecular level.
Your immune system (when it’s working right) recognizes self and non-self. It protects the self and attacks the non-self. It does this in a couple of ways. First, you have generalized reaction. When cells are distressed, they release cytokines, and those switch on a kind of white cell called the NK-cell. NK stands for Natural Killer (no, I’m not making this up). The NK cells find anything they don’t recognize, and, using specialized proteins, destroy it. When you’ve got an infection, those are the first things that come on line.
The next thing to arrive are the antibodies. These are specialized cells that are keyed to find one specific protein—the foreign invader protein—and destroy it. Before your body can produce antibodies, it has to have been exposed to the antigens (which is what you call non-self proteins), and be sensitized.
Meanwhile, your body is releasing enzymes, hormones, peptides, and other chemicals that act as messengers to produce various effects. Fevers, swelling, sweating, headache … all enzymes. The aching in your bones that you feel is the marrow pumping out white cells to fight the infection.
Once your body has successfully fought off an invader, the antibodies remain. If they ever again encounter proteins of the same shape, they’ll be on ‘em fast. The infection won’t have a chance to start.
Now, your influenza virus is a simple one. It doesn’t even have DNA in it. It has strands of RNA in its center. RNA mutates pretty fast. But here’s the really tricky part about the flu: it has a sneaky way of getting past the immune system, even if you’ve had the flu before. The shell or capsule that surrounds that RNA is made of two proteins, hemagglutinin and neuramidinase. Hemagglutinin and neuramidinase can move like the tiles in a sliding-block puzzle, presenting different protein shapes to your antibodies. Hemagglutinin and neuramidinase are the H and N that you see when people talk about Influenza H5N1 or H1N1 or H3N2 or what-may-have-you. There are fifteen known types of hemagglutinin and nine known types of neuramidinase, and they have subtypes below that. Those two substances keep moving around, so that antibodies don’t recognize them. This is called “antigen drift.”
It only gets better after this.
Viruses have the ability to pick up useful traits not just by means of mutation, but by grabbing them from other microbes directly—even across species lines. Flu, moreover, doesn’t have a single strand of RNA inside it—it has unconnected strands. So if two viruses infect the same cell at the same time, the RNA can play mix-n-match, take virulence from one virus and infectivity from another, and come up with something both infective and virulent. (That’s what happens when a swine flu or an avian flu gets loose: Someone has both human influenza and swine or bird influenza at the same time, the two viruses enter the same cell at the same time, and what comes out shares the worst features of both.)
As I keep saying, flu is as simple as drool. It only has eight genes in its genome. Those genes insert themselves into the living cell’s genes, and start producing viruses. In about ten hours, the infected cell explodes and releases somewhere between 100,000 and one million brand-new viruses into the body; and, through coughing and sneezing, into the world. RNA doesn’t have a checksum. And when you have unconnected strands of RNA, you have a high probability of mutation. So all of those million new viruses won’t be exact copies of the original. We’re seeing mutation on steroids, figuratively speaking. Pretty much every possible combination will be present. That means that influenza strains can adapt rapidly to different drugs, to different environments, to different species.
Other RNA viruses include measles and HIV. They’re both nasty. But HIV is very hard to catch, and measles never changes its protein shape so having once had it (or vaccination) lends permanent immunity.
Once influenza starts cooking, you have a lot of virus in your body. And this is where the swine flu gets not just miserable but rapidly lethal. Remember those cytokines, the chemicals released by cells-in-trouble that cry havoc and let loose the Natural Killer cells? Get enough cytokines going, and you’ve got two kinds of trouble. First, those NK white cells they activate are fairly large. In order for them to get to the scene of the infection, the capillaries have to be weakened so that the NK cells can pass through their walls. This also allows fluids to pass through. Your body starts dumping fluids through the capillaries and into your lungs. The ultimate effect is viral pneumonia. If it’s bad enough, you drown.
Second, NKs are very nonspecific. Their basic programming consists of “Something’s not right. Kill it.” That capillary process I just described reads a “damage” to Natural Killer cells, so they start attacking those tissues. Then they call for more help, and cells that weren’t even attacked by the virus get devastated. This feedback loop is called a “cytokine storm.” Effectively, it’s the body necrotizing itself. Once that process starts, stopping it is very tough indeed. That’s what killed so many people in 1919, particularly young, strong people with well-developed immune systems: that influenza attack was so strong that their own immune responses killed them. In some cases, the process could be measured in hours from first symptom to last. Far more, better, actual information in this post in the comment section from Nix.
You don’t need to have everyone sick in order to have a pandemic. Just having 15-40% infected will do nicely. The only question is what the mortality rate among those 15-40% is going to look like.
The next couple of weeks could get interesting. And it ain’t over ‘til it’s over.
I am not a physician. I can neither diagnose nor prescribe. I am really not a microbiologist, virologist, epidemiologist, or immunologist. These posts are presented for entertainment purposes only. Nothing here is meant to be advice for your particular condition or situation.
Flu Redux by
James D. Macdonald is licensed under a
Creative Commons Attribution-Noncommercial-Share Alike 3.0 United States License.
(Attribution URL: http://nielsenhayden.com/makinglight/archives/011241.html)
Index to Medical Posts
Flu news links:
http://scienceblogs.com/effectmeasure/
http://crofsblogs.typepad.com/h5n1/
http://pandemicchronicle.com/
...and lets all take a nice, deep breath...
Then there's this from Food Renegade -- that Mexican media are all over the connection between swine flu and CAFOs (confined animal feeding operations, or factory farms). The US media ... "What's a CAFO? Can't be important."
There's a good chance I'm getting another immunosuppressant on Wednesday and having to stay home for a long time. Bah.
Did they prepare the right flu vaccine for this year, or did this new incarnation of Swine Flu come out of left field? I'd like to think that with the coming of Spring that people would be outside more and this virus would be stopped in its tracks, but this sounds like it could be a persistent cuss. One we'll be seeing the sequel of in the fall.
The CDC also has a Twitter feed.
I've renewed my stash of cans of Campbell's chicken stock (the double-strength kind), which is our favorite sickroom food. When Patrick's ill, he likes it as chicken soup with rice. When it's me, I dissolve several packets of unflavored gelatin in the chicken stock, drink some of hot it out of my big soup mug, and pour the rest back into the soup cans to set up in the fridge for later.
I want to double the size of my chick soup stash, pick up at least one flat of the larger-size cans of V-8, and get another family-size bottle of ibuprofen.
(I don't need any more Jello. Believe me, I've got plenty of Jello. What do you take me for -- a gentile?)
I will now pass on the weirdest sickroom tip I know, which I learned from Ted White. Say you've got someone down with a nasty influenza-type respiratory infection, the kind that hurts all the time and makes them utterly miserable. If it should happen that you have the appropriate technology to administer an occasional snort of nitrous oxide, it does them no harm whatsoever, cheers them up a bit, and temporarily makes their lungs stop hurting. Even if it's just for a little while, that respite from misery can mean a lot.
Jim, Misia's list has four things on it I wanted to ask about. Are decongestants, antihistamines, cough suppressant, and/or cough expectorant there for the purpose of comfort or safety? I have all sorts of idiosyncratic reactions to medications and I have generally found these things to make me feel much worse during colds, so naturally I'm a bit dubious about their utility for me personally during a flu. Is this a problem I should seek a solution to for safety reasons? Does not having, e.g., a decongestant that works for me mean I'm at much some greater risk for fatality, or just mean I would feel extra special miserable?
I'd recommend pandemicflu.gov as a central government news source in addition to the CDC and WHO. It was originally setup for the avian flu scare, and is being updated for the current swine flu incident/pandemic scare.
As far as the efficacy of this year's flu shots, there isn't a clear answer yet because tests are still in progress at the CDC. This year's vaccine did target H1N1, but the genetic makeup of this is nasty. Besides the swine flu, it incorporates elements from three other genetic lines.
Jim, any chance you could add a Halligan Bar to the Flu Kit list? See, Patti won't let me make a Zombie Apocalypse Kit but she's all for a well stocked Flu Pandemic kit...
For the last couple of months, I've been buying $100 of food for the local food pantry. Canned food (Safeway and Green Giant -- ho ho ho -- are changing their can labels and units with the old designs are selling for $.25 - $.50!), cereal, pasta and pasta sauce.
I kind of jumped the gun on May and started buying stuff this week. I guess I'll hang on to it for a little while. What would you put in it?
* * *
#7: So you're saying that it couldn't hurt to have a case of Whip-Its in the first aid kit?
* * *
Here's a related challenge.
What would you put in a Sick Neighbor bag? Say you want to have two or three brown paper bags ready that you can drop on the stoop of neighbors who are really ill.
#10: Only Johnson & Johnson(tm) Halligan Bars in a sterile wrapper should be put in your flu kit. (J&J makes kid ones with little Spongebob stickers all over. Really cute!)
@breakingnews on Twitter (run by Michael van Poppel) is a good up to the minute source on various press conferences taking place). He seems to be doing a good job of taking questions from people and asking for answers.
Although he occasionally chooses to reTweet snarky and hyperbolic comments from other Twitterers, which is a little stupid, because occasionally his readers seem to take them seriously.
My unusual disaster kit item: Penguin caffeinated peppermints.
Chocolate Penguin caffeinated peppermints. We keep 'em in the car. Nature's Perfect Food!
Also: coconut rum is bad enough. Schnapps, well, schnapps was meant to be abused. Recently I spotted flavored bourbons: vanilla and peach. Is nothing sacred??!
Stephan @11,
As I just wrote in Pre-Pack, that's exactly how I provision my emergency pantry. What I buy is bulk (from Costco or otherwise very good prices), tasty, and won't expire for at least a year. 6 months later, I donate it.
Advantage: speed, lack of waste. Disadvantage: lump sum cost (not spread out). Neutral: my personal budget, because I already have food donations in it.
Canned foods tend to not have many calories, though. My plans include using one can of soup (300-600 calories) to flavor pasta (1600 calories/lb) or rice. I also have a pressure cooker, so I can quickly make dishes from dried beans. This way the price/serving stays reasonable.
I also get inexpensive shelf-stable premade Indian, Thai and other foods (Trader Joe's Jaipur Veggies [340 calories/package] and even cheaper types from the local Indian grocery stores). I find that they're better than canned foods for being ready-to-eat at room temperature (if necessary) and for flavoring a big batch of rice or pasta.
Much thanks, Jim. Mom and I are both looking it all over; I was delighted to find that as of tomorrow's grocery delivery, I'll have a complete flu pre-pack's worth of stuff, along with other general goodness.
#8:
Aside from specific anti-virals, the way you treat a flu is symptomatically. Those are all things that can keep the airway clear.
Let your conscience (and your particular medical condition) be your guide.
A reliable source from Mexico City has stated that the cartels are responsible for the outbreak. Spreading a mutated virus from the air by helicopter to weaken the Calderon administration
bassguy @18 -- do you have a source for that?
I would expect that a Sick Neighbor kit would have the same load-out as the Filling A Much Needed Void flu kit.
Or some subset thereof.
Leighton #19: bassguy @18 -- do you have a source for that?
I've read a second-hand report that one of the people making this allegation is Wayne Madsen. Good luck on trying to find a conventional source of the allegation that purports to reveal names.
Weaponized flu virus has been on the wish list of evildoers for a while now. I expect that this idea will gob on the online carpet every time someone gets the sniffles.
Earl Cooley III @21
Yeah -- that was my thought.
Pedant point: while a handful of the intercellular messengers that signal infection and control immune responses are enzymes, most of them are not enzymes, because they do not *catalyze* chemical reactions.
Non-enzyme messengers include peptides, among these all of the cytokines (interferon, TNF-alpha, and IL-1 and all of the other interleukins). Other non-enzyme messengers are not peptides, including the prostaglandins and the glucocorticoids.
Here's some more reason for concern. In two years, endemic seasonal H1N1 in the United States has gone from ~12% oseltamivir (Tamiflu)-resistant to 98.5% resistant this year.
Reference: JAMA.
The other neuraminidase inhibitor besides tamiflu, zanamivir, is in relatively short supply. Endemic seasonal H1N1 in the U.S. is also 98% resistant to the second class of drugs, the adamantine ion channel inhibitors.
As Jim points out, flu viruses are good at recombining, especially with very similar viruses. The bad news: the Mexican strain is also in the H1N1 subgroup. So, while news reports indicate that the Mexican strain is still Tamiflu-susceptible, it is unlikely to remain so...
Bassguy @18: as someone who has spent a *lot* of his career at the bench working on the molecular bases of microbial pathogenicity, I think that that allegation is preposterous and foolish.
Wyman Cooke @ 5. Nothing to do with the vaccines and their efficacy; this is a new assortment of virus.
General: best place on the 'net to keep of an emerging infectious disease such as this is, in my opinion, ProMED-mail (www.promedmail.org/).
"ProMED-mail - the Program for Monitoring Emerging Diseases - is an Internet-based reporting system dedicated to rapid global dissemination of information on outbreaks of infectious diseases and acute exposures to toxins that affect human health, including those in animals and in plants grown for food or animal feed. Electronic communications enable ProMED-mail to provide up-to-date and reliable news about threats to human, animal, and food plant health around the world, seven days a week. "
You get the major news reports together with sensible comments from moderators who know what they are talking about (e.g. the post "Influenza A (H1N1) virus, human: worldwide" - Archive Number 20090426.1577 has a section at the end starting "The media feeding frenzy" with a summary of the present situation, without hype, and with good comments).
Also, they have links back to previous related posts and Archive Numbers mean you can go look at the info. again, any time (even years later) - it doesn't disappear because the website had a reorganisation.
Spiny Norman @ 25 -
Bassguy @18: as someone who has spent a *lot* of his career at the bench working on the molecular bases of microbial pathogenicity, I think that that allegation is preposterous and foolish.
While IANAMB (I am Not a Microbiologist), from a security and newshound standpoint, I would need to see a whole lot of verifiable information to treat that allegation with anything more than "shyeahh, right" levels of disbelief. (this is not a reflection on you, Bassguy).
"Narcotraficante Cartels" are the new Terrist in the eyes of our media overlords - a real problem, rapidly being blown into the Source of All Evil in the world - but, in terms of effective weapons in a drug war, a bioweapon has to rank about five grades below Harsh Language* in terms of how useful they're going to find it, versus the amount of hellfire and brimstone it will bring down on their heads when discovered.
I suspect the Usual Suspects are, naturally, going to blame their Usual Suspects for the outbreak, especially if it gets bad - homophobes will be sure teh Gays have something to do with it, Glen Beck, et al, will blame (probably is blaming, the stupid shit-eater) illegal immigrants, there will be Very Earnest Young Marxists on the street corners informing us that it is All A Government Plot, etc.
But, really, we seem to go about forty years between pandemics - the last really bad influenza outbreak was Hong Kong flu, back in 1968. So, statistically, we're due.
And this one looks like it's been caught pretty early (for certain values of "pretty early" - first cases apparently reported in March). So who knows? It's likely to be worse than Avian ended up being (because it already is), and maybe worse than SARS (which had only 8 cases in the US, but over 700 fatalities worldwide) - but that leaves a whole wide range of bad before we get to Spanish Flu level bad, let alone the "empties the cities" levels that the survivalists will doubtless be expecting.
*(at least with harsh language, the dude on the other side of the street might get so enraged about what you called his mother that he forgets to look both ways while crossing the street to kill you that he gets flattened by a cross-town bus, or something. And that would look like an accident).
Another vote here for PRO-MED mail, a website run by ISID (International Society for Infectious Diseases).
To add to all the useful references with a completely useless but entertaining one: http://xkcd.com/574/
"The #1 public health measure the authorities can take is close the schools."
Is closing the schools dramatically more effective than closing work-places or malls?
Johan @ 30: Amazingly, yes. Schoolchildren pay less attention to hand-washing, tend to wipe their noses without using appropriate technique, and generally share germs with enthusiasm. Plus, the older kids are coming from a wider area of dispersal, as well as a wider range of socio-economic status, so germs mix nicely there.
Closing schools also has the benefit of keeping more adults at home, simply to watch the kids, because the daycare and other options also close when the schools do (at least in a lot of places it's set up like this). It makes the adult population less mobile, which is essentially a quarantine.
Finally, in a pandemic situation, " The clinical disease attack rate will likely be 30% or higher in the overall population during the pandemic. Illness rates will be highest among school-aged children (about 40%) and decline with age. Among working adults, an average of 20% will become ill during a community outbreak." (Flu Plan) You want to keep your target population out of harm's way.
Scott @27 The anti-vaxxers are already blaming flu vaccination as a possible cause, not withstanding the 1918 pandemic.
Elaine @ 32 -
Scott @27 The anti-vaxxers are already blaming flu vaccination as a possible cause, not withstanding the 1918 pandemic.
Not surprising. Stupid f**kers.
Siderea @8: It depends -- my internist recommends decongestants and expectorants, but nixes antihistamines and cough suppressants.
The problem with antihistamines is that they can be excessively drying, which can block the sinuses and voila! cause a sinus infection. From experience, I can tell you that a cold/flu that turns into the sinus infection from hell is not something I desire to repeat.
After several years of trial and error, I've found that Mucinex works best for me -- and in my case works like a decongestant as well as being an expectorant.
Re: cough suppressors -- Use only if you are down to a dry non-productive cough. The last thing you want is to stop your lungs from moving the mucus out.
If you are using OTC combination remedies (like Theraflu) keep track of what drugs are used in them so that you don't give yourself an overdose.
General flu question - what is the incubation period from infection to symptoms?
I just got back from Cozumel (which is nowhere near the epicenter of the infection, I know) a week ago today. So, at what point would I consider myself clear - at least from that trip?
(Yeah, mild case of hypochondria working here - sorry.)
The incubation period of influenza is one to five days, but generally two days.
Jim - thanks for the info. I thought it was quick, just didn't know how quick.
It's annoying that this thing hit just as hayfever season is starting. Occam's Razor and that yellow haze on my car say that my sneezing and watery eyes are being caused by trees having sex, but every time I do sneeze I have that momentary panic moment.
When you're using OTC drugs, one ingredient to look out for is acetaminophen. It's in an awful lot of things, and you really don't want to overdose.
Thanks for the update. As soon as the news broke, I came to ML for useful information and the dulcet tones of reason.
I'm scheduled, this afternoon, to attend class in an underventilated room with about 18 high-school teachers who all teach in Queens. I have an autoimmune disease, and I'm beginning to wonder if it would be silly to attend class until it's clear how quickly the virus is spreading in Queens schools, particularly since many of the 100+ St. Francis kids suspected of having the flu have been wandering around seeing their friends over the weekend.
Argh. This sort of fussing isn't my style.
Sneezing is rare in flu. Fever and body aches are nearly universal.
Sneezing is nearly universal in hay fever. Fever and body aches are rare.
So you can be guided by that.
I would add, if you do get sick with a virus, stay warm. The chemical reactions the virus depends on to reproduce become less efficient at higher temperatures. In other words, if you have a virus, running a fever is a good thing, as long as it doesn't get so high as to be life threatening (see: body turns on itself). Also, resting when sick is really important. Your body is working really hard fighting the virus. It really bugs me to see people coming in to work sick with colds and common flu, because not only are they risking their coworkers, they are likely prolonging their own sickness and misery. It's better to focus as much as you can on getting well and get it over with quickly.
Caveat: This is totally my personal opinion, not medical advice. Take with a grain of salt and call me in the morning.
For sinus problems, I highly recommend the saline flush (aka neti pot). Recent studies are showing this has benefits besides physical removal of gunk; it also moisturizes the nasal mucosa (unlike medications which tend to dry things out) and is likely to reduce bacterial (or viral) populations. Somewhere around ML is a description of how to make the rinse -- it's 1/4 teaspoon of salt in 1 cup (250 ml) warm water. The amount of salt is critical; the origin of the salt isn't -- I routinely use table salt (iodinized) because iodine is also a mild antiseptic.
When you do it right, there's no stinging or really much of any sensation except water flowing out the nose. I am using it several times daily to keep the pollen out, which has decreased my daily consumption of ibuprofen, which can only be beneficial to my liver.
Chris 35: (Yeah, mild case of hypochondria working here - sorry.)
As soon as I read the symptoms of hypochondria I knew I had it.
I'll second the neti pot recommendation! Since the pollen has been in overdrive the last couple of weeks, I've been using mine every evening.
Also, change your pillowcase frequently -- pollen from your hair will collect on the pillow, and if you change position during the night, it gets on your skin (itchy), or you breathe it in (worse).
"Bruce Sterling's sensible perspective on swine flu" on PNH's Sidelights is coming up 404 from Wired, and didn't come up in a search there.
Sometime yesterday Bruce Sterling's Beyond the Beyond blog at wired.com lost all of its posts back to the middle of March. I'm hoping it was a technical flail somewhere that will be restored soon.
Comment 24 expressed concern that Tamiflu was becoming less effective. On a related note, my mother forwarded an alarming note from her community of wingnuts, warning that Tamiflu was about to become less available, so they should stockpile it. (And also buy warehouses full of star anise, in order to extract the active ingredient from which Tamiflu was originally made.) My mother intended to express concern for my health, in her way, for which I thanked her. And I decided some time ago that 1) it's better for her to connect to a community of angry, paranoid, wingnuts than for her to be angry, paranoid, and completely isolated. and 2) I can't stop her.
But about Tamiflu. How important is it, clinically? How much trouble is it worth to have the flu for 6 days instead of 7? Or to trade a lower risk of secondary infections (ear infections, pneumonia) for Tamiflu side effects (which include nausea, dizziness, and a risk of bronchitis)? It seems like something that has substantial value only in specialized situations, like for immunocompromised patients. Am I missing something?
Or is Spiny Norman talking about a problem like the first cases of MRSA in hospitals? Methicillin was not a common antibiotic; it was used for nasty bacterial infections that resisted all the usual antibiotics. It's a tool you want to have in the toolbox all the time, ready for infrequent but stunningly effective use. It's scary to have it suddenly stop working, but I'm not sure if the Tamiflu thing is "it stopped working" or "it's a different problem, where this tool never did work."
David Wald @ 29: I see your xkcd and raise you Two Lumps: http://twolumps.net/d/20090427.html
Bruce Sterling's post cached here.
Another source of info synthesis is Effect Measure at the ScienceBlogs network. Those folks are public health professionals.
Xopher @44, As soon as I read the symptoms of hypochondria I knew I had it.
Naah, you're just talking yourself into thinking you have it!
I can third the neti pot. I haven't read the research on other effects, but the physical removal of gunk is enough for me. The last time I had a nasty head cold, using a neti pot let me breathe freely for a good 15-30 minutes before my nose re-clogged, and it was like heaven.
The big trick to using a neti pot, for me, was to press my tongue up against my soft palate as though saying "ing."
There is not a run on the pharmacies here in NC. I was at CVS yesterday and Target pharmacy today (yesterday to pick up a few OTC meds; today to actually pick up a prescription), there were no extra customers, and everything was in stock. I'm gratified to see the lack of panic. (I was envisioning the kind of run on the grocery stores we get when snow is forecast: shelves completely empty of bread and milk, except in this case shelves completely empty of Tylenol.)
Regarding Tamiflu, I think the advice in this post over at Shakesville is good: When is it sensible to take an antiviral? When it is part of the public health measures to contain an outbreak.
I'm beginning to think that a lot of this media hysteria over the so-called "outbreak" of swine flu is just, that, hysteria.
1) 36,000 people in the US alone died last year of the usual strains of flu. Swine flu deaths in the US this year? Zero.
2) This version of the swine flu appears to respond to various treatments, including Tamiflu.
3) Everyone that has caught it in the US is recovering. No deaths have been reported.
4) Anyone think that Mexico's health care, or their public health in general, is anywhere close to the US' population? Could that be at least part of the reason behind their deaths and our cases being described as "mild"?
Yes it's sad that nearly 100 people in Mexico have died of this disease, and it does appear to be spread around fairly quickly. But, swine flu 2009 is not necessarily the same flu that was going around in 1918, or any other year of a huge outbreak. I keep seeing media articles about "OMG swine flu!" and lots of sensational numbers and reporting, but dig down and there's little behind the stories but stuff designed to sell articles.
#48 Heck, I was reading comments from wingnuts months ago about how they were planning to stockpile Tamiflu and guns.
Because given a choice between a case of chicken soup and an assault rifle for fighting off a viral disease you know what I'd choose....
Well, yes, but gnus are the cure for anything.
I am bemused to find that the useful H5N1 blog comes from sf writer Crawford Kilian.
Well, yes, but gnus are the cure for anything.
I am bemused to find that the useful H5N1 blog comes from sf writer Crawford Kilian.
John L @ 54: The interesting part of this outbreak is the new combination of avian, swine and human influenza genes. That, plus the rapid rise in cases, makes this a public health emergency. Secondly, the Mexico health authorities are reporting only those cases that have ended up in a hospital (i.e., have more severe signs), so they are (1) over reporting the severity and (2) under reporting the incidence of illness. They should be reporting all cases of the flu, but that may be difficult for them to do.
In this country, and in Canada, and probably the other countries as well, we're reporting all the cases of confirmed swine flu, not all the hospitalized cases, so we're not overreporting severity.
In any case, this is a good test of the pandemic warning system.
I believe Mr. Mcdonald has covered why the swine flu is so "scary", but here's a recap: pigs are mixing vessels for avian and human influenza viruses as well as their own flu. This means reassortment of the genome can occur very quickly in a few pigs, resulting in a brand-new influenza with human, swine, and avian genes. That means you have another potential 1918 outbreak, only with modern transportation to assist the virus in its world-wide spread.
Just because the media is hyping this outbreak doesn't make it meaningless. There's all kinds of lessons to be learned -- the Hong Kong and mainland Chinese governments are already demonstrating the lessons they learned from SARS.
Here's my question: if this current flu variation induces cytokine storms, the way the 1918 flu is thought to have done, and results in the same sort of "death within 24 hours of onset of symptoms" reported with the 1918 flu, are we actually any better equipped to handle it now than we were in 1918?
Yes, we have Tamiflu -- but if the strain kills that quickly, are people going to have the chance to GET Tamiflu? Are there other treatments available to counteract cytokine storms, and will it be possible for people to get the treatments as soon as they're needed? With most seasonal flus, it seems like if you miss the window for antivirals, the answer is supportive treatment (which hasn't changed much since 1918, unless you get dehydrated enough to need IV fluids, or you feel like getting nitpicky over aspirin vs. ibuprofen vs. paracetamol/acetaminophen) and monitoring/treating secondary infections (which HAS improved since 1918, yay antibiotics). But if this is one of the kills-healthy-adults-in-24-hours varieties, can we do anything about it?
That's what worries me.
But, do we have ANY evidence that this strain of flu does indeed kill healthy adults?
I'm taking anything said by the Mexican health officials on this subject with a grain of salt; if it is as dangerous as they're trying to make it out to be, where are the US fatalities, or for that matter, any other nation?
This flu may be one that the various immunizations don't work on, but that's typical each year, and while it may get spread around easier, its lethality in a 1st world country doesn't appear to be any worse than any other strain of flu.
Madagascar has already closed its port.
(Note: This is not actually true. It is a reference to the game Pandemic.)
John L. @54, I'm beginning to think that a lot of this media hysteria over the so-called "outbreak" of swine flu is just, that, hysteria.
A long time ago, I've begun to think that whenever someone uses either scare quotes or the term "so-called", this is a very bad sign, and that this goes double so when the two are combined. Frankly, I wonder why noone has come up with a variation of Godwin's Law for the 'so-called "(something)"' construction yet.
1) 36,000 people in the US alone died last year of the usual strains of flu. Swine flu deaths in the US this year? Zero.
That's two factoids carefully cherrypicked out of all the available information. Almost like "The Inquisition didn't kill anyone." (Sure, it officially declared a lot of people heretics in times and places when the secular authorities had a habit of killing people who had been declared heretics, but technically, the Inquisitors themselves didn't kill anyone.) The whole thing has only been noticed on Friday. "Noone died of this in the four days since we noticed it" is not exactly a good point.
2) This version of the swine flu appears to respond to various treatments, including Tamiflu.
That's good news. It does not mean that everything is sunshine and flowers and bunnies.
3) Everyone that has caught it in the US is recovering. No deaths have been reported.
At this point, "everyone who has caught it in the US" is a pretty small sample size.
4) Anyone think that Mexico's health care, or their public health in general, is anywhere close to the US' population? Could that be at least part of the reason behind their deaths and our cases being described as "mild"?
Of course. So?
But, swine flu 2009 is not necessarily the same flu that was going around in 1918, or any other year of a huge outbreak.
Err, every outbreak of flu is different. No two flus are the same. Which you would know if you had bothered to learn some basic stuff about health, or if you had bothered to read the post at the top of this thread.
I keep seeing media articles about "OMG swine flu!" and lots of sensational numbers and reporting,
Judging from your comment and most other comments in this thread, you seem to rely more on media reports to form your impression of this whole thing than anyone else here. Which makes it pretty unimpressive when you act as if you're the only one here who gets information from other sources than the media.
John @60: Most of the deaths reported in Mexico are adults aged 20 to 50.
Rikibeth@59: It isn't yet clear how quickly death occurs, though. We do have a few advances on 1918 that might help at least a bit; various immune-suppressant medications and intubation spring to mind. The reports out of Mexico don't quite sound like that 1918 degree of "couldn't get to the hospital on time," to me.
Anyone else have better data?
Don't listen to the nay-sayers. Assault rifles can provide immediate full symptomatic relief of all flu symptoms. You know all those times you were lying there with a fever and headache and muscle aches, and you said "I wish I were dead?" There you go, instant relief!
Note: this post should not be construed as medical advice.
Any ideas about what a pregnant woman might do to prepare for a pandemic that overloads the hospitals, aside from trying really hard not to get sick in the first place? My understanding is that pregnancy is a risk factor for needing to be hospitalized with ordinary flu. And from what I can tell, both the antivirals (Tamiflu, etc.) and many of the symptom-mitigating medications (with the exception of acetaminophen) are contraindicated in pregnancy. And high fevers may be associated with birth defects. Aside from all the standard preventive and preparatory measures, including being especially careful about handwashing and avoiding sick people, is there anything a pregnant woman specifically should be doing?
#46, #47:
Via email from bruces:
"*They're migrating everything. Also, my laptop broke and I'm getting a new one. Pluto must be in the House of Saturn or something."
* * *
I had a dental exam and cleaning this morning. I joked with the hygienist, reassuring her that my stuffy nose and sneezing were due to allergies and not swine flu.
"Swine flu? What a silly name! You're making that up, right?"
She hadn't heard of the outbreak.
Rikibeth @59 asks: Are we actually any better equipped to handle it now than we were in 1918?
We know what is going on to a much higher degree of precision. Here's a quote from a paper on the CDC's web site:
In 1918, the cause of human influenza and its links to avian and swine influenza were unknown. Despite clinical and epidemiologic similarities to influenza pandemics of 1889, 1847, and even earlier, many questioned whether such an explosively fatal disease could be influenza at all. That question did not begin to be resolved until the 1930s, when closely related influenza viruses (now known to be H1N1 viruses) were isolated, first from pigs and shortly thereafter from humans.
And we have the Internet and other modern communications tools. These are not trivial advances. As a commenter on TPM just pointed out, we're less than a month since the first report of this flu in central Mexico and we've got half the world obsessively washing their hands. Our warning and tracking systems are a lot better than the ones they had in 1918.
From PRO-MED Mail:
At least 62 people have died from severe pneumonia caused by a flu-like illness in Mexico, WHO says. Some of those who died are confirmed to have a unique flu type that is a combination of bird, pig, and human viruses. The virus is genetically identical to one found in California. US authorities said 8 people were infected with swine flu in California and Texas, and all recovered.
*********
As of [26 Apr 2009], the United States Government has reported 20 laboratory confirmed human cases of swine influenza A/H1N1 (8 in New York, 7 in California, 2 in Texas, 2 in Kansas, and 1 in Ohio). All 20 cases have had mild influenza-like illness with only one requiring brief hospitalization. No deaths have been reported. All 20 viruses have the same genetic pattern based on preliminary testing. The virus is being described as a new subtype of A/H1N1 not previously detected in swine or humans.
Also as of 26 April, the Government of Mexico has reported 18 laboratory confirmed cases of swine influenza A/H1N1. Investigation is continuing to clarify the spread and severity of the disease in Mexico. Suspected clinical cases have been reported in 19 of the country's 32 states.
*********
In an earlier posting, this moderator pointed out that the reported cases in Mexico were hospitalized pneumonia cases, with surveillance data coming from inpatient facilities. In contrast, the information on the reported cases in the USA involved surveillance data coming from outpatient facilities. This difference in sentinel reporting sites biases reported cases in Mexico to be more severe cases as they are cases that were severe enough to merit hospitalization. In turn, the use of outpatient sentinel surveillance sites in the USA leads to a bias selecting milder cases -- those that do not require hospitalization. One suspects that once the countries heighten ILI surveillance to include both inpatient as well as outpatient facilities, these disparities will lessen. One also suspects that the true number of cases in Mexico is significantly higher than the currently reported approximately 1500 cases, which would further lower the calculated case fatality rate (CFR). (Information on the actual number of reported cases in Mexico is not readily available on the Ministry of Health website, so all figures are estimates based on earlier figures provided in CDC and WHO reports and on newswire reports. Hopefully these figures will be available on a regularly updated basis to permit following the course of the outbreak).
Hi everyone, I'm posting from Canada, a few hours drive from Toronto, one of the SARS "hotspots".
I'm mostly posting to report on the general mood around here, which is a combination of alarm and "Well heck, we know what to do with flu here!" That last one is probably bravado.
I'm also kicking myself, because just last week I was congratulating myself on escaping yet another flu season unscathed... As an asthmatic and a gal with chronic sinusitis, the prospect of the flu right in the middle of my allergy season fills me with horror.
I don't really care if it turns out to be "just" flu, rather than OMGWTFBBQFLU. I Don' Wannit either way.
Fortunately, this isn't flesh-eating demon flu that can drill through walls or follows me down dark hallways to mug me, so if I've survived this winter by keeping my hands clean and not touching anyones runny-nosed kids, I should make it through the new outbreak too. *crosses fingers*
Thanks for this lovely, sensible post. I just wrote an exam this morning on this very topic. You've gotta have respect for the virus, it's an efficient little thing.
Scott Taylor #27: Michelle Malkin is already blaming "uncontrolled immigration" for the swine flu, thank you. She's also extremely angry that Democrats have dared to point out that Republicans stripped out funding for pandemic prevention from the stimulus package. That's just mean of the Democrats, since such money was wasteful spending (until it suddenly became necessary, whereupon fiscally sensible Republicans would have magicked it out of the alternative universe where they keep their brains).
The 1918 Pandemic had total death rates of over 20% in some places. It did vary.
Clearly, it's nothing like as bad in Mexico.
Will the better flow of information let us fight back effectively. The wartime secrecy of 1918 might not have made much difference, but we routinely produce a lot of influenza vaccine, every year. Trouble is, even the latest, least tested, production methods need three months.
We travel differently than in 1918. We will have vaccines. It's a race, but I have an uncomfortable suspicion that the USA imports too much across the Pacific through ports in Mexico.
Tamiflu is Oseltamivir
Zanamivir is Relenza
Well, I've been sneezing and coughing like mad since Thursday. Fortunately swine flu hasn't spread to Bedfordshire and thanks to my hospital-grade pollen filter I can be sure this isn't hay fever either: just a particularly unpleasant cold caught from idiots at work who came in despite it (*AGAIN* despite my begging them not to: every time they do it and every time I catch it, I wonder if they even what contagion means).
TomB@#42, it's not just reduced efficiency: it's also that infected cells tend to die (much) faster than other cells when the temperature rises, because they're so busy making new virus that they can't spare any time to uprate their production of heat-shock proteins.
And, despite my rant above, I'm astounded that anyone needs advice to go to sleep when ill. I find it physically impossible to do anything else. The fortitude (and stupidity) of the people resoluted ignoring their immune systems screaming at them to SLEEP NOW amazes me. Do they think their immune systems are going to be wrong, or just that infecting everyone is less important than that quarterly report?
Jim, a few piddling corrections, if I may. None affect the entirely accurate thrust of your article.
The NK cells find anything they don’t recognize, and, using specialized proteins, destroy it.Well, no. Cells routinely chop up random proteins from inside themselves and display fragments of those proteins on their surfaces, so if you get virally infected, viral protein will soon be displayed on the surface of the infected cells. But NK cells seem to use indicators from the cell or its neighbours that 'all is not right, I am severely stressed': cytokines, interferon, a few specific markers common to prokaryotes or viruses but not animals. They don't look for anything they don't recognize or they'd be killing virtually everything. (This is an area of active research and still somewhat unclear.)
Once they've spotted something suspicious they kill it, generally by engulfing and lysing it (mostly by throwing a bunch of the same machinery at it that cells use to degrade broken protein, but also throwing things like acids at it, in tiny quantities of course). (NK cells are quite large, and can gang up on things bigger than they are.)
The next thing to arrive are the antibodies. These are specialized cells that are keyed to find one specific protein—the foreign invader protein—and destroy it. Before your body can produce antibodies, it has to have been exposed to the antigens (which is what you call non-self proteins), and be sensitized.
The B cells that secrete antibodies spend much of the period before puberty replicating in your lymph nodes. But this isn't ordinary replication. The region which codes for the shape of antibodies (the 'B cell receptor locus') is intentionally and repeatedly damaged by the cells themselves using machinery stolen from ancient viruses before the mammals were heard of. The damage is fixed by error-prone repair mechanisms, so that the region's chance of mutation is maybe a hundred thousand times greater than it would otherwise be. This pushes up the mutation rate to such a degree that virtually every B cell produces antibodies matching a different antigen.
This 'hypermutation' produces a vast number of B cells which can match just about every invader you could possibly imagine... and most of yourself, as well. So the best current understanding (last I heard) is that they spend some time wandering around lymph nodes in e.g. your appendix, trying to match everything they can, and if they match anything in this time period, they assume themselves to be a false-positive match against your own body or something common and harmless in food, and kill themselves. This particular phase stops at puberty, or slows to very low levels, presumably on the basis that you've got a reasonably complete coverage by then, and that keeping hypermutating just raises the likelihood that something will end up tuned against self anyway, by chance, and give you an autoimmune disease.
So you end up with a vast number of latent B cells which match pretty much everything you're likely to come into contact with (and hopefully not yourself, or grass pollen), all indicating on their surfaces what sort of antibody they could produce. They wander around in the bloodstream for decades, replicating occasionally in a non-hypermutating way.
Now, when infection happens, antigen-presenting cells (such as macrophages) soon encounter cells infected with the virus showing signs of damage, or the debris of such cells after virus has burst from them. These cells engulf the fragments and present them to any cells in the adaptive immune system that they may chance to meet, on their surfaces (attached to a marker that says "hey, we're not an attacker, just showing you one"), in conjunction with a tremendous variety of other signalling molecules, thus activating them. This isn't just B cells: the adaptive immune system is bewilderingly complicated and there are dozens of players.
Sooner or later, an activated antigen-presenting cell runs into a B cell, out of the horde, capable of producing an antibody that can come close to matching the piece of viral wreckage it's presenting. It doesn't need to be a perfect match, because what the B cell does then is turn on its hypermutation and replicate *again*, hunting for a perfect match. Soon enough, it finds it, and all the failed copies die. Then the B cell, now a perfect match for the attacker, starts replicating like crazy *without* hypermutating, until there are lots of them. Some of the daughters start spitting out antibody (these kill themselves when the invader is gone), and some become memory cells, like their parent, except finely-tuned. This cycle keeps happening as long as the invader is present: each time it happens, more of the offspring become memory cells, strengthening future responses.
Most of these cells other than memory cells also turn into antigen-presenting cells themselves, so the whole thing keeps getting exponentially faster until either the invader is dead or you die from immune overreaction :/
Antibodies help kill infected cells in several different ways. Firstly, they directly bind to any pathogens that happen to replicate outside the cell (i.e. not viruses), tending to cause them to clump together in giant lumps that can't infect anything. Secondly, they bind to infected cells and act as a signal to phagocytes to 'eat me', turning the hugely-variable signal of the antigen into a constant signal that even something as stupid as a phagocyte can grasp. Thirdly, they trigger the formation of 'membrane attack complexes', which are essentially protein rings holding open holes in the cell membrane. Punch the infected cell full of enough holes, and it dies.
Sorry, I think this is really cool so I can't stop myself going on about it.
Meanwhile, your body is releasing enzymes that act as chemical messengers to produce various effects. Fevers, swelling, sweating, headache … all enzymes.
Well, they're mostly not enzymes. They're mostly extracellular messenger molecules which trigger cells to produce enzymes themselves. Signals, not machines.
I see one of the largest barriers to flu preparation are companies with a policy of zero or fake sick leave for service workers and other public-facing people.
Far, far too many workers know that taking a sick leave day significantly increases the risk of being fired, whether or not that day is paid.
If a person is feeling slightly under the weather and should take a day off to see if it is going to get worse, company policies make this impossible.
As an example, look at the fight in San Francisco about restaurants having a paid sick leave policy. Because how could it possibly matter if restaurant workers have no choice about coming in to work sick?
And then there's the even larger problem of what happens when schools are closed.
There are also companies with a gung-ho "never say sleep" culture, but that's culture not policy.
My only worry about getting sick enough to be bedridden is who would walk the dog. She's a one-man beast . . . might have to pop her in the kennel for the duration. (The kennel owner gets along fine with her.)
Can dogs transmit influenza?
Stefan - dogs can catch influenza from horses and get very sick with it. I don't think they can catch Type A influenza, but they could transmit it on their fur just as easily as a human can with their hands.
More so, because a coughed-over dog is more likely to get a stranger hugging it and rubbing their face in their fur than you are going to get a stranger hugging your hand and rubbing their face on it.
In that xkcd I love "How long before the swine flu reaches me in Madagascar?"
The swine flu is never going to reach you in Madagascar. Madagascar already closed its port.
Syndaryl @ 77: Canine influenza (H3N8) is indeed an equine influenza that mutated into something infectious to dogs, but it is not the same thing as a dog getting sick with equine flu. A horse with equine flu will not make a dog sick, and so on. The dog has to catch the canine (mutated) flu virus in order to get sick.
In fact, the mutation of equine into canine influenza mirrors the mutation of avian into human influenza. Many changes must occur for the influenza virus to jump species. There's a list of about 10 specific items that a non-human influenza needs to change in order to become infectious in and transmissible to humans. So far, avian influenza H5N1 has not made all those changes, and it might never become the pandemic flu that we all feared. It certainly looked scary for a while, though.
The new recombinant H1N1 influenza (Mexican Flu, Swine Flu) is a mixture of avian, swine and human genes, and is transmissible from person to person. In contrast, "bird flu" (H5N1) has not demonstrated person-to-person spread, not widely. (Every case of bird flu in people has been connected to an exposure to some bird species.)
Dogs cannot get sick with human influenzas, and vice-versa. Mainly, this means your dog has no sympathy for you loves you madly and really needs to be walked right now, even when your fever is raging. (Note: so-called feline influenza is not even an influenza virus. Cats have no sympathy at all for your weaknesses.)
Nix @74: It is really cool.
One question, though. When you say:
It doesn't need to be a perfect match, because what the B cell does then is turn on its hypermutation and replicate *again*, hunting for a perfect match. Soon enough, it finds it, and all the failed copies die.
How does that work? How do the failed copies know that it is time to die?
Obviously "we don't know" is a perfectly valid answer. (There are many impressive things about the immune system, but one of the most impressive is the sheer amount of work required to formulate and confirm each sentence of your explanation.)
If Madagascar does manage to close its port and if the rest of us all die horrible deaths, I wonder if that means that the earth will be repopulated by a strange human-lemur hybrid. Because I'd like to be half lemur.
Also, Gods from Madagascar? Pretty damn weird. In an awesome way.
/shakes fist at Madagascar
ALWAYS getting stopped by Madagascar. Grrrr!
For years (well, ok decades), my first line of defense when starting to feel under the weather is a brutally hot bath, for as long as I can possibly stand it.
I then bundle up in a robe and drink chicken soup.
I've always thought of it as kick-starting a defensive fever.
John L@60
I'm taking anything said by the Mexican health officials on this subject with a grain of salt; if it is as dangerous as they're trying to make it out to be, where are the US fatalities, or for that matter, any other nation?
The Mexican public health system may not be up to US standards in some ways, but I don't see any reason to doubt that (a) people died, (b) they had influenza, (c) they were previously healthy adults or (d) that this is H1N1 flu.
The first three are within the competence of pretty much any health system in the world, and the last has been confirmed by CDC, who are among the top world experts. Now, there hasn't been an H1N1 flu in living memory, so the fact we have one now is scary even without any news about deaths -- new antigen combinations in flu are usually bad news.
It may well turn out not to be a worldwide disaster, as SARS and the bird flu also did not, but public health officials always react like this to anything novel that is transmissible person-to-person and causes pneumonia in healthy adults. Most such diseases turn out not to be disasters, but that is at least in part because of the public health reaction. SARS certainly could have been much nastier if not for the public health response, and we were lucky that it turned out to cause symptoms before it became contagious (unlike influenza).
So far the cases have been milder in the US, but even the milder symptoms are something you would definitely prefer not to have. There are fewer than 50 confirmed cases in the US so far, so we can't be sure that the severity is that much lower than in Mexico. A lot of the apparent difference could be that the diagnosis of mild cases is better in the US.
Having a first-world medical system should reduce the death rate, by reducing the death rate from pneumonia and other complications, and it might reduce the size of the epidemic by reducing secondary transmission [in simulations this depends a lot on details]. It shouldn't have much impact on the rate of serious illness in the initial wave of the epidemic. If the disease is much less serious in the US than in Mexico it's more likely to be due to something about people's previous health status than about the health care system.
I think the coverage on the San Francisco affiliate of NBC, which I've been watching in the past few minutes, has been pretty reasonable. They have said that there is concern, and that people should perhaps avoid travelling to Mexico. They described the symptoms of influenza. They said that you should wash your hands, that wearing masks won't stop you getting infected, that past vaccinations wouldn't protect, and that you shouldn't go out and take Tamiflu prophylactically. They also said that it wasn't yet understood why there had been worse cases in Mexico than in the US, and that it wasn't clear how bad the epidemic would be. All in all, a good summary.
[Note: I am even less a physician than James McDonald, but I am a medical statistician, so I do have some clue what I'm talking about]
Ginger @ 80
It's a good thing I don't expect sympathy from the cat when I'm sick. On the other paw, the cat always wants to get close when her people are sick. (Or use us as heat sinks in the summer: LOL.)
thomas @85, there hasn't been an H1N1 in living memory? I thought that this winter's seasonal flu included an H1N1 strain. I was under the impression that this one was particularly worrisome because in addition to the human H1N1 strain, it also incorporated avian and swine traits, and so people's partial immunity from earlier H1N1 variants wouldn't be as protective.
I'm very glad I read the John M. Barry book mentioned, a few weeks ago, as it happens. Not only is it one of the most amazing history books I've ever read, it also assuages my fears somewhat about this outbreak. A huge factor in the virulence and spread of the 1918 flu pandemic was the Great War; military camps in the US were so overcrowded that against even the public health advice of the day, they had three shifts of soldiers rotating in through the same bunks without even time to change the sheets in between. Lethal strains could pass easily; carriers didn't have to get very far to infect the next set of victims.
Thanks for mentioning the book; more people should hear of it and more people should read it, not least because it's such an incredibly engaging piece of work - as someone who normally prefers fiction to history, just on the merits of writing style.
Mind, I'm also grateful to live in a world where the agencies in charge of public health are declaring this a public health emergency and taking measures accordingly. Updated knowledge and rapid action on a societal scale are why I don't expect this to tip over into something like 1918.
Rikibeth:
D'oh. Yes, it's not that it's H1N1, it's that the H1 and/or the N1 contain new fragments. Same basic idea -- we know (or at least the CDC reliably tells us) that the flu contains new antigens that people haven't been exposed to before, which has historically been bad news.
Rikibeth @ 87: I think here we're overlapping with other considerations besides H1N1, which is only a small part of the viral genome. If you look at the entire viral genome, this particular combination hasn't been seen in a while. The last previous H1N1 strain to cause problems showed up in 1977, and was closely related to a 1950 type A/H1N1 virus.
If you look solely at these two genes, then yes, we already have an H1N1 virus included in this year's vaccine. If you look at the genomes involved, then you can talk about many different H1N1 viruses, as in this review.
Ginger @90: good to know! Wish I could get beyond the password wall to read the article. I'm not a medical professional, but I follow along pretty well.
I'm interested in part because I *had* this winter's flu, whatever it was, and if I've got even a partial immunity, that'd be awfully helpful. Plus I don't want to get even a "mild" (as in, recovered fully at home with only supportive care, mostly tea with brandy in it) flu like that again any time soon. Yuck.
I just had a thought on why Mexico City is having more fatalities than the percentage in the US: high altitude and heavy air pollution can't be GOOD for respiratory illness, can they?
Terry Karney @ 84, I do the same (except that post-bath I usually just go to bed and snuggle up in blankets). There have been a couple of times that I swear it beat back a cold -- or at least I had mild cold symptoms before the hot bath and good night's sleep that I did not have afterwards.
In fact, I think I'll go and do that right now. Developing nasal congestion, headache, and tiredness today. I may be glad I bought that chicken soup. (I suspect it's just a regular garden-variety cold. Keith is getting over one.)
Rikibeth
high altitude and heavy air pollution can't be GOOD for respiratory illness, can they?
That was one of the explanations given on NBC. There have been both experimental studies in small furry animals and observational studies in people that suggest that air pollution really does make you more susceptible to infection. The question is whether this is enough to explain the difference (which, of course, depends on how big the difference really is, which we don't yet know reliably).
The high altitude would make pneumonia worse, but I don't know that it would make you more likely to get pneumonia, especially if you are used to it. I don't think Colorado gets more flu deaths than Arizona in normal years, for example.
Rikibeth
high altitude and heavy air pollution can't be GOOD for respiratory illness, can they?
The link between air pollution & increased illness and death has been known for some time.
Why this happens is only more recently being found out. Within my lj post "Another omega-3-fatty-acid study (fish oil) on inflammation and asthma" I summarize a study that came out last year that showed:
Particulates--> lungs release interleukin-6 --> excess blood clotting (sticky blood)
If there's a link between pneumonia severity and IL-6, then that'd be a big clue.
I'm worrying myself by solving for "X" here.
Mexico has 149 officially reported dead. We can't determine a CFR (case fatality ratio) from that because we don't know how many are sick. However, we can make some interesting extrapolations if you apply CFRs to that number.
Rounding it up to 150 dead gives you 6,000 cases @ 2.5% CFR, which was the CFR of the 1918 pandemic.
At .5% CFR (seasonal flu) you have 30,000 sick.
Of course, there's no guarantee that Mexico's reporting the numbers correctly (and a lot of suspicion they may not be, because of sheer confusion, if nothing else).
In either case, we're past the point at which we could stop it. Which everyone has been saying. But ... still, it's worrisome.
Also, I have seen several bloggers observe that the flu isn't growing exponentially like it did in 1918 and using this to claim it's not as contagious. I turned this around in my head a bit, wondering what other factors might be at play if we assume it IS as contagious ... and one thing that occurs to me is that families are smaller now.
Could the slower rate of growth have something to do with families that are a few people rather than a dozen? Used to be, you had three generations including several kids in one family. Mexico still has its share of large families, but I suspect they're a lot smaller than they used to be.
So, for example, Dad comes home with flu and infects the wife and six kids and gramma and grandpa and spinster aunt Bertha in 1918 ... then they go out in the community and infect two people each, who each go home and infect a family with a dozen members ... vs. the same scenario today, with dad coming home, and infecting mom and two children and that's it.
Anyway. Something I was mulling over today.
If there's a link between pneumonia severity and IL-6, then that'd be a big clue.
It's not just severity, it's pneumonia incidence. Last I heard there haven't been any cases of pneumonia in the US from the swine flu.
It would be easy to explain differences in pneumonia fatality rates between Mexico and the US. The potentially important question is why there haven't been (even non-fatal) pneumonia cases in the US, and whether this represents a real difference from the situation in Mexico.
Even mild pneumonia is No Fun, as I can confirm from personal experience, and having mild pneumonia in, say, 0.1% of the population would be a major disaster even if no-one died of it.
I had mild pneumonia twice as a kid, mild enough that they called it "walking pneumonia."
I thought it was a LOT of fun, because I was not inclined to active play or sports anyway, and I got to stay home from school, where the other kids made my life hell, knock off my sent-home schoolwork in a much shorter period than a school day, and I could read for pleasure the rest of the time. Wasn't itchy like chicken pox, didn't feel very feverish, just... kinda tired. I was sorry to go back.
Much less fun, I'm sure, when there are adult worries of bills added in, but it was a great time for me as a kid.
Rikibeth,
If it hadn't been for the coughing, I could see what you mean.
I have asthma.. Bonus, I'm on methotrexate and prednisone for rheumatoid arthritis, and so my immune system is crap. Pneumonia? Oh, yeah. Been there, done that. It is absolutely miserable ...
(I figure if I get the swine flu at a time when modern medicine is overwhelmed, I'm basically screwed. I WILL get pneumonia. The common cold gives me pneumonia. If they're triaging victims due to scarce resources, the decision about me would likely not go in my favor ...)
thomas, while I'm sure I had a cough to get diagnosed, they must have given me codeine cough syrup or something, because once I was actually home from school, I was tired but happy. Or maybe I just don't remember it very well from when I was nine.
I remember this winter's flu cough, though. It wasn't pneumonia (well, if it was, it got better on its own), but it was pretty damn miserable. I did a lot of sleeping sitting up.
Anyway, I seem to have gotten distracted from one of the points I wanted to make, which is that CDC are not FEMA or the TSA or even FDA. I know it seems a bit strange for a foreigner to be saying 'trust the US government' (especially after the past eight years), but the CDC is one of the things that your public health system does right.
I am decidedly less than enthused to discover via this Google Map Tracker* that one of California's most recent confirmed cases is across the street from a coffee shop my wife and I regularly go to, and not at all far from the place we ate dinner and bought groceries earlier this evening. We build flu preparedness kits so we don't need to use them dammit!
*(Map legend:
* Pink markers are suspect
* Purple markers are confirmed
* Deaths lack a dot in marker
* Yellow markers are negative
Link originally from Gizmodo, but I found it elsewhere)
Good grief, I hope that privacy lawyers think that tracker information is anonymized enough; we don't need panicked riots of people burning down the houses of suspected carriers. The other thing that smacked me around a bit about that site was the note that one of the confirmed cases had been treated with Augmentin and released. Bleargh.
Leva @ 95: Crowded conditions (and the reduction of them in most of the modern US, compared to 1918) are very much on my mind. I posted upthread about the army barracks effect. Now I'm wishing I hadn't returned that book to the library just now, so I could examine the sections about the spread patterns more thoroughly. I believe there was a war fundraiser parade involved in one city which was shortly after most thoroughly devastated.
A.J. Luxton @104: That would have been Philadelphia. Worse, the mayor had been told to cancel the event to prevent such an occurrence and ignored the advice.
Raphael @62:
Wow, you're right, I just listen to the TV and get all my information from there. (note: that was sarcasm).
The point I am trying to make is yes, this flu is real, and yes, it appears to get spread fairly easily, and yes, it killed some people in Mexico, but no, it's not killed anyone in the US (or anywhere outside of Mexico IIRC), and flu tends to kill a lot more people than this every year, so if you take the usual precautions against getting the flu (stay away from people who might have it, wash hands, etc) your chances of getting it are reduced.
I keep seeing the deaths being reported in Mexico and nowhere else and wondering why; were they less healthy than first thought, was the disease somehow different, were there other environmental factors that made the symptoms worse? If it's as dangerous as some media outlets are making this out to be, where are the other deaths?
And yes, for your information one of the reasons I came here was to get more rational info on this issue than what I was getting on the TV. I still think the media is overreporting this event just like they did the shark attacks along the coast and the contaminated food recently reported.
As of this morning, NPR is reporting that the alert level has been raised to four: confirmed ready human-to-human transmission.
And it appears that Mexico may have had milder cases for a while, which got lost in its usual winter flu load.
I am officially updating my own personal alert status to "concerned."
I can report that Nashville's Baptist Hospital has started their early stage Big Time Flu precautions: When you show up at the emergency room, you are met by a sign listing the typical symptoms of influenza, and stating that if you have these, you must take a mask from the staffer by the door, and wear it. They had several bemasked customers waiting, but since it's high allergy season in Nashville, they may have had complications of allergies, or just bad colds.
In other news, it is the vehicle that does not have the stop sign that is the one with the right-of-way, not the newer vehicle, the larger vehicle, the shinier vehicle, or the more expensive vehicle. My housemate, who was driving the small, old, slightly grubby Chevy S-10 that was t-boned and rolled by the ginormus shiny new SUV, states very firmly that if she was exposed to swine flu in the ER because "that !@()$$@$*%#@*$&#%^# &%#$^*!@! $^@*&^&#%" didn't stop for his stop sign, she's going to be Very Annoyed. (She's OK, for someone who was driving a small truck that was, you know, T-boned and rolled by a larger vehicle. We suspect her truck is not doing quite as well.)
How long is the contagion active outside the host's body?
I've been trying to find some information on this, but I'm unsure of how to formulate my search. Maybe we don't have that kind of detailed info about this particular strain yet, but is there a quick'n dirty guide for flu viruses in general?
Fragano @ 71 -
Scott Taylor #27: Michelle Malkin is already blaming "uncontrolled immigration" for the swine flu, thank you. She's also extremely angry that Democrats have dared to point out that Republicans stripped out funding for pandemic prevention from the stimulus package.
That figures.
(the rest of this missive deleted as unprintable in a paper suitable for dockside bars, let alone polite company).
Flu virus can survive for a fair amount of time, but the exact time it lives in the environment really varies. Typically, cold and dry is better than hot and humid (for the virus) and what it landed on matters too.
It can survive hours to, under perfect conditions, weeks. *shrug*
I saw a recent report somewhere today that "the authorities" also think the incubation period for swine flu may be up to seven days now. If that's true, schools and workplaces will need to be closed for at LEAST a week to break the chain of transmission if an outbreak occurs.
#109 Eirin: Not An Expert here, but somewhere bouncing around in my head is the idea that it's ~24 hrs on surfaces. I could be horribly wrong, I could be remembering something about the common cold, or I could be remembering salmonella. *waves hands*.
The general advice from the CDC is to not share towels or bedding at all, and to wipe down hard surfaces near the sick-bed daily with bleach-water or another disinfectant. That suggests at least 24 hr survival on hard surfaces - it might be longer on soft bedding.
#111 - Eeee! Weeks! I guess that's why you're supposed to kill it all daily. Good to know.
Scott Taylor #27: Michelle Malkin is already blaming "uncontrolled immigration" for the swine flu, thank you. She's also extremely angry that Democrats have dared to point out that Republicans stripped out funding for pandemic prevention from the stimulus package.
The Republicans have also blocked the confirmation of a new Secretary of Health and Human Services. Currently the department is being run by a Bush-appointed accountant.
Influenza virus does not last weeks in the environment, but you have to look at whether this is a non-porous surface or a porous surface. A porous surface gives particles a little more protection from disinfection.
Some studies of contaminated duck ponds have found viral RNA out to 6 days after the last known infectious duck, but there is no proof that there were infectious particles in the environment. In 1998, a study of highly infectious H5N1 Avian influenza found viral particles up to 40 days later, in wet feces at 4 degrees C. [Shortridge KF, Zhou NN, Guan Y, Gao P, Ito T, Kawaoka Y, et al. Characterization of avian H5N1 influenza viruses from poultry in Hong Kong. Virology. 1998;252:331-42.] However, at 35 C, it was stable for 48 hours. In dry feces, the virus lasts 24 hours (any temperature).
Orthomyxoviruses are enveloped in lipid, which means they are highly susceptible to detergents, drying, heat, and disinfectants. Plain alcohol will kill it. (That's the alcohol wipes, not the hot toddy.)
That's why washing your hands is an effective means at preventing transmission.
Thanks. I was thinking of all the sufaces and things one really can't help touching during the day, such as doorhandles, money, the neighbor's adorable puppy...
Thus the importance of careful handwashing, of course. Sensible vigilance and hygiene will have to do, since I can't really see myself carrying a can of Lysol around, spraying random surfaces and stray change.
I was a microbiology grad student before I went off to vet school, and outbreaks like this remind me of some very basic microbiology: while everyone freaks out about preventing the transmission of influenza, please keep in mind that we are all "swimming in a soup of microbes". You carry microbes of all kinds on your skin, in your hair follicles, within your gut, and throughout your lungs. Everything you touch has microbes on it. Some of these are benign, some can cause problems if given the chance, and some will make you sick as soon as they get in (assuming they slip past your second line of defense, the immune system).
This is why you don't need to worry about doing your normal daily activities. Handwashing and proper sanitation are to prevent unwanted visitors from entering the body in larger numbers, not to sterilize the area around you. Making sure you don't come near coughing people is another good idea. Petting puppies will improve your health by lowering your blood pressure (which has been raised by all the news about the Mexican Flu), which is only a win-win situation for everyone.
Is this flu going to create zombies? Because I need to know if I should add "shotgun" to my flu kit list.
fidelio @ 108: Quote from the article: "They said it couldn't be influenza because influenza had been eradicated from Mexico."
Um... okay. *headdesk*
Yeah, I'm not going to be trusting the news from Mexico on this.
In case of zombie attack you don't need a shotgun, you need a chainsaw.
Any ful know that.
B Durbin @ 119: Yeah, the state health department of Vera Cruz (eastern Mexico) didn't come off well.
James Macdonald @ 120 -
In case of zombie attack you don't need a shotgun, you need a chainsaw.
Any ful know that.
Now, now everyone knows you need a shotgun and a chainsaw to deal with the Restless Dead...
:-)
thomas @85
I think the coverage on the San Francisco affiliate of NBC, which I've been watching in the past few minutes, has been pretty reasonable.
Must be nice.
Just the local news promos during last night's Castle was enough to send people already inclined to anxiety into full-blown panics. The newsreader seemed on the edge of panic herself, having to report that we might have a case of this strain of swine flu inside our state borders.
The flu is making a pincers attack on Maryland, I see from the map. I will need to get a shotgun just to get past the lines of people at the store trying to buy toilet paper and bottles of hand sanitizer.
Ginger @ 117
"I was a microbiology grad student before I went off to vet school"
What worries me is the number of veterinary students (and staff) who ignore in their daily lives the ramifications of what they must have been taught in microbiology lessons. You would have thought they might be aware of, and following, basic sanitation such as hand washing, but no...
In case of zombie attack you don't need a shotgun, you need a chainsaw.
Well, the shotgun will run out of ammo, and the chainsaw will run out of fuel, and they both make enough noise to attract other zombies... claymore for me, I think. (The sword, not the mine.)
dcb @ 125: Over the years, I've gone from full microbial care (i.e., opening jars and packages while holding them tilted to the side) to complete apathy about all the microbes -- except for washing my hands. I work with a variety of species and wash my hands many times a day, at work and at home. We also have hand sanitizer at the entrances/exits for ease of use. My hands would get dry from all the washing, but I treat them with petrolatum first thing in the morning, and they're in pretty good shape (I do say so myself).
Then I let my (indoor only) cat drink from my cup of tea, held by my clean, clean hands.
My son, as is typical, tries to skate out with just a mere dipping into the waters. We routinely send him back for a full scrubbing. Just last week at "Take Your Child To Work Day", I showed him how to do a surgical scrub, and we demonstrated that he'd scrubbed off the "monkey cooties" from his hands with the ever-neato UV light.
The factory-farming link is looking more plausible; WHO is investigating.
We have the following frantic denial from the Fidel Herrera Beltrán, governor of the Mexican state of Veracruz:
"[The virus] is found in Asia, in China. From there it came, via travelers to North America. Certainly from there it went to the D.F. and the State of Mexico. There is no connection with the factory farms in the valley of Pertote", he stated, and denied that the porcine influenza has any relation to Granjas Carroll which operates in Perote.[...]
The company [...] clarified that they have no records of outbreaks of porcine influenza in any of its 907 workers, not in their over 60,000 pork bellies, nor in their over half a million pigs.
Tested each one of them, I'm sure.
Tara C. Smith over at the Aetiology ScienceBlogs outlet has this to say about Cytokine storms
Breaking: Number of cases in USA up to 68, and some of them are hospitalized. I'm betting those in the hospital fall into the 20-45 age range.
Question: Is "cytokine" pronounced
SIGH-TOH-K-EYE-N or SIGHTOH-K-EE-N?
Hmm. I'm sure it's the latter, but I couldn't actually point to any documentation of that.
This thread has been BoingBoinged. Some people there are picking on bits of sarcasm and claiming that we're all a bunch of loonies. A few have pointed out minor factual errors in the original post, with varying degrees of politness. I just invited one of the most polite to come here:
MisterFricative, if you went over to Making Light and posted just as you have here, you would be welcomed. Jim does sometiimes update posts with corrected information, too, when he has time; but most of the participants in ML read the whole thread, which is still active.
Can't ever have too many people who really know what they're talking about! ...and, I should add, can correct errors of fact without denouncing the entire article and thread as unreasonable and unreasoning. I'm confident of your welcome at ML because of the tone of #38 and #39, not just their content.I hope he does. Very civil, very knowledgeable. Grab him for the Fluorosphere!
(BTW, MisterFricative used the phrase "really knows what he's talking about" in reference to Nix #74 here.)
Nix@74: Thanks for going on about it, it's really cool!
Ginger...is '-kine' pronounced like the word 'keen' or like the word 'kine' meaning cattle? That is like 'kind' without the d? Like kyne?
Ginger, #117:
They're all over me!
They're inside of me!
I can't get 'em off of me!
(I'm covered in) Microscopic Bacteria!
... sorry, couldn't resist.
Xopher @ 137
I'm keen to inform you that the correct pronunciation is -kine as in cattle.
That's one scientific word pronounced the same on both sides of the Atlantic. Now "prion" on the other hand we say "pry-on" and North Americans say "pree-on."
Xopher @ 137: As in kind minus the d, of cattle-kine.
Lee @ 138: I can only hope my partner doesn't see that, or else she'll burst into song again. She was full of songs this morning, and I protested that our life "isn't a Broadway show", to no avail. She maintains that it is indeed all a stage. (The only way to stop her is to promise that I'll start singing...)
dcb @ 139: Since Stanley Prusiner, the discoverer of prions, pronounced it "pree-ons", I think this is one that should be awarded to the USian side. We'll leave aluminium and garage for the latter debate.
Ginger @ 141
Granted - but it did confuse me the first time I heard it. Isn't it weird when you have to say out loud for the first time a word you've only ever seen written down - and suddenly realise you're not sure how it's pronounced? I had that when I needed to talk about North American deer - Odocoileus spp. in a presentation (Open Meeting and Webcast!) on chronic wasting disease to SEAC (UK government's Spongiform Encephalopathy Advisory Committee). The night before the presentation I was checking with an American colleague, then sitting in my hotel room practicing it again and again.
As for "aluminium", you don't even spell it correctly!
"Garage" is well-divided over here between the north and south.
I just emailed the facilities manager and head of HR here at work:
---, ----:I’m not an alarmist or germophobe . . . you learn not to be squeamish when you have a dog.
But if the current flu gets legs, the office might want to prepare by:
* Order lots of extra boxes of tissues. Make sure they’re readily available, e.g., by copy machines, in the cafeterias, meetings rooms, etc.
* Make sure there is plenty of hand soap stocked up. Doesn’t need to be special stuff.
* Put up “please wash your hands!” signs by the kitchen sinks and in bathroom stalls.The aim of the above would to be to create a “no excuses” environment for keeping hands clean and controlling sneezes. I’ve read that an Army study showed that the spread of cold and flu could be reduced by 80% by sneezing into tissues and washing hands.
Keeping just a couple of people working when they’d otherwise be sweating it out at home would more than pay for any extra expense.
I plan on buying a couple of pump bottles of bathroom cleanser, the nasty foaming stuff, and putting them in the restrooms. If one person in twenty gives the faucets and knobs an occasional spritz and wipe-down, mission accomplished.
dcb:
As someone who is interested in all this stuff, but only learns about it from reading, it is deeply annoying to not have a faint f--king clue how to *say* any of it.
Nix:
I thought B cells needed to be helped (basically allowed to start reproducing very quickly and morph into antibody factories, and told to switch to making IgG's or IgB's instead of IgM's) by helper T-cells. If I understand correctly, T-cell receptors have use a similar kind of mechanism to get massive numbers of possible receptors, and also go through a pretty cool weeding-out process in the thymus to make them unlikely to react directly with anything they are expected to encounter in the body.
(But this isn't remotely my field, it's just something that fascinates me, so I could be missing something.)
Steven:
Maybe another nice thing to do would be to bring hand sanitizer[1] to the office.
[1] Called "hand goop" by all members of my family, for some reason.
Careful with those hand sanitizers. Some of them use antibiotic chemicals as their active ingredients, which allow microbes to breed selectively (they've been implicated in the spread of hospital infections like MRSA.) Alcohol-based is a better bet. Soap and water is probably even better than that.
I prefer soap and water.
I'm thinking of bringing a tub of bag balm to work.
Use pump-bottle soap rather than bar soap if you're sharing with others. Some microbes can live surprisingly long times on wet bars of soap.
Stefan - The proper HR policy should be to just send sick people home ASAP to avoid infecting more people. Saying "Keeping just a couple of people working when they’d otherwise be sweating it out at home would more than pay for any extra expense. is dangerous. The sensible thing to do is to just let them "sweat it out at home"
So I'm hoping that sentence I quoted was sarcasm.
Josh, I think you misread Stefan's intent. The idea is to keep people from getting sick so they can stay at work, not to keep people working once they've gotten sick.
albatross @ 144
Sympathies. And of course developing the vocabulary to understand what you're reading about can take time (which is part of why veterinary/medical courses are so long). When I was reading about prions I decided that while having the abnormal type was very bad for your brain, studying them was pretty bad for your brain also: huge specialist vocab. with lots of words which were never defined anywhere.
JOoh: what Lee said (I did have to read it twice to get that).
dcb @142: You did notice that I spelt ..ok, spelled aluminium in the British manner? I'm willing to concede that one. Yes, pronouncing words I've only seen written is tricky. I remember messing up Amite and Atchafalaya. Then there's the town in North Carolina that is really difficult to get right: Rutherfordtown. British-speakers might actually guess the correct pronunciation.
#150. What Lee said.
Hand washing and proper sneeze handling is to prevent the spread from non-symptomatic carriers to others.
Of course actually sick people should be sent home, ASAP. And employees with ill relatives might consider it . . . in my line of work, being at home is only a minor impediment to working.
Stefan - Thanks for the clarification. I translated "sweating it out at home" to mean staying home while sick.
So if two viruses infect the same cell at the same time, the RNA can play mix-n-match, take virulence from one virus and infectivity from another, and come up with something both infective and virulent.
Why is it that a flu virus and an HIV virus never walk into the same cell at the same time and come out with something as easy to spread as flu, but that sucker punches your immune system like HIV?
(I infer that this hasn't happened from the fact that my species is not extinct, and given the number of viruses and virus-infected cells, it's hard to believe that it wouldn't have happened if it were possible.)
Ginger @152,
It isn't really fair to expect a proper pronunciation guess on Rutherfordton when it's not spelled correctly. It doesn't help much though ;)
I had a college folklore professor who had me pronounce Rutherfordton for him repeatedly because he loves regional pronunciations (and he just couldn't quite say it right).
My family is from up that way and my college boyfriend even had trouble with Cherryville - didn't slur it enough. I assume you're close by - or related to someone who is?
chris #155: The short answer is that even viruses have some species barriers, and flu and HIV are very different.
The longer answer is a bunch of issues:
1) The virus capsules (both species) have only a certain amount of room in them for their RNA payload -- they might be able to pick up a stray plasmid, but probably not a whole new viral genome.
2) These viruses don't have full-fledged "chromosomes", but their genes aren't just floating around loose, either -- they're bundled into sections of RNA, in a fairly consistent way for each species. Mostly, it's those segments that get reshuffled, much like chromosomes in sexual reproduction.
3) Both the individual genes and the divisions between segments will vary between flu and HIV viruses. Mix-and-match is unlikely to produce anything viable, especially since to count as "surviving", the new virus particle would need to reproduce "after its own kind". That gets even tougher if the capsule choice or structure is also up for grabs....
So, seriously, what I'm wondering is how long these little germies will live on library books. Is leaving the book in the bookbag after checking them out for a day or two before reading them going to leave me with a safe book?
Since we are supposed to stock up on broth, jello, water, food, and tylenol...will no one think of the books?
Chris @155: HIV is a lentivirus, in the family of retroviruses. Flu is an orthomyxovirus, which is not the same. Although both are RNA viruses, they cannot exchange genetic material.
Donna n-w@156: I lived in Winston-Salem for three years, and knew at least one person from Rutherfordton. That kind of name just sticks in my memory, I guess.
Joy @158: If you keep your hands away from your face while you read (and keep the book away from your face, too) you should have any transmission of virus. After all, if books were possible fomites, we'd all get sick a lot more often. Past experience suggests that books aren't a major source of contamination, although your question is certainly reasonable.
Whoops! I needed a "not" in there. Darned tiny ipod screen.
"Use pump-bottle soap rather than bar soap if you're sharing with others. Some microbes can live surprisingly long times on wet bars of soap."
...But influenza virus is not among them. BAR SOAP AND WARM WATER ARE MORE THAN FINE FOR THE PRESENT PURPOSE.
Re: books & viruses
Maybe I'm being irrational, but I make a point of not touching the magazines in the doctor's office. God only knows what the last person was carrying when they sneezed all over last year's tattered Newsweek ...
Jim @ 120:
In case of zombie attack you don't need a shotgun, you need a chainsaw.
And then, WASH YOUR HANDS.
Zombies are best dealt with through positional defenses (trenches with, slightly, overhung countescarps) and flamethrowers, fougasse, etc.
Ginger @ 152
Yes, I noticed the way you spelt "aluminium" and I was impressed.
Regional pronunciations of towns etc. can be very difficult and there are a number of wonderful examples in the UK (some of which were discussed on a previous thread some time ago - "Yes, a little fermented curd would do the trick").
What is the correct pronunciation for Rutherfordtown, North Carolina?
As for "aluminium", you don't even spell it correctly!
"Honour?" I bellowed, working myself up into a fine fury. "What do you Americans know about honour? You can't even spell it!"
-- Flashman and the Angel of the Lord
The garridge-garahzhe split is mostly US/UK now, but it used to be a UK class marker; the upper class used the latter, French-sounding pronunciation, the lower orders had it rhyme with courage and lovage.
#161 Spiny Norman ...But influenza virus is not among them. BAR SOAP AND WARM WATER ARE MORE THAN FINE FOR THE PRESENT PURPOSE.
True. Any soap at all will do a number on flu's lipid capsule. But flu virus isn't the only, or the worst, thing in the great world of viruses, bacteria, parasites, and fungi that might be on someone's hands.
Rutherfordton, NC is pronounced:
ruhth-ur-furd-ton, with some emphasis on the first syllable.
Breaking news: CDC confirms first swine flu death in the US, a 23-month-old in Texas.
ajay @ 166
"The garridge-garahzhe split is mostly US/UK now"
No, I'm a northerner (proud Mancunian) and I say "garridge". My husband (London/Kent) says "gararge" (closest I can spel it - long "a" anyway - still very much a north/south divide in my experience, along with bath (again, short a in the north, long a in the south).
John L @ 168
Rutherfordton, NC is pronounced:ruhth-ur-furd-ton, with some emphasis on the first syllable.
Sounds reasonable to me - but then I'm a Brit. How else would you say it?
dcb@ 165: It's pronounced "Ruvverton" -- it reminds me of the British pronunciation of Cholmondeley (or "Chumley").
Louisiana is full of towns with different pronunciations, because of that fine French influence (not to be confused with French influenza).
(See how I sneakily returned us to the original topic?)
As for French Zombies, I know not. Would they prefer their brains properly aged? In small quantities? On a baguette?
John L @ 168
Rutherfordton, NC is pronounced:ruhth-ur-furd-ton, with some emphasis on the first syllable.
Sounds reasonable to me - but then I'm a Brit. How else would you say it?
"Torpenhowe"?
Ginger, Lori Coulson and Caroline: Thanks for the neti pot recommendation. Despite some initial heebie-jeebies after watching a how-to video, I gave it a try and it's definitely helping me breathe easier, in addition to giving my husband a source of mirth (my pot is a smiling blue elephant).
Re alcohol gel: how much goop should we use for it to be effective? A dime-sized blob?
Ginger @ 171
"Ruvverton". Oh well, yes, that works as well, rather like "Edinbru" (the "u" ending short, not like "brew".
Ginger @171: This is fascinating! I grew up a couple of counties over from Rutherfordton and we always pronounced it the way John L. @168 describes. After moving from NC to northern VA, though, I discovered that I use all sorts of regional pronunciations (much to the amusement of certain friends and coworkers). Also terms like "straightdrive" for a manual shift automobile.
There are a lot of small towns in Missouri and Illinois with oddball pronunciations like this, though with a different pattern: the towns are often named after some existing or historical place, but then pronounced phonetically. Thus, you can go to Versailles (ver-SALES), Haiti (HAY-teye), or Cairo (KAY-roe).
Then there's Conetoe, NC.
And no, it's not pronounced like that.
In Winston-Salem, there is a road called Buena Vista, only it's pronounced "Byuna Vista".
The horror is with me still -- and I studied French!
caffeine @ 175: I made the mistake of pronouncing it as Ruther-ford-ton in front of a native Ruvvertonian. He was nice enough about it, though.
I liked living in NC, even though they can't pronounce Buena Vista correctly.
re 176: The general rule seems to be that foreign placenames must be "mispronounced" somehow when they become American placenames. Another favorite: BERlin (in various US states), as opposed to BerLIN (in Germany).
Instant freshman detector at UMCP: the English department is in Taliaferro* Hall. Just getting the right number of syllables is a significant achievement.
* pronounced "Toliver"
Ginger: I went to high school in a little town (census area, actually, too small to be a town) called Icard. At a marching band competition--at Rutherfordton-Spindale (R-S) Central High School, I think--the announcer called it 1-card.
My favorite town name, though, is Lizard Lick, NC.
C Wingate #179:
I knew that only because of General Taliaferro in the American Civil War. The books describing the battles he fought in also helpfully gave the pronunciation for his name...
My nineteenth century prose fiction teacher in high school was Mrs. Courtois. Her husband, from Iowa, spent much of his youth correcting the spelling of his last name from C-u-r-t-i-s.
I grew up in Okemos, Michigan (OAK-uh-muss, not owe-KEE-muss as some dingfutz radio announcers kept saying). It's the name of a Chippewa chieftain. A friend grew up in Novi (NOE-vigh), but it used to be pronounced "number six" (it was stop No.VI on the Pony Express in the area).
In New Jersey, there are some weird names, like Ho-Ho-Kus, that are I-think Algonquin. It also has names that follow the pattern C.Wingate points out, like Bogota (buh-GOAT-uh).
HOUSE-ton street NYC, HUSE-ton Texas :-)
Then there's always the Bow-fort vs. Bue-fort argument for how to pronounce Beaufort. (The one in NC is Bow-fort, the one in SC is Bue-fort.) And Con-cord vs. Conquered for how to pronounce Concord (the one in NC is Con-cord; the one in NH is Conquered.)
They have a Chili (chilly) festival in nearby Chili (Chai-Lai)...
And I want to jump through the radio and strangle the announcers who don't know that it is not the Van W-eye-k expressway, but the Van Wick!
Or the local twit of a traffic reporter who doesn't know "Morse" rhymes with "horse" not "Horace".
(We have a street--Morse Road--that has a lot of traffic, and every morning that there's an accident there this fool mispronounces it. And I grind my teeth and mutter...)
Breaking at MSNBC:
WHO raises flu pandemic alert to level 5.
I recently got around to reading 1491. In it, the author says that Native American populations have fewer disease-fighting alleles than European and African descended people. If this is true (and if I'm remembering it correctly) it might explain why the Swine Flu has been more deadly in Mexico. If the disease is more deadly for NA people because their immune systems aren't tuned as well for it, then Mexico, with its large number of primarily NA descended people, would be hit harder than the more immigrant-descended US. I hope that one of the more-informed denizens of the Fluorosphere can correct and/or expand on this.
Cally Soukup @190, thing is, what was true back in 1492 about that probably isn't true anymore, because, well, most Native Americans died back then, partly of European diseases and partly of hunger, wars, massacres and the like, and those who survived the various epidemics were, most of the time, on average, better at fighting off European diseases than their dead relatives.
It may be here -- according to WBNS10TV, Columbus (Ohio) Health Department officials are investigating one probable case of swine flu and five additional suspected cases.
Raphael @191: Certainly modern Native Americans are descended from those who survived the devastating series of plagues of all sorts that swept through the Americas, and can thus be presumed to have better European disease resistance on average than the pre-Columbian population. Unfortunately I returned 1491 to the library last week, but if I remember the book correctly the genetic studies on disease-fighting alleles were done on modern Native American populations. If this is so, then even if they're better equipped to deal with European diseases than their ancestors were, they're still at a disadvantage, relatively speaking, when it comes to dealing with European diseases. I'm sure someone out there has a copy of the book (or the studies the book bases that chapter on!) and can confirm or deny this.
WHO has raised the pandemic alert level to five (human-to-human transmission in at least two countries).
Of course, tomorrow is Koninginnedag (Queen's Day) in the Netherlands, meaning that Amsterdam will be one solid, heaving mass of humanity. Great timing!
(No suspected or confirmed cases in the Netherlands at the moment. But Koninginnedag is a tourist attraction and draws people from all over.)
The WHO definition for Level 5 is pretty trivial, at first sight. Human-to-human transmission in more than one country.
Most flu strains, the ones which the annual vaccine are targeted at, already appear to be at level 5.
The key point is that this is a new strain.
I'm not sure about the concerns over this displacing something else in the vaccine mix. They usually cover three distinct strains, don't they? So are we trading the spread of cover for a greater number of total vaccinations?
Cally Soukup, you're right about more recent studies being cited in that book. Pages 114-117 discuss human leukocyte antigens, HLAs. (From this point I summarize the book.) Long story short, the more different types of HLAs that exist in a population, the less susceptible that population is to the spread of pathogens. A 1990s review of 36 studies of South American Indians, done by Francis L. Black (a virologist at Yale), showed that South American Indian populations have no more than 17 HLAs, whereas European populations have at least 35. (Black also did studies in the 1960s and 1970s, on measles vaccines, that showed a much smaller spectrum of immune responses from South American Indian populations than from other populations.)
This might possibly explain a faster spread of the virus in Mexico, but I'm not sure it would explain its being deadlier. But I'm no immunologist.
Hey Cally! I read 1491 a while back and the thing is, most people in South America are not native Americans. They're descendents of colonists.
Hi Marilee! I've only been to Mexico once, but unscientifically the majority of the Mexicans I've seen sure look visually as if they've got a high percentage of Native ancestry, especially compared to us USans. How that translates to immune response genetics I don't know.
Sorry you couldn't be at Minicon.
The CIA world factbook says:
Ethnic groups: mestizo (Amerindian-Spanish) 60%, Amerindian or predominantly Amerindian 30%, white 9%, other 1%
These numbers are vastly different in South American countries like Argentina (97% white), Brazil, etc. Because of the difference in environment and history, I don't think you can generalize on South America any more than you can generalize on North America (where Mexico is, as I am positive Marilee does in fact know. I always need one more preview myself.).
Not that I know what this has to do with the alleles in question. For me, air pollution / altitude / under-reporting suffice to explain the apparent difference in lethality. This is definitely an argument against letting census takers have meetings with each other during flu season. I wonder if it'll change how the 2010 census is carried out.
Keep in mind that in a population descended from two groups (in this case, European colonists and Native Americans, and as a third group, some Africans), how big or small each group's share of your ancestry is doesn't necessarily say anything about how many of each group's more "typical" alleles in any given area you have. So the share of different groups in the "official" racial "classification", or in the self-identification, of Mexico, doesn't say much about which kind of immune system alleles are how prevalent there.
Fungi et al:
I gather there are a bunch of different things that could explain the pattern of fatalities, ranging from genetic differences[1] to differences in how illnesses and deaths are reported and tracked, with lots of other alternatives, any subset of which might be interacting.
However, if this strain of flu is much more dangerous to mestizos[2] than everyone else, we should expect to see a lot of deaths and serious illnesses here, because we have a lot of first- and second-generation immigrants from Mexico, Guatemala, El Salvador, etc., who I expect are pretty similar genetically to Mexicans. In particular, swine flu viruses in California and Texas won't have any trouble at all finding folks of Mexican descent to infect.
[1] If I understand correctly, the genetic diversity in MHC/HLA mainly affects the adaptive immune response. (Is there some diversity in PRRs or something, too?) I think that means that this kind of diversity should have less impact on whether you catch the flu than on how well your body deals with it. This page describes this in some depth. (Disclaimer: This isn't my field, so I could be misunderstanding some of this stuff.)
[2] I wonder how different, genetically, central American Indians from whom most Mexicans are partly descended are from North American Indians and South American Indians. My impression here is that all the Indians wound up with a lot less diversity in their MHC/HLA genes, presumably because of some combination of a small founding population and not having had anything like the same level of constant exposure to nasty pathogens, century by century. But it would be interesting to see some details on this....
Xopher@183
"I grew up in Okemos, Michigan (OAK-uh-muss, not owe-KEE-muss as some dingfutz radio announcers kept saying). It's the name of a Chippewa chieftain. A friend grew up in Novi (NOE-vigh), but it used to be pronounced "number six" (it was stop No.VI on the Pony Express in the area)."
Neat! I grew up in MI too, and can pronounce Ossineke (OSS uh neek if you're local), and Novi, but didn't know the Pony Express anecdote. At my well-known Research I university, if you search for "six editor" you will get, well, you figure it out. I kid you not - I just checked.
Fungi et al:
For some informed speculation[1] on why the flu looks so much more lethal in Mexico than elsewhere, check out:
This post on the virology blog and this post from Mystery Rays From Outer Space.
All:
On the radio today, there were unconfirmed reports of cases in Maryland. I expect we'll hear for certain in the next couple days. I do wonder if we're going to see schools close anytime soon, and also if we should keep our two small kids home from school....
[1] Contrast with my basically uninformed speculation....
Revere of Effect Measure also linked to the Flu Wiki. I'm not qualified to evaluate the technical content (I might catch obvious nonsense, but not subtly wrong stuff) and some of it is still focused on H5N1 bird flu, but there appears to be some really nice in-depth discussion of the underlying science.
Abi @ 182: How did she pronounce it? There's a river in Missouri called the Courtois. The locals apparently pronounce it "COURT-uh-way"
Adding to the pronunciation wackiness: "WOR-ches-ter" (or "WOR-ses-ter") vs. WUS-ter for "Worcester." "WOR-ches-ter" is in Pennsylvania. "WUS-ter" is in Massachusetts (also IIRC, England). BTW, Pennsylvanians seem to be convinced that Bay Staters pronounce it "WOO-ster."
Inquisitive Raven @206:
She pronounced it core-TWAH.
The English Worcester is indeed WUS-ter.
Xopher @ 208: "U" as in "put."
Abi @ 207: So, actually somewhat close to the French. I never did figure out where the pronunciation of the river's name came from.
put, in England. Maybe better rendered as WOO-ster.
It just struck me that "Flu Redux" sounds like a symptom:
"Reduxed? Really?"
"All over the living room floor. There's a special cleaner to break up the nodules, but it stains linoleum, so it's actually a blessing that he duxed on the carpet."
albatross@201:
[1] If I understand correctly, the genetic diversity in MHC/HLA mainly affects the adaptive immune response. (Is there some diversity in PRRs or something, too?) I think that means that this kind of diversity should have less impact on whether you catch the flu than on how well your body deals with it.
You're correct in the MHC variation -- mainly adaptive responses. There are variations in PRRs but the clinical relevance of this isn't clear except for the really blatant cases where some receptors are missing completely. Some of the large-scale genome scans have turns up allelic variants in some of the PRRs as links with risks of some diseases, but the differences are not huge. I'm not aware of any genomic scans for flu susceptibility (though it would be very interesting -- but I'm not aware of any evidence for genetic variation in flu susceptibility at all, though I'd bet there is some.)
I wonder how different, genetically, central American Indians from whom most Mexicans are partly descended are from North American Indians and South American Indians. My impression here is that all the Indians wound up with a lot less diversity in their MHC/HLA genes, presumably because of some combination of a small founding population and not having had anything like the same level of constant exposure to nasty pathogens, century by century. But it would be interesting to see some details on this....
Native Americans have reasonable MHC diversity (see for example the map in http://www.iayork.com/MysteryRays/2007/10/09/ ). The region diversifies incredibly rapidly (for an example see http://www.iayork.com/MysteryRays/2007/09/20/ .
I think it's extremely unlikely (though nothing's impossible) that there's any kind of significant genetic difference underlying the apparent differences in mortality rates; I am fairly confident that it's a case of the missing denominator -- the Mexican authorities mainly tested seriously ill hospitalized patients, so it's not surprising that a larger proportion died -- they didn't test the general population, which was how the original US cases were identified. I strongly suspect that the virus is much, much more widespread in Mexico than the authorities were aware, and so the mortality rate is much, much lower than it seems.
But we won't know for a while.
albatross @210 and iayork @212: Thanks for clarifying things. It looks like I was jumping to conclusions from inadequate data.
WHO has announced that they won't be calling it swine flu anymore, because that makes people think it comes from pigs, and that you can get it by eating pork, and other nonsense. Egypt is using this as an excuse for slaughtering all the pigs in the country, ostensibly as an anti-flu measure. Yeah right.
So far, WHO is being sensible. But I think they're idiots. Why? Because the catchy new name is 'H1N1 influenza A', that's why. Rolls trippingly off the tongue, doesn't it?
Hey, WHO morons: THIS WILL NOT WORK. Until you give it a name that's as easy to say and remember as 'swine flu', "swine flu" it will remain, and the fact that YOU call it by a fancy-ass name won't make one lick of difference to how many pigs get slaughtered, or how many people shy away from ham in the supermarket.
I think I'll buy pork chops this weekend, just because.
Stefan@215: I bought a nice large pork roast last night, just because.
Mm, pork.
Hmmm, how to make it sound appealing? A designer name? Something that sounds like a gated community or only something that cool people get? A hip-hop name? Chihuahua flu, Petunia (keeping the piggy connection), or a fancy zipcode?
What's a catchy name for a flying pig?
Xopher @214: Because the catchy new name is 'H1N1 influenza A', that's why. Rolls trippingly off the tongue, doesn't it?
How about 'Hinia flu'?
I think it should be called Mexican flu. This has the virtue of being accurate, though it has its own drawbacks (like feeding the wingers' agenda).
Xopher @ 221: It would probably be officially named A/Veracruz/01/2009 (H1N1), so the Veracruz Virus works for me.
Naming viruses is difficult sometimes. When the CDC isolated the new virus in the Southwestern US that was causing acute respiratory distress syndrome, and first named it "Four Corners Virus", the locals objected because it was culturally insensitive (Navajo have certain taboos against death and related items). After discussion, it was renamed "Sin Nombre Virus", which became the official designation for the Hantavirus discovered in that region.
Hantaviruses, of course, are named for a river in Korea, the Hantaan, where the original virus in this family was found.
Marburg Virus is another example of a location being appended to the virus name, when the origin of the virus was actually somewhere in Uganda, not Marburg, Germany. Even though the first people died in Uganda, the "outbreak" was identified in Germany.
There's already a standardized notation for influenza viruses, and it isn't HxNx. You can download a copy of the WHO memo from 1972 that discusses the standardization here, but basically it's the species, the type (A, B, or C), locality, isolation number, year, and HxNx identifiers.
How about Marranitos Flu? People would be less afraid because they taste good.
Navajos also have taboos about mice, and traditions that mice will attack the strongest person in the household with their saliva, urine, and feces.
"Four corners" hantavirus (last I heard) is transmitted by mice through their saliva, urine, and feces. And it's one of those cytokine storm killers. And the Navajo victims were non-traditional Navajos who didn't keep the strict rules regarding mice.
I have this from Tony Hillerman, and I have no idea whether it's true or not.
208 ::: Xopher
Um, what's the difference in pronunciation of the "u" in "put" vs. "but"?
Abi @ 210 "Maybe better rendered as WOO-ster.": No, that would be pronounced very differently (at least it would in England - like "rooster").
'Flu naming: Xopher @ 214. You're right, an alternative "catchy" name is needed.
dcb at #225: the u in but is an unrounded open-mid back vowel whereas the u in put is somewhere between close and close-mid and not quite as far back. And if that doesn't mean anything to you, you probably didn't study linguistics ;P
This handy chart has sounds. The but u is the upside down v, the put u is the upside down omega.
Or to put it simpler (and less exact), put is closer to "oo" while but is closer to "uh". In England I believe put can be even closer to oo (that is to say, produced further back and higher up in the mouth), but it's been oh so long since my phonetics classes (with the legendary William Barry).
It depends which part of England you come from.
Me, I'm from the old Danelaw, the part of the country where accents and dialect wasso heavily inflenced by the Danes. The differences are fading, but you can still hear Geordie on Tyneside. It's no so alien to me, but I recall how some fans at the first Mexicon, in Newcastle seemed bemused by the local accent.
Cumbria and SW Scotland are more influenced by Vikings from Norway.
Now, how the locals say Worcester, or even Cirencester, I'm not sure. I doubt that my personal phoneme library has the distinction Xopher reports. Our local Henry Higgins is a local lass called Loretta Rivett, only a few years older than I am, and from a Kelsey family.
She said that my parents had different accents, coming from different parts of Lincolnshire, and mine was a mix of theirs and the accent of the area around Kelsey.
These things can be very subtle.
There's recently been one of those odd little cases where somebody, after a brain injury, has recovered with a different accent. This time it was claimed to be from Yorkshire to Irish.
It's plausible enough that the way somebody pronounced a sound can shift. And that can affect the overall sound of their speech in a way that isn't obviously broken. But I do wonder what somebody who had studied accents would hear. Sort of Irish, or broken Yorkshire?
Daniel Klein @ 226
No, I've not studied linguistics.
Thanks for the link - it helped me to realise that for some reason I was verbalising "put" as "putt" (as in golf) - which of course is more like "but" (which, confusingly, is pronounced the same as "butt" (as in "water butt")).
Ah, the English language is a wonderful thing.
Yes, okay "Worcester" is pronounced "Wuster" with the "u" as in "put" rather than "but".
albatross @ 203 - Rockville HS in MD is closed today due to a flu case. No word on when it'll reopen.
Not where I went to HS, but where a large number of my friends and all of my family went. Makes me really wish I were still in school, because I could really use a few days off. Even better than a snow day!
Terry @164, Les fougasses?
Keep well Marilee, Dave & Scraps.
I got my degree in linguistics, but I didn't remember all the descriptive terms, so thanks, Daniel!
My parents were from Chicago, and I was a small child in Illinois before moving to Michigan. Consequently I distinguish /i/ (as in 'bit') from /e/ (as in bet); most Michiganders* do not (their vowel is somewhere between the ones I use; sometimes it's even a diphthong). Growing up I never noticed they didn't, but I did wonder why some people said "ink pen," which struck me as redundant.
Of course, it wasn't redundant to them (in speaking). They added the word 'ink' to disambiguate** between 'pen' and 'pin', which are pronounced identically. Homophonous heterographs, to them. Completely distinct words to me.
____
*Yes, that's really the word, and yes, I've heard every possible joke about it 100 times.
**One of my very favorite words ever, along with 'pathognomonic' and 'callipygian'.
Xopher, #231: Native Detroiter here, and I definitely distinguish between the sounds of "pin" and "pen" -- as did everyone else I grew up with. I didn't encounter the blurring, nor the "ink pen" idiom, until I moved to Nashville. To me, that's a Midsouth* regionalism, especially in the rural areas.
And yes, it is indeed "Michigander". There is no such thing as a "Michigoose". ;-)
* KY, TN, southern IN and IL, northern AL and GA
* KY, TN, southern IN and IL, northern AL and GA
Also NC, at least in parts; my father grew up in Winston-Salem, and although he knows there's a difference in those words to some people, he can't hear it unless we really exaggerate it for him. I grew up in Atlanta, and they're different to me (unless I've recently spoken to my father's family).
So, this morning I had an appointment with my dermatologist and was greeted at the entrance to his building (a large multi-practice with over 100 MDs) by a woman wearing a surgical mask, eye shield, gloves and scrubs.
She was quizzing everyone on the way into the building about flu symptoms and if they said yes to anything, they were asked to put on mask, clean their hands with disenfectant and go to a screening area.
I felt as if I had wandered into a bad movie.
But, I also think they were doing the right thing in attempting to protect their patients and staff from an unknown but growing threat.
FWIW, my doctor said that at the very least they were having a chance to do a good test of their procedures, and that they seemed to be working OK.
The factory farming link looks pretty certain:
Swine Flu Ancestor Born on U.S. Factory Farms
Scientists have traced the genetic lineage of the new H1N1 swine flu to a strain that emerged in 1998 in U.S. factory farms, where it spread and mutated at an alarming rate. Experts warned then that a pocket of the virus would someday evolve to infect humans, perhaps setting off a global pandemic.The new findings challenge recent protests by pork industry leaders and U.S., Mexican and United Nations agriculture officials that industrial farms shouldn’t be implicated in the new swine flu, which has killed 176 people and on Thursday was formally declared a pandemic by the World Health Organization.
“Industrial farms are super-incubators for viruses,” said Bob Martin, former executive director of the Pew Commission on Industrial Animal Farm Production, and a long-time critic of the so-called “contained animal feeding operations.”
Obviously we need to ban the label "factory farm" and call them something cute and natural sounding. Maybe "piggy creches."
Let's call it the Cruelty Penalty Flu. Or the Pork Industry Flu.
Wow. Come back after a couple of days and find that people have actually read that huge splurge of dense gumph from me. Astonishing. You all have more fortitude than I (and this makes a nice birthday present, thanks!)
Mike @#81, much of the info on this is behind paywalls that I can't get past, but I *think* (take with pinch of salt) that what is believed is that they die after a while if antigen doesn't bind to them, and replicate if it does bind: antigen binds to the not-so-good copies to some extent, but falls off more easily the worse the fit is: so after a while the limited supply of presented antigen is entirely consumed by the best fitted hypermutated clones.
albatross@#144, yes, helper T cells are essential. There are several stages I chopped out because, dammit, the comment was already too long and I was having network problems and didn't want to lose the lot (it nearly happened twice), and 'cos all they do is activate and modulate the behaviour of the bits I *did* talk about, and there are lots of other things that modulate that as well.
Xopher @ 231 -- I grew up in SE Michigan, and I'd say it's about half-and-half. It's not actually a MI accent, but one from KY/NC/SC/TN, etc; and one that's found far more often in rural areas than in metropolitan. A lot of people in the mid-mitten area moved north from Appalachia, and kept the accent.
I grew up in western Wayne County, and we had a fairly distinct split between families whose ancestors had settled in MI and those which had moved up from Kentucky/Carolina/Tennessee. Most of the southerners didn't differentiate between /pin/ and /pen/, but the rest of us did (Mum was a "city girl", and my dad's parents were born overseas).
FWIW, I got the 'crackling' pun.
Xopher @ 231 -- I grew up in SE Michigan, and I'd say it's about half-and-half. It's not actually a MI accent, but one from KY/NC/SC/TN, etc; and one that's found far more often in rural areas than in metropolitan. A lot of people in the mid-mitten area moved north from Appalachia, and kept the accent.
In western Wayne County we had a fairly distinct split between families whose ancestors had settled in MI and those which had moved up from Kentucky/Carolina/Tennessee. Most of the southerners didn't differentiate between /pin/ and /pen/, but the rest of us did (Mum was a "city girl", and my dad's parents were born overseas).
FWIW, I got the 'crackling' pun.
My grocery has spare ribs for $1.99/lb, minimum three pounds, next week and I was thinking of getting some. Already portioned!
grrr. sorry for the double post. (Have no idea how that happened. Did have an ISP burp, but still....)
If I was still in Germany I'd make a point to barbecue a Schwenker (fun fact: the slab of meat, the free-swinging grill, and the person operating self-same are all "der Schwenker"), being a scrumptiously marinated piece of pig-neck.
Factory Farms
Some researchers argue that avian flus emerge from factory farming of poultry. I haven't done quite enough research to state confidently that I agree with them. But it makes sense: bring together large numbers of animals in unsanitary conditions and you create an ideal situation for viral recombination.
Looks like the DFHs were right, again. One more thing we have to fix in the 21st century.
Another factor in factory farming: limited genetic diversity among the inmates.
This has been a fascinating, useful thread for many reasons -- and I have little to add except:
Tonight on The News Hour, one of the disease experts made a point of stressing the sacrifice Mexico has made by virtually shutting down its entire economy in an effort to halt the spread of this virus. She identified this sacrifice, whether ultimately successful or not, as being a tremendous boon to the world and to the scientific community, in creating a sufficient break in the chain of transmission that the events of 1918 are not doomed to be repeated.
Where I live, in Southern California, there have been incredulous accounts of the pain this is causing to high school students, whose Proms may have to be cancelled.
Mexico has made sacrifices on a scale I can't imagine, and those sacrifices benefit the world. I don't think it can be repeated enough.
Larry @235: I've been tangentially involved in preparing an after action report for a preparedness exercise the FDA recently conducted. The scenario involved pandemic influenza. We're not done with the report yet, but they've asked for it back pronto. It's a good sign that they want to use the lessons learned.
My own company is pulling out all the stops. We got an email with information about our corporate emergency operations center before any cases were even identified in the DC metro. I'd imagine it's a combination of paranoia and "yay, I finally get to show off what I've been working on!" Either way it's good to see a lot of training paying off.
LLA #246: Mexico has made sacrifices on a scale I can't imagine, and those sacrifices benefit the world.
That sounds like a pretty compelling argument to increase foreign aid to Mexico in spite of the US economic downturn, or rather, in defiance of the US economic downturn.
Earl Cooley @ 248:
At the very least.
They may or may not have calculated such a reason. I only know that their actions exceed my pampered comprehension.
Perhaps I should say that I'm uncomfortable when I approach the point where utilitarianism and possible self-interest meet. I don't personally claim to have any special insight into Universal Truths, but when I see people do something that is so risky in the short-term, and so unlikely to be equally recompensed in the long-term, I move past cynicism to awe.
Xopher@#231: Count me as another without the pen/pin distinction; I was born in Florida and schooled in Florida, Texas, and Arkansas. It's only with considerable effort that I'm able to convince my mouth and tongue to pronounce the short-name of my graduate school alma mater as Penn-with-an-eh.
Xoper:
Hey, WHO morons: THIS WILL NOT WORK. Until you give it a name that's as easy to say and remember as 'swine flu', "swine flu" it will remain, and the fact that YOU call it by a fancy-ass name won't make one lick of difference to how many pigs get slaughtered, or how many people shy away from ham in the supermarket.
This reminds me of the most bullshit answer I've ever heard on NPR. A group of medical researchers had discovered a malaise/syndrome where body parts act independently--your arm or leg or fingers or toes start doing stuff without conscious direction to do so. The interviewer was speaking to the head of the research team--say he was Dr. Huey of Huey Dewey Louis Syndrome. The interviewer asked "Have you seen Dr. Strangelove?" He said no. The reporter described the wheelchair scene (not the one at the end of the film, the earlier one with the gloved hand making its bid for freedom) and asked if he didn't think his malady would end up known as Strangelove Syndrome. You could hear the smug dripping off the researcher's voice as he said "No, I'm sure it will be Huey Dewey Louis Syndrome." And I remember thinking "You stupid ass. You think your name is going to get a bigger plot of mental real estate than Peter Sellers and Stanley Kubrick working together?" Yeah, right.
My daughter has a small hope that school will be closed because she has 4 AP tests scheduled in the next week.
Obviously we need to ban the label "factory farm" and call them something cute and natural sounding. Maybe "piggy creches."
Swinetanamo?
Jennifer Barber @ 234, I can anecdotally attest to the use of "ink pen" among NCers. In elementary school, I heard "You need a ink pen" from teachers and teachers' assistants frequently.
Caroline (255): Not 'an ink pen'? That's interesting.
Mary Aileen @ 256 -- no, it was nearly always "a ink pen." I don't know why.
I'm not sure when it was around, but I'm sure I've heard "ink pen" in British usage: fountain pen as distinct from ballpoint.
TomB @ #254 wins my copy of today's internet for "Swinetanamo."
Dave Bell @ 258: "but I'm sure I've heard "ink pen" in British usage: fountain pen as distinct from ballpoint"
Yes, you remember correctly. But we do say "an ink pen" not "a ink pen".
California dialect quite definitely has the i/e distinction. I remember some years ago I was working and a customer in the shop asked for an "ink pin". (Sounded more like "pin" than "pen" to me at the time.) Never having heard the phrase before, I was very confused, and it took some time to work out just what was being asked for. I occasionally worry that they thought I was making fun of them.
Re: library books not being a major source of infection. Given that most Americans read 1-2 books a YEAR, I wouldn't expect them to. I (like many here) read 100-300 books a year, many from the library. My husband has this idea that library books are crawling with germs. I think it's rare for a library book to be returned while a germ is still living on it--people may get out of a sickbed to go to work or vacation, but not go on a trip to the library.
David, #262: Yes. That was something I'd been meaning to mention -- that spelling it "ink pen" as we've been doing here is going to give people who do have the i/e distinction the wrong idea. The reason for the idiom is that both words, in that idiolect, are pronounced "pin" -- so you have to distinguish between a pin (straight pin) and an ink pin. (Safety pins already have a distinguishing word.)
Is there any word on whether this H1N1 is expected to be contagious to / transmissible by birds?
Which of you medical/bioscience types can tell me why we can't synthesize antibodies, and inject them into people who are sick with the flu? Is the problem that they wouldn't work, that the body would reject them, or that we just can't make them?
Also, if the gene sequence of the flu virus is so short, and there are a finite (albeit very large) number of combinations of the surface proteins, is someone working on synthesizing a vaccine that contains all the hundreds of thousands of combinations, and thus confers immunity from all forms of flu forever and ever amen?
I know that has to be a stupid question, but it seems like it would work. Obviously no one's done it yet, but I don't know whether the problems are with the theory (nice way of saying "because you're stupid, Xopher, and that wouldn't work") or the technology.
Xopher: I suspect the answer is, we already do synthesise them. It's called the flu vaccine, and takes 6-9 months.
Xopher, now I'm imagining a doctor holding a syringe about the size of a barrel. "This might sting a little..."
Terry, if I'm not mistaken the vaccine is made of bits of the actual virus, to stimulate your immune system into making appropriate antibodies.
Joel, you could have a course of them. Why would the volume have to be so huge? Many cases, yes, but of leeeetle teeeeny things.
I think I just realized the answer to my question, though. Attempting to develop immunity to all that stuff at once would break down your immune system. Might cause a cytokine storm, in fact.
That's assuming that synthesis is possible.
I do wonder how precise the match has to be, between the virus and the vaccine.
But if the number of possible proteins is large enough, a fuzzy match might be nothing like enough. The difference between 10% fuzz and 50% fuzz might not make a useful difference if there are a million combinations.
Xopher 266/269: Synthesizing whole proteins on a bench top (as opposed to in an animal) in the way you're talking is a royal pain in the rear.
First, you have to add each individual amino acid in the right order, which involves washing the molecules after each step before adding the next amino acid group. A rough guesstimate is that your average antibody has about 1000 amino acids in it (~150,000 kDa protein, a high average of 150 Da/amino acid). A lot of that stuff is automated, but he facility I used to purchase peptides at, they charged 30$/aa for 10mg quantities (that is, you start with 10 mg of material. There's a good amount of loss after every step.) That gives a sense of the amount of work involved.
Second, having the chain doesn't mean that it folds correctly. There's an amazing amount of machinery in cells to make sure things fold right, and all the recognition ability of antibodies is dependent on the folding.
Even if you could get things to fold right, you'd need to figure out some protein shapes that would plausibly fit into the protein shapes the viruses present. That's wicked complex, computationally.
The way antibody synthesis usually happens (for biological purposes) is that you inject a useful piece of protein into an animal, pull some blood a few days later, and purify the antibody left over. But for recognition useful to humans, you'd need to raise the antibodies in people (any other species and our immune system would attack the antibodies before they did anything useful). And human products for humans are also fraught--not only ethically, but for the FDA, you also need to prove that there's no chance that the product contained any disease that could ever exist.
This is the second H1N1 death in the US that I've seen report of - the first was a child just back from a trip to Mexico.
Xopher: I was being semi-flip. They choose the strains they think will be common, and use eggs to get huge wodges of the vaccine.
It's a form of synthesis.
Joel Polowin @265: H1N1 can be carried by ducks, but it's not these two proteins which determine the species affiliation -- it's at least one other internal gene that codes for species specificity. Knowing that this is H1N1 only tells us what kind of HA and NA genes this particular subtype of Influenza A contains. Your body reacts to the HA and NA proteins, which is why this information is important, but the other genes will make this virus more or less virulent.
Xopher @ 266: Antibodies aren't carrying bits of viral DNA. They match up against antigens, or bits of protein on the invader. Proteins need to be above a certain size or the antibodies won't react. (A hapten is a protein that is not antigenic, but can pick up a small piece of protein (which is too small to trigger a reaction) and make it "big enough" to induce an immune response.)
When we make antibodies, we are essentially dealing ourselves a deck of cards. You get the same chances as every other human, but you get your hand and I get mine. Your cards will protect you against some things automatically, and the others are added as you go through life, so your pile of cards grows. We do this naturally, by being exposed to illnesses, and "artificially" by generating vaccines.
Vaccines in general are either killed nasty things, or inactivated nasty things. In either case, they cannot infect other cells*; the body doesn't know this, and responds to the presence of the nasty things by generating antibodies.
Newer vaccines can be pieces of DNA, incorporated into bacterial DNA plasmids, or circles of DNA. What happens here is the plasmids are injected into the skin, where they enter the skin cells and the plasmid generates the piece of viral protein that stimulates the most protective antibodies. There's no other viral DNA, therefore no other viral proteins are made. The body generates the antibodies, as above, and there's no chance of any infection. Skin has a lot of protective cells (dendritic cells, helper cells, APCs), so the immune response tends to be rapid and strong. That helps the process.
*Sometimes inactivated viruses can become "reactivated", so to speak, and can then become infective again. This is not appreciated by the patient.
Jeremy, #272, other way around. The first was a child visiting from Mexico. Hmmm, even says so in the article you referenced.
Pardon me while I bang my head on my desk...
As a timekeeper, I get to hear all the reasons people are taking leave -- and CDC won't like this one bit but this week I heard:
"So-and-so is taking leave today, he thinks he has the flu, but he'll be back tomorrow."
I work for HHS -- our HQ has been sending us notices on how to prevent the spread of flu, with specific statements, "wash your hands frequently" and "if you have flu-like symptoms stay home."
I don't think the idiot has H1N1, but if he did he'd be coming to work shedding the virus everywhere. If this bug gets more virulent, I have real doubts about being able to stop the spread -- because of the actions of fools like this fellow.
Belgium's first confirmed case of H1N1(A) was announced yesterday - a man who spent a couple of weeks in the US.
He's been confined at a Brussels hospital to prevent it from spreading.
Meanwhile, his contact circle, including the plane passengers, are "being tracked and told to watch out for symptoms" or "being tracked, seen by a doctor, and given medicine if deemed necessary" (reports vary).
That'll really contain the spread of disease. *headdesk*
Swine Flu in the News:
Three New York City schools closed today.
Also: Lou Dobbs
WHO considers move to pandemic phase 6 for H1N1 virus
Fukuda was quick to remind journalists that the designation does not reflect the severity of the disease, but how widespread it is.
Madagascar is gonna close its port for sure.
It's official: H1N1 is now pandemic.
That means a) there are more cases than expected, and b) they are in many areas of the world. Virulence isn't a element of pandemic status.
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