Keeping up with all the flu news

A lot of people are wondering, Just how dangerous is the swine flu virus? (More formally known as, 2009 H1N1.)

The word from epidemiologists is: Not very dangerous, for most of us.

However ….  It’s quite dangerous to people falling in certain categories.  Watch out if you are: a pregnant women, a baby, elderly, immune-compromised, morbidly obese.  Or, if you have: any lung disease or disorder, an underlying chronic health problem.  (More details on this at the federal flu website.)

H1N1 virus particles invading body tissue. (CDC)

H1N1 virus particles invading body tissue. (CDC)

The easiest way to think about swine flu is that it’s remarkably similar to regular flu, except it spreads more rapidly.  Most people get only mildly sick and are better in three days or so.  I was surprised to hear epidemiologist Jeff Duchin of Public Health Seattle & King County go so far even as to urge most of us not to call the doctor.  There’s too much over-crowding as it is.

But there is some research that indicates this virus might be a little more dangerous than seasonal flu—especially for those in the “vulnerable” list I mentioned above.  For example, one team of researchers (at Imperial College in London) found the novel H1N1 flu virus lodges deeper in the lungs than regular flu virus.  That enables it to cause more severe lung infections and may account for some of the fatalities.  But it also is less aggressive in the nose and throat – making most infections less severe.

The message from this is, if you notice complications, such as breathing problems, don’t delay seeking medical help.  The best way I’ve found to sort all the usual questions is via Children’s Hospital of Atlanta, on their website.

Other tidbits:

  • The vaccine tests are full of good news. It appears to be highly effective and can be given in a single dose.
  • The first vaccine shipments may arrive on time, or even in early October.

Other recent posts and stories:

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Schools ready for swine flu?

Soon after kids return to school, in the coming few weeks, we may see  the H1N1 swine flu come back with sudden swiftness.  That’s based on what’s happened during past pandemics, such as in 1957, and on the virus’ behavior in the southern hemisphere.  Are the schools ready?

It’s hard to tell.  They basically are continuing where they left off when the first wave of sickness passed through last spring.

My colleague, Jennifer Wing, reports on discussions between Public Health Seattle & King County and school districts.  They don’t plan to close schools this time, and sick kids won’t have to stay home for as long (it was a full week last spring).  But, from what we’ve heard so far, it doesn’t seem like anyone’s making contingency plans for absentee rates that might range in the 30-50% range.

The Virus: H1N1

The Virus: H1N1

Epidemiologists are concerned with getting timely updates on the numbers of absent students.  This is essential for monitoring when and where outbreaks are happening, and last spring some schools were better than others about reporting.

Don’t be surprised if outbreaks begin as early as September.  The evidence keeps mounting that wherever kids congregate in large numbers, that’s where you’ll see rapid transmission of flu virus.  In 1957, it took just 3-6 weeks after school started before  many cities saw a surge of illness.

What about a vaccine, to prevent illness?  The first doses may not be available until after the first wave of sickness.  But, there may be additional outbreaks long into winter, and the vaccine will protect against those.

On the other hand, swine flu infections still appears to be mild, unless you have an underlying sickness or medical condition.

Flash-forward, the flu of December 09

Here are four interesting items I learned yesterday from King County’s chief epidemiologist, Jeff Duchin, MD.

  1. Lesson learned:  Closing individual schools is not effective for limiting flu transmission in a community.  Next time — if the virus appears to be more deadly — the health department will close all schools in the county, perhaps for 8 weeks or longer.
  2. Lesson learned #2: This virus spread far more rapidly than planning scenarios had predicted.  Basically, flu virus can be widespread before we know what’s hit us.
  3. Who’s first in line for a vaccine, if there’s a limited supply? Heavy-duty planning is underway for how to distribute an A-H1N1 (swine flu) vaccine next winter, assuming it’ll be available.  This will be in addition to the normal, annual flu shots.   First-responders, and most medical workers, are clearly at the top of the list.  Pregnant women, and people with compromised immune systems.  After that, it might be all children under 18, given signs that they’re being hardest hit so far.  (Normally, the elderly are considered most at risk, but not in this case.)
  4. If the virus remains less severe?  Expect simply a lot of people to be out sick, especially in schools, as everyone who didn’t get sick this spring, gets it on the second pass.   But, it wouldn’t be much different from what we’ve seen this past month.

And one note to the King County Board of Health:    Anyone watching (the meeting was recorded by King County TV) might be disappointed at the level of questioning by board members, as Dr. Duchin and other staff testified.  They asked thoughtful questions to clarify the facts.  But, nobody on the Board asked the simple questions, What parts of the “pandemic plan” did not work?  What surprises did the staff face? What needs to be improved before we face a severe pandemic?   (The lessons learned above came from a private interview, after the meeting.)

Swine flu and school closures – how much longer?

Wondering if you child’s school will be next?

The top public health officials in King County — Dr David Fleming, Director, and Dr. Jeff Duchin, Chief Epidemiologist — have been hinting that school closures may not be a tactic for much longer.

As my KPLU colleague Liam Moriarty reported this morning (Friday),  “So far, none of the folks in King County with the H-1-N-1 (swine) virus have gotten any sicker than they might from any of the old familiar flu viruses. Dr. Fleming says if that trend holds in the coming days – and this bug proves to not be particularly nasty – some of the precautions such as closing schools could be relaxed ….”

On the other hand, three students at Lakes High School, south of Tacoma, were taken to Madigan Army Hospital with severe flu-like symptoms, and as of Friday morning, two of them were in intensive care units, in serious condition.  That led to closing the school, as a precaution.

Seems sensible and prudent.   If tests show that they indeed are suffering from the swine flu H1N1, then we might see school closures  as a good tactic that should continue.

I have to say, the top officials in public health agencies and school districts have seemed remarkably indifferent to the hardship the closures cause.  In particular, for single parents and parents working jobs that offer little or no sick/vacation leave, this is a whole separate crisis.

When will a leader (the Governor? a Health Director?) stand up and say to employers, “We are in an emergency situation, and I’m asking all employers in the state to give extra sick days to anyone whose child’s school has been closed for a week?”

[UPDATE, Friday afternoon: Seattle Mayor Greg Nickels deserves a prize for being the first to address the work issue.  He told a news conference today that the city is offering extra flexibility to its employees … and he called on other employers to do the same. ]

In case you missed it, in King County, four schools have been closed (as of noon Friday)(five schools as of Friday 4 pm)  because they each have a student who probably has swine flu.  (The reason for closures is to slow down the spread of the virus — to prevent a situation where lots of people are getting sick at once.  But, once the virus is confirmed to be widespread in the community, then there’s not much benefit from closing individual schools.)

If you’re like me, keep crossing your fingers that your child’s school doesn’t have a “probable” case during the next week, and maybe after that we’ll be beyond school closures.

Washington’s “Swine Flu Six”

I’ll offer a few posts here, shortly. First, for those of you craving detail during these anxious times, here is full text of the radio stories for KPLU:

Version one:  Six Local Cases of Swine Flu Called “Probable”

The swine flu outbreak has officially reached Washington state. Last night, the state health department announced it’s identified six people as probable cases. They’re in Seattle, Snohomish County and Spokane. More from KPLU science and health reporter Keith Seinfeld:

We have the most details about the three from Seattle. They include:

A 33-year-old female doctor, whose husband and two children are also likely infected. They’re being treated at home.

A 27-year-old single man is at home.

And an 11-year-old boy has been hospitalized but is recovering. The boy’s school is Madrona, and it is staying open because the boy did not come to school at all after he became sick over the weekend.closed for a week. UPDATE – The decision was made early Thursday morning, after public health officials determined the boy may have been contagious last Friday when he was in School.   Washington Secretary of Health Mary Selecky says this all sounds alarming:

“The reason we’re being very cautious is because this is a brand new virus, and as a result there really isn’t any immunity in the population. So, we want to prevent it from spreading.”

Public health is especially on the lookout for how easily the virus spreads, and how severe the flu is once people get it. Dozens more possible cases are in early testing stages. The best way to keep it from transferring the flu, she says, is to stay home if you’re sick, cover your cough, and wash your hands. If you don’t have enough sick days? That policy, she says, is up to each employer. Keith Seinfeld, KPLU news.

More:

  • In Snohomish County, the public health department wasn’t able to get any details, as of Wednesday night, about a 6-year-old 3-year-old boy or a 34-year-old woman who are probable cases.
  • None of Washington’s six probable cases appears to have involved travel to Mexico.
  • So far, about 95-percent of the cases labeled probable by different states have proven positive at the federal labs in Atlanta. But it may take several days to get results for Washington.

Version Two: Probable cases of Swine flu in Washington

Six people in Washington are now considered to “probably” have swine flu, according to the state Department of Health. All six are recovering. Also one woman in Victoria, B.C., has confirmed she caught the swine flu while on vacation in Mexico. More details now from KPLU science and health reporter Keith Seinfeld:

Just a few hours after saying there’s no sign of any swine flu in Washington, the state health department got results from a new batch of tests. Six people have a strain of flu that is probably the new strain of swine flu – and their samples have been flown to the federal laboratory in Atlanta for confirmation.

Of the six, three are from Seattle, two from Snohomish County and one from Spokane. An 11-year-old boy in Seattle and a six-year-old boy in Snohomish were the only children. The Seattle boy’s mother is being praised for keeping him home – so his school, Madrona, won’t have to be closed. UPDATE – But Madrona was closed Thursday, for a week, because it turns out he may have been contagious last Friday when he was in School.  Dr. Jeff Duchin, chief epidemiologist for King County, spoke at a Wednesday evening news conference televised on northwest cable news.

“You shouldn’t go to school when you are sick.  You shouldn’t go to school if you have a fever or are coughing, all around the community, because if this virus has made its way to Washington state, the way to prevent it from spreading is by keeping away from one another when we’re ill.”

The Seattle boy has been hospitalized since Tuesday, with a fever and shortness of breath, but now is in good condition. None of the others required hospitalization. One case is a 33-year-old doctor from Seattle. She and her famly are being treated, but it’s not clear yet if she may have exposed others.

Public health officials say, you should expect to see more cases in Seattle and all over Washington, as more people are tested. Results from the federal labs may take several days. Keith Seinfeld, KPLU news.

More:

  • A shipment of anti-viral medicines is en route to Washington, to add to the state’s stockpile, in case the outbreak becomes an epidemic.
  • Seattle has activated its Emergency Operations Center, at the lowest alert level, to be ready should the situation change suddenly.
  • The advice to the public remains, stay home if you’re sick, wash your hands and cover your cough.

Swine flu, without Mexico

I may be gloriously wrong on this.  But, Ill go out on a limb and suggest the possibility that this H1N1 swine flu has been in Washington state, and other states as well, for quite a while.  I won’t be surprised if it turns out that many people who suffered a flu or flu-like illness over the past month actually had this strain.

And last night’s announcement of Washington’s first six “probable” cases (see this post) added some support.  I was told by both the state Department of Health and King County’s public health officials that none of the six people who harbor the suspected virus has any connection to Mexico. They didn’t travel there, nor did they contact anyone who recently did.

In fact, in King County, the three cases only came to light because they bypassed the health department.  Why?  Because the health department was only agreeing to test samples that met the criteria of severe flu symptoms PLUS some connection to Mexico.  These three, then, were tested by independent clinical laboratories, and then forwarded to the state when they proved to be a Type-A influenza virus.

(One of those labs was at the University of Washington, and I’m still trying to learn about the other two, as well as the cases in Snohomish and Spokane.)

If they had no connection to Mexico, and they caught it locally, then this suggests that there was a good-sized reservoir of infected people in Seattle by the end of last week.  It still may have come from Mexico, but perhaps  a month ago, or longer.

Swine flu, the mystery

Everyone’s talking about swine flu. Every major news organization has done a decent job covering the basics. Here are a few extras, based on what I’ve learned so far:

  • We won’t know for a week or longer if this is indeed a serious pandemic or not. The information from Mexico is still too incomplete to tell us if the flu there is killing an unusual number of healthy young adults. It appears to be unusal, and that’s what has public health leaders around the world worried. But that appearance may prove false, once we get more data. They’re handling it with “an abundance of caution,” says King County’s chief epidemiologist Jeff Duchin. (For example, they may not be getting an accurate measure of how many people are infected with mild cases of swine flu, and that number is key to telling you what percentage are severe cases.)
  • In British Columbia, two cases of swine flu were confirmed over the weekend. Both were men who were returning from Mexico. Both cases were considered “mild” (in which case, I’m not sure how they were detected).
  • It would take six months or longer to create a vaccine. In the meantime, for those who do get sick, a drug called Tamiflu can effectively treat the disease. A stockpile is on hand, in King County and elsewhere, to deliver Tamiflu in the event this does become a major epidemic. The stockpile would be used primarily for police, fire and medical workers.
  • “What should I do?” In most cases, nothing. Public health officials say, if you are sick enough that you think you need medical attention, then call your doctor’s office. But, don’t just show up. And if you’re mildly ill and wouldn’t normally seek medical attention, then don’t seek it now. (But do take the usual precautions, such as covering your coughs, handwashing, etc.)