Swine Flu 4.1: The Perfect Storm?

Our Flu A (highly likely swine flu) count is now up to 8, 2 more coming in yesterday and being diagnosed by a rapid test, and the more I think about the Mexico death toll, the more likely it seems that a perfect storm of risk factors is responsible.  The most dramatic example of a perfect storm is a cancer called Burkitt’s lymphoma, common in Equatorial Africa but rare in African Americans.  It turned out that a combination of a gene mutation, malaria and Epstein-Barr virus infection is necessary to trigger it, and only in Africa do the 3 factors (each common elsewhere) come together.  The 1976 Swine flu outbreak went nowhere outside a basic training cadre in a military base — it is theorized that a packed-in crowd of stressed-out individuals created the fertile environment not duplicated elsewhere (outside of most middle schools I know).  And, the great mathematician Srinivasan Ramanujan, deprived of vitamins A and D by his dark skin, living in sun-starved England, and vegetarian diet, succumbed to tuberculosis after being thus weakened.  I have already mentioned my thoughts on risk factors possibly prevalent in Mexico; iron deficiency, in particular, is common in my patients from Mexican families, and may contribute as well.  I am sure that is being thoroughly investigated, and more than one risk factor may be responsible, delineating areas of concern for other countries.  In the meantime, we should go about out lives, washing our hands perhaps more often and going into crowds perhaps a bit less, and as for vitamin supplements — make sure A and D are in them.


Swine Flu IV: The Voyage (that the virus already made to our) Home

Three more Flu A cases yesterday, only one (a Mexican teenager) looking sick enough to suspect flu, but nowhere near life-threatening.  Called NYC Health Department.  Guess what?  They agree with me!  They think all new Flu A is swine flu; they agree that it is less severe than “regular” flu; they think the cases in the city are too numerous to count or confirm, and that many are so mildly ill that they will never even see a doctor; they do NOT want me to report cases or send samples for confirmation UNLESS the patient is sick enough to be hospitalized (which is perfectly reasonable, if they try to count every sniffle in New York they will have no time left for their real jobs dealing with life threatening disease).  Channel 7 News at 11 interviewed me yesterday and this is pretty much what I told them; either I was too boring or what I said was too boring, and they chose not to run my segment, opting instead for more exciting news of school closings and masks running out in pharmacies all over town.  This being the case, I will enlist professional help in bringing my message to the public: (click on the Comments link below):


Swine Flu III: The Search for Snot

(Diagnosis is made by analysis of nasopharyngeal secretions, you see.  It’s a pun.  It’s supposed to be funny.  You may laugh when ready.)

Here’s a draft of an interview I gave on Swine Flu as it impacts new mothers:

> 1)  What exactly is swine flu?

It’s a flu previously only seen in pigs.  IN fact, all flu strains arise
in pigs and poultry, and cause human epidemics when they become
transmissible between humans.
> 2)  New moms may have added concerns over the current swine flu threat.
> What should a new mom know about swine flu in regards to her baby?

The “additional” concern is really only for families that received the flu
vaccines as recommended by the CDC, because the seasonal flu shots do not
appear to prevent this new strain.  For people who were not immunized this
season, the garden variety, “regular” flu is probably still the greater
threat, with thousands of fatalities in US.
> 3)  How serious is the swine flu in regard to small infants? Are some
> infants more susceptible than others?

Possibly; the only place where serious cases have occurred so far is
Mexico, and the risk factors are still being analyzed there.
> 4)  What precautions should a mom take to keep her baby healthy?

Keep out of crowds, wash hands and everything else that touches a baby.
Vitamins A and D should be supplemented, especially in breastfeeding
babies over 2 months age and all mothers, as they are vital in maintaining
appropriate immune response, and are most often deficient.
> 5)  What symptoms should she keep an eye out for in her baby and when
> should she seek medical attention for her baby if she suspects swine flu
> contact?

The usual — fever, cough, poor appetite, cranky or lethargic, looking sick.
> 6)  If an infant does contract swine flu, what is the treatment?

Tamiflu appears to be effective; you and your doctor will decide if it is
> 7)  Is there anything I have forgotten or that you would to add to the
> topic?

The early returns suggest that this is a milder disease than regular flu,
amd is probably very widespread already, with lots of mildly sick people
running around, going about their business, and getting better without
ever being diagnosed with swine flu.  In fact, the countries reporting
cases now are those with real-time capability of analyzing virus genome to
identify it, and I doubt anyone is spending the money to test mildly ill
persons.  We will soon know why Mexican patients are more severely
affected; possibility include genetic (Native Americans appear to have
different immune response to certain infections), vitamin deficiencies, a
pool of infected individuals well into the millions leading to fatality in
a rather small percentage of cases, existence of a co-infection in Mexico,
and toxic folk remedies or counterfeit medications.


Swine Flu II: The Wrath of Ham

OK, here is what happened today:

3 children tested positive for Flu A.  2 of them had been immunized with Flumist, which up till now only rarely failed (maybe 5 previous positive Flu A’s out of hundreds previously immunized children tested).  The 3rd child was not immunized.  NONE of the 3 had “severe” flu — none had high fever, none looked as miserable as actors in NyQuil advertisements, none had anything resembling complications — in fact, in the middle of the epidemic 2 months ago, I probably would not have tested them because they did not look sick enough to have the “real” (garden variety) flu.  I gave Tamiflu to all three, and will follow them closely.  I do not know for sure that they had “swine” flu, but it is unlikely that “garden variety” flu would produce equally mild disease in immunized and unimmunized individuals.

So what is the most likely explanation?

I think this “new” swine flu is actually quite widespread already; I think the great majority of people who had it, never knew they had it because they did not feel sick enough to go to the doctor, and if they did, they did not look sick enough to be tested for flu.  I do not know what was different about the fatal cases in Mexico (apparently caused by the same virus), but I suspect we will find out soon.

Coming soon: Swine Flu III: The Search for Sanity…


Swine Flu: The Muddled Picture

The good news is, as of right now it does not appear to be significantly more severe, more contagious, 
or more drug-resistant than garden variety flu, and the H1N1 component of previous flu vaccines may 
actually create at least a small immunity against the swine flu, so the need to worry about this epidemic
 is most pressing for chronically ill and/or elderly individuals who are at high risk for complications from 
any strain of influenza, with the added caveat that the flu shot they received this year may not offer 
them significant protection.
We are also continuing to test for flu in the office; today we have had 3 positive
for flu A so far. (2 PM, we are open 9am to 7pm).  I have to assume these are all
swine flu, as all "regular" flu activity lately has been "B".  None are very sick;
all are getting Tamiflu, with expectations that it will work.  If you are worried, we can help.