Swine Flu, Well prepared or Over-reacting?
By Supanida S.
By Supanida S.
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Swine flu pandemic warning levels may rise, says WHO chief
Giles Tremlett in Madrid guardian.co.uk, Monday 4 May 2009 20.37 BST
Giles Tremlett in Madrid guardian.co.uk, Monday 4 May 2009 20.37 BST
The head of the World Health Organisation, Margaret Chan, yesterday suggested the swine flu pandemic alert would eventually move to its highest level.
But the woman in charge of the global fight against the H1N1 outbreak said a move to level six should not be taken as a cause for panic.
"Level six does not mean, in any way, that we are facing the end of the world. It is important to make this clear because [otherwise] when we announce level six it will cause unnecessary panic," she told Spain's El País newspaper.
Officials from the United Nations and the WHO later insisted that there were no imminent plans to raise the alert level. But they agreed that going to the highest level could be an eventuality.
Raising the alert level to six would mean that a global pandemic was in full effect. However, the officials emphasised that a pandemic did not necessarily mean the disease was particularly deadly.
And in a video link with the UN, Chan appeared to attempt to allay fears, adding: "We are not there yet."
The Financial Times also reported that Chan, who recently raised the threat of a pandemic to level five, had suggested a move to level six was likely. She warned that the real blow might come if a second wave of cases swept across the globe at the start of the winter flu season.
"If it's going to happen, it would be the biggest of all outbreaks the world has faced in the 21st century," she said.
The UN secretary general, Ban Ki-moon, said: "Let us remember that even if the WHO does declare phase six, a pandemic, that would be a statement about the geographic spread of the virus, not its severity."
Spain remains the European country with the most cases of swine flu. By yesterday there were 54 reported cases, including four people who were infected in the country. The outbreak has raised concerns over its potential impact on tourism.
Swine flu no worse than regular flu, Napolitano says
WASHINGTON (CNN) -- The swine flu virus that has sparked fear and precautions worldwide appears to be no more dangerous than the regular flu virus that makes its rounds each year, U.S. officials said Monday.
"What the epidemiologists are seeing now with this particular strain of U.N. is that the severity of the disease, the severity of the flu -- how sick you get -- is not stronger than regular seasonal flu," Homeland Security Secretary Janet Napolitano said Monday as the worldwide number of confirmed cases of swine flu -- technically known as 2009 H1N1 virus -- topped 1,080.
The flu has been blamed for 26 deaths: 25 in Mexico and one in the United States, according to the World Health Organization.
Still, Napolitano noted, the seasonal flu results in "hundreds of thousands of hospitalizations" and roughly 35,000 fatalities each year in the United States. There are still concerns that the virus could return in the fall, in the typical flu season, as a stronger strain.
"We are cautiously optimistic that this particular strain will not be more severe than a normal seasonal flu outbreak," Napolitano said.
Napolitano acknowledged claims by health officials in Mexico, the epicenter of the H1N1 outbreak, who believe their cases have peaked and said, "I have no reason to think that is inaccurate."
The WHO said there were no immediate plans to raise its alert to the highest level, Phase 6. That designation would mean "that we are seeing continued spread of the virus to countries outside of one region," Assistant Director-General Keiji Fukuda said.
"If you are seeing community outbreaks occur in multiple regions of the world, it really tells us if the virus has established itself and that we can expect to see disease in most countries in the world."
In the United States, the CDC on Monday reported confirmed 279 cases across 36 states -- 60 more than were confirmed the day before. Several states, including New York and Massachusetts, confirmed dozens more cases Monday that were not immediately added to the CDC tally.
Earlier, Louisiana Gov. Bobby Jindal said the CDC "erroneously" doubled the cases in his state. Jindal confirmed his state's total is seven, and the CDC dropped its nationwide count from 286 to 279.
Many of the cases are among children; the median age is 16, said Dr. Richard Besser, acting director of the CDC. The youngest confirmed case is a 3-month-old, he said.
There are also more than 700 probable cases across 44 states, Besser said.
"This likely represents an underestimation of the total number of cases across the country," he said, because not everyone with flu-like symptoms goes to the doctor and gets tested.
The numbers are expected to increase. Dr. Anne Schuchat, the CDC's interim deputy director for public health, said Sunday, "We believe we're just on the upswing here."
But in Mexico, where the first cases were reported, illnesses may have peaked for now.
Mexico City will reopen government offices and restaurants Wednesday, and museums, libraries and churches Thursday as officials cited improvements in the battle against swine flu.
Officials said university and secondary students can return to class Thursday while younger students will wait until May 11.
In another sign of improving conditions with the H1N1 virus, federal officials lowered the nation's health alert level Monday from red, or "high," to orange, or "elevated."
"The measures we have taken, and above all the public's reaction, have led to an improvement," Mexico City Mayor Marcelo Ebrard said at a news conference.
"But I insist that the virus is still present, that we need to remain on alert, and the resumption of activities will be little by little, not all at once."
In China, an airplane will be picking up dozens of Mexican citizens who want to return home after being held by Chinese officials for "health reasons," Mexico's Foreign Ministry announced Monday.
China has denied discriminating against Mexicans, saying it is exercising proper precaution to prevent the spread of the virus.
The plane will stop in various cities in China where there are "concentrated" numbers of Mexican citizens who wish to leave the country, the foreign ministry said in a statement.
In the U.S., residents gripped by concerns about the swine flu, also had a hopeful sign Monday. The St. Francis Preparatory School in Queens, New York -- which had the first confirmed U.S. cases of swine flu -- reopened Monday.
More than 100 St. Francis students had come down with flu symptoms two weeks ago. Some were tested and found to have the H1N1 virus.
New York City Mayor Michael Bloomberg was on hand to welcome them back to a school that had undergone an intense scrub-down.
"The school has been completely sanitized," St. Francis Principal Leonard Conway said in a letter to students and their parents.
The U.S. Department of Education said that 533 schools were shut Monday, about 100 more than Friday and about half of 1 percent of all schools in the United States. The closures affect about 330,000 students in 24 states.
New cases of swine flu were leaving soldiers isolated in California.
A spokeswoman for the U.S. Marine Base at Twentynine Palms, north of Palm Springs, California, said two new cases of the flu were confirmed by the CDC. The two Marines show no symptoms but are being kept in isolation, spokeswoman Jennie Haskamp said. Previously, one other case was confirmed at the base.
The U.S. Defense Department also reported that a crew member stationed aboard the USS Dubuque in San Diego, California, was confirmed to have swine flu and is currently ashore. The department said there were 13 other "probable" cases among Dubuque personnel.
And California officials were looking into a suspected case at Centinela State Prison in Imperial County. Authorities suspended visitation and other "non-essential activities" at the prison pending confirmation.
Even as health officials worldwide worked to battle the outbreak, intense efforts were under way to develop a vaccine -- with lessons from history in mind.
"In 1918, the Spanish flu showed a surge in the spring and then disappeared in the summer months, only to return in the autumn of 1918 with a vengeance," WHO spokesman Gregory Hartl said Sunday. "And we know that that eventually killed 40 million to 50 million people."
Health officials are not making such dire predictions in this case. And they can't know for certain whether the swine flu will make a big return later in the year.
Still, they're taking no chances. In that effort, health officials have a tool unlike anything they've had before.
"This is the best surveillance we've ever had," Fukuda said Monday. "You know, we're really monitoring and able to see a situation unfold in a way we have never been able to do in history before."
In Hong Kong, about 200 hotel guests and 100 staff members at the Metropark Hotel remain under quarantine until Friday after health officials determined that a guest there had contracted the H1N1 virus.
"We go down to the lobby for food and then back to the room to eat your food," said Leslie Carr, a British man who is one of the 300 stuck at the hotel. "Not many people are downstairs hanging around to talk or discuss anything."
Hong Kong, in particular, is extra careful after a SARS outbreak in 2003 killed almost 300 people.
"In view of the lack of data ... we have to be very cautious," said Yuen Kwok-Yung of Hong Kong University. "I believe that as time goes by, we can change our strategy."
Swine Flu Update: Five Things Not to Do
TIME
TIME
By BRYAN WALSH Bryan Walsh – Sun May 3, 1:50 pm ET
The global rise in swine flu has showed few signs of slowing. Now in 11 countries, the H1N1 flu virus was confirmed on Thursday in the Netherlands and Switzerland; in Canada, cases rose to 27 and in the U.S., the caseload increased to 109 in 11 states, with hundreds of school closures that sent some 160,000 students home. Meanwhile, the World Health Organization (WHO) has said that a new flu pandemic is imminent, yet some pharmacies (in New York City at least) are temporarily running short of the antiviral Tamiflu. So, no one would blame you for feeling scared about getting sick.
But when people get scared, they sometimes say or do dumb things. That includes Vice President Joseph Biden, who said Thursday morning on the Today show that the swine flu virus could spread easily on airplanes, and that he has advised his family against traveling anywhere on mass transit. "When one person sneezes, it goes all the way through the aircraft," Biden told Today host Matt Lauer. "I would not be, at this point, if they had another way of transportation, suggesting they ride the subway."
In fact, as Dr. Richard Besser, the acting director of the Centers for Disease Control and Prevention (CDC), pointed out just a few hours later, there's no real risk for a healthy person in the U.S. to ride mass transit - not with the outbreak as small as it is currently. It's true that crowded trains and subway cars can be a vector for disease transmission if sick people are on board. You can catch the flu if you're within about six feet of a sick person - otherwise known as the "breathing space" - who coughs or sneezes on you, and a small amount of the virus can survive on inanimate surfaces. But with just a tiny number of cases in the U.S. right now, there's little risk that you'll encounter a sick person - certainly not enough to make it worth becoming a shut-in.
(To the Vice President's point about air travel: Aboard a plane, the air flows side to side, with air circulating in from above and traveling across rows - with little front-to-back air movement - before exiting the cabin. Most aircraft also ventilate the cabin with fresh air from outside and use HEPA filters to clean recirculated air.)
But misconceptions spread quickly during the early stages of a new disease outbreak. In Egypt, authorities culled some 300,000 pigs - even though there was no evidence that the H1N1 virus was circulating in these pigs or was actively passing from pigs to people. In France, authorities have said they want to ban flights to and from Mexico, even though WHO officials and other epidemiologists say such extreme measures are likely to hurt far more than they'll help. (The E.U. rejected the French request on Thursday.) "The risk of collateral damage [on top of the flu] is very real," says Michael Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
GENEVA (Reuters) - Swine flu will carry the name "pandemic" even if the new virus turns out to cause mainly mild symptoms as it sweeps the world, raising questions about how serious the global alert actually is.
Although it has been deadly in the disease epicenter, Mexico, and caused the death of one Mexican infant in the United States, in other countries people infected with swine flu have fared well, with diarrhea the biggest complaint.
The World Health Organization is expected to move quickly to designate a full pandemic -- at level 6 of its 6-point scale -- within days to reflect the continuing spread of swine flu among people who have not been to Mexico, including in Europe.
Margaret Chan, the WHO's director-general, on Wednesday night raised the world flu alert level from 4 to 5 and said: "It is really all of humanity that is under threat during a pandemic."
Echoing other infectious disease experts, and drawing on her experience fighting SARS and bird flu outbreaks as health director of Hong Kong, she said viruses such as the H1N1 swine strain needed to be closely watched in case they worsen.
"We learn from previous pandemics. Pandemic virus is precarious, unpredictable, and will take us by surprise," she told reporters at the WHO's headquarters.
But Chan acknowledged that the disease may well cause more discomfort than death, noting that many patients infected in the United States have recovered on their own and without medicine.
"It is possible that the full clinical spectrum of this disease goes from mild illness to severe disease. We need to continue to monitor the evolution of the situation to get the specific information and data we need to answer this," she said.
"There may be a possibility that the virus will die out and stop, and that would be the best for us. But it can turn the other way."
Several theories are circulating about why swine flu has killed as many as 176 people in Mexico while having mild and more manageable effects elsewhere.
Some experts speculate that the Mexican victims did not receive appropriate medical care or suffered other health complications that made them vulnerable to the flu.
For the time being, the WHO's own guidance to people who suspect they have been infected with swine flu is essentially the same as advice for seasonal flu care.
Its website's "frequently asked questions" about the virus tell people who have a high fever, cough or sore throat to rest and take plenty of fluids, wash hands frequently, and avoid work, school or crowds as much as possible.
(www.who.int/csr/disease/swineflu/faq/en/index.html#q11)
MILD OR SEVERE PANDEMIC?
Keiji Fukuda, the WHO's acting assistant director-general, said that swine flu appeared very similar to normal seasonal flu, a disease that is rarely fatal for healthy adults but can kill the elderly and infirm.
Between 3 and 5 million people experience severe illness due to regular, seasonal flu around the world each year, and between 250,000 and 500,000 die as a result.
Fukuda said it was not yet clear whether swine flu would turn into a mild or severe pandemic, raising the possibility that the virus could have more serious effects as it continues to permeate new communities or as climate conditions change.
There were three pandemic flu outbreaks in the 20th century -- in 1918, 1957 and 1968 -- known respectively as Spanish, Asian, and Hong Kong influenza. An estimated 50 million people died in the first outbreak, about 2 million in the second and between 1 and 3 million in the third.
"In the 1918 pandemic, the first wave was mild, but by fall, the second wave killed many people. So whichever way this virus swings, we can't possibly know," said Guan Yi, a microbiologist at the University of Hong Kong.
"At this point, chances are it will be mild, but we can't rule out it will turn virulent. And even if it turns milder, it can still kill, depending on the kind of person it infects."
Health experts fear swine flu could be especially dangerous for the old and infirm, especially those with immune-system suppressing diseases such as HIV/AIDS.
Its spread to poor countries that lack medical staff, drug stockpiles, and diagnostic tests -- and where tropical and other diseases are also prevalent -- is another serious concern.
Guan Yi said that if it spread to Egypt or Indonesia, where H5N1 bird flu is endemic, it might combine with that virus.
"It could turn into a very powerful H5N1 that is very transmissible among people. Then we will be in trouble, it will be a tragedy."
http://www.reuters.com/article/swineFlu/idUSTRE53T34B20090430?pageNumber=2&virtualBrandChannel=10528
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Well prepared or Over-reacting?
By Supanida S. 4907640249 (21)
My reactions
1.) WHO has recently announced the H1N1 (swine flu) alert level to 5 and it seems to be raised to the highest level (level 6) soon.
Phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short.
Phase 6, the pandemic phase, is characterized by community level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in Phase 5. Designation of this phase will indicate that a global pandemic is under way.
(Information from WHO)
2.) In the WHO report update 15 on 5 May 2009 -- As of 06:00 GMT, 5 May 2009, 21 countries have officially reported 1124 cases of influenza A (H1N1) infection.
Mexico has reported 590 laboratory confirmed human cases of infection, including 25 deaths. The United States has reported 286 laboratory confirmed human cases, including one death.
3.) At the early stages of a H1N1 (swine flu) outbreak, many people and media exposed a lot of information about this new disease which created a global awareness in a short time.
4.) People around the world are petrified and distressed. Hence, the panic rapidly created the misconceptions about the H1N1. For example; avoid eating pork.
5.) Eating pork will NOT cause the H1N1 infection.
6.) This panic distressed many people. For example; buying masks, going to the hospital, worrying that they have H1N1, and stocking the antiviral Tamiflu.
7.) But at this time, there are many articles stating that H1N1 is just another flu. They are saying that we are overreacting.
8.) Some people are blaming the media that have sparked fears and panic throughout the world.
9.) While some articles keep reporting on its severity.
10.) Therefore, many people are confused whether H1N1 is mild or severe.
My conclusion
Well prepared or Over-reacting?
“Prevention is better than cure” has always been an idiom that seems to have always worked. I do not think people are over-reacting. I think it is very good that people around the world are alert with this new flu. I do not think it is bad being precautious as some people have said. Because, it is something new and the viruses are unpredictable. The virus can transform in any form; mild or severe and who will be the one to confirm to the whole world. According to Keiji Fukuda, the WHO's acting assistant director-general, told the Reuters that “it was not yet clear whether swine flu would turn into a mild or severe pandemic, raising the possibility that the virus could have more serious effects as it continues to permeate new communities or as climate conditions change.”
It is not a fault being well-prepared as we can learn from the previous epidemics. "In the 1918 pandemic, the first wave was mild, but by fall, the second wave killed many people. So whichever way this virus swings, we can't possibly know," Guan Yi, a microbiologist at the University of Hong Kong, said with the Reuters.
The past has left us with many great lessons. Some i.e. people’s reactions toward epidemics, are shown below.
Above is a diagram from Macroeconomic Review of Monetary Authority of Singapore. It explains the four-staged characterisation of an epidemic during the Spanish flu in 1918 which I think it works for the case when human have to face with new epidemics.
In my opinion, many organisations, governments and media have done a good job by warning people to be aware and prepared for this pandemic. Furthermore, the governments and media should create the mutual understandings about the H1N1 as soon as possible. I believe that a good understanding provides a real effective preparation.
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We should not ignore nor panic but should understand this issue at hands. Hence, let’s understand and be precautious for the pandemic H1N1 with crucial information from the most trusted sources; the World Health Organisation and the Centers for Disease Control and Prevention.
What is Swine Influenza?
CDC: Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza virus that regularly causes outbreaks of influenza in pigs. Swine flu viruses cause high levels of illness and low death rates in pigs. Swine influenza viruses may circulate among swine throughout the year, but most outbreaks occur during the late fall and winter months similar to outbreaks in humans. The classical swine flu virus (an influenza type A H1N1 virus) was first isolated from a pig in 1930.
How do people become infected with influenza A(H1N1)?
WHO: Outbreaks in humans are now occurring from human-to-human transmission. When infected people cough or sneeze, infected droplets get on their hands, drop onto surfaces, or are dispersed into the air. Another person can breathe in contaminated air, or touch infected hands or surfaces, and be exposed. To prevent spread, people should cover their mouth and nose with a tissue when coughing, and wash their hands regularly.
What are the signs and symptoms of infection?
WHO: Early signs of influenza A(H1N1) are flu-like, including fever, cough, headache, muscle and joint pain, sore throat and runny nose, and sometimes vomiting or diarrhoea.
Is there any confirmation of transmission between pigs and humans at this point?
WHO: No.
Is it safe to eat pork and pork products?
WHO: Yes. influenza A(H1N1) has not been shown to be transmissible to people through eating properly handled and prepared pork (pig meat) or other products derived from pigs. The influenza A(H1N1) virus is killed by cooking temperatures of 160°F/70°C, corresponding to the general guidance for the preparation of pork and other meat.
What are the recommendations for face masks?
WHO: If you are not sick you do not have to wear a mask. If you are caring for a sick person you should wear a mask. All home made masks should be cleansed regularly.
If you are sick, stay at home and avoid contact with people.
How can I protect myself and prevent illness?
WHO: Practise general preventive measures for influenza to prevent infection:
- avoid close contact with people who appear unwell and have fever and cough;
- wash your hands with soap and water thoroughly and often;
- practise good health habits including adequate sleep, eating nutritious food, and keeping physically active.
What medications are available to treat swine flu infections in humans?
CDC: There are four different antiviral drugs that are licensed for use in the US for the treatment of influenza: amantadine, rimantadine, oseltamivir and zanamivir. While most swine influenza viruses have been susceptible to all four drugs, the most recent H1N1 influenza viruses isolated from humans are resistant to amantadine and rimantadine.
Is there a vaccine for swine flu?
CDC: Vaccines are available to be given to pigs to prevent swine influenza. There is no vaccine to protect humans from swine flu. The seasonal influenza vaccine will likely help provide partial protection against swine H3N2, but not swine H1N1 viruses.
More information:
http://www.who.int/csr/disease/swineflu/en/index.html
http://www.cdc.gov/h1n1flu/key_facts.htm
More information:
http://www.who.int/csr/disease/swineflu/en/index.html
http://www.cdc.gov/h1n1flu/key_facts.htm
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