Monday, May 4, 2009

Swine Flu / Influenza A(H1N1) - Mexico Re-opening, WHO Cautious - I Doubt This is Over

Swine flu, influenza A(H1N1), is still showing up in more people in more places around the world - but not killing people. And, 'swine flu' is apparently waning in Mexico. As far as it goes, that's good news.

Kudos to the Mexican government, for having the good sense to shut down Mexico city - shops, soccer fans, Masses, and all - until they
  1. Had some idea of what they were dealing with and
  2. Could see that the disease had (apparently) peaked and was on the wane
People will be criticizing Calderon's government for generations for doing too much, doing to little, doing it to early, too late - or not doing something that will be "obvious" thirty years from now. That's the way things go.

I think that, ideally, the Mexican government would have noticed the first few cases a little earlier. That didn't happen - and once the existence of the disease was known, the Mexico's government seems to have skipped the step of denying that there's a problem, and jumped straight to setting up barriers to influenza A(H1N1)'s spread.

By that time, it was already in several other countries: but that's almost inevitable in a world with fast transportation and people who can afford to use it.

Meanwhile, it looks like Mexico City and the rest of Mexico are re-opening - and dealing with a massive international public relations problem. People in most countries seem to be aware that influenza A(H1N1) started (apparently) in Mexico - and are extraordinarily cautious about anybody with a Mexican passport. (Reuters, Independent Online)

Flue Alert Level Lowered: in Mexico

Mexico's lowered its national alert level. The Mexican epidemic is waning where it began: and the universities, cafes, museums and libraries that were closed will be opened again this week. (AP)

That's good news.

And, although influenza A(H1N1) is spreading around the world, it doesn't seem to be as lethal as the first cases in Mexico were.

That's more good news.

But, swine flu / influenza A(H1N1) is an influenza virus. They mutate readily and quickly: That's how we got influenza A(H1N1) in the first place.

Which is why the World Health Organization (WHO) is keeping the global alert level ("phase," actually) at 5: "Evidence of significant human-to-human transmission"

The 1918 Spanish Influenza Wasn't Much of a Problem - At First

" WHO alert over second attack"
Gulf Daily News (May 4, 2009) ("The Voice of Bahrain")

"MEXICO CITY: The World Health Organisation (WHO) chief warned yesterday that swine flu could return with a vengeance despite Mexico's President Felipe Calderon insisting his country has contained the epidemic. WHO chief Margaret Chan said that a second wave of the virus 'would be the biggest of all outbreaks the world has faced in the 21st century', confirming the total number of cases at 1,003 from 20 countries.

"Twenty-five people have died from swine flu, according to the WHO, all but one of them in Mexico. Twenty-one countries have confirmed cases of the virus which has affected more than 900 people.

"Calderon said Mexico had managed 'to contain the epidemic' and was now 'in a position to overcome' the influenza A (H1N1) virus.

"But Chan said the end of the flu season in the northern hemisphere meant that while any initial outbreak could be milder, a second wave could be more lethal...."

My oldest daughter told me that a number of students at the post-secondary school she's attending see the swine flu / influenza A(H1N1) as a joke. I think I can understand that, to some extent: during the last two decades, there hasn't been a disease that spread and disrupted life - not here, near the center of North America, at least. The last three big ones were during the 20th century:
  • "Spanish flu"
    • 1918-1920
    • An H1N1 virus
  • "Asian flu"
    • 1957-1958
    • An H2N2 virus
  • "Hong Kong flu"
    • 1968-1969
    • An H3N2 virus
    (WHO)
I remember the last two, particularly the "Hong Kong flu," and know something about the 1918 pandemic.

That Gulf Daily News article is one of the relatively few I found that seem related to a Spanish-language article posted by a Madrid news outlet today: " 'Los virus de la gripe son tramposos, no hay que confiarse' ." (EL PAÍS (May 4, 2009) )

The headline translates, more or less, as "Influenza viruses are cheaters, we should not rely" - And yes, I know: that's not the best translation. I know a little Spanish - but for this I relied on Google Language Tools.

Part of the article is a Q & A (P. and R. in Spanish). One of the answers given by WHO's director-general, Dr. Margaret Chan, included this (translated):

"...If we take the pandemic of 1918 started as a very mild illness, and had a calm period in which it appeared had been withdrawn. But again, causing millions of deaths and disease. And this is something I want to emphasize: the influenza virus is very unpredictable, very tricky. We should not trust. In recent years we have made a lot of preparation. We are miles away from where we were five years ago, but we also need a great way to go." (EL PAÍS) 1

That's 'way too long to be a good sound bite, and doesn't lend itself to catchy headlines - but I think that Dr. Chan has a good point. The odds are that this swine flu, influenza A(H1N1), isn't done with us quite yet.

The flu season is starting in the southern hemisphere, where a few cases have shown up. And it's not at all unimaginable that a few people in the northern hemisphere may catch influenza A(H1N1) - even if it's not the right season for doing it.

Dr. Chan is right: the 1918-1920 pandemic had a lull before it killed over 600,000 Americans - and maybe 40,000,000 people around the world.

This year's human/avian/swine flu variant, influenza A(H1N1), may turn out to be relatively innocuous. An American official has declared that it's more dangerous than ordinary influenza. That may continue to be true, and influenza A(H1N1) may not go on to infect large numbers of people.

That would be nice.

But I've noticed that viruses are notoriously inconsiderate of official pronouncements. I think that WHO's cautious 'keep a close eye on this' approach is prudent - and may save a great many lives.

In the news: Background: List of posts relating to Swine flu 2009; and list of background resources:
1 Quote from " 'Los virus de la gripe son tramposos, no hay que confiarse' " ("Influenza viruses are cheaters, we should not rely" - more or less) (EL PAÍS (May 4, 2009))

Original excerpt, one question and response:
"P. ¿Ni aventurarse a predecirlo?

"R. Ahora que ya estamos viendo un número de casos en México y en Estados Unidos, estamos enfrentándonos a muchos leves, algunos graves e incluso a unas cuantas muertes. Estamos en una fase muy temprana de esta nueva enfermedad, y por eso lo que digo es que nuestra obligación es mantener la atención, no perderle ojo y no dejar que se nos escape nada. Si tomamos la pandemia de 1918, empezó también como una enfermedad muy leve, y tuvo un periodo de calma en el que parecía que se había retirado. Pero volvió y causó millones de muertos y enfermos. Y esto es algo que quiero destacar: los virus de la gripe son muy impredecibles, muy tramposos. No debemos confiarnos. En los últimos años hemos hecho mucha preparación. Estamos a kilómetros a distancia de los que estábamos hace cinco años, pero también nos falta un gran trecho por recorrer."
Translation, using Google Language Tools:
"P. Not daring to predict it?

"R. Now that we are seeing a number of cases in Mexico and United States are facing many minor, some serious and even a few deaths. We are at a very early stage of this new disease, which is why I am saying is that our obligation is to keep the attention, not losing an eye and not let anything slip away. If we take the pandemic of 1918 started as a very mild illness, and had a calm period in which it appeared had been withdrawn. But again, causing millions of deaths and disease. And this is something I want to emphasize: the influenza virus is very unpredictable, very tricky. We should not trust. In recent years we have made a lot of preparation. We are miles away from where we were five years ago, but we also need a great way to go."

2 comments:

ecrunner said...

When it comes down to it, preventing the flu, in any form, is the smartest thing to do. This nursing health resource offers many useful tips on how to prevent the flu from spreading. Very helpful.

Brian, aka Nanoc, aka Norski said...

ecrunner,

Thanks. I've already added "What Nurses Can Tell Patients About Swine Flu" (Scrubs / the nurse's guide to good living (April 28, 2009)) to the anchor page for this topic: "Swine Flu 2009".

As to the advisability of preventing any form of flu: yes, that's clearly a good idea. I don't, however, think the special attention to influenza A(H1N1) given by organizations like CDC and WHO is unwarranted. this year's novel swine/avian/human flu virus is new, unknown - and potentially very troublesome.

People who are professionally connected with disease control and prevention seem to have a laudable awareness of their lack of prescience.

In other words: when there's a new bug, it's a good idea to study it. And, if it kills a lot of people at first - as influenza A(H1N1) did - watch it very carefully.

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