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Thursday, May 14

H1N1/Swine Flu: Was Cuba's airport blockade an over-reaction to the outbreak?

Let me put the answer this way:
Several Pacific island territories were particularly hard-hit [by the 1918 swine flu]. The pandemic reached them from New Zealand, which was too slow to implement measures to prevent ships carrying the flu from leaving its ports.

From New Zealand [which had a 5% mortality rate] the flu reached Tonga (killing 8% of the population), Nauru (16%) and Fiji (5%, 9000 people).

Worst affected was Western Samoa, a territory then under New Zealand military administration. A crippling 90% of the population was infected; 30% of adult men, 22% of adult women and 10% of children were killed.

By contrast, the flu was kept away from American Samoa by a commander who imposed a blockade.
Any other questions about the Cuba airport blockade?

Next question: Was Castro right to accuse Mexico of being tardy to issue a flu warning for fear it might have led to the cancellation of President Obama's April visit?

Castro is factually incorrect if he thinks Calderon's government had identified the swine flu virus prior to Obama's visit. As to whether the government had exerted itself to alert all countries of the outbreak of a 'regular' influenza -- I don't know.

But I think Castro is asking for an era that's not quite here, if he wants nations to issue a strongly worded flu alert every time the flu strikes. Yet I also think the world changed forever during the past month because of the realization that the outbreak of a new virus was initially camouflaged by a routine influenza.

Probably Castro became so very angry with Calderon's government when he realized that, given the way the swine flu progressed, it could just as easily have alighted in Cuba from a country other than Mexico. As the Western Samoa example illustrates, an island becomes a death trap when a highly lethal infectious disease breaks out there.

I think that's why his government sent out teams of doctors to scour Cuba, looking for signs of swine flu, even though they had caught and quarantined the one case that was in the country before the government ordered suspension of flights to and from Mexico.

Below are links to the big news of the day on the swine flu front, which point to a gathering storm emanating from the poorer countries about how to divide up the swine flu vaccine when it's ready.

WHO estimates that if the vaccine manufacturers go full tilt, they can still only crank out about one-two billion doses this year. So it's coming down to a very ugly triage situation -- who gets thrown off the lifeboat. The Cuban government's decision to suspend Mexico air traffic is even more reasonable in tight of that grim question. Castro knows that his country would be among the last in line for the first batch of the swine flu vaccine. And that the same would happen if demand for Tamiflu and Relenza exploded around the world.

To give you some idea of how seriously the swine flu virus is being taken in the developing countries, China has given the green light for Taiwan to attend the upcoming WHO assembly meeting, which will be dominated by discussions of the swine flu pandemic.

WHO met yesterday to discuss the production of swine flu vaccine. Two reports, one from AP and the other from AFP, portray somewhat contradictory views of what happened at the meeting.

The AP report conveyed that the decision had already been taken to start production and that only the details had to be worked out.

The AFP report indicates that WHO ended up the meeting by sitting on the fence. Or else they're easing up on the pace of decisions in order to placate concerns that the manufacture of swine flu vaccine is very problematical at this time:
WHO puts off decision on swine flu vaccine

GENEVA (AFP) — The World Health Organisation said Thursday that scientists will need more time to decide whether to start mass production of vaccines against the swine flu virus.

Acting assistant director-general Keiji Fukuda told journalists there have been "no big decisions" from a meeting of experts on Thursday on an A(H1N1) vaccine.

He added that more meetings were needed to examine the technical process for manufacturers to ready themselves to go into mass production which will "require several weeks."

"It's not possible to say that there will be a decision by this date, really it's a painstaking and difficult process," said Fukuda.

Marie-Paule Kieny, WHO director for vaccine research, said last week that the manufacturers and experts meeting Thursday would decide whether to ask the UN agency to give the go ahead for large-scale manufacturing of a vaccine.

But Fukuda said production of vaccines against the new virus could disrupt production of seasonal flu vaccines and so needed careful thought.
It could be that WHO is also trying to head off that gathering storm of fury, or at least delay its onset.

The storm has been building for a long time; the general perception in the less-rich countries and the poorest ones is that the wealthier nations have always given them the short end of the stick when it comes to which nations have the most access to critical drugs. Whether or not the perception is overblown, it'll set off crises if the swine flu virus begins taking many lives.
Comments:
The real heros of this April 2009 swine flu spread are several high school principals who closed the schools.

I heard today from a patient that her daughter's Catholic school in the Wash DC area was closed on a Tuesday in Feb 2009 when 40 children were absent on Monday and 80 absent on Tuesday. They reopened one week later with some additional absences, but no further increase.

Common sense among the school principals made a significant difference, as well as various news media talking about it which discouraged many people from some of the group activities that were planned.

So if you can't close a port, you may at least close the school or church or synagogue and discourage large groups of people coming together for a week or two.

Every little bit helps in these episodes, because influenza is very contagious—almost as much as smallpox.
 
Oops, forgot this interesting URL. It suggests the swine flu may predominate in the fall 2009 flu season. (I plan to get the flu shot as early as possible this fall.)

http://content.nejm.org/cgi/content/full/NEJMp0903906?query=TOC
 
DocJim -- That is the most interesting news! I live in the District but I'm embarrassed to say that I have been watching swine flu so much all over the country and the world that I haven't been keeping up with local news.

However, the day before the CDC reversed their advice on school closings, I heard a comment by a local disk jockey who was upset about the school closings and planned closings in Maryland and DC in response to the swine flu outbreak. She said that if they closed her daughter's school she was bringing her to the studio while she worked.

She said angrily, "They" don't care about what working single mothers will have to go through if they start closing the schools.

Bingo, the very next day, the CDC announced that due to the relative mildness of the disease they were no longer recommending school closings unless staff and facility were so sick they couldn't function. That struck me as a rather silly comment. Of course in that event!

But the DJ's complaint also surfaced at the House flu swine inquiry on May 7. It's a huge social and economic issue, yet the country has to start grappling with it.

For decades we've been relying heavily on the vaccine fix. What happens if there's a killer outbreak and there's no vaccine, or a very poor match?

In that event you have to go to quarantine and school closings, etc. but we now have a society where we depend on public schools to be the cheap babysitter. So what happens with single mothers who're just making ends meet and suddenly they have to stay home for a week or more?

Re the blockade, I used the Samoa examples because, like Cuba, they're islands and such places become death traps in a killer viral outbreak. I never thought I'd see the day when I was in complete agreement with Castro's government but they acted intelligently.

Again, I think Fidel was so upset because he realized too late that Cuba's government should have imposed a full blockade until they could figure out what was going on.

I agree about getting an early flu shot -- I'm wondering if the government is going to push for an early release of the vaccine, maybe late July.

What worries me the most is that under severe pressure from developing countries, WHO, the World Bank, UN assembly, etc. they're going to rush the swine flu manufacture and skimp on testing.

That could be a nightmare scenario in itself if just one of the manufacturers caves into pressure.
 
Worries about the flu vaccine are real, based on some past problems. I announced to my nurse wife this evening that "We should all take the 2009 vaccine and get it as early as possible." She balked, "Are you sure the swine flu vaccine problems won't come back?"

I'm not sure of much of anything. I plan to get the vaccine, if several companies are making it. If there is one that includes the H1N1 vaccine, I will worry a lot about it.

But the history of flu pandemics shows an initial flicker of an onset in the spring behind the usual season and then a really bad surge the following fall that may go on for two years. The Mexican swine flu has not been contained well. It will probably surge badly in fall of 2009, based on past history.

The economic impact of closing schools, airlines, etc is real. The aggravation will be worse, but it beats a dead daughter or son. The DC DJ made a childish outburst with the "they don't care" comment. This is serious stuff, as Pundita has vividly acknowledged by several posts on the topic.

It is the young who are most at risk from the Mexican swine flu variety. Apparently we older Americans have partial immunity. Recalling my personal experience in 1957, I want to avoid it.
 
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