Wednesday, May 20

Stop misleading the public about the true lethality of H1N1/swine flu virus. Memo to CDC, WHO, New York City Department of Health

Officials at the above-named organizations have deployed a verbal sleight-of-hand in their communications with the public that is as dangerous as the swine flu virus itself:

The officials have announced that the death rate from swine flu infections is low. They have leapfrogged from this fact to the inference that the virus is not particularly lethal. Would that be with or without the administration of Tamiflu to affected patients?

Now let's stop clowning around. Officials do not know for certain how lethal swine flu is. But it doesn't take a lot of data collection to figure out that if a teenaged healthy patient presents with symptoms of a 103 degree and rising fever, and who is unable to move, and who "looks as if she was run over by a truck," as the father of one swine flu sufferer described his daughter's condition, she might not be long for this world without rapid medical intervention. The student in question started a quick recovery after two doses of Tamiflu.

From this, and from many aspects of the data so far, it is very likely that Tamiflu, and not a wimpy version of a swine flu virus, explains the low death rate so far from H1N1 infections.

That also explains the higher death count in Mexico. Money says that many of the Mexico deaths occurred before doctors in Mexico realized they were dealing with more than an ordinary flu virus and thought to administer Tamiflu or Relenza.

When we drill down into the data we also see that anecdotal reports about some of the deaths in Mexico, and recent research in Hong Kong, suggest that deaths from swine flu among the young and healthy are not so much from the virus itself as from a "cytokine storm" -- a healthy immune system overreacting to an unknown invader with such force that it kills the flu sufferer. (1) I believe it's been scientifically established that the cytokine storm reaction killed many who contracted the 1918 flu virus -- if not, the researchers have made a reasonable guess.

To put all this another way: Health officials should stop putting all their eggs in the vaccine basket, if you'll pardon the expression. Act with intelligence in the face of what might be a mass murderer of the young if not for the limited supply of anti-virals:

  • Alert the public that just because people exposed to swine flu don't get ill, that doesn't mean they're not a carrier for the disease.

  • Hospital emergency rooms should immediately establish separate interview/waiting room areas for people who have a fever. Temperature should be taken even before the interview process starts.

  • Close entire school systems on a regional basis (e.g., one borough) on the first sign of a flu outbreak in a school. In New York City, Mayor Bloomberg should immediately declare a city-wide school holiday for at least eight days. (2-7 days are the best estimate of the virus's incubation time.)

  • Ask close family members of flu sufferers to self-quarantine, after explaining the true seriousness of the situation. I do not recommend at this point that the National Guard be called up to enforce government-imposed quarantines in the USA. That shouldn't be necessary unless Tamiflu stocks run low.

  • It is not possible to close down all airport traffic to and from the United States for eight days, although that would be the most humane thing to do at this point, but in the strongest manner possible urge Americans to forgo all but essential overseas air travel.

  • Officials at the CDC should tell trade, airline, and diplomatic representatives that they're going straight to hell if they continue trying to block rational measures to fight swine flu. And if the officials hear as much as one peep in argument from those parties, they should threaten to read the riot act during nationally televised press conferences.

  • Those items are just to get the ball rolling in the right direction. More later this evening. For now, two closing points:

    Officials should stop yammering that 36,000 people die every year from flu. I understand that's a well-intentioned effort to calm fears about swine flu. However, the statistic is very misleading; all health officials know this, and when the general public discovers this, it's gonna be furious.

    If there is intelligent life in the infectious disease division at the National Institutes of Health, they should step up to the plate and recommend that the US follow Hong Kong's lead in battling the swine flu virus and that as many temperature monitors as possible be immediately installed at ports and airports.

    NIH shouldn't worry about ruffling feathers at the CDC; just tell them, 'Get the hell out of our way.'

    I address the same advice to the Department of Homeland Security.

    Let's move it, ladies and gentlemen; you've lost almost a month to crapping around with data collection.

    1) From a May 11 Bloomberg report:

    "About 56 percent of people who died from flu in Mexico showed signs of a “hyper-immune reaction” according to the health ministry, which didn’t give details."

    That would be the cytokine storm reaction.

    7:30 PM Update
    Email from a reader:

    "My memory is that there are limited Tamiflu stores, not nearly enough for the multiple doeses needed; none for the underclass in the fifth world"

    I believe the reader's memory is correct, although it's not just the underclass in the poorest countries that don't have access to Tamiflu. Reports surfaced early on from WHO sources that there were horrific fights going on about which governnments got how much of the presently available anti-virals. Japan snapped up a huge supply of Tamiflu. Looks as if they're going to need it, if the disease keeps spreading there. The Indian pharmas might play deus ex machina here; days ago WHO talked about getting the patent rights waived and allowing generic versions of Tamiflu to be produced. Somehow I doubt Indian (and Chinese) companies are waiting around for the red tape to be cut.
    Previous Pundita posts on swine flu

    May 19
    Mr President, fire NYC health commissioner Thomas Frieden from his post as CDC director before he even starts to work there

    May 15
    Say, whatever happened to that 2007 Senate subcommittee report on CDC fraud, waste, galloping mission creep, and failure to control disease?

    May 15
    Enraged U.S. lawmakers, union leaders, attack Homeland Security's negligent swine flu policy

    May 14
    H1N1/Swine Flu: Was Cuba's airport blockade an over-reaction to the outbreak?

    May 13
    H1N1/swine flu: CDC and WHO help unleash a pandemic

    May 11
    Swine flu/H1N1: Your life, riding on the CDC's slow boat from China

    May 4
    What Joe Biden knows about the jet-setter swine flu that you don't

    May 2
    H1N1 swine flu: WHO circles the wagons in response to criticism they were slow to warn

    April 30
    H1N1 swine flu pandemic threat: While WHO and the U.S. government dithered, Veratect Corporation raced to warn the world

    April 27
    Mexico-U.S. swine flu outbreak and the U.S. Department of Slime

    April 26
    Mexican-U.S. swine flu outbreak. Caution: blind curves and fog ahead
    This entry is crossposted at RBO.


    bullmoosegal said...

    The idea of a 'cytokine storm' (basically, an over-reaction by the immune system to a virus that it has not encountered previously) being the reason for the 1918 deaths among the young and healthy has a lot of merit. The problem is, it's very difficult to observe in a person (without killing them, that is), since cell cultures behave somewhat differently than tissue cells in vivo. Vaccination is based on training the immune system to recognize a virus before actually encountering it, thus enabling a robust, but relatively normal, immune response. What bugs me (no pun intended) is the large minority in society that rejects vaccines, as if they're all the same and haven't changed in the last twenty years.

    CGardner said...

    Yesterday Chancellor Joel Klein of the NYC Education Dept. finally sent a letter home to parents re: school closings and H1N1:

    NYC is still very cagey about its criteria for closing individual schools, saying they look for "clusters" of illness, the % of students in school with a documented fever of 100.4 and overall absenteeism.

    Parents and the Teachers' Union DID manage to get the Education Dept. to start posting daily student absentee rates for each school in the city.

    Anonymous said...

    People refusing vaccines, whether for religious or conspiratorial beliefs are a hazard, especially when they exist in communities which can provide a breeding ground yet are not completely isolated from the vaccinated public, some of whom may be incompletely protected or those non vaccinated because they are too young to acquire immunity from inoculation, i.e. newborns. This has already been a non-academic issue with meningitis being spread from non vaccinated Mennonite communities to non Mennonite infants. About all you can do is encourage people to shun them and hope that they don't breed a strain that the vaccine does not protect against.

    I am not certain I am convinced that the virus is more deadly than it appears but you make a good case for the possibility. I was beginning to be convinced that the lethality inside Mexico was due to the disease being far more widespread there than is understood and because only the worst cases were coming into regional centers like Mexico city for treatment and late in the course of the disease. The fact that this flu has the odd trait of diarrhea and vomiting would mean that dehydration would compound the problem where poor health care levels existed.

    But if anti-flu meds are reducing the apparent lethality then this could be very disturbing. I have noticed that there are more cases being reported around the world where the person was not in Mexico but rather America or Spain or another nation. Meanwhile, some nations like those in Africa have been suspiciously quiet which could mean that their labs and health systems are just are not able to detect and track the disease rather than them actually being free of it.

    A virus which is more lethal than anticipated combined with dehydration from diarrhea and vomiting in dense poverty stricken slums where AIDS and TB are already endemic could cause a humanitarian disaster. Even a death rate well below the 1918 when played out in mega cities and slums could quickly become a nightmare.

    Pundita said...

    snakeoilbaron: The last observation in your note put a chill up my spine.

    Odd, isn't it, how we can be staring straight at the truth and not see it?

    Yes, now that you mention it, just the present version of the 2009 swine flu virus could be more devasting than the 1918 one. That's even without a more lethal mutation.

    With regard to my thesis -- again, the business of staring straight at the truth. The constantly repeated statement by officials that the virus was no more lethal than regular flu didn't stack, if this was a new virus. But even after I found a report that indicated a cytokine storm reaction in some patients. the implication didn't hit me until I'd chewed over the seeming contradiction a thousand times. Then suddenly: Duh, just remove Tamiflu from the equation.

    FYI I put up a post today that continues my argument with NYC dept. of health -- and now Mayor Bloomberg.