Archive for the ‘Swine flu’ category

Excuse my lateness

May 3, 2009

Sorry I’ve disappeared from the blogosphere for a few days folks. I’ve been mostly out of town. New content coming soon, really.

Once I get settled back in here, tonight or tomorrow we’ll have my final (for now) piece on H1N1 (swine) flu. That’ll be the last piece on the subject unless something new develops. I feel that writing more on it would be me hypocritically feeding the hysteria for readers instead of contributing to the discussion. Then we’ll return to finish up Hard Conversations, Vaccines and Autism. I’ll be aborting that promised column on Jim Carry – I feel it’s so out of date as to be relevant now. But we will finish out on a post about the mitochondrial disease hypothesis, and at a post on possible actual causes of autism, with some good resources for those who would like to read further.

In the mean time, some links:

After a series of (literally) crappy articles from HuffPo, culminating in Kim Evans gibberish, ScienceBlogs has been discussing how to deal with this new threat to rationality. PalMD thinks that the problem is letting ideology creep into science.

As always, Effect Measure is the place to go for swine flu news. Among other developments they have a story about a person passing H1N1 back to pigs. Please note once again, properly cooked pork can’t give you swine flu!

File:Pork chops served.jpg

Figure 1: Porkchop, delicious, and won’t give you swine flu (via wikipedia here, courtesy of Stu Spivack, under creative commons share alike license.

Also, Effect Measure has a post discussing overreaction. It’s not about the hysteria. It’s about how people may regard H1N1 as not at all a threat because the public health services may have done their jobs too well…

Today’s Swine Flu Big Picture

April 29, 2009

Sadly I’m time limited today, and I suspect everyone else is too so I’m going to try something a little different. This post will be an update on the swine flu news today, and later tonight, if possible, we’ll have our primarily educational post.

Those who want a more technical breakdown, as always I recommend Effect Measure, whose coverage of this is unparalleled.

The Bad News

The threat isn’t as clear as we thought it was. Previously, I had said on this page that the CDC reported this swine flu strain was a reassorted strain, with more than just swine flu genes. Well scientists have taken a look at the published sequence of the swine flu genome and so far it looks like only swine sequences.

What does that mean for you? Not a whole lot. It means that when things happen quickly, you sacrifice accuracy for speed. Whether this is a swine flu that can infect people, or a reassorted mixed swine flu that can infect people the effect is the same. 

We now have a virus that is relatively new to our immune systems, that has shown us it can go from person to person. It is now confirmed, with human to human spread in multiple countries. All of this has lead the WHO to raise the Swine Flu Pandemic alert level to phase 5.  I’ll touch back on what those phases mean in our teaching post. Can you guess what I’m going to say?

That’s right, I’m going to say Don’t Panic!

One other place where the scientists aren’t all on the same page: Just how many people have this disease, and how bad is it? We don’t know if this is a very bad influenza, that kills alot of people. We don’t know if it’s a relatively mild influenza, that caught almost all of Mexico, but was only diagnosed in those patients worst hit by the disease. We don’t know if it’s somewhere between those extremes.

What we know is that despite the large numbers being thrown around about how many patients are dieing in Mexico, very few have lab diagnosed Swine Flu. In fact we have more lab diagnosed cases of swine flu in this country than in Mexico.

Lastly, we’ve had our first casuality, a child in Texas has died of this illness. It looks like the toddler contracted swine flu in Mexico. Where this happened is perhaps important to the epidemiologists, but cold comfort at best to families, worrying about their own children.

Bad news summary: We don’t know a whole lot of anything. A child has died, and thats tragic,

The Good News

While I just mentioned the tragedy of the first death of this disease above, it’s important to maintain perspective. Things aren’t as bad as MSNBC is telling you. In my brief glimpses of TV news,  the main stream media makes it sound like fire is raining from the sky.

The WHO level has been raised to 5, but that doesn’t mean you’re going to die! It means that governments, public health services, doctors and healthcare workers need to get on the ball. We need to be prepared to nip things in the bud. Resources need to be available to put out fires, and be prepared. Some Science needs to kick into high gear – like efforts to create, and mass produce a vaccine, and produce more antiviral medications. It’s less of an issue for the US, where we were already gearing those things up. It’s more a warning to the rest of the world to get their stuff together.

Keep in mind, for reasons we don’t understand, the flu is seasonal, and this isn’t the most fertile time for the flu to spread out and cause havok. We still don’t know how bad this flu is. One patient has died here, and we have quite a few confirmed cases, but they all seem to have relatively mild illness. So far, this doesn’t look like the next bubonic plague, or the 1918 flu.

So what does all this mean for you? How is your life different today than it was yesterday? It isn’t. We don’t know as much as we’d like to about this virus. We’ll learn more as time goes on. Wash your hands, carry hand sanitizer. If you have a fever and a bad cough, don’t go to work, call your doctor. Don’t panic.

Swine flu and Woo

April 28, 2009

Continuing with the theme I’ve had on swine flu, I’ll start with this: Don’t panic.

Don’t start looking for random alternative medicine treatments and prevention for swine flu.

Don’t, for example, give yourself an enema. That may seem like it’s in bad taste, and tangential at best, but it’s exactly what Kim Evans, author of “cleaning up!” over at Huffington Post is suggesting. Her article is so ridiculously wrong that I feel the need to explore it with you.
She starts with some potentially relevant information.

1) Stay home as much as possible.
2) Avoid public places unnecessarily.
3) Wash your hands frequently, and keep your hands from your face.
4) Get some surgical face masks and wear one when you need to be in public places, even if you feel a little foolish and until others have caught on.

I agree completely with number 3. Hand washing is key. It’s a good idea to avoid smearing all the junk that is on your hands onto your face. The rest of this, is fear mongering.

Given the small number of cases, and the mildness of the cases seen in America so far, 1, 2, and 4 are overboard. They aren’t completely unreasonable, unless you’re in mexico. If you have a risk factor – you’re on chemotherapy, you’re otherwise immunosuppressed, maybe even just bad asthma, than you might consider being cautious and avoiding public places. The evidence is out on whether or not masks are that helpful right now.

Not that it matters, that’s not why she’s writing all of this though. As far as I can tell she’s really writing this to create an atmosphere of fear.

Why scare people? She has a hook. A hook that sounds crazy unless you’re scared!

The above is all pretty basic stuff, I’m going to offer more as well. But before I do, you should know that I’m a huge proponent of body cleansing, or removing the accumulated waste that most people have stored in their bodies. I’ve been a fan for years and have seen cleansing work miracles in myself and others, but in circumstances like this, I believe deep cleansing could actually save your life

I hate it when people say they can save your life. I hate it when doctors say it, and sometimes they’re right! Doctors aren’t usually the ones who say it. Liars say that. Hustlers say that. In fact, it looks like she only says that there distract from the fact that she still hasn’t given us a reason to believe cleaning out your colon would heal your lungs.

And it’s my understanding that many people who took regular enemas instead of vaccines during the 1918 pandemic made it out on the other side as well.

This is impressive. Her understanding is that people who took enemas instead of vaccines in the 1918 pandemic made it out on the other side as well. Why is this impressive? There wasn’t a flu vaccine in 1918. In 1918 we weren’t even sure of the cause of influenza, at that time some people thought it was caused by hemophilus influenza, a bacteria. We couldn’t grow influenza virus until 1931, and the first inactivated vaccine was used in World War II. Either she didn’t do her homework at all, or she thinks people used time machines to go forward in time, get a flu vaccination, then go back, and die.

This is normally the point at which I’d cite articles on why this is wrong. The problem is I can’t even find articles on this! I haven’t found one scientist who was willing to test enemas for the flu. In lieu of direct evidence, I tried to look up her basic science on this. Why would this even potentially work? Her article has some junk about taking out the trash to get rid of flies. I found it patronizing AND uninformative. I checked her website, and found it a barren wasteland of propaganda. Not a fact in sight.

Failing to find anything helpful on her website, I exercised my google-fu, which reveals: Not much. On one website, Diagnose-Me.com, I found this. That website recommends a warm, and then a cold soda enema. Why?

Most of the mucous from the respiratory tract is swallowed and waste to be expelled from this mucous makes its way to the colon. During an illness like a cold, viral particles remain in quantity in the colon. The gentle washing away of the bulk of this material allows the immune system to focus on the respiratory tract rather than maintain a second larger front in the colon. This is one reason why almost all doctors in the preantibiotic era recommended enemas, or at the least laxatives, for colds. The use of enemas gives immediate relief of symptoms and helps to concentrate the immune response where it is needed.

That almost sounds reasonable if you haven’t studied medicine. When you have influenza, you primarily have lung problems. You are not fighting a second battle in your colon. When you have something that feels like influenza, and you have diarrhea, nausea, vomiting, you might not have influenza. It’s not impossible, sometimes influenza can cause those symptoms, but there are a lot of other viruses that are more likely the culprit.

I can’t find anything anywhere saying that doctors in the pre-antibiotic era prescribed laxatives or enemas for colds… It’s not as if doctors in the antibiotic era prescribe antibiotics normally for the flu – it’s a virus, so I’m not sure where she was going with that.

The use of enemas doesn’t relieve any symptoms! If we stick a tube up your butt and clean out your colon, your lungs will still be filled with junk. Your immune response will do just fine without the enema.

This whole article is just irresponsible. Blogging may be a less formal media form, but if you have a large audience and you act like a newspaper, like HuffPo does, you’re obligated to do some fact checking. This goes double for when you’re offering medical advice. This goes triple when you’re writing about a potentially panic-causing issue like epidemic swine flu!

Shame Huffpo, shame

Swine Flu and You

April 27, 2009

ResearchBlogging.org
Regular readers know that I like to touch back to the published research when we talk about a topic. Obviously swine flu is brand new, and it would be pretty darn fast to get good research out on the subject. Luckily there is at least one very recent article that is very relevant.

The CDC releases a weekly morbidity and mortality report online, they can be found here. For some reason the researchblogging.org citation isn’t quite working, so the article we’re discussing is found here, and an update to it found here.

So what do the articles say? Sadly they don’t say a lot. The initial article is a pair of case studies in southern California, the update includes 6 more cases – four from California and two from Texas, and mentions the outbreak in Mexico. In the two initial cases in the report, the same virus appears to have been isolated – it is an H1N1 strain of influenza. The CDC has further described this as a swine flu virus. The new cases in the update were still in the process of typing as of the publication if this article, but preliminarily it looks like the same virus.

In all cases, the patients have not been exposed to pigs. It looks more like the disease spread from person to person. As I said previously, you don’t get swine flu from eating pork. You get it from being exposed to a person with swine flu. If you work closely with pigs, it’s entirely possible you could get swine flu from a sick, life pig.

The viruses they found were resistant to amantadine and rimantadine – two common antiviral medications. However the viruses were sensitive to zanamavir and oseltamivir – better known as Relenza, and Tamiflu respectively. This is great news. The US has pretty large stockpiles of zanamavir and oseltamivir, and the government is already deploying these for use. So if this does end up being a pretty large breakout, or even a pandemic, we are in good shape treatment-wise.

That’s about all that’s covered in the article, I’d like to use that as a jumping off point for some relevant education on influenza in general, and this outbreak in particular. It’ll be in multiple parts, but today we’ll just discuss some basics – including why public health officials are so trigger happy about influenza outbreaks.

We talked about H1N1 earlier, what does that mean? Well there are two types of influenza: influenza A and influenza B. We won’t be discussing influenza B today, the virus we’re worrying about with this outbreak is a subtype of influenza A virus. Influenza A viruses are divided up into subtypes based on two surface proteins – hemagglutinin, and neuraminidase. These proteins are numbered, and different subtypes can infect sets of different species. The species that most commonly infect people are H1N1, and H3N2. The much feared Avian flu is a variety of H5N1.

Now that doesn’t mean that one H1N1 is the same as every other H1N1. Influenza can be further broken down into different strains. The influenza vaccine this year contains a H1N1 strain, but not the same strain that is in this outbreak.

This is where it gets complicated. The influenza virus evolves over time, to evade our immune systems. It can do this in two big ways. One is called antigenic drift, and the other is called antigenic shift.

Antigenic drift is what we normally think of when we think of evolution. Over time, as the virus reproduces, mutations occur and as they occur, those proteins – hemagglutinin and neuraminidase – change too. Eventually, the right mutations occur and the proteins are different enough to look “new” to our immune system, to not be the same virus to our immune system. The thing is, since they just mutated from a virus we’re familiar with, they’re still somewhat familiar to us, not completely different.

Antigenic shift is far scarier. Each gene in influenza’s genome is in it’s own separate chunk of DNA. If two or more different influenza viruses infect the same cell, their DNA chunks can mix together, and the virus can pops out can be completely new. For example it could have some primarily human infecting DNA, and some primarily pig infecting DNA. A virus like that could be completely new to our immune system, and that can be scary.

The balance of evidence says that this swine flu outbreak results from an antigenic shift event. That’s why people are freaking out. That’s one of the reasons that the CDC was pretty quick to declare this a public health emergency. We don’t know yet if this is or even if it could be a pandemic, but we’re prepping in case it is.

It’s worth noting that as far as we can tell so far, the American cases are very different from the Mexican cases. The American cases appear to be relatively self limited –people don’t seem to be getting so sick that they die. Many of the Mexican cases appear to be resulting in hospitalizations and death. This is despite the fact that they seem to be the same virus, genetically we are seeing different things. We do not why that is. If I see credible information on the reason, I’ll be sure to post it here in followup.

So, is this swine flu outbreak the new 1918 flu? Or is it a mere hiccup, not even worth worrying about in the grand scheme of things? The unsatisfying real answer is that it’s too early to tell. It would be like watching a college basketball game, and after 5 minutes saying “aha, this is the next Magic vs Bird in NCAA finals!” 

In the mean time, do your part: wash your hands, and if you or your child is sick, take the day off. If you’d like more posts like this, or like my initial swine flu post, check back here, I’ll be trying to post at least once a day.

Centers for Disease Control and Prevention (CDC). (2009). Swine Influenza A (H1N1) infection in two children–Southern California, March-April 2009. MMWR Morb Mortal Wkly Rep., 58 (15), 400-402 DOI: 19390508

Swine Flu: What should you do right now?

April 27, 2009

I’m interrupting our series on Vaccines and Autism now to discuss the recent swine flu issues. My apologies to those looking forward to a picking-apart of Jim Carrey’s drivel today.

I’m going to be aiming my posts on swine flu at the general population; I’ll also be keeping them short and posting pretty regularly. If you find my coverage overly simplistic and you’d like a more technical breakdown, I highly recommend Effect Measure – the coverage on that blog is just excellent.

First things first:

Don’t panic.

That’s important. So I’ll say it again

Don’t panic!

There is a lot of media attention, and a lot of CDC activity trying to spread information right now. That’s not a bad thing! That’s the system in action – and it’s why the US right now, is better prepared for this outbreak than Mexico, or Indonesia. Mexican and Indonesian readers: it’s not an insult, but the public health systems in your respective countries just haven’t been prepared for a flu outbreak.

Right now, the hype isn’t because Swine Flu is killing more people than cancer. The hype is because this virus is new. Since the virus new, we don’t know exactly what to expect.

What should you do right now?

First, you should wash your hands, and then go buy a bottle of alcohol hand sanitizer that you can carry with you. It might look like this:

Why? Because the evidence says that this virus is spreading from person to person – from people sneezing on you, shaking hands with you after sneezing on their hands, etc. Wash your hands regularly, and use hand sanitizer when you can’t wash your hands, with that alone you can do a lot to prevent the spread of almost infections you come into contact with. Swine flu is just another flu virus. The flu virus spread through respiratory secretions – stuff that comes out of your lungs. Sometimes it’s the stuff you’ve wiped onto your hands. If you’ve wiped it onto your hands – wash your hands! Especially if you’re working with other people, wash your hands! Even if you don’t work with people, wash your hands!

You can still eat pork. Respiratory secretions are NOT in your pork chop, delicious pork is in your pork chop. You cannot get swine flu from eating a ham sandwich.

If you’re feeling sick, stay home! Another reason the flu virus is so quickly passed around is that people come to work sick and sneeze all over everyone. Then things spread. Also, cover your mouth and nose when you sneeze, preferably with a tissue paper, then throw the tissue paper away. After that… wash your hands!

Now that has a flip side. Just because you haven’t seen someone sick, doesn’t mean you haven’t been exposed to something. Viruses have an incubation period, where you have the virus, and can conceivably spread the virus, but you don’t LOOK like you have the virus… yet.

Just having the sniffles does not mean you have swine flu. If you are a little sick, don’t panic! A quick guideline: If you have high fevers (>100.4 F, or 38C) – use a thermometer!), respiratory symptoms (runny nose, dry cough, or sore throat), muscle aches, fatigue, and you’ve been sick longer than 2 days go see a doctor! But if you just have the sniffles, don’t go to the doctor, you have more to lose by exposing yourself to sick people there!

 What shouldn’t you do? Don’t panic. Don’t go buy homeopathic remedies for flu prevention – even hyped up water is just water. I mention this because more than 1 person has reached this blog in the last day by googling “homeopathic swine flu prophylaxis”. Don’t go buy “alt med” preparations to save you from the flu. They don’t work!

Next up: What exactly is going on?

If you’d like more information right away, the CDC has put up a pretty informative website here.

Please note: I will be taking an especially heavy hand to the comments in any swine flu related post. This is a public health matter, and there is no room for hysteria. You may have a right to free speech, but you cannot shout fire in a theater. That’s how I’ll be treating any comments that I deem ridiculous. If you have a legitimate fear, please voice it, and I’ll respond if appropriate. If you post some ridiculous theory about how this is all a government conspiracy to boost Tamiflu sales, or some such crap, I’m banning right away, I’m not in the mood to suffer fools lightly.