H5N1

US: Preparing for the swine flu

Via the New York Times, an editorial: Preparing for the Swine Flu. Excerpt:

There was a lot of confusion last week about swine flu. A presidential advisory group issued a “plausible scenario” in which a swine flu epidemic could cause up to 90,000 deaths, three times the mortality in a typical flu season. 

The Centers for Disease Control and Prevention countered that the toll would most likely not approach that number. 

Our own take is this: A swine flu epidemic this fall and winter is likely to infect more people than a normal flu, but the virus will not be abnormally lethal. If it spreads rapidly after schools open, we will have to face it without vaccine, which will not arrive in substantial quantities until the swine flu epidemic has peaked. 

The report that sparked concern was issued by the President’s Council of Advisors on Science and Technology. The council stressed that it was not predicting what would happen but was simply offering a scenario to help the government develop responses to a potential epidemic. 

The report posited an epidemic that could produce symptoms in 60 million to 120 million people and cause as many as 90 million to seek medical attention; up to 1.8 million could be hospitalized, 300,000 could flood into crowded I.C.U.’s, and 30,000 to 90,000 people could die. 

Even some members of the advisory panel think their estimates may be a bit high. In any case, this is a virus that is no more lethal, and possibly less lethal, than normal flu strains.

This is why politicians and politically involved professionals like to keep their mouths shut: Mention something "plausible," and the media scream "inevitable!"

I think the NYT is maintaining the ethical position, as Mark Twain described it, of a Christian holding four aces. 

We can shrug off H1N1 deaths if we don't care about pregnant women, fat people, children, diabetics, asthmatics, or others with underlying health conditions. As long as we're holding four aces, those deaths don't matter.

Brazil: Paraná state extends removal of pregnant civil servants

Via Folha Online: Paraná prorroga afastamento de servidoras grávidas por causa da gripe suína. [Paraná extends distancing of pregnant civil servants because of swine flu]

To summarize the story: Civil servants who are pregnant will be kept from public contact until September 14. The state of Paraná has had 4,931 H1N1 cases, including 285 pregnant women. One hundred and ninety-five persons have died in the state, including 20 pregnant women.

Bolivia: President Morales on Tamiflu

Via Cuba's Prensa Latina: Presidente boliviano recibe tratamiento preventivo por influenza. [Bolivian president receives preventive treatment for influenza] Except, with my translation:

El presidente boliviano, Evo Morales, recibe tratamiento preventivo contra la influenza A(H1N1), ante sospecha de contagio en la reciente Cumbre de la Unión de Naciones Sudamericanas (UNASUR), precisaron hoy autoridades sanitarias. 

The Bolivian President Evo Morales is receiving preventive treatment against H1N1 after possible infection at the recent UNASUR summit, health authorities said today.   

De acuerdo con el director nacional de Epidemiología, Eddy Martínez, el dignatario se somete a métodos profilácticos, al tiempo que descartó que padezca la enfermedad.

According to the national director of epidemiology, Eddy Martínez, the president is receiving prophylactic treament, while denying that he has contracted the disease.  

En la ciudad de Bariloche (Argentina) en la cumbre de UNASUR, el pasado viernes dijo, Morales se sentó cerca de su par colombiano, Álvaro Uribe, a quien se le confirmó el virus,del cual se recupera de manera paulatina.

In Bariloche, Argentina, at the UNASUR summit last Friday, Martínez said, Morales was seated near his Colombian colleague Álvaro Uribe, who has since been confirmed as an H1N1 case and is recovering.  

"Se inició el tratamiento utilizando el medicamento Tamiflu con fines preventivos", precisó Martínez.

"We have begun treatment using Tamiflu as a preventive measure," Martínez said.

Egypt: Two human H5N1 cases

Bird flu may be forgotten, but it's not gone. Via CIDRAP: Egypt reports two human H5N1 cases. Excerpt:

Egyptian authorities have reported two more H5N1 avian influenza cases, both in children, raising the country's total for this year to 34, the World Health Organization (WHO) reported today. 

Both patients have been treated with oseltamivir (Tamiflu) and are in stable condition, the WHO said. One is a 14-year-old girl from Damitta governorate who fell ill on Aug 21 and was hospitalized 2 days later. The other patient is 2-year-old girl from Menofyia governorate. She became ill Aug 23 and was admitted to a fever hospital Aug 26, the agency said. 

The WHO said investigations indicated that both girls had contact with dead and/or sick poultry. 

Meanwhile, the Egypt-based Web site Strengthening Avian Influenza Detection and Response (SAIDR) reported that sampling triggered by the human case in Menofyia detected the virus yesterday in some household chickens. SAIDR said two other poultry outbreaks were also found yesterday, in Fayoum and Beheira governorates.

Here is the WHO cumulative total of H5N1 cases. And here is WHO's latest Egypt update.

Brazil: Some answers, some questions

Finally, some news. Via Folha Online: Paraná e Espírito Santo confirmam mais 18 mortes por gripe suína.[Paraná and Espírito Santo confirm 18 more swine flu deaths] Excerpt, with my translation, and then some commentary:

As secretarias de Saúde do Paraná e do Espírito Santo confirmaram nesta segunda-feira, ao todo, mais 18 mortes por gripe suína --a gripe A (H1N1). Com as novas confirmações, o total de óbitos no Paraná já chega a 195. No Espírito Santo, esta foi a segunda morte confirmada.

The health secretariats of Paraná and Espírito Santo confirmed this Monday a total of 18 more deaths from swine flu. With the new cases, the total of deaths in Paraná is now 195. In Espírito Santo, this was the second confirmed death.  

De acordo com balanço divulgado na semana passada pelo Ministério da Saúde, o Paraná é o Estado com o segundo maior número de mortes em decorrência da gripe suína, ficando atrás apenas de São Paulo que, segundo a pasta, já registrou 223 óbitos. 

According to the total reported last week by the Ministry of Health, Paraná is the state with the second-highest number of swine flu death, behind São Paulo, which now records 223 deaths.

Já no Espírito Santo, a segunda vítima da doença é uma mulher que estava grávida, foi internada em 1º de agosto e morreu no último dia 13. O bebê nasceu e passa bem. O órgão não divulgou, no entanto, outros detalhes sobre a vítima --como a cidade de origem e a idade que ela tinha. 

In Espírito Santo, the second victim of the illness was a pregnant woman, hospitalized on August 1 and who died on the 13th. The baby was born and is doing well. The authorities did not report any other details about the victim, such as her city of origin and age.

As mortes, no entanto, ainda não foram contabilizadas pelo Ministério da Saúde, que contabilizava 557 mortes até a semana passada. 

The deaths have not been tallied by the Ministry of Health, which reported a total of 557 deaths last week.

Os dados do Ministério da Saúde são parciais. Dados atualizados de secretarias estaduais da Saúde apontam maior, ou menor, número de mortes em alguns locais. As secretarias do Amazonas (2) e do Acre (1), por exemplo, também confirmaram mortes.

Data from the Ministry of Health are partial. Data from the state health secretariats report more or fewer deaths in some locations. The secretariats of Amazonas (2) and Acre (1), for example, have also confirmed deaths.

This sounds to me as if various bureaucracies are unhappy about the way H1N1 is being reported, especially the deaths. 

So the federal Ministry of Health is silent about deaths since last week. State health secretariats may not be reporting accurately, and slow lab testing may be a factor: the pregnant woman mentioned died, after all, two weeks ago. Folha Online is reporting what the states are saying, but now it's not totalling those statistics.

But if the 602 deaths reported on Saturday are correct, Brazil now has 620 deaths. Maybe 623.

ECDC: August 31 update

The ECDC has published today's update at Pandemic (H1N1) 2009. The table of worldwide cases still shows Brazil with 557 deaths.

Canada: Can we beat the pandemic?

A must-read editorial in the Canadian Medical Association Journal: The H1N1 vaccine race: Can we beat the pandemic? After comparing fast-track and slow-track licensing methods, the editorial concludes:

Other countries, such as Australia, members of the European Union and the United States, plan to license their 2009 pandemic vaccine by the faster path. Some, in fact, are choosing both: fast track licensing for use in high-risk groups and the slower process for the rest of the population. 

Health Canada has chosen the slower path. That might be reasonable if the vaccine without adjuvant fails to be effective. But what if ongoing clinical results show good performance of the fast-track vaccine? Can the fast-track approach be used to license such a product quickly? At present, in Canada, the answer is “No.” 

We are not suggesting that we sacrifice safety. But we must be able to readjust our plans quickly, depending on results of the soon-to-be completed trials. 

Having enough vaccine for every Canadian would make more sense if the pandemic virus were highly virulent for large proportions of the population. But given current evidence, it seems a poorer choice than providing coverage to high-risk groups as early as possible. 

Time is running out. Only by providing fast-track standard vaccine might high-risk groups be protected in a timely way, while the general public awaits the arrival of the adjuvant vaccine. 

Without an immediate change in policy, high-risk groups in Canada will be waiting for protection, while their US and European counterparts are vaccinated. Health professionals must have access to standard vaccines by early October and to adjuvant vaccine no later than mid-November to protect the public. 

Health Canada seems to have forgotten that while being first with a plan is good, being fast to vaccinate will save lives.

China: Back to school in a pandemic

Via Xinhua: China's schools prepare for new semester -- and A/H1N1. Excerpt:

Chinese schools and universities are ready to fight the A/H1N1 influenza virus during the new semester starting on September 1.     

Beijing will provide free traditional Chinese medicine to prevent A/H1N1 infection for 3 million students in primary schools, middle schools and universities, said an official of the Beijing Centers of Disease Control and Prevention (CDC).     

The medicine will be distributed in schools and students can take the granular infusion voluntarily, the official said.     

Health monitoring would be launched in educational institutions and the condition of students' health was expected to be reported to the CDC daily, the official said.     

Military training which takes up students' time for weeks or even months will be required to be rearranged, the official said.     

A/H1N1 might begin spreading earlier than previous flu and its effects might be more pronounced with ordinary flu happening at the same time, he said.     

The Beijing municipal government will begin to offer flu vaccinations in September and complete its program in late October.     

Free vaccinations will be provided to 1.8 million residents who are 60 years or older as well as all primary and middle school students.     

Temperature monitoring has already started in some Shanghai schools as students register for the new semester.     

Students, parents and teachers queued in front of Shanghai Meilong Central Primary School on early Monday to have their temperatures taken.     

"The situation is still very severe. We need to do more for flu prevention," said school master Wu Min.

Still quiet in Brazil

Folha Online has published some new flu stories today: Colombia's foreign minister is down with H1N1 while on a visit to China. Colombia's president, a confirmed case, is working online and recovering well. Swine flu is going to cost Spain an estimated US$ 1.4 billion. And the Eiffel Tower is providing masks and alcohol gel for visitors.

But nothing about the situation in Brazil itself. I have no idea what's going on.

When and whether to close schools

Via The Star in Toronto, an AP report: Swine flu authorities around the world contemplate whether - and when - to shut schools. Excerpt:

Experts say school closures simply buy time. They don't reduce the number of cases; they just spread them over a longer period. Closing schools is also disruptive and costly as working parents must juggle their schedules to take care of their children. 

"With a mild virus like swine flu, I think it is not necessary to close schools," said Simon Cauchemez, a flu expert at London's Imperial College. "The only reason you would do it in the current outbreak is if you're afraid the healt

In France, however, officials may send an entire class home or even close schools if as few as three students in the same class have flu symptoms within less than a week. The French education minister, Luc Chatel, said the country is ready to broadcast lessons on TV and radio if many schools are closed. 

Other European nations, including Austria, Germany, Spain and Switzerland, say they will consider closing schools on a case-by-case basis.