Swine flu: In the footsteps of a flu

Another day, another dose of troubling developments

In the footsteps of a fluTHE NUMBERS
The official infection count continues to climb. As of this afternoon (April 30) there are at least 262 confirmed swine flu cases around the globe—a significant jump from yesterday’s tally of 148. Most of the patients are in Mexico (97, including seven deaths) and the United States (109; one death) but the virus has also spread to nine other nations: Canada (32 cases), the United Kingdom (8), Spain (13), Germany (3), New Zealand (3), Israel (2), and the Netherlands, Austria and Switzerland with one case each. Much of the spike can be attributed to the fact that Mexico—the suspected “ground zero” of the current outbreak—is still in the early stages of testing patients. Over the past week, Mexican officials have blamed the new swine flu for up to 178 fatalities and almost 3,000 illnesses, but very few of those cases have actually been scientifically validated. Laboratory technicians are now frantically examining thousands of lung swabs, trying to figure out which potential cases are officially linked to the new virus. Yesterday it was 26. Today it’s 97. Expect that figure to jump even higher by tomorrow. But don’t be surprised if some of those 3,000 illnesses—and the 178 deaths—turn out to be unrelated to swine flu.

Like the rest of the world, confirmed illnesses are also on the rise in Canada. With four new cases in Nova Scotia, four in Alberta, three in British Columbia, one in Quebec and one in Ontario, the country’s swine flu tally is now 32 (nine in British Columbia, eight in Nova Scotia, eight in Ontario, six in Alberta, and one in Quebec). The surge, however, is not the most disturbing development. Health authorities in Nova Scotia revealed today that they have encountered the first human-to-human transmission on Canadian soil. The first four cases on the Atlantic coast were teenagers at a private school in Windsor, N.S., who contracted the virus during a spring break vacation in Mexico. Until now, every the other Canadian case also involved people who recently returned from Mexico. But of the four new cases reported today in Nova Scotia, one did not participate in the school trip. Instead, the unnamed student fell ill after coming into contact with another classmate. Leona Aglukkaq, the federal health minister, did not mention that fact during her daily press briefing with reporters. “Thankfully, all cases in Canada continue to be mild,” she said. “I repeat again, these new cases were anticipated and do not affect our approach. Aglukkaq also announced that the government is launching a “national citizens’ awareness campaign” tomorrow morning. “We want all Canadians to have the information they need to protect themselves and their families,” she said. “I want to reassure Canadians that our government is prepared to deal with this situation and we will do whatever it takes to protect Canadians and their families during this time.”

Although the World Health Organization jacked up its so-called “pandemic meter” to the second-highest level on Wednesday, officials are downplaying suggestions that a worldwide pandemic­—or Phase 6, as it’s known—is imminent. “As of today, that assessment holds steady,” said Dr. Keiji Fukuda, the WHO’s assistant director-general of Health Security and Environment. “We do not have any evidence to suggest that we should move to Phase 6 today, or that any such move is imminent right now.” During his daily press briefing, Dr. Fukuda tried to explain why, in just two days, the alert level vaulted from Phase 3 to Phase 5. Phase 3, he said, indicates that an animal influenza virus (avian, for example, or swine) has infected people, but not at a high rate. When the WHO moved to Phase 4 on Monday, it was because the evidence revealed that this newest flu—a never-before-seen mixture of avian, swine and human influenzas—was capable of spreading from person to person at a relatively rapid clip. And the jump to Phase 5? That came after “sustained” human-to-human transition was confirmed in at least two countries (Mexico and the United States). “These phases are not intended to be a barometer of the epidemiology per se,” Dr. Fukuda said. “It’s really a warning and an alert to countries and to the global population that the risk of this new virus spreading and reaching their countries is now judged to be significantly higher. It’s really a call for governments and people to really take stronger preparations, to move ahead and take the preparations that they need to reduce the health impact of a new virus.” The final impact, though, is impossible to predict. Remember, a pandemic does not automatically mean that millions will die. Pandemic simply means “widespread.” The real question is whether this swine flu results in widespread muscle aches or widespread funerals. “The move from pandemic alert Phase 4 to 5 means we are closer to this being a pandemic virus,” explained Dr. David Butler-Jones, Canada’s chief public health officer. “To clarify, the WHO’s pandemic alert level speaks to the current global situation. It’s really a global snapshot of what the state of the outbreak is on a global scale. Right now, that snapshot shows that a pandemic is highly likely. How severe it is remains to be seen.”

Joe Biden certainly seems to think the end is nigh. In an interview with the Today Show, Barack Obama’s right-hand man said he has warned friends and relatives to stay away from airplanes and subway trains. “I would tell members of my family—and I have—that I wouldn’t go anywhere in confined places now,” Biden said. “It’s not just going to Mexico, if you’re in a confined aircraft and one person sneezes it goes all the way through the aircraft. That’s me. I would not be at this point, if they had another way of transportation, suggesting they ride the subway.” Many countries, including Canada and the U.S., are encouraging citizens to avoid unnecessary trips to Mexico. But nobody—not even the World Health Organization—is urging people to avoid air travel. “To suggest that people not fly at this stage of things is a broad brush stroke bordering on fear mongering,” said Tim Smith, a spokesman for American Airlines. Not surprisingly, Biden’s office has issued a “clarification.” Said a spokeswoman: “The advice he is giving family members is the same advice the administration is giving to all Americans: that they should avoid unnecessary air travel to and from Mexico. If they are sick, they should avoid airplanes and other confined public spaces, such as subways.” Ah, yes. That’s exactly what he meant.

According to the experts, there is plenty of Tamiflu to go around. The leading antiviral flu drug, patented and produced by Roche Holding AG, is not in short supply, and if a pandemic does strike the company assures us it can make as many pills as the world needs. However, recent lab tests—including some conducted by Canada’s National Microbiology Lab in Winnipeg—have shown that Tamiflu is not effective against the H1N1 virus that causes the common flu. Which, of course, raises a troubling question: if Tamiflu doesn’t work against the common Type A/H1N1 flu virus, will it be an effective against this new strain, which is a so-called “distant cousin” of H1N1? Speaking of medication, Dr. Fukuda was asked how long it would take to create a vaccine that will protect against this newest strain. The answer: months, not weeks. “In order to make a vaccine against a new virus, such as this new H1N1 virus, you have to go through several different steps,” he explained. “And going through these steps takes months of work, even when you accelerate the pace at which you’re doing them.” In other words, keep coughing into your sleeve.


In the hopes of dispelling the outbreak’s biggest myth—that eating pork causes swine flu—The World Health Organization says it will stop using the phrase “swine flu.” It will instead refer to the virus by its scientific name: “H1N1 influenza A.” Dr. Butler-Jones said Canadian officials will follow the WHO’s lead. “From this time, we will be referring to this human virus as the H1N1 flu virus, to make it very clear that this disease is not spread from pigs or from either pork or pork products.” Unfortunately, the Egyptian government didn’t get the memo. At last check, every pig in the country is still slated for slaughter.

• In the U.S., schools are closing by the hundreds: 200 in Texas, 62 in Alabama, and scattered closings in New York, California, South Carolina, Connecticut, Minnesota, Illinois, Wisconsin, Arizona, Ohio, Utah, Washington state, Michigan and Maine. In Texas, Governor Rick Perry has issued an official disaster declaration and suspended all high-school sports until May 11.

• Mexico is closed for business. Acting on the orders of President Felipe Calderon, government offices and private businesses not crucial to the economy have shut their doors in an attempt to avoid further infection. “There is no safer place than your own home to avoid being infected with the flu virus,” Calderon said in his first televised address since the outbreak started. The official shutdown is expected to last until May 5.

• A Mexico City toddler who became the first swine-flu death on U.S. soil spent a day with his family shopping at a huge Houston indoor mall the day before he began to show symptoms. Cameron County Judge Carlos Cascos, who spoke with the boy’s aunt, said the family spent three nights in Houston just before he fell ill. After spending time in Houston, including at The Galleria mall, they drove the 350 miles back to Brownsville, where he was hospitalized on April 8. Houston health officials now say another boy—a 10-year-old American—is recovering from swine flu.

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