The Coughing, Aching, I-Can't-Get-To-Sleep Report

Coffee Brown, MD, University of New Mexico, Talk Radio News

A-H1N1 flu Update #4, 05/04/09

What’s new today?
Dr. Richard Besser, Centers for Disease Control and Prevention, says this flu appears to be about as contagious as the more usual varieties.

Jose Angel Cordova, Mexico’s Secretary of Health, believes the epidemic there is beginning to wane. 

According to the World Health Organization, there are a total of 1005 cases in 21 countries: In the U.S. 286 cases in 36 states. In Mexico, 590 cases with 25 deaths for a 4.2 percent mortality, which is half again the rate of the 1918 flu pandemic. The total mortality, if Mexico is not separated would be 2.5 percent, the same as in 1918. However, the mortality rate for those contracting this flu outside of Mexico remains zero.

What about medicines?
The CDC has issued a reminder that aspirin is dangerous for children under 18 years old, especially if flu is suspected, because of the risk of Reye’s Syndrome. Tylenol/acetaminophen, taken as directed, is safe for fever and body aches. It does not shorten the infection, nor does it treat any respiratory symptoms.

The atypical flu is sensitive to the readily available antivirals Zanamivir and Oseltamivir, but resistant to Amantadine and Rimantidine. Patterns of sensitivity to antivirals vary from season to season.

And Travel?
The WHO has no travel advisory in place presently, but the CDC recommends curtailing non-essential travel to Mexico. The University of New Mexico, which maintains strong ties with Mexico, has issued its own travel advisory for staff and students.

While there have been reports that the WHO has elevated its alert status to Phase 6, as of 09:00 EDT their website still lists phase 5. Phase 6 will represent confirmation of local outbreaks in more than one country i.e., person to person transmission will be occurring within the separate countries. It is an expected stage. Note that phases 7 and 8 will describe the tapering off of the contagion.

Can we go back to calling it swine flu?
For the first time, in Canada, a herd of pigs has been shown to be infected, according to Reuters. Neither the CDC nor the WHO has issued any warnings about pork. (But you shouldn’t kiss a pig.)

So ... is it over?
In the U.S., the cycle has not yet begun to decline. Because of the possibility of this variant flu returning in fall and winter, Besser says, the CDC is proceeding with the first steps in the manufacture of a vaccine.

Pandemic Or What?

Coffee Brown MD, University of New Mexico, Talk Radio News

There are three main differences between a normal flu and a pandemic flu, as described by the Department of Homeland Security: incidence, virulence, and demographics.
Incidence refers to how many of us will get it. In a normal year, about 15 percent of 300 million Americans, or about 45 million people will get infected. In a pandemic, rates rise to 25-50 percent, or 75-150 million cases.
Virulence refers to how many of us will die of the infection. In a normal year, that’s about 0.07 percent, or about 35 thousand out those 45 million. In 1918, mortality was about 2.5 percent, which would be about 7.5 million deaths, given today’s population.
Demographics refers to which of us are at most risk. In a normal year, nearly all deaths occur in people over 65 years old. In 1918 and 1957, mortality was highest among school-aged children and young adults.
This summary, with some calculations, comes from information provided by DHS and presented at GlobalSecurity.Org
Let’s compare the 2009 A-H1N1 Flu. “Atypical flu” may be a handier name. “Swine flu” is passe’.
Incidence: As of 05/02/09: There have been 615 confirmed cases in 15 countries. Attack rates so far are too low and data too incomplete to meaningfully calculate.
Virulence: Mortality in Mexico, the country hardest hit so far, is 16 out of 397 cases: about 4 percent, which works out to four thousand per hundred thousand (a common way of expressing this type of number).
The one U.S. death might properly have been considered a Mexican death, since that child contracted the disease there. If calculated as U.S. data: one death out of 141 cases: about point seven percent. If that fatality is not charged to the U.S. account, the mortality rate outside of Mexico is zero percent as of this writing.
Demographics: Reports say that the Mexican victims were young, but I have not been able to locate details to confirm that. The World Health Organization says that more study would be needed to confirm that younger people are more at risk.
Other: The other elements of this flu that merit precautions are that it is genetically unique, meaning we may have no immunity, and that it is slightly out of season, meaning that it exhibits at least some unpredictable behavior.
We are still at phase 5, so clusters of cases in multiple countries, which would define phase 6, have not yet been confirmed.
Per the WHO, there no travel advisories at this time.
Do masks help? Yes, no, and maybe. Yes: as tiny as viruses are, they could slip right through any screen that we could breathe through, but the virus is carried in droplets of exhaled moisture, and those droplets do stick to the mask. No: But the masks dry, and it’s not clear whether the virus survives and detaches into the inhaled air. Maybe: the real test would be whether people with masks get fewer infections (though such people probably also take more precautions in general), and the Centers for Disease Control and Prevention says that data is not yet available.

If There's No Pork, Where's The Beef?

Coffee Brown, MD, University of New Mexico, Talk Radio News


A typical flu season kill 37,000 Americans. The swine flu, officially known as "2009 H1N1", may be responsible for up to 160 deaths in Mexico and one infant death in the U.S.

Of those who have contracted the disease outside of Mexico, the illness has been relatively mild. So, what's the big deal?

"This is a whole new kind of flu," said Dr. Anthony Fauci, Director of the National Institute for Allergy and Infectious Diseases. Flu viruses mutate slightly every year, but not like this, Fauci said. Genes from four separate viruses - avian, human, and two kinds of swine flus, have combined into this strain.

Our vaccines and immune systems have "never seen anything like it," Fauci said. That's what makes it potentially more dangerous. While this means that we have little or no natural immunity, it does not necessarily mean that this flu must be any more infectious or virulent than the average flu.

So, why is it called "swine flu"? Actually, Sen. Pat Roberts (R-Kan.) really wishes we wouldn't call it that, as it's hurting the pork industry. Fauci agrees, "The name that is now being used is 'the 2009 H1N1 flu.'"

Despite Egypt's decision to eliminate all swine from the country, people can still eat pork without contracting the swine flu. The American Heart Association may advise moderation, but this flu is entirely unrelated to pigs. Still, the pork industry and health officials are going to have to come up with a catchier name than "2009 H1N1 flu" if they want us to stop calling it "swine flu."

Epidemic or Pandemic? An epidemic means that more cases are occurring than predicted. With seasonal flu, epidemiologists have so much experience that they can usually predict the number of cases fairly accurately. The number they are seeing right now wouldn't even be noticeable in the middle of flu season, but this one was winding down for the year. Since this is really a new type of flu, the CDC don't yet have the experience to predict a "normal" season or number of cases.

A pandemic occurs when a disease covers a large geographic area, such as a continent, or multiple continents, as this one has. The common cold is a type of pandemic, though we usually don't bother to call it that. Neither word actually refers to the severity of the disease, the likelihood that a sufferer will end up in the hospital or even die.

So what about the rising number of cases? If that makes you nervous, stop watching them, because the numbers will rise steeply with every re-count for the foreseeable future, whether this is a killer flu or of ordinary severity.

On April 29, 2009, the WHO raised the level of alert to "phase 5. "What does that mean? Phase 4 meant human to human transmission, phase 5 means the same thing, but in more than one country, phase 6 will mean clusters of cases, outbreaks, in more than one country. Phases 7 and 8 describe the trailing off of the disease.

So, is it going to get worse, or go away? It may do either. The behavior of flus is variable, and epidemiologists don't have enough information yet to predict this one's course. Almost any scenario imaginable could occur.

At a Senate hearing Wednesday, convened on short notice in response to this flu, John McCain (R-Ariz) asked, "Should we close the borders?"

"No," Richard E Besser, MD, Acting Director, Centers for Disease Control and Prevention, HHS,responded. That was tried during the SARS outbreak, and it appears to have been unsuccessful. Simulations suggest that closing the borders would have little, if any, effect on limiting spread, and it would tie up massive resources that could be put to much better use elsewhere. If we had been one of the later countries to be hit, we might have tried closing the borders to buy a few more weeks to get ready, but even then the gain would be slight, Besser said. The World Health Organization concurs.

That led Sen. Richard Burr (R-N.C.) to ask about resources. Besser told him that stockpiles of antivirals , masks, and respirators are sufficient, because they had been bought when funding was better. Recent cutbacks have cost public health thousands of jobs, lost or threatened, and have made it harder for states to exercise their pandemic control plans.

The Office of the Biomedical Advance Research and Development Authority , which prepares contingency plans and caches supplies, has never had its own funding, but has receives sporadic money from NIH, according to Fauci.

In his 100 day address last night, President Obama re-iterated many of these points, saying "We are continuing to closely monitor the emergency ... (This is) obviously a very serious situation," adding that schools with confirmed or suspected cases should close temporarily.

Obama is requesting $1.5 billion for the further stockpiling of medicines and equipment, and for logistical support. He echoed the CDC and WHO by reminding people, "I've asked every American to take the same steps you would take to prevent any other flu: Keep your hands washed; cover your mouth when you cough; stay home from work if you're sick; and keep your children home from school if they're sick."

Readers: Please send questions, tell us what you need to know.

Getting Past Republicans' “No”

Coffee Brown, University of New Mexico, Talk Radio News

“The hole we’ve inherited is very deep,” said U.S. Senate Majority Leader Harry Reid (D-Nev.), “but we’ve accomplished a lot in the first 100 days.”

Reid listed the Lands Bill as “the most significant environmental legislation in a quarter of a century,” the Lilly Ledbetter Act, S-CHIP, the Economic Recovery Package, the Omnibus Spending Bill and National Service legislation, “even though we’ve had little cooperation from those on the other side of the aisle.”

In the coming weeks the Senate has a lot of work to do: the bankruptcy provision in the housing legislation, credit consumer protection, tobacco legislation “is way, way overdue”, and the supplemental provision bill. Republicans have to do more than just say no, he finished. He added that procurement was crucial to the defense department.

Pointing toward an empty easel, Sen. Charles Schumer (D-N.Y.) said, “As you can see, this is what the Republicans want us to accomplish. Their three words are ‘no, never, nothing.’”
“We have not blocked them on any amendments they want to offer,’” he said, adding they have no reason to make the Senate wait by using filibusters.

Sen. Richard Durbin (D-Ill.) reported that President Obama has the greatest upward shift in polls in the first 100 days since before the first Bush. He presented Associated Press findings showing a 44 percent increase in the President’s approval rating. This contrasts with several recent statements made by Republicans that voters are turning away from Obama.

Mark Silva, of the L.A. Times, gives a detailed report showing consistent 63-64 percent approval in Pew, Gallup, Associated Press and GfK Roper Public Affairs and Media polls, and says this is the first time in 10 years that the majority of the public feel the country is going in the right direction.
.

“Who speaks for the Republican Party today? Dick Cheney? Newt Gingrich? Sarah Palin? Michael Steele?” Durbin asked, adding, “This is a party in search of an identity and a mission. The only mission they’ve had so far is to resist and fight this president.”

“It will not harm the Grand Old Party to spend this year in a cooperative effort to solve the problems of America,” he said.

Sen. Patty Murphy (D-Wash.) said Republican delays and filibusters are preventing Congress from solving pressing problems.

Regarding another bone of contention with Republicans, Reid said he couldn’t discuss security briefings he’d attended on sanctioned torture, but that justice, and “not vengeance, must be served.”

Reid also confirmed that the Senate is considering a 9-11 style commission to evaluate the causes of the financial meltdown.

A Full House

Coffee Brown, University of New Mexico, Talk Radio News

House Majority Leader, Steny Hoyer (D-Md.) presented the House Democrats’ agenda for the economy, energy, education and healthcare.

The economy remains the top item, divided between the budget and legislation to address the crisis. “The economy is continuing to suffer, we’re continuing to see the loss of jobs, many Americans continue to be put at risk,” Hoyer said.

The budget focuses on making “strategic investments” and reversing “years of irresponsible Republican policies,” he said. “We believe all of the bills we’ve passed are consistent with trying to create jobs and invest (in economic recovery).”

Two corrective legislations arebeing proposed. The “Credit Cardholders’ Bill of Rights Act of 2009”, which is designed to require fairer interest rates and practices for consumers. For example, it would require that the highest interest rate-bearing part of a debt be reduced first by payments, rather last, as is now the often the case.

“In addition, the Mortgage Reform and Anti-Predatory Lending Act should come out of committee this week or next,” Hoyer said.

There is a 600 page “discussion document” and four more hearings to shape the American Security and Clean Energy Act, which the House hopes to consider in early summer. He noted that this is this is the 39th anniversary of Earth Day, “I remember because I’ve been working here since the first one.”

The Energy and Commerce, Ways and Means and the Education and Labor Committees are all simultaneously working on healthcare reform. Democrats hope to have healthcare legislation on the House Floor for consideration by the August break. The goal is universal coverage and accessibility, though probably not a publicly funded single-payer model.

Hoyer discussed his recent trip to South America. Mexico seems to be committed to working with the U.S. to fight drug smuggling and related violence. Panama is willing to work on their role as a drug smuggling highway, which has increased as American forces become more successful at interdiction at sea, and on money laundering. Columbia has reduced the power of the drug lords. He described the discussions with Brazil as “positive’” “useful” and “engaging,” and said they are interested in advancing a partnership with the U.S.

Gun control may have to remain in the DC voting rights bill, if it is to pass within this session, according to Hoyer, who said, “The biggest objective is to enfranchise the roughly 600,000 citizens of the United States who happen to live in the District of Columbia.” He called their current lack of voting rights “an egregious hole in the integrity of our democracy.”

Next congress looks at hate crimes legislation