Posted by: Snake Oil Baron | May 23, 2009

So What Should We Make of This Flu?

Lots of people have been decrying the “hype” surrounding the new variant of A/H1N1 flu. Too much news coverage, they say. Too many unnecessary measure to contain what seems to be a less lethal  flu than most seasonal varieties, it is claimed. Too much panic, they tell us. Well, I don’t know what people really define as panic. Issues are often discussed in terms of how much information can we give the public, they may panic. No one wants to start a panic. Certainly, under extreme conditions (perceived or actual) people can make poor decisions which make the situation worse but that does not seem to me to be a universal occurrence. It has taken years of scare stories and propaganda to get people to suitably overreact to apocalyptic climate hypotheses. And I don’t see the use of face masks, a few quarantines and some other concern related actions to be synonymous with panic. People in Mexico and elsewhere where scared but given the information that was available, they had reason to be and they were not throwing themselves off the roofs of office buildings. Granted, Egypt’s decision to slaughter all pigs in the country was an over reaction but really it was just an excuse to screw with the Coptic Christians and other nations’ banning of pork imports likewise were opportunistic trade protection rather than real fear based measures.

In reality, claims about the supposed over reaction to this flu have been based on the current view that it is no where near as lethal as we thought it was. Nice to have this view in hindsight (assuming it is accurate – more on this below) but really, do you want to have authorities wait until an accurate fatality rate is fully established before any measures to contain an emerging disease are taken? The best info at the time was that significant numbers of Mexicans were dieing of a brand new flu strain that seemed to be behaving like the 1918 flu that caused a disastrous pandemic. This was potentially the big threat that everyone had been waiting for and we now want to condemn people for taking it seriously?

Another condemnation is that we are losing sight of really lethal pandemics like AIDS, TB and malaria because of this sexy new disease that is being hyped in the news. Sorry, I like to condemn the media for their warped priorities as much as anyone but saying that we should ignore a potential emerging pandemic that we might actually be able to stop or slow down because there are existing pandemics in the world is not sensible. Are HIV and TB infected patients going to be better off if we let a potentially fatal, emergent strain of flu sweep into their communities simply because we were treating their existing problems with a higher priority? Personally, I doubt it.

At the very least, we can consider this as a dry run for the real lethal pandemic that pops out of nowhere and starts to spread, killing people at an unknown but seemingly disturbing rate. We may have just got a dress rehearsal for the next 1918. Much has been made about how the experience with SARS has helped in our understanding of how to deal with this virus. Lessons learned from this incident will be of even greater value.

Certainly there have been some suggestions on how to deal with this incident that were not based on all the best information. Those who called for an immediate closure of the Mexican American boarder seemed to have overlooked the fact that almost all of the cases of US flu seemed to be returning tourists. Is America really going to shut out it’s own citizens when simple quarantine or monitoring would suffice? Illegals who make the desert crossing are unlikely to have been successful if sick and most of the migrants coming in to work in the agricultural industry are billeted near the fields which amounts to a form of quarantine. A system of infrared fever detectors at airports and border points would have been a far better response.

And here is the kicker: We seem to have become convinced (myself included to a degree) that this disease is not as fatal as it first appeared. Mexico, especially Mexico city is a very densely populated place and health care and lab facilities are not top of the heap. It could very well be that far more people actually got the flu but did not require hospitalization. The people who died are said to have been mainly people who got to hospital late in the infection process. It seemed that the people outside of Mexico who got the disease were almost always folk who had been to Mexico and few outside that country had died. It points to the possibility that this disease is much less lethal than we thought. But this might be misleading.

A recent post at a website which I can not, unfortunately, remember, made the suggestion that the fatality rate outside of Mexico is being kept artificially low by the use of anti-flu drugs like Tami-flu. The site mentions how some of the cases presented with signs suggesting a cytokine storm – a massive over reaction by the immune system to a pathogen. It is believed by many today that certain diseases like the 1918 flu caused these over reactions, which explains both their lethality and the fact that more of these deaths tended to occur in young healthy people than in small children and elderly who are the usual victims of flu fatalities. Having a strong immune system is suddenly not an asset but a liability. If – and this is a major if – this is correct; that this H1N1 variant is being kept from being realized as a better killer than it really is, we could be in trouble. Tami-flu stocks are not likely sufficient – anywhere. And if the virus continues to spread and when you consider all the densely populated developing nations with no Tami-flu like drugs and few adequate laboratory systems to track the disease…

Let’s just say that this might not be over by a long shot.

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