More About The Swine That Flew

One of Google Image hits from a search for "sick pig"

Yesterday’s Swine Flu post got a lot of attention, and I’m still fielding many questions. The Maytree Foundation’s DiverseCity Voices project, of which I’m a member, issued the following blurb on their e-alert today:

“From the Swine Flu to SARS, global health specialist, professor, author and journalist Dr. Raywat Deonandan is available for comment on the societal and public health impacts of infectious disease outbreaks.”

As of today, the global distribution of Swine Flu cases looks like this:

map

Unsurprisingly, the cases are clustered in North America and in other OECD nations, which suggests two things: cases are still predominantly people who have traveled to Mexico; or, cases in non-OECD nations have not been detected due to lesser surveillance methods. I do hope it’s the former.

After my very calming and conservative post yesterday, I thought it best to now talk a little about the potential threats posed by the disease. This seems reasonable, given that President Obama has announced $1.8 billion to protect Americans from the flu, and that California’s Governor Schwarzenegger has declared a state of emergency in his state, for the purposes of receiving more funds for pandemic preparation. Indeed, I’m sorry my back condition prevents me from attending the City of Ottawa’s pandemic forum next Tuesday, where their pandemic preparation plan will be unveiled and discussed.

Our PM Harper has declared that we in Canada are doing all we can to prepare for pandemic flu. I believe this is true. Canada has one of the better flu response plans among OECD countries. Our experience with SARS forced us to take this seriously. One of my consulting gigs was to help the CPHA develop an educational plan for family doctors regarding pandemic flu, and another looked at whether a certain class of drugs could be used as prophylaxes in the case of widespread outbreaks. Canada has some pretty good protocols in place, including management and legal frameworks to fast track into production vaccine shots for every Canadian. In fact, we keep a steady supply of hens and eggs just for this very task. (Flu vaccine is incubated in chicken eggs, which is why people with egg allergies should avoid them.)

Even with all this excellent preparation, it’s important to note that a vaccine is only possible once the virus strain has been adequately identified, and assuming it’s not mutating so fast that a vaccine no longer has any traction. Moreover, vaccine production takes weeks, if not months. Add to that the time for packaging, distribution and the time for the recipient’s biological response to the vaccine to take effect, and it’s clear that rapid vaccination production is not a perfect solution for a very fast moving and lethal airborne pathogen.

See, this is a big deal. Kind of. Even if nothing comes of this infection, to be prepared for a big one is vital. We’ve all been waiting for the return of the 1918 Spanish Flu. Heroic efforts by the much maligned WHO have quashed several potential pandemics of avian flu over the years. But you just never know which pandemic strain will be the one that takes that important mutative step to become a worldwide plague. So it’s best to always err on the side of caution –but not of panic.

This is sort of why everyone is freaking out. Let’s remember that the 1918 Spanish flu simply devastated the developed world, and was very much unlike our annual flu pandemics in that it was taking out people in the prime of their lives (20-44 year olds). Usually, the flu only has a fatal effect on the very old, very young, or the weak. The current strain of swine flu appears to have the same demographic preference… which is not to say that the old and weak are safe, but rather that the young and strong are a little more vulnerable than they (we?) currently believe ourselves to be.

This has implications for care, as hospitals may tend to not treat young, healthy people for flu symptoms, and focus on the elderly and infirm. This may in fact be a cause of some of the heightened fatality rates coming out of Mexico: it’s a function of care, not of disease virulence.

For the last couple of decades, we’ve been obsessed with avian flu from East Asia being the likely candidate for the Next Great Pandemic. H5N1, as it is called, has a serious fatality rate (about 50% of humans infected die). But outside of a few poultry farmers, the disease has not managed to mutate its way into the general population. That H1N1, pig based, from Mexico has jumped into the milieu kind of took everyone by surprise, even though the same bug freaked out the USA in 1976. There is strong evidence that the 1918 Spanish flu was also of the H1N1 variant, but is not the exact same disease.

What then am I trying to say? Again, I stress calmness. With only a handful of cases in this country, all contained and mild, there’s no reason to fear your neighbour. BC has reported the first human-to-human transmission in this country, which is not a good thing. But the excellent public health platform of that province has it under wraps.

What we should be worried about, I believe, is whether this strain of H1N1 makes it East Asia or the more crowded centres of the Middle East. There, if it infects someone who already has been exposed to a variant of H5N1, then there emerges a chance that the two strains will swap DNA and become something significantly more virulent. Or not.

So in many ways, we are lucky that the disease has found footing first predominantly in well developed nations, where public health infrastructure can best help to stomp into out, lest it seep into the well of more H5N1 endemic zones.

Fascinating, no? Let’s keep watching to see what happens. For a better discussion of the issues than I can provide, check out this article.

In Other News…

Apparently Barbie has turned 50. Darth Vadum sends us this appropriate video of this new era of Barbie’s life:

Cougar Barbie

Meanwhile, Cousin Ajay sends us the following tasering video. Warning: you will find this either really hilarious or really disturbing, or both. A flamboyant naked man resists policemen’s orders to clothe himself, then physically resists their attempts to cuff him, so they tase him publicly and repeatedly:

It’s an interesting case. On the one hand, he really was physically resisting the lawful orders of police. On the other hand, at the end of the day, he was tased for being naked. Is being naked worthy of a tasing?

Of course, the real story here is why is a man with the smallest penis in the world so eager to display it to everyone?

Lastly, you’ve probably noticed that I’ve disabled the Daily Twitter function on this blog. I’m going to try to post Weekly Twitter updates manually instead. Hope that’ll stop all yer whinin’.