Swine Flu Pandemic - Preparation

[Amon]

Also, my intuition is that the large number of deaths in Mexico City, or near the now infamous pig farm, is due to poor air quality and other environmental factors. Having just visited India, well, it's hard to imagine how people even live in large "third world" cities with such quantities of air pollution.

So I guess my point is that if it hits a place like Mumbai, forget it.

Correct me if I'm wrong, but wouldn't India potentially have it better than countries such as the U.S.? I know my understanding could be wrong, but from what I had gathered, over there, the people are naturally far more resistant to just about anything, whereas here, we're too busy sterilizing the place to maintain most of these resistances. Again, this is something they may not be likely to have faced before, but my guess is that the Indians could easily avoid being hit as hard by this virus as many other countries, almost regardless of exposure levels.

[Marshall Kane]

Amon,

This detail from the Wiki article on the 1918 flu is disturbing:

Scientists have used tissue samples from frozen victims to reproduce the virus for study. Given the strain's extreme virulence there has been controversy regarding the wisdom of such research. Among the conclusions of this research is that the virus kills via a cytokine storm (overreaction of the body's immune system) which explains its unusually severe nature and the concentrated age profile of its victims. The strong immune systems of young adults ravaged the body, whereas the weaker immune systems of children and middle-aged adults caused fewer deaths.

Another sobering observation from CNN.com (http://www.cnn.com/2009/HEALTH/04/30/sw ... 8.lessons/)

In each of the four major pandemics since 1889, a spring wave of relatively mild illness was followed by a second wave, a few months later, of a much more virulent disease. This was true in 1889, 1957, 1968 and in the catastrophic flu outbreak of 1918, which sickened an estimated third of the world's population and killed, conservatively, 50 million people.

However, they go on to say this knowledge could give them time to develop a vaccine before the fall.

[Amon]

I've read it. I don't know what I should say in response, because I'm not doing a good job of staying rational about this.

[John]

I've read it. I don't know what I should say in response, because I'm not doing a good job of staying rational about this.

I sympathize. For some strange reason, I find it easier to write about
war with China than about this.

I think we all have to start focusing on what we should (individually) do to
prepare for this.

Over the weekend I'm going to move this thread into the "Spotlight" category.

Sincerely,

John

[Witchiepoo]

Correct me if I'm wrong, but wouldn't India potentially have it better than countries such as the U.S.? I know my understanding could be wrong, but from what I had gathered, over there, the people are naturally far more resistant to just about anything, whereas here, we're too busy sterilizing the place to maintain most of these resistances. Again, this is something they may not be likely to have faced before, but my guess is that the Indians could easily avoid being hit as hard by this virus as many other countries, almost regardless of exposure levels.

There are lots of potential factors, including prior exposure to viruses, strong immune systems, overreactive immune systems, availability of medical treatment, pollution, overcrowding, etc etc. However, the similarities between Mexico City and Indian cities are striking. On the other hand, maybe they just have more deaths because they have more overall cases, who knows.

As for staying rational, I think most of us have seen one too many Hollywood disaster movies. Might be a good idea to take a step back.

[John]

There are lots of potential factors, including prior exposure to viruses, strong immune systems, overreactive immune systems, availability of medical treatment, pollution, overcrowding, etc etc. However, the similarities between Mexico City and Indian cities are striking. On the other hand, maybe they just have more deaths because they have more overall cases, who knows.

As for staying rational, I think most of us have seen one too many Hollywood disaster movies. Might be a good idea to take a step back.

Everyone should be aware the Witchiepoo is a doctor (a witchipoo doctor???), and so her
remarks are more credible than most.

Sincerely,

John

[Centuron]

Among the conclusions of this research is that the virus kills via a cytokine storm (overreaction of the body's immune system) which explains its unusually severe nature and the concentrated age profile of its victims. The strong immune systems of young adults ravaged the body, whereas the weaker immune systems of children and middle-aged adults caused fewer deaths.

This seems to be a consensus. So with this idea, is there, or could there, be a way to safely mitigate or prevent the effects of a cytokine storm (without compromising the integrity of the immune system)? I say that last part because immune suppression is a possibility, but I'd imagine that might simultaneously leave the body weakened to other disease, which could be just as bad.
This is from limited secondhand understanding mind you. I'm no doctor, but as there seem to be a few here, I'd like to pose that question. It seems that its not the virus itself that kills, but our own immune system. So it seems that if we could find a way to adapt or adjust the immune response, that would be a big help in preventing fatalities. People might still get sick, but they wouldn't die, and they therefore build a natural immunity to the virus itself.
This would also seem to be a possible factor in the occasional fault of vaccines, because it'd be essentially promoting the same immune response as the virus.

As an aside, I had an interesting thought with that quote about "the strong young" immune systems "ravaging the body" while the "children and middle aged adults (i.e. more elderly) caused fewer deaths." It seemed like a strange parallel with the idea of a crisis war.

[Witchiepoo]

As a disclaimer, I went to med school 20 years ago, and a lot has changed since then. Also, I am certainly no immunologist or epidemiologist.

That said, I do remember that we used steroids quite often in children with viral illnesses when I was a pediatric intern, because sometimes the inflammatory response to the viral infection was worse than the infection itself. However, it has to be done very carefully in a hospital setting with close monitoring, because (I think) the steroids make you more susceptible to bacterial illnesses. Kids who were really bad off ended up on steroids, oxygen, IV fluids, and antibiotics all at the same time. Those were the days before we had a lot of antivirals available. Oh yeah, they also used asthma meds like albuterol to keep the airways open.

Since nobody in modern times has really treated this kind of virus before, doctors will be learning on the fly. I know that's not very reassuring, but that's the way it is ... in my opinion.

[Marshall Kane]

This thing is certainly demonstrating generational theory at work. Sure, as readers of this site we're already bracing for the end of the world, but the general reaction has really exposed how jumpy everyone else is. The reactions I get from people is "oh, the media is being so silly, ha ha ha..." but the underlying, unspoken sentiment I pick up is "Please say something to counter my sinking feeling that no one in charge has any idea what's going on..."

Although, this week I've noticed an odd sense of shared humanity among strangers - very subtle, though; not in a stark post 9-11 way.

But this optimistic "oh, don't worry - we've have a vaccine by the time it mutates" strikes me as 4th turning era hubris.

[Matt1989]

I know a woman who knows a child that has swine flu. He's fine, and was on some TV show the other day.