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Swine flu pandemic?
05-01-2009, 03:08 PM,
Swine flu pandemic?
Swine flu pandemic? It feels like a phoney war

Dr John Crippen is the pseudonym of an NHS doctor who writes a popular medical blog. This is his account of the view from the GP's surgery

Oh! God, now I know it is serious. The Health Protection Agency has sent me an algorithm to tell me how to deal with swine flu. It arrived today in an email with one of those red exclamation marks at the side. An algorithm, for those who don't know, is a "finite sequence of instructions, an explicit, step-by-step procedure for solving a problem". It is very complicated. I do not understand it. Fortunately the primary care trust has also sent me a red exclamation mark email with instructions I can understand: "The main message remains: always use a tissue to catch coughs and sneezes, throw away used tissues and regularly wash your hands."

I can relate to that. Trouble is, it makes me giggle. I can't get that old jingle, from somewhere in early childhood, out of my mind. "Coughs and sneezes spread diseases, trap your germs in your handkerchief." It has rhythm. It is best recited in a "Mail train" monotone. Lovers of Tony Hancock will want to sing it to the tune of Deutschland, Deutschland über alles.

Doctor, you're not taking this seriously. Actually, I am. We have all read our way through the mountains of circulars that have arrived. We are having a daily practice meeting. We have one partner designated to take all the "flu"-related calls so our advice is consistent. Yesterday we had two such calls: a patient just returned from Turkey who had diarrhoea and wondered if it could be flu, and an elderly lady wanting advice about her husband who has respiratory problems. Should he be started on Tamiflu? Simple answer: No.

Today, so far, there have been no calls at all. We have 15,000 patients and are close to one of the larger airports in England, but have not seen a case of flu. We have not had a single patient worrying that he or she might have flu. It feels like a phoney war. We have seen two patients with heart attacks, three acute asthmatic attacks, and a child who had swallowed an implausibly large piece of Lego. Such is general practice.

We met at lunchtime, not to talk of heart attacks and Lego, but of flu. There have been deaths in Mexico. There has been one in the US. Our Indian partner said: "There were 2,000 deaths, mainly children in Africa and Asia, yesterday."

Our medical student looked shocked: "I didn't know swine flu had reached that part of the world." "It hasn't," said our partner. "I'm talking of deaths from malaria. But that isn't news, is it?"

We were silent for a while. Time to get things in proportion.
“Everything Popular Is Wrong” - Oscar Wilde
05-02-2009, 01:46 AM,
Swine flu pandemic?
Only 7 swine flu deaths, not 152, says WHO
April 29, 2009
Sydney Morning Herald

A member of the World Health Organisation (WHO) has dismissed claims that more than 150 people have died from swine flu, saying it has officially recorded only seven deaths around the world.

Vivienne Allan, from WHO's patient safety program, said the body had confirmed that worldwide there had been just seven deaths - all in Mexico - and 79 confirmed cases of the disease.

"Unfortunately that [150-plus deaths] is incorrect information and it does happen, but that's not information that's come from the World Health Organisation," Ms Allan told ABC Radio today.

"That figure is not a figure that's come from the World Health Organisation and, I repeat, the death toll is seven and they are all from Mexico."

Ms Allan said WHO had confirmed 40 cases of swine flu in the Americas, 26 in Mexico, six in Canada, two in Spain, two in Britain and three in New Zealand.

Ms Allan said it was difficult to measure how fast the virus was spreading.

She said a real concern would be if the flu virus manifested in a country where a person had had no contact with Mexico, and authorities were watching all countries for signs of that.

"There is no pattern that has emerged at this stage to be able to say that it is spreading in a particular way or it is spreading into a particular country ... the situation is continuing to evolve," she said.

She said the WHO was not recommending against overseas travel, but urged those who felt sick to stay home and others to ensure they kept their hands clean.

No decision had yet been made about vaccinations.

"This virus is not airborne, it's caused by droplets ... so it's not a time for worry. It's a time to be prepared," Ms Allan said.

&Alice laughed, &There's no use trying,& she said: &one can't believe impossible things.& &I daresay you haven't had much practice,& said the Queen. &When I was your age I always did it for half-an-hour a day. Why, I've believed as many as six impossible things before breakfast.&
- Lewis Carroll

&Things are seldom as they seem ... Skim milk masquerades as cream.&
- Gilbert and Sullivan (Pinafore)

At NASA, it really is rocket science, and the decision makers really are rocket scientists.
But a body of research that is getting more and more attention points to the ways that smart people working collectively can be dumber than the sum of their parts. .. Irwin Janis? &Groupthink:& is a mode of thinking that people engage in when they are deeply involved in a cohesive in-group, when the members' striving for unanimity override realistic appraisals ? It is the triumph of concurrence over good sense, and authority over expertise.&
-John Schwartz & Matthew L. Wade
05-02-2009, 02:36 AM,
Swine flu pandemic?
Quote:Think I'll play some more swine fighter lol cheers drummer:)

05-02-2009, 11:52 PM,
Swine flu pandemic?
http://news. 2/hi/health/ 8028371.stm
<http://news. 2/hi/health/ 8028371.stm>

What scientists know about swine flu

Emma Wilkinson
Health reporter, BBC News

Preliminary analysis of the swine flu virus suggests it is a
fairly mild strain, scientists say.

It is believed that a further mutation would be needed in order
for the H1N1 virus to cause the mass deaths that have been
estimated by some.

But at this point, it is impossible to predict with any accuracy
how the virus will continue to evolve.

UK experts at the National Institute for Medical Research
outlined on Friday the work they are due to start on samples of
the virus sent from the US.

The research, being done at the World Influenza Centre in Mill
Hill, will be vital for working out the structure of the virus,
where it came from, how quickly it is capable of spreading and
its potential to cause illness.


Analysis done so far suggests what they are dealing with is a
mild virus and nowhere near as dangerous as the H5N1 avian flu
strain that has caused scientists so much concern over the past

Influenza A viruses are classified according to two proteins on
the outer surface of the virus - hemagglutinin (H) and
neuraminidase (N).

H1N1 (seasonal flu/swine flu) * Spreads easily through
coughing and sneezing
* Less severe symptoms, but can be deadly H5N1 (avian flu)
* Can mutate rapidly
* Causes severe illness and can trigger pneumonia
* Spreads easily between birds but human transmission rare
The swine flu strain is a H1N1 virus, the same type as seasonal
flu which circulates throughout the world every year, and kills
roughly 0.1% of those infected or higher in an epidemic year.

Professor Wendy Barclay, chair in influenza virology at Imperial
College London says initial indications suggest there is nothing
about the genetic make-up of the new virus which is a cause for
particular concern.

The key to its potential lies largely in the H1 protein.

"There are two aspects - one is which receptors the virus tends
to bind to and what we see is that it is binding to the upper
respiratory tract rather than deep in the lungs."

* Can spread between humans
* Attaches to receptors in the upper respiratory tract
causing mild illness
* A pandemic is thought to be imminent

When a flu virus binds to the upper respiratory tract, it tends
to cause mild illness but can be easily spread as people cough
and sneeze, Professor Barclay explains.

If a virus binds further down in the lungs, it tends to cause
much more severe illness, as in the case of the H5N1 avian flu
virus which has caused concern in recent years.

"With the H1 gene we also look at the cleavage site," she adds.

"The virus has to be cut into two pieces to be active and it uses
an enzyme in the host to do that.

"Most influenza viruses are restricted to the respiratory tract
because they use enzymes in the lungs.

"But some, like H5 viruses can evolve to cut into two pieces
outside the lungs, so they can replicate outside the respiratory


These initial indications are largely guesswork from looking at
the genetic sequence of the virus and comparing that to what is
known from work on other influenza viruses.

It will take weeks and months of biological analysis to properly
get a handle on the potential of the H1N1 virus.

The team at Mill Hill, one of four World Health Organisation' s
centres for influenza research will be working in close
collaboration with the Health Protection Agency who are carrying
out testing in the UK, and their findings will also feed into the
development of a potential vaccine.

“ What this outbreak does highlight is how difficult it
is to predict new pandemic strains �
Professor Jonathan Ball, Nottingham University
Soon, the Wellcome Trust Sanger Institute in Cambridge will begin
the genetic sequencing of the virus and will also be monitoring
any mutations or changes in how virulent it is.

However, there is one other reassuring aspect about what is known
so far.

That is there seems to be nothing unusual as yet in another
protein in the centre of the virus, called NS1, which is linked
to the strength of the immune response the virus produces.

In some more pathogenic viruses, it is this NS1 protein which
initiates a "cytokine storm", a particularly severe immune
reaction that can be fatal in even healthy young people.


Scientists have also played down concerns that the milder H1N1
virus, could combine with the more dangerous H5N1 avian flu
virus, causing a super virus that has the ability to both spread
easily between humans and cause severe illness.

This is unlikely - or at least just as unlikely as it ever was
and the H5N1 virus has been around for a decade without combining
with normal seasonal flu.

Professor Jonathan Ball, an expert in molecular virology at the
University of Nottingham said: "The chance of swine H1N1
combining with H5N1 is as likely as any other strain recombining.

"What this outbreak does highlight is how difficult it is to
predict new pandemic strains.

"Many people suspected that H5N1 was the most likely candidate
for the next pandemic strain, but now it appears that this was a
mistake - but that's not to say H5N1 or another reassortment
containing parts of H5N1 may not happen in the future.

"That's the trouble - you can't predict."

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