Flu outbreak....

[dipbait]

In less than 24 hours , Ned Beatty's immune system has effectively thwarted the virus . He is now at the CDC in Atlanta where a antiviral serum is being developed from his blood.

 

[CaptInsano]

Given the results of the 1918 edpidemic, this is not unreasonable, nor illogical, and does in fact form the basis for a lot of the concern people are showing. A disproportianate increase in the mortality rates of the 'healthy and active' population would most probably be due to a flu variant causing the immune system to go into an overdrive state and killing the people normally least affected in very high numbers.

What were the mortality rates by demographics for the 1918 epidemic in the US? Do you feel it is likely that the flu could cause autoimmune effects or cause the body's immune system to harm itself in some other fashion? If so, how?

This is really core to the whole discussion of possibilities in this flu outbreak. And you may not think it is plausible, as you've stated, but it has happened in the past. This is one case where a lot of us are hoping history doesn't repeat itself, but are looking at history for lessons on what is plausible and possible.

Interesting. Earlier today the discrepency just between the Mexican government and the WHO reports was over 20%. I classify that as large, though I find neither of those numbers particularly credible at this point.

What was the difference in total cases of infection?

 

[CaptInsano]

I guess I see that point. It's already having it's effect, if it were going to turn bad, then we should expect to see a drastic increase in the number of people dying.

Right, and not just the number of people dying, but the rate at which infected persons die.

You already asked this of Skammer, and I think he was right to tell you we don't know. Just because no one knows doesn't mean you assume there are no distinguishing pathological characteristics. I did not dismiss disparities in healthcare, I'm saying we don't know the effects. We don’t know HOW MUCH of an effect a difference in healthcare actually has. You feel that the obvious answer is differences in healthcare while stating that you'd need to see more data to make any kind of statement.

Choosing a more complicated unknown factor is usually not preferable to choosing a simple known factor.

As for reasons a strain would be more virulent against the strongest demographics, sure, the proposed "cytokine storm" has historical precedent, that could be one.

We have NSAIDs and steroids out the wazoo to handle that very kind of problem these days, not to mention vasoconstrictors and agents designed to control the permeability of the vessels.

I'm sure there are other possible reasons. You still seem to be ignoring the simple fact that the reason the experts are getting upset is because this flu is thought to be killing people who shouldn’t be dying with normal flu. I don’t believe that can be explained away entirely with a disparity in healthcare. If so, why wouldn’t leading experts say “oh well duh, Mexico doesn’t have as great a medical system as other places, that is obviously the reason people are dying and we can therefore discount this as a threat.”

I don't see experts who aren't getting paid to be on TV getting upset. I see them following prudent precautionary procedure.

No but if a strain is virulent enough to kill non-immunocompromised individuals, that is something to consider. No one has defined the virulence of this strain yet, so we can’t know just how bad it is yet.

The data isn't very descriptive yet, but initial reports do give us an idea of whats happening.

Again, we don’t know the virulence so there’s no way you can quantitatively compare rates between this strain and a seasonal flu strain or human-pig strain, especially this early on. We can qualitatively say that this strain is thought to kill non-immunocompromised individuals though. So an increase in transmission as pointed out, plus a possible increase in virulence since young healthy people are dying (this would mean it is MORE virulent than the normal seasonal strain), leads to an increase in the rate of mortality.

Like I said before, the data concerning the number of infections and the number of deaths is more solid right now than the demographics.

You completely missed my point and that was probably my fault due to the wording. I see Christof has addressed this though and got my point, and you pretty much said the same thing in post 168. I was trying to say that all other factors the same, the demonstrated increase in transmittance in combination with an increase in virulence for one demographic (non-immunocompromised individuals) would result with an INCREASE in mortality OVERALL as compared with the seasonal flu. It is a possible outcome, depending on virulence of the new strain, (which as it stands now, looks to be worse than seasonal flu simply because it can kill the strongest demographic). That’s why I laid out the assumptions. You just seem to be ignoring the fact that in contrast to normal seasonal flu, this strain might be killing otherwise healthy young individuals. That is an increase in virulence as compared to seasonal flu.

I'm not ignoring it. I just don't think that it is likely to kill the healthiest population at a higher rate while killing the less healthy populations at a lower rate in order not to bump the overall mortality rate. It certainly could, but then it it wouldn't be more virulent than seasonal flu, it would be more virulent than seasonal flue against one population and less virulent against others. In that case, the overall mortality rate would still be the same or lower than seasonal flu. Its mortality rate is still lower than seasonal flu right now. I think the effects of being more virulent against the people who do the most work in our society could have bigger impacts than losing the very old and the very young.

Anyway, my main point is, we don’t know yet. I just think you can’t say there is no reason to believe it’ll be nothing more than seasonal flu part duex and that mortality rates are unlikely to increase. I think at this point we can say, there MAY not be an increase in mortality and this might not turn out to be anything significant. But that’s as far as I think we can go given the information that is available.

 

[HikingMano]

Choosing a more complicated unknown factor is usually not preferable to choosing a simple known factor.

True, I guess in my head it’s no more complicated and unknown given it (or something that produces similar effects) has happened before (1918). It seems to me just as simple an explanation.

We have NSAIDs and steroids out the wazoo to handle that very kind of problem these days, not to mention vasoconstrictors and agents designed to control the permeability of the vessels.

I don’t recall seeing anything in the literature to suggest we now can easily handle “cytokine storms”. I definitely don’t recall seeing anything that says NSAIDs and steroids are easy fixes. As far as I know, treatments are still being explored and in the experimental stage. I think you are greatly oversimplifying possible pathology and down-playing its potential seriousness.

I don't see experts who aren't getting paid to be on TV getting upset. I see them following prudent precautionary procedure.

And you’re calling it “prudent” because that implies a degree of uncertainty. We’re not sure, so better safe than sorry. This is a large part of the point I’m trying to make. If no one thought this would turn into anything more than seasonal flu part duex, why are we behaving so prudently?

The data isn't very descriptive yet, but initial reports do give us an idea of whats happening.

Like I said before, the data concerning the number of infections and the number of deaths is more solid right now than the demographics.

I'm not ignoring it. I just don't think that it is likely to kill the healthiest population at a higher rate while killing the less healthy populations at a lower rate in order not to bump the overall mortality rate. It certainly could, but then it it wouldn't be more virulent than seasonal flu, it would be more virulent than seasonal flue against one population and less virulent against others. In that case, the overall mortality rate would still be the same or lower than seasonal flu. Its mortality rate is still lower than seasonal flu right now.

Ahhh! I understand your view now and see upon what you are basing your predictions. However, I still don’t agree. I would not feel comfortable making the quantitative assertions and drawing the inferences you’re doing at this point without more robust data. The only way I would feel comfortable making those quantitative assertions is if I had accurate mortality rates for the current epidemic, the average seasonal flu epidemic, and the 1918 flu pandemic within the same time-points (first week or two or however long it’s been since it’s started). Even if you were able to mine the data from the CDC on the latter two (since the first is still unknown), you and Christof have already said that in general the data isn’t the most reliable. On top of all that, this is the outset; you may not think mortality rates will change, but for some reason it did in the 1918 flu. So it has happened before and is conceivable.

I think the effects of being more virulent against the people who do the most work in our society could have bigger impacts than losing the very old and the very young.

Yes, I agree. :thumbup:

 

[HikingMano]

Anyway, really the moral of the whole story is wash your hands, cover your mouth, stay home if you're feeling sick :thumbup:

 

[CaptInsano]

True, I guess in my head it’s no more complicated and unknown given it (or something that produces similar effects) has happened before (1918). It seems to me just as simple an explanation.

Something similar has happened for decades. Diseases carry higher mortality rates in mexico than in the US. Its not the disease.

I don’t recall seeing anything in the literature to suggest we now can easily handle “cytokine storms”. I definitely don’t recall seeing anything that says NSAIDs and steroids are easy fixes. As far as I know, treatments are still being explored and in the experimental stage. I think you are greatly oversimplifying possible pathology and down-playing its potential seriousness.

It is a gross simplification, but we treat certain symptoms with certain medications and procedures. It doesn't usually change because the disease changes. For example: If you have a hyperacute reaction to peanuts, its going to be treated similarly to a hyperacute reaction to shellfish because while they originate from different "perceived" pathogens, they follow a similar pathological progression. I think a greater understanding of disease pathology makes methods and modes of treatment more apparent. To understand a cytokine storm you need to understand the inflammatory process. You also need to understand that while something different maybe causing it, it works the same way and can be treated the same way.

And you’re calling it “prudent” because that implies a degree of uncertainty. We’re not sure, so better safe than sorry. This is a large part of the point I’m trying to make. If no one thought this would turn into anything more than seasonal flu part duex, why are we behaving so prudently?

Because it could.

Ahhh! I understand your view now and see upon what you are basing your predictions. However, I still don’t agree. I would not feel comfortable making the quantitative assertions and drawing the inferences you’re doing at this point without more robust data. The only way I would feel comfortable making those quantitative assertions is if I had accurate mortality rates for the current epidemic, the average seasonal flu epidemic, and the 1918 flu pandemic within the same time-points (first week or two or however long it’s been since it’s started). Even if you were able to mine the data from the CDC on the latter two (since the first is still unknown), you and Christof have already said that in general the data isn’t the most reliable.

I think all these inferences are well supported as of now, but are tenetively based on less data than I would like. They're good indications for now, but the longitude of the info available hardly sufficient for any real conclusions.

On top of all that, this is the outset; you may not think mortality rates will change, but for some reason it did in the 1918 flu. So it has happened before and is conceivable.

In what way did mortality rates change from the onset of the 1918 epidemic?

 

[HikingMano]

Something similar has happened for decades. Diseases carry higher mortality rates in mexico than in the US. Its not the disease.

Again, you don't have enough information to rule out the disease. you may be right and it's not the disease at all, but I think it is likely a combination of the disease itself and mexico, a combination of genetic and environmental factors.

It is a gross simplification, but we treat certain symptoms with certain medications and procedures. It doesn't usually change because the disease changes. For example: If you have a hyperacute reaction to peanuts, its going to be treated similarly to a hyperacute reaction to shellfish because while they originate from different "perceived" pathogens, they follow a similar pathological progression. I think a greater understanding of disease pathology makes methods and modes of treatment more apparent. To understand a cytokine storm you need to understand the inflammatory process. You also need to understand that while something different maybe causing it, it works the same way and can be treated the same way.

Yes, I understand treating diseases by inhibiting mechanisms of action, regardless of underlying etiology, especially as it relates to inflammation and cytokine signaling pathways. I am not lost on that point. But I don’t know if any of these experimental etiology-independent treatments (which are usually more specific in mechanism than things like NSAIDs or control of systemic vasculature) have been applied in clinical trials and demonstrated to improve the outcome of infected patients. I actually would love to read such refs if you have them. I just reacted to your gross oversimplification which amounted to giving infected patients NSAIDs, slapping them on the back, and calling it good.

Because it could.

Exactly. Because it could.

In what way did mortality rates change from the onset of the 1918 epidemic?

http://www.cdc.gov/ncidod/eid/vol12no01/05-0979.htm Refer to fig. 1.

Cited source: Jordan E. Epidemic influenza: a survey. Chicago: American Medical Association, 1927.

Not the newest most comprehensive source, I know, but as you can see, the rate (deaths/1k persons infected) jumps up several months after the so-called first wave. I have not read the article in full detail so I will not debate with you the authors finer points, but there is the relevant info you requested from at least one source. I will concede I didn’t find as much on this wave phenomenom as I thought there’d be, but if you read the article, it seems that no one yet knows why they observed this jump in mortality.




I can tell this will never end, and I may be completely wrong and in over my head, so I respectfully bow out of arguing this with you and thank you for the discussion Capt. :thumbup:

 

[LupaWolf]

ok, let's be real time for a moment:

my child has been sick for a week... so we went to the dr...

from the dr. office:

they do a nasal swab that will tell them in 15 minutes if you have a type A flu virus... if the test is positive, then a culture is sent off for further testing.

Antivirals are only effective if administered within the first 48 hours.

Drink plenty of fluids.
Wash your hands regularly.
Dont touch your face.
Have what you need on hand at home in case you or someone in your family does get sick.

There you go.

 

[Ramm9]

they do a nasal swab that will tell them in 15 minutes if you have a type A flu virus... if the test is positive, then a culture is sent off for further testing.

Something I haven't seen anywhere is the wait time on testing. Did they tell you?

I read that samples have been sent to the CDC but that California is now doing testing in-state.

I get the impression that Mexico is sending samples via slow boat on a weekly basis.

 

[LupaWolf]

he did not tell me how long the wait would have been if it had been positive. I'm not sure he knew.
I was given to understand that we have in state testing now, but i do not know how long it takes them to culture it.

 

[CaptInsano]

Again, you don't have enough information to rule out the disease. you may be right and it's not the disease at all, but I think it is likely a combination of the disease itself and mexico, a combination of genetic and environmental factors.



Yes, I understand treating diseases by inhibiting mechanisms of action, regardless of underlying etiology, especially as it relates to inflammation and cytokine signaling pathways. I am not lost on that point. But I don’t know if any of these experimental etiology-independent treatments (which are usually more specific in mechanism than things like NSAIDs or control of systemic vasculature) have been applied in clinical trials and demonstrated to improve the outcome of infected patients. I actually would love to read such refs if you have them. I just reacted to your gross oversimplification which amounted to giving infected patients NSAIDs, slapping them on the back, and calling it good.




Exactly. Because it could.



http://www.cdc.gov/ncidod/eid/vol12no01/05-0979.htm Refer to fig. 1.

Cited source: Jordan E. Epidemic influenza: a survey. Chicago: American Medical Association, 1927.

Not the newest most comprehensive source, I know, but as you can see, the rate (deaths/1k persons infected) jumps up several months after the so-called first wave. I have not read the article in full detail so I will not debate with you the authors finer points, but there is the relevant info you requested from at least one source. I will concede I didn’t find as much on this wave phenomenom as I thought there’d be, but if you read the article, it seems that no one yet knows why they observed this jump in mortality.




I can tell this will never end, and I may be completely wrong and in over my head, so I respectfully bow out of arguing this with you and thank you for the discussion Capt. :thumbup:

OK, I don't see a lot of difference between peaks and troughs in the 1918 epidemic and what happens every year. Of course, the mortality rate was much higher for the epidemic, but the pattern isn't all that dissimilar. The key here are the PEAKS, and its an excellent point. Since this period of infection is only a couple of weeks old, its is very difficult to get an idea of the real peak numbers under ideal conditions -- flu season. So even if we take the greatest "peak" we have so far, there just isn't enough data to make it very significant or to give it a very high level of confidence. Very good point.

That is a great page on the 1918 epidemic, btw. I'm still reading through it. I enjoyed talking with you.

 

[CaptInsano]

Just received this email

The Commissioner of Administration has requested that we distribute the Swine Flu message below from DHH Secretary Alan Levine.

==================================

Dear State of Louisiana Employees:

By now, you have seen media coverage or heard of the spread of swine flu in the United States and several other countries. Swine flu is a respiratory disease of pigs caused by type A influenza viruses. It occasionally spreads to humans, although human to human transmission has been rare until now. The Department of Health and Hospitals is working closely with the Centers for Disease Control and Prevention, the Governor’s Office of Homeland Security and Emergency Preparedness, and other partners to ensure we are conducting appropriate surveillance to detect any cases in Louisiana early so we can respond quickly if we have an outbreak.

As we seek to prevent the spread of this virus in our state, you and your families, just like all other Louisianans, can be our partner in this effort. There are everyday actions you can take to protect yourselves and your families, while at the same time helping to prevent the spread of germs that cause respiratory illnesses like influenza.

1. Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
2. Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.
3. Try to avoid close contact with sick people. If you are sick, stay home. Limit contact with others.
4. Avoid touching your eyes, nose, or mouth because germs can spread that way.
5. If you or anyone in your family feels sick with flu-like symptoms, stay home and away from other people. Do not send your children to school if they display flu-like symptoms. Symptoms may include: high fever, body aches, headaches, coughing, sore throat, diarrhea, vomiting, fatigue and chills.

If you live in an area where swine flu infections develop, or if you are exposed to someone who has traveled to such an area, and if you become ill with influenza-like symptoms, you should contact your physician immediately. Your doctor will determine whether influenza testing or treatment is needed.

DHH has notified hospitals and physicians through the state’s Health Alert Network and activated its statewide surveillance system of sentinel physicians—about 35 private doctors who volunteer to serve as a ‘front line’ of detection to assist in any public health or infectious disease investigation. The department has shipped 30,000 specimen collection kits to be available to sentinel physicians, and will have specimens tested for infection as needed. Should cases arise in Louisiana, the state has a plan for antiviral treatment that will be directed by CDC guidance.

The Department is also working closely with the Louisiana Hospital Association, Louisiana Pharmacists Association, faith-based organizations, and many others to make sure you are properly informed and cared for. We’ve also recommended that all schools across the state monitor absences and illness of their students and report any problems to the DHH Office of Public Health.

If Louisiana begins to see a significant number of cases, you may be called on to assist the State in emergency operations. Keeping ourselves and our families safe is vital at this critical time. For regular updates, I encourage you to visit www.flula.com, our DHH site for swine flu information.

Aggressive prevention is the best thing to keep you and your loved ones well. Please heed the recommended steps and stay tuned for additional updates.

Sincerely,

Alan Levine

 

[HikingMano]

The key here are the PEAKS, and its an excellent point. Since this period of infection is only a couple of weeks old, its is very difficult to get an idea of the real peak numbers under ideal conditions -- flu season. So even if we take the greatest "peak" we have so far, there just isn't enough data to make it very significant or to give it a very high level of confidence. Very good point.

Yes, you expressed it much better than I did.

That is a great page on the 1918 epidemic, btw. I'm still reading through it. I enjoyed talking with you.

I am saving it for wind-down reading tonight, but it seemed pretty interesting when I glanced through it :thumbup: It was good talking with you as well, brain exercise Take care.

 

[CaptInsano]

First US death: 23 month old baby.

 

[LupaWolf]

in Texas.

 

[HikingMano]

Today, CDC reports additional confirmed human infections, hospitalizations and the nation’s first fatality from this outbreak. The more recent illnesses and the reported death suggest that a pattern of more severe illness associated with this virus may be emerging in the U.S. Most people will not have immunity to this new virus and, as it continues to spread, more cases, more hospitalizations and more deaths are expected in the coming days and weeks.

http://www.cdc.gov/swineflu/

The child was reported to have underlying health issues too, so I'm still hopeful. Still keeping my fingers crossed it won't amount to much. Take care down there LupaWolf :thumbup:.

 

[ron_m80]

I'm not watching the news anymore than normal, in fact less.

I'm not anymore concerned for my health anymore than normal.

I typically don't react much to things that other people sensationalize for my benefit(?).

 

[Fletcher Knives]

All I know is, this whole thing has thrown a big wrench into my cruise plans for this weekend. The wife and I have been waiting to go on this cruise for months and months. First time getting to take a cruise. I paid way too much for these tickets. Veranda suite with balcony over the ocean, Western Caribbean, Grand Cayman and Cozumel... @#$%!!!!!!!!!! STUPID @#$%ING PIG FLU BULL@#$%!!!!!!!!!!!!!!!!!!!!!!

 

[CaptInsano]

http://www.cdc.gov/swineflu/

The child was reported to have underlying health issues too, so I'm still hopeful. Still keeping my fingers crossed it won't amount to much. Take care down there LupaWolf :thumbup:.

True. It was a normally susceptible population and the baby did already have health issues. Plus it was a "mexican national" so its still possible that the swine flu just hates mexicans.

 

[KEmSAT-Survival]

Yep, I'm watching it...right in between episodes of "Spongebob" and "Deadliest Warrior; as well as what time I'm not outside enjoying myself and doing something besides panicking over another media hyped version of "Captain Tripps".

Number one line of defense against any form of the rhinovirus, flu, etc? Wash. Your. Hands.

GASP!

And here's the kicker...come closer...little bit more...little bit more...right there...

::whisper, whisper:: It doesn't even have to be with antibacterial soap....

Some folks live to make mountains out of mole hills.

I actually saw a guy at the gas station today wearing one of those little paper surgeon's masks...which would do about much to curb a viral infection as a newspaper would to a bullet.

So my evil-bone lit up and I started coughing and acting like I was getting sick...I know, I'm a bastard...

God love their gullible little hearts.

Don't queue the "Don't Fear the Reaper" just yet, kids...