Posted by: Taylor Hoff | July 10, 2009

All Fall Down

There’s an instinct, a bad feeling people get when they know something is going horribly wrong. It feels a bit like a pit in your stomach, the bottom dropping out as the adrenaline rushes to your head.

It’s a bit how I feel about the vengeful return of H1N1 “Swine Flu”.

As far as viruses go, H1N1 has had a very, very, very quick start. The gun had barely fired before it was around the track of the world in three months. From a minor infection in a little mexican town to an unstoppable global outbreak. Yet the public image of it has dulled. In the layman’s eyes, this virus was just a boring and mild strain of the flu that sprung up out of season. But to a virologist’s eyes, the picture is much darker. We failed to prevent the spread of a dangerous disease, and by doing so we failed a test. Had the virus been more virulent, it still would have broken containment and gotten to where it did today. We failed the test of our quarantine system to control the outbreak of a rapidly spreading airborne disease. The worst part is that this has happened before, and the results were uncannily similar.

The “Spanish Flu” of 1918 was a similar strain of H1N1. Its “butcher’s bill” tolled from fifty million to one hundred million dead. Approximately a third of the world’s population was infected, and this was accomplished without the assistance of air travel. It started with a weak first wave, and then caught up in its second wave, killing millions. It killed in the same way that today’s H1N1 does, by using the immune systems of healthy young adults against themselves. The threat posed by H1N1 is not something that can be swept under the rug, as much as we wish it could be.

Hell, I hope I’m wrong.

Obama Warns of Swine Flu Return

Published: July 9, 2009 by New York Times

BETHESDA, Md. — The Obama administration warned Americans on Thursday to be ready for an aggressive return of the swine flu virus in the fall, announcing plans to begin vaccinations in October and offering states and hospitals money to help them prepare.

“The potential for a significant outbreak in the fall is looming,” President Obama said by telephone link from Italy to the White House’s H1N1 Influenza Preparedness Summit, held at the National Institutes of Health.

With good planning, “we may end up averting a crisis,” Mr. Obama said. “That’s our fervent hope.”

The summit meeting was jointly led by the secretary of health and human services, Kathleen Sebelius; the secretary of homeland security, Janet Napolitano; and the secretary of education, Arne Duncan. It gathered health and school officials from across the country and took questions by video link from the governors of several states, most of whom wanted to know who would pay for preparations like the vaccination drive.

Vaccinations will begin in October only if tests scheduled to begin in August prove that the vaccine is safe and effective. Even then, officials expect only tens of millions of doses to be ready, so they will have to decide who is vaccinated first. The most likely candidates, Ms. Sebelius said, are school children, health care workers, pregnant women and people with asthma or other conditions that make the flu riskier.

While health officials were careful to warn that there was no evidence that the flu had mutated into a more dangerous form, they noted that it seriously disrupted some cities, including New York, in the late spring and could do worse as the fall flu season begins.

“This flu is not over,” said Dr. Thomas R. Frieden, the new head of the Centers for Disease Control and Prevention, describing its continuing spread in more than 50 summer camps, the large numbers of cases seen in Chile, Argentina and Australia, which are now at the beginning of their flu season, and the initial detections of three cases resistant to the drug Tamiflu.

At the flu’s peak in May, Mr. Duncan noted, 726 schools were closed across the United States. Decisions on closing schools will be made locally, he said.

Officials from New York and Texas described the difficulties they had in deciding which schools to shut down and how hard it was to explain why they picked those they did.

Both schools and businesses need to prepare for the possibility of several weeks of high absenteeism, Ms. Napolitano said. She also reminded governors that not only the obvious services, like hospitals and schools, would be affected.

“As a former governor, I can say: make sure your payroll continues,” she said. “Whoever processes your checks, make sure they have a backup.”

Ms. Sebelius outlined actions the federal government was taking. It will offer $260 million in “preparedness grants” to states and cities for the vaccination drive and $90 million to hospitals preparing for surges of cases. (Congress has already appropriated $1 billion for vaccine ingredients and up to $7.5 billion more for testing, buying and distributing vaccine if health officials decide it is safe and effective.)

The Health and Human Services Department is also remaking its Web site,, to be the central repository of information for everyone, including parents, school officials and doctors. And it will hold a contest, asking Americans to film their own public-service announcements about flu.

“This is a YouTube challenge to everyone,” Ms. Sebelius said. “The best will be aired nationwide.”

Health officials said that they were aware of fears that a Tamiflu-resistant strain of the virus was already spreading silently in the United States, but that they had not seen evidence that it was a threat.

The worry stems from a single case found in a teenage girl who flew to Hong Kong from San Francisco on June 12. According to Hong Kong media reports, she was found to have a fever during a routine airport screening and was hospitalized as a precaution and tested.

The girl was never dangerously ill, was not treated with Tamiflu and recovered. But the sequence of her virus, released last week by the authorities in Hong Kong showed that it had a mutation, known as H274Y on the neuraminidase gene, making it resistant to Tamiflu, a neuraminidase inhibitor.

The fact that the girl had a resistant strain without being treated suggests that she caught an already resistant virus from someone else, presumably in Northern California, said Henry L. Niman, who runs a Web site tracking flu mutations (

The Centers for Disease Control and Prevention has intensified its monitoring in Northern California, and no other samples with Tamiflu-resistant virus have been found.

Therefore, Dr. Frieden said, “it does not appear to be widespread.”

Different strains of virus “compete” with one other each year, and the drug-resistant strains do not always win. But a Tamiflu-resistant strain of seasonal H1N1 flu utterly crushed its rivals during the last American flu season, rising to 99 percent of sequenced samples.

Also, Tamiflu-resistant strains can sometimes be successfully treated with Relenza, another neuraminidase inhibitor, with older drugs like rimantadine, or even with larger Tamiflu doses.

Cadets Tested for Swine Flu

COLORADO SPRINGS (AP) — The Air Force Academy says 84 cadets with flu-like symptoms have been isolated and are being tested for swine flu. A spokeswoman, Capt. Corinna Jones, told The Gazette here on Thursday that most of the cadets were members of the entering freshman class who began training June 25. Captain Jones said the cadets began coughing and showing other upper respiratory symptoms over the past two days. She said that tests had been sent to a laboratory in San Antonio, and that results were expected within 24 hours.

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