H1N1 – here already (6/26/09 update)

Update, 6/29/09: BBC reports “The number of confirmed swine flu cases in England has jumped by nearly 20% in a single day, latest figures show. The Health Protection Agency statistics show that 535 new cases were confirmed on Friday, bringing the total to 3,364.” Closer to home, KARE 11 reports that Wisconsin is leading the nation in reported swine flu cases, hitting 4251 confirmed or probable cases of H1N1 this week.

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“She has H1N1 flu,” said the voice on the other end of the line. And so swine flu got a little closer to home. The daughter of a friend probably has H1N1, though doctors have stopped testing for it, so the diagnosis will never be made with 100% certainty. Another friend’s email explains:

The pediatrician said that more than 90 percent of Influenza A cases have been positive for H1N1, that the Health Department is no longer testing and that there was no reason to bring a kid with typical symptoms into the clinic.

Though it has fallen below the radar, H1N1 (the virus formerly known as swine) is here and growing. A Maple Lake, MN summer camp for kids with special needs closed after a number of campers and staff came down with the flu, and the Muscular Dystrophy Association announced that it is canceling all summer camps. Another California camp closed because so many staff were sick that it could not run programs.

The CDC website gives no-nonsense information and advice.

What it looks like About like any other flu — fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. Sometimes also diarrhea and vomiting.

How severe is it? At this point, about like any other flu, though flu viruses can and do mutate, so this might change in the fall/winter ahead. Flu, including H1N1, is more serious for people with people 65 years and older, children younger than five years old, pregnant women, and people of any age with certain chronic medical conditions.

For information on treatment and on danger signs indicating the need for hospitalization, see the CDC website.

Staying healthy The CDC advises common-sense precautions:

• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
• Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.
• Avoid touching your eyes, nose or mouth. Germs spread this way.
• Try to avoid close contact with sick people.
• Stay home if you are sick for 7 days after your symptoms begin or until you have been symptom-free for 24 hours, whichever is longer. This is to keep from infecting others and spreading the virus further.

Be prepared For a family preparedness checklist, see the Pandemic Flu Planning Checklist, which includes recommendations about supplies to keep in your home. Be prepared in case you get sick and need to stay home for a week or so. Think ahead about child care in case schools are closed for a week or two.

What comes next?

Summer is not flu season, but H1N1 already is infecting lots of people. The big unknown is what will happen this winter, during the real flu season. One of the best description/predictions that I have read comes from John Barry, writing in the Washington Post. Barry, a distinguished scholar at the Center for Bioenvironmental Research at Tulane and Xavier Universities and the author of The Great Influenza: The Story of the Deadliest Pandemic in History, writes:

Influenza is one of the fastest-mutating organisms in existence, which makes it unpredictable, and a virus newly infecting the human population is likely to be even more unpredictable as it adapts to a new environment. There have been four pandemics that we know about in some detail: 1889-92, 1918-20, 1957-60 and 1968-70. All four followed similar patterns: initial sporadic activity with local instances of high attack rates — just as H1N1 has behaved so far — followed four to eight months later by waves of widespread illness with 20 to 40 percent of the population sickened. (In a normal influenza season about 10 percent of the population gets sick.) Subsequent waves followed as well.

In all four pandemics, lethality changed from wave to wave — sometimes increasing, sometimes decreasing. It’s impossible to know what will happen this time, but in 1999 the Centers for Disease Control and Prevention modeled a moderate pandemic in the United States, including a vaccine in its calculations, and concluded that the death toll would probably be 89,000 to 207,000. If the virulence of this virus does not significantly increase — and right now there is no reason to think it will — something close to the lower number looks probable.

The CDC says that normal, seasonal influenza kills about 36,000 people each year, and that “over 90% of deaths and about 60 percent of hospitalization occur in people older than 65.”

Strangely enough, H1N1 flu hits more young people than older people, with the largest number between the ages of 5 and 24. There’s some speculation that people who lived through the “Asian flu” pandemic of 1957-1960 might have some immunity. The CDC says that “about one-third of adults older than 60 may have antibodies against this virus.”

The Daily Kos warns:

Lots of “if’s”, but the best scenario Barry lists is three times worse than a bad seasonal flu, and we don’t know that it’ll be the best scenario. Even at that, if schools close this fall for a few weeks you need to be prepared with alternate child care plans. HHS has never stopped suggesting 2 weeks of food (and water plans for same) as minimal family prep, so you can take care of yourself or folks at home. Do it now before the fall, while you have time.

As of now, reports the San Francisco Chroicle, there are 21,000 cases reported in the United States and 81 deaths. The Minnesota Department of Health reported on June 11 that, “MDH is now focusing testing on severe cases. Therefore we will not identify most cases of H1N1 novel influenza, particularly those with mild illness.”

The World Health Organization has classified H1N1 flu as a Phase 6 pandemic, meaning that the virus is widespread throughout the world. WHO said on June 11:

“The virus is contagious, spreading easily from one person to another, and from one country to another. As of today, nearly 30,000 confirmed cases have been reported in 74 countries.”

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