Flu Fears

The media loves a good scare and the word pandemic is a guaranteed headline grabber. By this evening, there were nearly 70,000 news stories about an influenza pandemic, many accentuated by pictures of crowds of people wearing blue surgical masks. But scaring you half to death with speculations of a new pandemic does little to help you. The known facts, offered in a balanced perspective, is really news you can use.

As is the case with virtually everything scary in the media, reputable scientists and health experts provide reassuring facts and information. The world is not coming to an end and there is surprisingly little cause for panic.

Words for shock value

Why have the words epidemic or pandemic been used in nearly every headline? The numbers of people who’ve tested positive for the flu are actually so low, these cases don’t come close to meeting either definition.

But the words strike fear into the hearts of people. Most consumers think pandemic means something like the Spanish flu pandemic of 1918-1919, which is said to have killed between 20 million to 100 million people. Something like that is unlikely to happen today, however. Nearly a century ago, the standards of living and medical care, for humans and animals, were vastly different. The country was recovering from World War I, with widespread poverty, hunger and unsanitary living conditions, coupled with no available antibiotics or flu medications or modern medical care.

In fact, most of us have lived through a flu pandemic and never even realized it. The Hong Kong flu pandemic in 1968-69, for example, killed an estimated 33,800 Americans. That sounds like a lot, but it’s about the same number of Americans who die from the flu in a typical year.

Swine flu has even been around us for years. It’s not new. Did you know that influenza as a disease of pigs was first recognized during that Spanish flu pandemic of 1918-1919? Swine flu was first isolated in laboratory tests from a human in 1974. Sporadic cases of swine influenza viral infections in humans have been reported in the United States, Canada, Europe and Asia for decades. “There are no unique clinical features that distinguish swine influenza in humans from typical influenza,” said Dr. Kendall P. Myers at the Center for Emerging Infectious Diseases at the University of Iowa, Iowa City, and colleagues.

Every few years, we are surrounded by dire warnings of an impending pandemic — such as the SARS, avian flu, and 1976 swine flu scares — pandemics that never materialized. As JFS covered during the avian flu scare (when we were being told that 81 million of us could die), these scary pandemic projections are based on computer models that assume the worse case scenarios: a world without medical care or medications, without veterinary medicine, and such social demise and unsanitary living conditions that people will die at the same rates they did a century ago during the Spanish flu pandemic. Most of all, they ignore the science.

Let’s look at some of that science. Because this story is evolving, the specifics will evolve, too, but the main point won’t. For a good scare, filled with sensationalized, exaggerated dangers, turn to mainstream media. For facts, go to the source.

The scientific information given to the media during the U.S. Centers for Disease Control and Prevention’s public briefings bears little resemblance to the versions that have made most of our nightly news and newspapers.

Seek and ye shall find

A point repeatedly emphasized to the media yesterday by Dr. Anne Schuchat, Director for the National Center for Immunization and Respiratory Diseases, was that they couldn’t credibly say the cases being identified in the laboratory are indicative of a new situation. Cases identified with increased surveillance is not the same thing as actual increased incidents.

As she said, we might never have even known about this a few years ago because health departments weren’t testing for unusual strains of influenza viruses. They only recently stepped up laboratory capabilities and in 2007 launched a new reporting system that now makes it mandatory for state health departments to report the detection of untypable influenza strains during their routine influenza season surveillance. “Ten years ago we were not doing that, so we may be seeing something and actively investigating something that has happened many times before,” said Dr. Schuchat. So, we really cannot say that this is anything new.

All of the cases have been detected through routine surveillance for seasonal flu after state labs found strains they couldn’t type and sent the samples to them. “We are doing more testing now and looking more aggressively for unusual influenza strains,” she said. “So we haven’t seen this strain before, but we haven’t been looking as intensively as we are these days.” Now, they’re in an active investigation mode, she explained. So, each case that tests positive for swine influenza A (H1N1) “prompts a contact tracing investigation that is much more aggressive than we would do with a routine season influenza patient.”

There’s been a lot of speculation in media that a new flu virus strain — with bits of avian, pig and human viruses and capable of spreading between people — is something ominous. But that’s just the nature of flu viruses: they replicate haphazardly, reshuffling their genetic material from multiple sources. “This natural reassortment will come up with a new flu virus,” said Dr. Christine Layton, Ph.D., MPH. “H1N1 swine flu is one of those, but we’ve certainly seen others in the past 30 years,” she explained to National Geographic News today.

That’s basically why a new influenza vaccine is developed every flu season. As the CDC explained, human infections of swine flu can and do happen.

When answering media questions about this year’s strain, Dr. Schuchat preferenced her answer by again emphasizing: “we’re looking a lot more intensively and so we may be finding more unusual things and we are really trying to have a balance of taking this very seriously. Actively investigating, sharing information as we have it, and trying to convey the idea that we really can’t differentiate whether this is truly new versus [or] that we have a better situational awareness now.”

Putting things in perspective

We’ve been hearing all sorts of numbers and speculations as to how many people have come down with the flu or are dying. We’re also being led to believe that the virus is actively spreading and sickening increasingly more people. “The number of cases has doubled,” television news reported tonight.

But, as Dr. Nancy Cox, Director of CDCs Influenza Division, explained to media yesterday, a total of seven cases of swine flu virus have been confirmed in California, but all of these patients had been sick weeks ago and all have recovered.

The number of confirmed cases nationwide now tallies about 40, but it’s not because the virus is spreading, said Dr. Richard Besser, acting director of the CDC. It’s because more tests are being completed. All of the patients have recovered. There have been no deaths. [That's not to say that there probably won't be, of course, because people do die from flus and respiratory infections.]

“So far this is not looking like very, very severe influenza,” said Dr. Schuchat.

The cases we’re seeing outside Mexico have been “no more serious than your average flu bug,” said Dr. Layton.

These numbers — 40 cases of this strain, that might have gone unrecognized from the regular seasonal influenza in past years, and no deaths — pale in comparison to the number of Americans who are estimated to die from the flu every year. According to government health statistics, about 30,000 to 50,000 people die every year from influenza in the United States. Princeton biologists estimated that from 1979 to 2001, annual deaths from influenza in the U.S. averaged 41,400. About a thousand times more people die every year from influenza than have from swine flu, yet there are no nightly death counts on the news during flu season each year.

Addendum: And how many cases of the flu are normally seen, for comparison? This week (April 12-18, 2009), the CDC confirmed 25,925 cases of influenza in the United States and 55 child deaths.

While estimates of annual influenza deaths vary depending on the methodology, each is consistent in showing that cases are not rising. For instance, MIT research found that there’s been a substantial decline in influenza deaths in the U.S. during the 20^th century. Not only that, but the influenza pandemics of 1967-8 and 1968-9 showed “substantial overlap in both degree of mortality and timing compared with nonpandemic seasons.” In other words: “The considerable similarity in mortality seen in pandemic and non-pandemic influenza seasons challenges common beliefs about the severity of pandemic influenza.” Don’t let the word pandemic play on your fears.

Deaths in Mexico

Media stories have been filled with ominous warnings about Mexico and suggesting that vast numbers of people are sick and dying, restricting their travel and near panic. But even the World Health Organization’s latest update reports only 26 confirmed cases and seven deaths in Mexico. (Canada has reported six cases with no deaths.) And, in contrast to the CDC:

“WHO advises no restriction of regular travel or closure of borders.”

The CDC’s MMWR Weekly report on the latest update of swine flu cases also emphasized that increased monitoring and testing for swine flu strains has been in effect the past couple of years along the border region. The CDC’s laboratory has only been able to identify the same strain of swine flu as seen in the U.S. in seven of the 14 samples sent to it from Mexico. They cautioned that not all of the reported flu cases from Mexico may actually be confirmed cases of swine flu. No clear data is available.

Most important, greater numbers of deaths in Mexico does not mean that a more virulent strain is present there. Mexico is a country with extreme poverty. Even in the 1990s, more than a third of households had no indoor plumbing and about 20% of homes had dirt floors. With poverty, hunger and lack of good medical care affecting large segments of the population, infections take a much higher toll. In 1990, one in five deaths were still due to infectious parasitic and respiratory illnesses and malaria claimed 31.1/100,000 people. Even the flu is more deadly for poor people.

Can you get swine flu from pork?

No. The U.S. Department of Agriculture reported this morning that there is no evidence that swine in our country are infected with this virus strain. Pigs in the United States are not contagious with this virus, nor can you get swine flu from touching pigs or eating pork. As the USDA explains, Federal veterinarians, state animal health officials and private practitioners regularly monitor U.S. swine for signs of disease and no cases have been found to be circulating anywhere in U.S. swine herds. Pork producers are on high alert and taking extra vigilance in animal safety practices.

You cannot get swine flu from eating cooked pork. Cooking pork to an internal temperature of 160°F kills all viruses.

What can you do to protect yourself and your loved ones?

The swine flu isn’t much different from any other flu or respiratory infection in how it’s spread, in its symptoms or in how you can protect yourself. As the CDC explains, just like seasonal flu is spread between people, the swine flu spreads mostly through respiratory droplets, such as infected people coughing or sneezing. You can also pick up flu viruses by touching something with viruses on it and then touching your mouth, eyes or nose. The symptoms of swine flu are the same as the typical flu: fever, cough, sore throat, body aches, headache, chills and fatigue, sometimes diarrhea and vomiting.

To help protect yourself:

1. Wash your hands with soap and water or hand sanitizer.

2. Don’t pick your nose.

3. Wash your hands.

4. Avoid close contact with people who are sick.

5. Wash your hands.

Forget about those blue surgical masks you see everyone wearing on television news. Viruses are tiny enough to go right through them or around the openings. They might help protect you from globs of mucus flying towards your face, but that’s about all. They’re mostly good for hyping the fear factor and looking scary.

For healthcare professionals caring for patients and engaged in aerosol-generating activities, such as respiratory treatments, the CDC recommends a fit-tested disposable N95 respirator. But even a respirator alone isn’t completely protective and offers limited protection from viruses. It can filter out particles down to 0.3 microns 95% of the time. You still have to: Wash your hands.

If you get sick

For heavens sake, stay home and don’t spread any respiratory virus with your friends, schoolmates, work buddies or fellow parishioners. And especially stay away from people who are more vulnerable to respiratory infections, such as babies, elderly, immunosuppressed patients and those with underlying medical conditions or chronic diseases. Just like the common sense advice your mother gave you when you had a cold: Cover your nose and mouth when you cough or sneeze. Throw your snotty tissue in the trash after you use it and don’t share your toothbrush or eating utensils. And wash your hands often with soap and water, especially after you cough or sneeze.

Medical care is available today for bad respiratory infections, including antibiotics for secondary bacterial infections. Laboratory testing has found the swine influenza A (H1N1) virus is susceptible to new prescription antiviral drugs, oseltamivir and zanamivir.

As the CDC cautions, if you or a loved one becomes sick and develops any of the following symptoms, seek emergency medical care.

In children, emergency warning signs that need urgent medical attention include:

· Fast breathing or trouble breathing

· Bluish skin color

· Not drinking enough fluids

· Not waking up or not interacting

· Being so irritable that the child does not want to be held

· Flu-like symptoms improve but then return with fever and worse cough

· Fever with a rash

In adults, emergency warning signs that need urgent medical attention include:

· Difficulty breathing or shortness of breath

· Pain or pressure in the chest or abdomen

· Sudden dizziness

· Confusion

· Severe or persistent vomiting

The bottom line is that there is no evidence we need to panic about another flu pandemic. The newspapers and television networks love a good scare, as do pharmaceutical companies. But scares do nothing to make us feel better. All influenza infections are worthy of prudent precautions, but panic can be far more virulent and more costly than the flu itself.

© 2009 Sandy Szwarc

For information on this evolving story, see the CDC Swine Flu “What’s New” page here.

Sadly, a lot of consumers don’t read, and pork producers are bracing for the worst. For readers who don’t submit to the media panic and who keep their common sense firmly intact: they may find some great deals on pork chops and ribs at the market this week.