[DEHAI] Swine Flu: 5 Things You Need to Know About the Outbreak

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From: Tsegai Emmanuel (emmanuelt40@gmail.com)
Date: Tue Apr 28 2009 - 11:46:08 EDT

 Swine Flu: 5 Things You Need to Know About the Outbreak By BRYAN WALSH Bryan
Walsh Mon Apr 27, 3:15 pm ET

Concern that the world could be on the brink of the first influenza
pandemicin more than 40 years escalated Sunday as France, Hong
Kong, New Zealand and Spain reported potential new cases in which people had
been infected with swine flu and Canada confirmed several new cases. In the
U.S., where 20 such infections have been confirmed, federal health officials
declared a public-health emergency and are preparing to distribute to state
and local agenciesa quarter of the country's 50 million-dose stockpile
of antiviral
drugs. Meanwhile, in hard-hit Mexico, where more than 80 people have died
from what is believed to be swine flu, the government closed all public
schools and canceled hundreds of public events in Mexico City.

Though the World Health Organization (WHO) is referring to the situation as
a "public-health emergency of international concern," the apparent emergence
in several countries of an entirely new strain of H1N1 flu virus has led
some scientists to believe that it is only a matter of time before the WHO
declares pandemic status, a move that could prompt travel bans to infected
countries. "We are clearly seeing wide spread," says Michael Osterholm, a
pandemic risk expert who runs the University of Minnesota's Center for
Disease Research and Policy. "There is no question." (See a photogallery on
swine flu hitting

Health officials in Washington were quick to point out Sunday that none of
the 20 cases identified in the U.S. so far has been fatal; all but one of
the victims has recovered without needing to be hospitalized. Officials also
noted that only one American has been infected so far who had not recently
traveled to Mexico - a woman in Kansas got sick after her husband returned
from a business trip in that country, where he became ill - but that could
change as more intensive disease surveillance begins. "As we continue to
look for more cases, I expect we're going to find them," said acting Centers
for Disease Control (CDC) director Richard Besser.

In the U.S., where cases have also been found in California, Texas, and New
York City, the declaration of a public-health emergency is part of what
federal officials termed an "aggressive response" to the outbreaks. In
addition to releasing from the national stockpile some 12.5 million doses of
the antiviral drugs Tamiflu and Relenza - which scientists say has so far
been effective against the H1N1 swine flu virus - the Department of Homeland
Security will begin "passive surveillance" to screen people entering the
U.S. Any traveler coming from a country with a confirmed human swine flu
infection will be questioned, checked for symptoms and potentially isolated
if they are found ill. Though the CDC has issued public warnings about the
more serious outbreak in Mexico, there are no recommendations from
Washington against traveling to the neighboring country. (Read about the
vaccine being prepared in case of a

That is in contrast to the more extreme actions of some other governments,
including Hong Kong, where officials on Sunday urged residents to avoid
going to Mexico. Hong Kong officials also ordered the immediate detention in
a hospital of anyone who arrives with a fever above 100.4 F, respiratory
symptoms and a history of traveling over the past seven days to a city with
a confirmed case of swine flu infection.

But Washington officials Sunday did their best not to overstate the
situation and emphasized that their response wasn't out of the ordinary. "I
wish we could call it declaration of emergency preparedness, because that's
really what it is in this context," said Secretary of Homeland
SecurityJanet Napolitano. "We're preparing in an environment where we
really don't
know ultimately what the size or seriousness of this outbreak is going to

See the top 10 medical breakthroughs of

See TIME's pictures of the
Right now health officials around the world are trying to take precautions
without inciting panic. Here are just a few of the questions facing them -
and ultimately, us as well:

 *1. Is this a flu pandemic? *

The influenza virus is constantly mutating. That's why we can't get full
immunity to the flu, the way we can to diseases like chicken pox, because
there are multiple strains of the flu virus and they change from year to
year. However, even though the virus makes us sick, our immune systems can
usually muster enough of a response so that the flu is rarely fatal for
healthy people.

But every once in awhile, the virus shifts its genetic structure so much
that our immune systems offer no protection whatsoever. (This usually
happens when a flu virus found in animals - like the avian flu still
circulating in Asia - swaps genes with other viruses in a process called
reassortment, and jumps to human beings.) A flu pandemic occurs when a new
flu virus emerges for which humans have little or no immunity and then
spreads easily from person to person around the world. In the 20th century
we had two mild flu pandemics, in 1968 and 1957, and the severe "Spanish
flu" pandemic of 1918, which killed an estimated 40 to 50 million people

The WHO has the responsibility of declaring when a new flu pandemic is
underway, and to simplify the process, the U.N. body has established six
pandemic phases. Thanks to H5N1 avian flu, which has killed 257 people since
2003 but doesn't spread very well from one human to another, we're currently
at phase 3. If the WHO upgraded that status to phase 4, which is marked by a
new virus that begins to pass easily enough from person to person that we
can detect community-sized outbreaks, such a move would effectively mean
that we've got a pandemic on our hands.

The H1N1 swine flu virus has already been identified as a new virus, with
genes from human and avian flus as well as the swine variety. And since it
is apparently causing large-scale outbreaks in Mexico, along with separate
confirmed cases in the U.S. and Canada and suspected cases in other
countries, it would seem that we've already met the criteria for phase 4.
But though an emergency committee met on April 25 to evaluate the situation,
the WHO hasn't made the pandemic declaration yet. Keiji Fukuda, the WHO's
interim assistant director-general for health, security and environment,
said on Sunday that its experts "would like a little bit more information
and a little bit more time to consider this." The committee is set to meet
again by April 28 at the latest.

As health officials have repeatedly emphasized, with good reason, the swine
flu situation is evolving rapidly, and more lab tests are needed to
ascertain exactly what is going on in Mexico and elsewhere. "We want to make
sure we're on solid ground," said Fukuda, a highly respected former CDC
official and flu expert.

*2. What will happen if this outbreak gets classified as a pandemic? *

Moving the world to pandemic phase 4 would be the signal for serious
containment actions to be taken on the national and international level.
Given that these actions would have major implications for the global
economy, not to mention the effects of the public fear that would ensue,
there is concern that the WHO may be considering politics along with
science. "What the WHO did makes no sense," says Osterholm. "In a potential
pandemic, you need to have the WHO be beyond question, and (April 25) was
not a good day for them."

Of course, declaring a pandemic isn't a decision that should be taken
lightly. For the WHO, phase 4 might trigger an attempt to keep the virus
from spreading by instituting strict quarantines and blanketing infected
areas with antivirals. But we appear to have missed the opportunity to
contain the disease at its source since the virus is already crossing
borders with ease. "We cannot stop this at the border," said Anne Schuchat,
the CDC's interim director for science and public health. "We don't think
that we can quench this in Mexico if it's in many communities now."

That would leave the WHO and individual countries to fall back on damage
control, using antivirals and old-fashioned infection control - like closing
schools, limiting public gatherings and even restricting travel - to slow
the spread of the virus. But such efforts would likely inflict serious
damage on an already faltering global economy - and the truth is, we don't
know how well those methods will work.

*3. Why have the U.S. cases been so much milder than the ones in Mexico? *

This is the question that has health officials from Geneva to Washington
puzzled. In Mexico, swine flu has caused severe respiratory disease in a
number of patients - and even more worryingly, has killed the sort of young
and healthy people who can normally shrug off the flu. (Fueling such
concerns is the fact that similar age groups died in unusually high numbers
during the 1918 pandemic.) Yet the cases in the U.S. have all been mild and
likely wouldn't have even garnered much attention if doctors hadn't begun
actively looking for swine flu in recent days. "What we're seeing in this
country so far is not anywhere near the severity of what we're hearing about
in Mexico," said the CDC's Besser. "We need to understand that."

Some of the difference may be due to the fact that Mexico has apparently
been grappling with swine flu for weeks longer than the U.S. As doctors
across the U.S. begin checking patients with respiratory symptoms for swine
flu, CDC officials expect to see more severe cases in the U.S. as well - and
as better epidemiological work is done in Mexico, we'll probably hear about
more mild cases there too. Right now, however, the true severity of the H1N1
swine flu virus is still an open question, whose answer could change over
time. The 1918 Spanish flu pandemic began with a fairly mild wave of
infections in the spring, but the virus returned a few months later in a far
more virulent form. That could happen with the current swine flu as well.
"It's quite possible for this virus to evolve," said Fukuda. "When viruses
evolve, clearly they can become more dangerous to people."

*4. How ready is the U.S. - and the world - to respond to a flu pandemic? *

In some ways, the world is better prepared for a flu pandemic today than it
has ever been. Thanks to concerns over H5N1 avian flu, the WHO, the U.S. and
countries around the world have stockpiled millions of doses of antivirals
that can help fight swine flu as well as other strains of influenza. The
U.S. has a detailed pandemic preparation plan that was drafted under former
President George W. Bush. Many other countries have similar plans.
SARS and bird
flu have given international health officials useful practice runs for
dealing with a real pandemic. We can identify new viruses faster than ever
before, and we have life-saving technologies - like artificial respirators
and antivirals - that weren't available back in 1918. "I believe that the
world is much, much better prepared than we have ever been for dealing with
this kind of situation," said Fukuda.

At the same time, the very nature of globalization puts us at greater risk.
International air travel means that infections can spread very quickly. And
while the WHO can prepare a new swine flu vaccine strain in fairly short
order, we still use a laborious, decades-old process to manufacture
vaccines, meaning it would take months before the pharmaceutical industry
could produce its full capacity of doses - and even then, there wouldn't be
enough for everyone on the planet. The U.S. could be particularly
vulnerable; only one plant, in Stillwater, Penn., makes flu vaccine in
America. In a pandemic, that could produce some ugly political debates. "Do
you really think the E.U. is going to release pandemic vaccine to the U.S.
when its own people need it?" asks Osterholm.

Indeed, the greatest risk from a pandemic might not turn out to be from the
swine flu virus itself - especially if it ends up being relatively mild -
but what Osterholm calls "collateral damage" if governments respond to the
emergency by instituting border controls and disrupting world trade. Not
only would the global recession worsen - a 2008 World Bank report estimated
that a severe pandemic could reduce the world's GDP by 4.8% - but we depend
on international trade now for countless necessities, from generic medicines
to surgical gloves. The just-in-time production systems embraced by
companies like Wal-Mart - where inventories are kept as low as possible to
cut waste and boost profit - mean that we don't have stockpiles of most
things. Supply chains for food, medicines and even the coal that generates
half our electricity are easily disruptable, with potentially catastrophic
results. Though we'll likely hear calls to close the border with Mexico,
Osterholm points out that a key component used in artificial respirators
comes from Mexico. "We are more vulnerable to a pandemic now than at any
other time over the past 100 years," he says. "We can't depend on

*5. So how scared should we be? *

That depends on whom you ask. Officials at the CDC and the WHO have
emphasized that while the swine flu situation is serious, they're responding
with an abundance of precautions. Even Osterholm, who has been highly
critical of the U.S. government's long-term failures to better prepare for a
pandemic, gives the CDC a 9 out of 10 for its response so far. Outside of
Mexico, the swine flu hasn't looked too serious yet - unlike during
the SARSoutbreaks of 2003, when an entirely new virus with no obvious
treatment took
the world by surprise. In the U.S., the normal flu season is winding down,
which should make it easier for public-health officials to pick out swine
flu cases from run-of-the-mill respiratory disease. And there are simple
things that people can do to protect themselves, like practicing better
hygiene (wash hands frequently and cover mouth and nose when sneezing) and
staying away from public places or traveling if they feel sick. "There's a
role for everyone to play when an outbreak is ongoing," said Besser.

But the truth is that every outbreak is unpredictable, and there's a lot we
don't know yet about the new swine flu. There hasn't been a flu pandemic for
more than a generation, and there hasn't been a truly virulent pandemic
since long before the arrival of mass air transit. We're in terra incognito
here. Panic would be counterproductive - especially if it results in
knee-jerk reactions like closing international borders, which would only
complicate the public-health response. But neither should we downplay our
very real vulnerabilities. As Napolitano put it: "This will be a marathon,
not a sprint." Be prepared.

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