Gill Stannard

Monday, June 15, 2009

Swine flu

Over the past month the local media has been salivating in the desire to spot the first case of Swine Flu in Australia. Now the inevitable has happened, there are only so many times they can show the same picture of primary school children covering their faces to ward off the disease. You get the feeling the press is rather disappointed that everyone is pulling through so far.

Below is an updated version of an article originally published in my May E-newsletter plus more news as the situation unfolds

Having a head cold that makes you feel awful and drags on for days is not flu. When you can’t sleep from coughing and you feel thoroughly miserable it is normal to think you must be suffering something far grander than a common bug. But a cold is not influenza.

Some of the notable characteristics of flu may include a sore throat and sinus congestion like a cold but influenza will also bring a fever (over 38c), chills, body aches, severe fatigue and loss of appetite. You cannot get out of bed and you will rarely, if ever, have felt this bad before.

Swine flu will begin like any other strain of influenza. The mystery is why this virus killed so many healthy and young people in Mexico. Disease and naturopathic discussion boards are rife with theories, just google “cytokine storm” for equal parts awe and bafflement to get an inkling of how complex this virus is. Certainly what is different about this variety of flu compared to the ordinary Influenza A strain is there is no prior exposure to give partial immunity and good health is no protection. This is likely due to the fact that it is only one part human in origin, with pig and bird forms of influenza completing the puzzle.

The most famous H1N1 (the flu strain that swine flu belongs to) epidemic was the 1918 Spanish Flu which claimed 50 million lives (approximately one hundred times our current worldwide annual influenza death rate of 250,000-500,000), so there is understandable cause for concern. Like the Mexico outbreak, the Spanish Flu also claimed a large amount of supposedly healthy young men. But as it came on the tail of a major world war with horror, poor nutrition and a large amount of post-traumatic stress perhaps this was the group in society most vulnerable to an attack on their immune system?

Usual prevention strategies involve good old fashioned commonsense. Do lots of hand washing and the disease is spread by droplets, when we absentmindedly rub our eyes, nose or put our fingers in our mouth we give the virus entry to our body via our mucus membranes. Following last March’s article on staying well in autumn, I strongly suggest that we all take a daily dose of cod liver oil to strengthen mucus membranes and get a much needed dose of immune boosting Vitamin D. Low Vitamin D is emerging as a significant factor in Swine Flu as well as general health.

But most importantly, don’t soldier on! If you feel like you are coming down with something, be it a cold or influenza – stay at home, go to bed, drink lots of water, soup, herb teas and lemon and honey. If it is Swine Flu, your boss will thank you for not coming in and spreading it around the workplace.

If you don’t have a thermometer in your house, go out and buy one now. This is a cheap and effective tool to monitor any illness. Normal temperature is around 37c depending on what part of the body it is taken (sublingual - under the tongue, axillary - under the armpits or rectal – you know where that is!). The agreed normal for sublingual temperature is 36.8c, although this can vary by a full degree throughout the day. Typically your temperature is higher in the afternoon and lower in the middle of the night, so here is no cause for alarm if you temperature is under 38c.

Be aware that if you have recently eaten or drunk hot or cold substances this may give an inaccurate oral temperature reading. Infrared ear thermometers are handy as they only take a second to get a measurement but studies show they can be less accurate than a correctly used oral thermometer. Strips that take skin temperature are considered least reliable.

Wear a mask if it makes you feel better but once again it’s the droplets on our hands that is often the culprit so this may just give you a false sense of security. On packet trains, trams and buses it may be handy to have a pack of antiseptic wipes to use once you get off at your destination.

There has been a rush of anti-viral medications like Tamiflu or Relenza. While it is well indicated if you have been exposed to any kind of influenza or if you develop the virus, be cautious about taking it unnecessarily. These are serious pharmaceutical drugs with a well documented list of adverse reactions including alarming psychiatric symptoms from hallucinations through to psychosis and suicidal thoughts, especially in children.

Interestingly a successful Swine Flu vaccine was developed in 1976 but caused more deaths than the illness itself. At least 500 people who were given the vaccine developed a life-threatening neurological condition, Guillain-Barré Syndrome.

Keep in mind that if you take the Mexican Swine Flu deaths out of the tally, the death rates in the rest of the world are not nearly as alarming. The World Health Organisation has running tally that is regularly updated. At the time of writing this there have been almost twice as many reported cases of Swine Flu in the USA, than in Mexico yet their have been 12 deaths in former compared with 85 in the later. What this means is, bar a mutation to the virus, we can be less paranoid about the current pandemic.

The take home message remains that prevention from exposure is the best, if not the only, measure to prevent getting Swine Flu. Stock up on your cod liver oil capsules, make sure you have some healthy food (e.g.: whole grains, legumes as well as canned organic beans, fish and fruit) in your pantry in case you are unexpectedly quarantined, practice hand washing and stay at home if you feel at all unwell.

More Swine Flu resources

The BBC Q&A about Swine Flu is useful and up to date.

WHO alerts.

Updated 15 June 2009:
According to The Age, up to 1:3 Victorians may have swine flu. Though a spokesman for the Department of Human Services said "it was difficult to estimate Victoria's swine flu prevalence because symptoms could range from a sniffle that would not prompt someone to go to the doctor through to fever, sore throat, aches and pains and other flu-like symptoms".

Last week the WHO officially upgraded H1N1 influenza from phase 5 to phase 6 pandemic, which is the highest alert. There are now over 30,000 confirmed cases of swine flu in 74 different countries. Currently there are 1515 confirmed cases of swine flu in Australia.

Worldwide, the number of deaths is small. Each and every one of these deaths is tragic, and we have to brace ourselves to see more. However, we do not expect to see a sudden and dramatic jump in the number of severe or fatal infections.

We know that the novel H1N1 virus preferentially infects younger people. In nearly all areas with large and sustained outbreaks, the majority of cases have occurred in people under the age of 25 years.

In some of these countries, around 2% of cases have developed severe illness, often with very rapid progression to life-threatening pneumonia.

Most cases of severe and fatal infections have been in adults between the ages of 30 and 50 years.

This pattern is significantly different from that seen during epidemics of seasonal influenza, when most deaths occur in frail elderly people.

Many, though not all, severe cases have occurred in people with underlying chronic conditions. Based on limited, preliminary data, conditions most frequently seen include respiratory diseases, notably asthma, cardiovascular disease, diabetes, autoimmune disorders, and obesity.

At the same time, it is important to note that around one third to half of the severe and fatal infections are occurring in previously healthy young and middle-aged people.

Without question, pregnant women are at increased risk of complications. This heightened risk takes on added importance for a virus, like this one, that preferentially infects younger age groups.(Dr Margaret Chan, Director-General of the World Health Organization)

Updated 18 June 2009

The Australian experience of swine flu (or swine influenza A as it is currently known) has been much milder than anticipated. However, there is concern that this is just the dress rehearsal for a future, more deadly mutation of this particular virus.

In the Medical Journal of Australia’s online report this week ”Swine flu update: bringing home the bacon”, several characteristics of this virus have been observed:

- the symptoms have been milder than expected
- on average there is an incubation period of 3-4 days between exposure to the virus and onset of symptoms
- unlike most strains of influenza, the majority of people with swine flu do not experience a significant fever (in both mild and severe presentations of swine flu)
- in the US over a third of cases have diarrhoea and vomiting along with the usual symptoms such as a sore throat and malaise
- it is not as deadly - when the Mexican death rate is excluded from the statistics the mortality rate is 0.2% (including Mexico it brings it to 0.5%)
- older people may have some degree of immunity despite it being a new virus as there may be some viral similarity with a previous seasonal flu or flu vaccine, explaining why younger people have been more vulnerable to acquiring swine flu

The MJA published another piece this week, “Australia’s influenza containment plan and the swine flu epidemic in Victoria” examining the response to the Swine Flu at the epicentre of the Australian outbreak.

In reality, the severity of the 2009 swine flu outbreak has fallen well short of the worst-case scenario: instead of resulting in high mortality, swine flu has been associated with only a 1%–2% hospital admission rate and zero mortality in Australia (so far); early experience has shown that the clinical case definition (fundamental to accurate disease modelling) was not an accurate model for the swine flu epidemic…”

The article also made an alarming reference to our faith in current antiviral medication (oseltamivir, marketed as Tamiflu) and its efficacy. Other than the drug needing to be administered within 48 hours of the onset of the disease the authors noted, “it is known that the main seasonal influenza strain in the United States in 2008 was resistant to oseltamivir. The real nightmare scenario will be if the current swine flu strain also develops resistance in the face of widespread use of oseltamivir, leaving us with few treatment options. We are currently wasting oseltamivir on a mild illness when we are likely to need it next year, when the current strain could become more aggressive.”

And on that note a sub-type of the H1N1 virus has just been identified in Brazil. It is not known yet if this mutation of swine flu is any more virulent or is resistant to medication.

1 comment:

Ann oDyne said...

Once again, yet again, the media love to whip up a bit of froth to justify their existence (advertising).

I do wish that Ms Roxon had thought of MERELY distributing to every person arriving in Australia, a pack of masks with instructions to wear for at least a week after returning here.
too simple really.
It would have saved those schools from closing and the flow-on effect of same.
I despair of commuters sneezing and coughing without completely covering their face, H1N1 or not.