June 20, 2009 — 392 H1N1 Confirmed Cases in the Phils — DOH Should Now Tell Us About H1N1, Cytokine Storms & the 1918 Spanish Influenza Pandemic

21 June 2009

As of June 20, 2009, there are now 392 confirmed H1N1 cases in the Philippines.  This is the report by Mariz Umali of Saksi courtesy of GMANews.tv:

For the latest Philippine news stories and videos, visit GMANews.TV

This is Update No. 46 from the DOH website:

Update No. 46- Duque: 70% of All Reported A (H1N1) Cases have Already Fully Recovered as 13 Moe Patient Were Sent Home Today

20 June 2009

Health Secretary Francisco T. Duque III today reported that 13 more fully recovered A (H1N1) patients were already sent home, thus bringing the total count of fully recovered cases to 275.  This figure constitutes 70% of the total confirmed cases reported since May 1.

Duque also disclosed that there are 48 more confirmed A (H1N1) cases recorded today, all mild in nature. These new additional cases bring the total number of (mild) confirmed cases to 392.

The new 48 mild confirmed cases involved 20 males and 28 females. The age range of cases is 1-53 years old, with 17 as median age.

Duque noted that 45 of the cases are Filipinos, while the remaining 3 are foreigners. He added that 12 of the new cases have a history of travel to a country affected with the novel virus.

Duque noted that all of these new patients are responding positively to their treatments. 

Duque reminded the public that the simplest ways to avoid contracting the flu are to wash hands thoroughly and to cover mouth and nose when you cough and sneeze, respectively.

Meanwhile, as of June 19, the World Health Organization reported 44,287 cases with 180 deaths from 90 reporting countries. Lao, Netherlands Antilles Sint Maarten, Oman, Papua New Guinea, South Africa andSuriname are the new countries reporting with A (H1N1) cases.

We have seen Secretary Duque of the DOH going the rounds assuring everybody that there is no need to be concerned about H1N1 because all we've had here in the Philippines are mild cases. We should all be thankful for that.   

However, I believe now is the time for Secretary Duque and our officials at the Department of Health to start talking more in public about the possible dangers that lie ahead based on historical precedents and what the entire nation can do to prepare for any future eventuality.

For example, the public's attention should be called to the existence of cytokine storms and their reported role in the grievously devastating toll in the number of deaths during the 1918 Spanish influenza global pandemic. 

Cytokine storms are not science fiction. They have happened in the past and one of the most authoritative pieces of literature on the subject is this article, written by Michael T. Osterholm, Ph. D., entitled Preparing for the Next Pandemic.  It appeared in the May 5, 2005 issue of the New England Journal of Medicine.

Dr. Osterholm is the director of the  Center for Infectious Disease Research and Policy, the associate directory of the National Center for Food Protection and Defense, and a professor of public health at the University of Minnesota, Minneapolis.

Although the article by Dr. Osterholm discusses cytokine storms in relation to H5N1 or the avian flu, the general principle remains the same when applied to the current H1N1 flu virus.

At the end of his article, Dr. Osterholm posed the question, "Is there anything we can do to avoid this course [meaning, the potentially large number of casualties in the event of the next global pandemic]?

And this is his answer:

The answer is a qualified yes that depends on how everyone, from world leaders to local elected officials, decides to respond. We need bold and timely leadership at the highest levels of the governments in the developed world; these governments must recognize the economic, security, and health threats posed by the next influenza pandemic and invest accordingly. The resources needed must be considered in the light of the eventual costs of failing to invest in such an effort. The loss of human life even in a mild pandemic will be devastating, and the cost of a world economy in shambles for several years can only be imagined.  

I guess few people have credentials similar to Dr. Osterholm's. Prudence dictates that we should at least spend a few moments to read and investigate further what he has to say.

 

Add Post To: | Digg| Technorati| Tip'd| del.icio.us| Stumbleupon| Reddit| BlinkList| Furl| Spurl| Yahoo| Simpy|

The Swine Flu Virus That Could Trigger a Global Pandemic Has Reached Kansas According to MSNBC

26 April 2009    9:18am, Manila time

No less than the World Health Organization (WHO) has raised the warning that the current swine flu virus could lead to a global pandemic.  The virus has been linked to the reported death of 68 people in Mexico and has caused the illness of at least a thousand more prompting the Mexican government to shut down schools, museums, libraries and other public places in Mexico City.  

Associated Press is quoting WHO spokesperson Thomas Abraham as saying, "We are very, very concerned.  We have what appears to be a novel virus and it has spread from human to human." The report also attributes to Abraham the statement that 'if international spread is confirmed, that meets WHO's criteria for raising the pandemic alert level.'

A news report I saw about an hour ago on BBC News World Report tells of a rare WHO emergency meeting in Geneva to deal with the developing crisis.  It showed WHO Director General Dr. Margaret Chan urging nations around the world to "heighten surveillance" to determine whether infection is happening in places other than the United States and Mexico.

Even as I write, MSNBC is reporting that another two swine flu cases have been confirmed in Kansas and possibly another eight in New York City.  This brings to 11 the number of confirmed instances of swine flu virus in the United States: 7 in California, 2 in Texas and 2 in Kansas.

In Canada, The Toronto Star has quoted Dr. Donald Low of the Mount Sinai Hospital as saying that "it is just a matter of time before we recognize it here":

There was no word today from the Public Health Agency of Canada. On Friday, Canada’s Chief Public Health Officer Dr. David Butler-Jones said there were no cases yet in this country.

With the mounting evidence of efficient person-to-person spread, infectious disease experts suggested Canada is likely to see its first cases soon.

“We now apparently have widespread swine H1N1 throughout the United States which tells us that it is highly infectious, therefore having all the makings of the next pandemic strain,” said Dr. Donald Low, chief microbiologist at Toronto’s Mount Sinai Hospital.

“It is just a matter of time before we recognize it here.”

The paper's HealthZone was even more anticipatory, saying:

The new strain of swine influenza is likely already in Ontario, said Dr. Michael Gardam, one of Ontario's top infectious disease specialists, because about 60,000 people return to the province from Mexico every month.

"We have to assume that it is circulating in Ontario," he said. "You just have to look at air travel patterns to realize that what goes on in Mexico has to come to Canada."

With the spectre of SARS still looming over the Toronto area, local infectious disease experts are emphasizing the new strain of swine flu should not be compared to the severe acute respiratory syndrome that swept the city in 2003 and killed 44 people.

The present situation has the elements of an explosive sci-fi thriller that might just become true.  And it has a precedent in history.  We need to head back in time, towards the end of the First World War, to find history's greatest killer, the Spanish influenza pandemic of 1918-1919.

This report by CDC (Centers for Disease Control and Prevention) entitled 1918 Influenza: the Mother of All Pandemics states the grim historical fact but discusses what has been done since that fateful year:

The "Spanish" influenza pandemic of 1918–1919, which caused ≈50 million deaths worldwide, remains an ominous warning to public health. Many questions about its origins, its unusual epidemiologic features, and the basis of its pathogenicity remain unanswered. The public health implications of the pandemic therefore remain in doubt even as we now grapple with the feared emergence of a pandemic caused by H5N1 or other virus. However, new information about the 1918 virus is emerging, for example, sequencing of the entire genome from archival autopsy tissues. But, the viral genome alone is unlikely to provide answers to some critical questions. Understanding the 1918 pandemic and its implications for future pandemics requires careful experimentation and in-depth historical analysis.

An estimated one third of the world's population (or ≈500 million persons) were infected and had clinically apparent illnesses during the 1918–1919 influenza pandemic. The disease was exceptionally severe. Case-fatality rates were>2.5%, compared to <0.1%>). Total deaths were estimated at ≈50 million and were arguably as high as 100 million.

That was ninety-one (91) years ago and the world is now better prepared, hopefully, to deal with this lethal menace. 

More when we return. 

Add Post To: | Digg| Technorati| Tip'd| del.icio.us| Stumbleupon| Reddit| BlinkList| Furl| Spurl| Yahoo| Simpy|