The H1N1 novel swine virus keep spreading around the World, things are getting worst but there is still a lot we can do to avoid being sick, to take care of our near ones infected at home and to not be a burden on the Health Infrastructures.
On Wed Jun 03, 2009 I wrote the following Hints and tips
From theory to reality, 1st wave of a World pandemic
I start strongly by recommending you to first buy the regular critical medicine that you need for few months ahead of Time and do it NOW.
As you are starting to realize, a world wide pandemic will affect each of us, each of our family, each of our Community and all Nations around the World.
And as you will find out a lot of things have change since the pandemic of 1968, 1957, 1918 or 1889, we do not have anymore thousand of farmers to delivers food in our big cities. Despite our technological huge leaps, we are in 2009 more vulnerable in many instances than we where back then.
This Diary Purpose is to Inform not to Inflame.
But mostly to incite as many as possible to respond to these Trends with Pertinence, Realism and Accordingly.
Snowy Owl
This morning the Reveres at Effect Measure ( A Professional Public Health blog ahead of the Parade wrote this article.
Severe cases in swine flu: lack of clinical details
Two elite flu reporters, Helen Branswell (Canadian Press) and Declan Butler (Nature), both noted yesterday the dearth of clinic information on the serious and fatal swine flu cases.
In Nature A renown Science and Medicine under the plume of Declan Butler a well verse and pro-active scientific reporter on Medical issue it is stated in Swine flu roundup - June 19, 2009
Flu continues to spread in many parts of the United States and elsewhere in the Northern hemisphere. Some had figured it might go away, as the normal flu season has ended, and not return until the autumn when seasonal flu activity typically picks up. In hard hit places such as New York almost a tenth of the population are showing influenza like symptoms.
In the Southern Hemisphere, where the flu season is getting underway, South Africa yesterday reported its first case, following recent cases in Egypt and Morocco. Africa has not reported anything like the same extent of spread asother parts of the South (such as Australia and countries in South America) - but that is likely down to lack of surveillance.
snip
They deplore the "lack of information" on the pathogenesis and clinical aspects of those with severe illness, and argue that trials and other clinical research are urgently needed to better understand the disease, and learn of necessary tweaks to treatment regimes. What research is being done isn't being published fast enough, add Farrar et al., contrasting this with the speedy publication by researchers in other disciplines who have published in fast-tracked journal articles, or shared on public wikis – eg here – in advance of formal publication. Clinical researchers need to "catch up," they conclude, "To do otherwise would be unethical."
Meanwhile Helen Branswell a Canadian Health reporter dedicated to the emerging pandemic and its consequences wrote two days ago;
Swine flu patients in ICU tough to manage, 'just really, really sick': doctors
A report compiled by the World Health Organization said between two and five per cent of confirmed cases require hospitalization. But no one yet knows how big a portion of the iceberg is above water (the confirmed cases) and how much remains submerged (cases that never come to the attention of medical authorities). People who end up getting admitted to hospital are generally presenting with shortness of breath. And by the time they get to the ICU, swine flu patients - most much younger than your average hospitalized flu patient - are gravely ill from a viral assault on their lungs.
"They're getting very bad, bad respiratory failure," says Dr. Michael Gardam, head of infectious disease prevention and control for Ontario's public health agency. Kumar and others describe patients whose care is challenging.
"The patients are difficult to manage. They're unusually difficult to ventilate effectively," he says, referring to the practice of putting patients who cannot breath adequately for themselves on a machine called a ventilator that takes over the job temporarily.
"They're just really, really sick. It's impressive how sick they are."
As Reveres points it up "I don't know the slowness is "unethical." Clinicians in the midst of an outbreak have their hands full managing critically ill patients. Papers don't write themselves. They require time, effort and spare energy, three things not so abundant in such circumstances."
We have no idea how representative this is of ICUs in areas with a lot of circulating swine flu, but this is without dobut an unsettling description. The data aren't available to calculate hospitalization rates or case fatality rates with any confidence, but the contrast with a regular flu season in this description certainly gives one pause.
At any rate, the clinical spectrum of underlying pathology has not yet been described. It sounds much like the patients that go sour fast are taken down by a rapidly progressive primary viral pneumonia (where the influenza virus infects the cells of the lower respiratory tract). What role, if any, a dysregulated innate immune response ("cytokine storm") or secondary bacterial infections play we don't yet know.
I expect we'll see some published case series relatively soon. Branswell reports the doctors she interviewed have some in preparation. They will almost certainly receive expedited review and publication, as would be appropriate. We're just two months from initial cases, so it's not surprising there's a lot we don't know about what is happening. But in the same time the virus has spread around the world, continues to circulate during summer months in the northern hemisphere and has established a foothold in the southern hemisphere, at the start of its flu season.
The world of public health is fastening its seat belts. It could be a rough ride. But flu is unpredictable, so you never know. Maybe it will surprise us pleasantly, this time. But I doubt it.
People have to at least reach out and to take knowledge of what is now unfolding right before their eyes.
As Former Secretary Leavitt said over and over,
"Do not expect the Federal or State Cavalry to come and help you, you are on your own."
Take some time to understand what is going on and what you can do to reduce morbidity and mortality, for you, your family and your Community.
Dare to Care
Snowy Owl