The proclivity of a flu virus to strike young people is one of the red flags of pandemic.

A friend of mine has had a major medical battle this year and is on medication that's suppressing her immune system. Her doctors will be giving her the normal flu vaccine and the swine flu vaccine as soon as it's available. She's expecting to get these late-September or early-October.

I think she said that her doctors told her the swine flu vaccine will be a two-shot deal. I'll double-back with her on that.

I had a scary bout with flu in 1994, when the virus got me at a vulnerable time. It knocked me flat for 10 days. Sickest I have ever been. That was as close as I've come to calling 911 for an ambulance. Ever since I have taken no chances even with "normal" flu. Vaccinations annually, don't touch door handles or knobs (all year 'round -- gloves or carry a handkerchief), carry hand sanitizer, avoid people who are sick or whose kids are.

And if you're single, just to save yourself having to go to the store when you're feeling miserable this winter, stock up now on food and meds. In normal winters, I always keep a couple weeks of soup on hand -- chicken noodle and French onion to soothe a sore throat. I'll up those stocks this year, starting today when I go to the grocery.

Have a functioning thermometer on hand.

QUESTION: What over-the-counter meds would people want to have plenty of for this contingency?

Tylenol, aspirin, cough & sore throat lozenges....

http://www.washingtonpost.com/wp-dyn/content/article/2009/05/16/AR2009051601850.html

The swine-origin influenza A (H1N1) virus that burst into public consciousness a month ago is starting to behave like a mixture of its infamous, pandemic-causing predecessors.

It seems to have a predilection for young adults, as did its notorious ancestor, the 1918 Spanish influenza. Many of the young victims who have become deathly ill turned out to have other medical problems -- a phenomenon first clearly seen with the 1957 Asian flu. H1N1 is spreading easily in North America but sputtering in Europe, just as Hong Kong flu did in 1968. And as in the mini-pandemic of Russian flu in 1977, some people appear to have a degree of immunity.

Exactly how swine flu fits into the pantheon of flu pandemics will not be known for a while. It will take months -- and many more victims -- for its full personality and behavior to emerge. But one thing is clear: This is a lot more than just seasonal flu out of season.

In and of itself the effects of the current incarnation of the swine flu may not be all you have to worry about.

Secondary infections, particularly infection with bacteria like MRSA, that are pretty much immune to all the common antibiotics and strains like KPC that may soon be immune to all the less common antibiotics if we don't play our cards right, may play the grim reaper as the relatively benign effects of the swine flu holds you immune defense system down. Even your garden variety seasonal flu can play that part. Even more likely if you are immune compromised already.

The young, old, those with chronic conditions like AIDS and those taking corticosteroids may start with a strike against them.

A nice piece on KPC: http://scienceblogs.com/mikethemadbiologist/2009/08/kpc_the_other_potential_pandem.php

Our government in Ontario (Canada) has just started a study to see exactly how many people have been infected and what the demographics of the people infected are.
It will be done by statistical sampling. It should have been done a few months ago in my opinion, but better late than never.



https://h1n1study.oahpp.ca/Pages/home.aspx

In the UK we were getting 100,000 new cases a week, but that's declined over the last couple of weeks down to 25,000 new cases. I think we are ahead of the curve compared to most countries, and we had a big jump in July which probably corresponds to your predicted "major outbreak", where it went from 100s to 100s of thousands. Only 44 deaths from that total.

But yes, we expect a lot of people to get it and we have, eg, streamlined the distribution of Tamiflu. Being more infectious means you are more likely to get it, but it doesn't mean you are more likely to die if you do get it.

I expect to get it; it's not academic in that sense. Reports of the relative mildness come from health officials. They are comparing it to real flu, rather than "man flu" which is usually just a bad cold. It'll be worse than a cold; you get fever, vomiting etc. It's not the end of civilisation unless it mutates, and as far as I can tell there's no reason to think it will. Here's an article supporting that view: NHS. Quote:

• Based on the pattern of spread for 14 different influenza pandemics over the past 500 years, there is little evidence to support the likelihood of a second or third more lethal wave of H1N1 influenza.

A lot more people will get it, and some tiny fraction will die, which will be sad for those that knew them, but for the rest of us life goes on.

Before you take the shot, make sure the potential benefits are not over-ridden by the neurological side-effects (Guillain-Barre Syndrome). As I understand, I'm not in an at-risk group so the odds of me taking this shot or any flu shot this year is nil to none.

OK, but you can get GBS from pretty much any viral syndrome. After all, it's an auto-immune reaction to a virus, usually weeks after the fact. I doubt I'd let the threat of GBS dissuage me from the relatively good coverage of most vaccines, ESPECIALLY if this turns out to be bad.

Personally, as a physician, I'm waiting to see what's going to happen. No point panicking, when there's enough crap out there making patients already.

I have asthma. I've been knocked out for weeks by the flu. I take any flu shot as soon as I can get it.

The reported mortality rate is something in the range of 1 in 315 or 1 in 375 so if 100,000 are infected every week, you should see over 200 deaths a week from Swine Flu in the UK.

I'm either missing something or those official "reported" death numbers are as fake as a 1.5 Dollar bill.

We've seen one case of H1N1 that I know of where I work. Unfortunately, it was fatal. The patient was an adolescent male in previously good health.

It just might turn out to be an, ahem, interesting winter. It seems they've run into a little production problem with the vaccine. There will be far less of it, and/or it will be coming a bit later than anticipated. It may give the health care and disaster medical systems a bit of a stress test. The previous administration's decision to partially dismantle or de-fund certain federal disaster medical resources may prove to have been a costly error.

There's a lot about this supposed pandemic problem that I don't understand.

First, everything was Bird Flu, there MIGHT BE a Bird Flu pandemic. So they started making vaccine based on that premise. Are they still doing that?

The Bird Flu was going to travel around the world with the migrating birds. That didn't seem to happen. A few birds tested positive for it, but no big deal.

Whenever the media had a slow news day, they trotted out the Bird Flu Pandemic articles, despite the fact that most of the human cases came from direct contact with birds.

Then in April, this Swine Flu was identified. So, did they continue making the Bird Flu vaccine? Or did they jump onto making a Swine Flu vaccine?

And they say it will get worse in the winter. Well, it's winter in half the world right now, and has been for a while. That should be something of an indicator for the northern hemisphere. As of yesterday, the death toll in Australia is 112. As of July 31, in Argentina, 337, in Brazil, 129 (Aug. 6).

In a NORMAL year in the U.S., more than 100,000 people are hospitalized with flu, and about 20,000 people die of it. That is one in five.

According to the CDC, they tracked 43,771 cases (confirmed + probable) of this flu between 4-24-09 through 7-24-09. Of these, 5,011 were hospitalized and there were 302 deaths. That is one in almost 17. (They stopped tracking 7-24-09)

According to the WHO, the latest figures 8-6-09) worldwide were 177,457 cases, with 1462 deaths. That is one death per 121 cases. Their figures also show that the Americas (top to bottom) is the hardest hit so far, with 102,905 cases and 1,274 deaths (one death per 80 cases). Europe is showing only one death per 604 cases.

And these figures only indicate confirmed or probable, not necessarily hospitalized.

Now, I'm not in the medical field, but how does this compute to a pandemic?