Swine Flu prediction.

I'm not seeing a lot of press on the swine flu and most of what I see is useless fear mongering.

Yes, the swine flu is still out there and moderately active in the southern hemisphere. The question is not if it will come back but when and how bad will it get.

Read: http://scienceblogs.com/effectmeasure/2009/08/swine_flu_this_fall_turbulence.php

Summary is, in rough terms, that if a flu outbreak starts late in the season the first year there is a good chance it comes back earlier and stronger the second. No guarantee but it seems like a reasonable assumption and one backed by real science.

It might be a good idea to start preparing now. The normal flu season is coming up fast and if this report is right the normal flu mix may show up with swine flu at the roughly same time with the swine flu taking off in a much more dramatic fashion than we saw last time.

It has to be pointed out that the numbers who die are likely to be relatively small. The 1918 flu only killed 2 or 3% in a day when oxygen was rarely used and respirators were even rarer. Medical science has advanced a bit since those days and survival is expected to be better.

Most major services, food delivery, garbage collection and power still worked and fuel got delivered. There was disruption and people died but society didn't fall apart. It frayed at the edges, and as usual the poor got the worse of it, but it limped along and didn't fall apart. While medical science has gotten better our supply system may have gotten more fragile with on-hand supplies smaller and run closer to the edge by using JIT, Just In Time, supply schedules.

The basics, food staples, soap, water and fuel are unlikely to run out for more than a day or two. A three day to one week supply is likely to serve you well. The odds of anyone starving, unless they have very special food requirements, are slim. Oatmeal, black beans, rice canned soups and canned meats are cheap, store well without special handling, and are cheap.

Some items, masks, gloves, hand sanitized will see a rush and short term shortages. Batteries, particularly the unusual ones like those that run some insulin pumps, may come up short and be only available in spurts. So stock up. Likewise if your dependent on certain drugs make sure you have a ample supply on hand. Thirty days supply on hand at a minimum is not, IMHO, excessive.

Art - Good idea on the items to stock up on

I snagged a bunch of masks from amazon before they jacked up the price! I not only am holding them for this winter potentially for the wife who works with different people daily but also to work with drywall and my house remodel! I would hate to slow down a project or get an infection from black mold because I couldn't get my mask

We also got a few large bottles of hand sanitizer from wal-mart while they had some still.... these items will be priceless come winter or a shortage at any time and cost PENNIES to stock up compared to stocking up on bulk food.

2-3% mortality may not seem like much... That is, until you or one of your beloved ones happen to be among those 2-3%.

Lately I've heard a lot of people talking about the swine flu as something harmless blown out of proportion. The mortality may be low right now but there's no guarantee it won't increase. Also, it is apparently very contagious and could affect a large part of the population. Who knows, maybe as much as 30%. At any rate, it could realistically mean a million (or millions) infected over a few months by a very conservative estimate. Even with just 0.1% mortality, that means a death toll in the thousands, with 1% death rate in the ten thousands. Those are serious figures.

Question: does one get (and trust) the vaccination or wait and see if you get infected since the “cure” seems to be effective?

The subject of vaccines can be polarizing. I'm not an MD but making an honest attempt to find the facts, sticking to the scientific literature and avoiding the pseudoscience and speculation, I have to conclude that your almost always better off getting, and getting your family, vaccinated. I don't for a second buy into the idea that vaccines are part of some conspiracy or plot.

It your not in the hardest hit demographic, young, old, fat, sick; you may feel like you can slide by. Good luck.

I will be getting vaccinated as soon as a vaccine is available. While your at it you may be able to get vaccinated in a way that might save you from the swine flu before a swine flu vaccine becomes available.

Read: http://scienceblogs.com/mikethemadbiologist/2008/08/bacterial_and_influenza_the_st.php

Seems a major proportion of those who died in the 1918 flu died from bacterial infections which caused pneumonia. The flu knocked out their immune defense system and the bacteria closed in for the kill. Most pneumonias come from "Streptococcus pneumoniae for which there is a highly effective vaccine". This is something you could do now.

FWIW I think the 'trust' in vaccination goes to side effects not so much black helicopter plots - the last go around with swine flu a number of people contracted something called Guillain-Barre Syndrome. I think people who are trialing early versions of a vaccine have a legitimate dilemma when it comes to risking side effects.

I agree though, you're almost always better off getting everyone vaccinated.

2%-3% of the human population world-wide is not small number - medical resources are quickly overwhelmed. Modern survival rates for *a* patient in the US will be very good, but not necessarily for *10 million* patients.


In 1918 even the US was primary rural. Most people got *none* of the above services even in normal times: "food delivery" was the chicken walking into the house and fuel was whatever the horse ate.


Again the difference is that we depend on a supply system at all. In 1918 most Americans didn't (for long periods; salt, sugar, etc, was traded when someone came through town) so the "system" had to cope with a much smaller number of people than it might seem.

Another difference will be the speed the disease spreads. In 1918 "Around The World In 80 Days" was not that far off the mark, but this time it's likely to take only a couple of weeks to do the same.

Thanks Art_in_Fl and James

I've always seen it as something currently harmless that the health authorities need to keep an eye on.

We have limited resources, so putting too much effort into swine flu distracts from normal flu, and could lead to more fatalities overall. In the UK we've already had cases diagnosed as swine flu when they were actually meningitis or kidney infection, with at least one fatality as a result. We shouldn't go over-board on this. Sometimes the cure is worse than the disease.

Well, yes, but life isn't safe. I'm well aware that historically some of the most lethal pandemics were preceded by much less lethal precursors. What I'm not sure about is how often the less lethal forms turn into the more lethal forms. I suspect it's actually quite rare. All serial killers drank milk as a baby, but drinking milk as a baby doesn't make you into a serial killer. The current mild pandemic isn't necessarily a precursor to a more serious one.

Obviously health authorities would be remiss not to keep an eye on it, and make sure their emergency plans are up to date. They'd had a 6-month warning, a chance to get their act together. But it probably won't materialise and the rest of us ought to be equally worried about completely unforeseen threats.

Well... Looking at the proliferation of zombie invasion and EMP threads I must be among the more conservative members here but I certainly don't take the swine flu pandemic lightly.

I'm no doctor but it doesn't seem to be "just" flu. Maybe the symptoms are mild right now and that is good, but we will see what happens during the winter. Where I live, the official standing right now is that a major outbreak is expected during the following months, with as much as 30% of the population infected. I'm not sure about everybody else but we have had flu epidemics before and they never affected that many people. Nor can I ever remember flu spreading that fast globally.

Also, I see a lot of people talking the talk but few have any direct experience with swine flu whatsoever. A colleague at work got infected last month abroad and after all she's gone through she says it's a lot worse than regular flu. Mind you, she is a young, healthy and reasonably fit individual aged 25. What are the odds of the general population though, the infirm, overweight, chronically ill? If anything, I'd suspect the health officials are trying to keep it down so as not to scare the public.

That doesn't mean I'm about to quit my job and retreat to a log cabin in the woods but I do perceive swine flu as a significant threat right now. Not so much to me personally but my two elderly grandmothers and my brother, who is disabled and suffers from immunodeficiency. In the event of a major flu outbreak their chances wouldn't be all that great. Especially if the health services become overburdened and one could no longer rely on prompt and proper medical assistance.

So it's really not just an academic issue to me. I very much hope the swine flu doesn't get any worse but I still see it as a substantial danger to some of the people I care about. Whether I can do anything about it is a different question. Maybe not as interesting as bracing myself for a zombie invasion but it strikes uncomfortably close to heart nonetheless.

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?

First, your numbers quote HOSPITALIZED patients. The mortality is even lower, across the board, since not everyone with flu gets put in the hospital.

A pandemic merely refers to geographic distribution, NOT mortality of a disease. In other words, swine flu is in many countries, around the world. But then, so is syphilis, TB, HIV... etc.

Yes, I know it's hospitalized patients, that's why I specified.

Okay, geographic distribution... so, what's all the excitement? From what I see, it isn't even as bad as the regular flu.

The panic is mostly media based, but I can tell you that at our hospital it is being watched very closely.

The main problem with this flu is that while it isn't any more lethal than other flu strains it is highly contagious, being twice as likely to be spread as previous flu. It simply becomes a numbers game, and when the numbers get large even small percentages become large populations of patients potentially hitting the hospitals.

Two seasons ago the regular flu taxed our particular facility to the limit, due to large numbers of flu patients and many ill staff members. If we see a large number of hospitalized patients from swine flu, it will hit the hospitals very hard, and limit our ability to care for other patients. I don't think most people realize how close to the limit most hospitals run at on a regular basis.

Plus, you never know when a virus is going to mutate into something nastier. So that is at least the concern amongst emergency management folks.

Greg

Which is exactly what worries me about the swine flu. Even without the strain mutating into something more lethal we could be in for a hellish ride if there is a real outbreak. And the damage is going to far exceed the actual number killed by the flu per se.

The words "epidemic" and "pandemic" do not convey the seriousness or communicability of a pathogen. I believe Swine Flu is at Level 6. This implies this pathogen is UNIQUE to humans and the particular strain is no longer present in other animals. The AIDS virus is an example of a pandemic. Everyone can get it. Not everyone has it.

For anyone medical out there, is there a better term to describe a "pandemic" that is very contagious like the 1918 Spanish Flu?

There is another social multiplier effect that will be a problem: past a certain threshold and parents will start bringing little Jonny straight to ER *every* time he gets the sniffles.

There was a fair amount of that this spring in South Texas.

I'm not medical people, but I finally thought to myself, "Look it up, dummy!"

PANDEMIC is defined as "universal".

CONTAGIOUS is defined as "communicable".

EPIDEMIC is defined as "a widespread outbreak of an infectious [or contagious] disease; many people are infected at the same time".

IMO, the media is trying to give people the impression that a pandemic is the same thing as an epidemic, which it is not, and may never be.

Also IMO, the American Public School System promotes ignorance. It is easier to confuse/control ignorant people than it is to confuse educated people. (And NO, I am not referring to anyone in particular.)

WHO has some very specific guidelines about how it classifies an infectious disease outbreak. A novel infection that demonstrates sustained human-to-human transmission in more than one region is their basic definition. Note that severity or lethality is not part of the definition, which turned out to be somewhat of a liability in the case of H1N1 since so far, it produces mild symptoms in most people it infects, and many people thought a Level 6 designation was crying wolf. The avian flu was novel to humans and highly lethal, but it never managed sustained human-to-human transmission, so it never got that far in the WHO scale.

There isn't really another alternative to the term "pandemic". Don't forget the term "endemic". Arguably, HIV could be endemic because it is well entrenched in many parts of the world, like malaria is. Only when the frequency of disease is higher than expected do we classify a disease as an "epidemic" or "pandemic".

I think that the WHO pandemic scale, like many other tools/guidelines used by planners, gets misused/misinterpreted when absorbed by the general public. Terms that have specific meanings to help make decisions could have very different meanings to the general public, like the word "pandemic". The average person may assume that any "pandemic" must be lethal, but from a public health planning/execution standpoint, that's not necessarily true.

Apparently with this virus it pays to be older....

In a report by the President’s Council of Advisers on Science and Technology, President SomePolitician PHRASECENSOREDPOSTERSHOULDKNOWBETTER. today was urged to speed vaccine production and name a senior member of the White House staff, preferably the homeland security adviser, to take responsibility for decision-making on the pandemic.


http://www.bloomberg.com/apps/news?pid=20601087&sid=a8_2nrwYD1kM

Aug. 24 (Bloomberg) -- Swine flu may infect half the U.S. population this year, hospitalize 1.8 million patients and lead to as many as 90,000 deaths, more than twice the number killed in a typical seasonal flu, White House advisers said.

The median age of those with the pandemic virus has been 12 to 17 years, the WHO said on July 24, citing data from Canada, Chile, Japan, U.K. and the U.S.

The H1N1 strain is genetically related to the 1918 Spanish Flu strain that killed an estimated 50 million people. Variations of the Spanish Flu strain circulated widely until around 1957, when they were pushed aside by other flu strains. People whose first exposure to a flu virus was one of those Spanish Flu relatives may have greater immunity to the current pandemic, Shaw said.

Really interesting article in today's Washington Post. Many think today's situation may well track the 1957 Asian Flu.

http://www.washingtonpost.com/wp-dyn/content/article/2009/08/24/AR2009082402431.html?hpid=sec-health

As summer gave way to the cooler days of fall, the virus swept through schools across the United States. Because of the time needed for transmission and incubation, it took at least three weeks (and usually five or six) after classes started for peak absenteeism to hit.

...A sample of how the flu hit adult workers was provided by the Bell System, then a nationwide telephone monopoly, which made regular reports on absenteeism from 36 cities. Bell's peak "industrial absenteeism," which was generally not more than 8 to 10 percent of the work force, lagged behind school absenteeism by two to three weeks. Businesses staggered briefly, recovering in a couple of weeks, as did most flu victims.

...By Thanksgiving, life was nearly back to normal...

...Asian flu came back for a third time, in late February, causing another spike in mortality, this time mostly in the elderly.

...............
Though reported Swine Flu cases have dwindled over the summer months, the Centers for Disease Control warns that a full-blown pandemic is on the horizon as fall inaugurates the 2009-2010 Flu Season, mirroring the progression of the 1918 Spanish Influenza. Now, with the advent of vaccines and medical technologies, as well as improved personal and public hygiene, communities are better equipped to control the spread of infectious disease. As the nation waits for the release of the H1N1 vaccine, ScienceBloggers weigh in on the implications, applications, and ethics of preventing, tracking, and controlling disease. Respectful Insolence discusses both the World Health Organization's vehement dismissal of homeopathic remedies in health care, as well as the rise of infectious diseases as vaccination rates fall. On A Blog Around the Clock, technology and medicine meet in PLoS Currents: Influenza, a "Google Knol hosted collection of rapid communications about the swine flu." Mike the Mad Biologist gets back to basics, discussing personal hygiene and easy flu etiquette such as "not spraying your snot hither and yon."
...............

Above from: http://scienceblogs.com/seed/2009/08/the_buzz_ramping_up_for_fall_h.php

That'd be a catchy Public Service Announcement:


"...not spraying your snot hither and yon."

The bloggers on http://scienceblogs.com are smart and quite creative. Their ability to turn a phrase and use humor, along with the factual and scientific basis for their observations, increases their value and makes them entertaining.

Or the UK reported infection rate is wrong. What you wrote there bothered me a lot, and I've several times tried to authenticate the figures, but without much success. Part of the problem is that the rise in reported infection rate coincided with differences in methodology. Early infections were confirmed by a local doctor doing blood tests. Now they have a "swine flu hotline" here, which you can phone if you think you have it. You get diagnosed over the phone and are then authorised to get Tamiflu.

The diagnosis is unreliable. Apparently the official figures are 5% of the hotline figures: ie 95% of the people given Tamiflu in England don't need it (and possibly do have some other illness which needs some other medication they aren't getting). Sometimes they send out swab kits which the patient is supposed to administer and send back, and those provide a statistical check - that's where the 5% comes from. Except it's highly variable - eg 10% some weeks, 5% others. There is probably bias in the samples. People who are feeling better are less likely to send back their swabs.

It still seems like there was a surge in July, and a tailing off in August. However, I'm now getting that from the death rate - presumably death statistics are a lot more reliable. For example Wolfram|Alpha shows a steep rise in the second half of July. That must have been preceded by a rise in infection rate, and probably it was that rise which triggered the Hotline launch, but I wouldn't like to put any figures on how big it actually was, and I don't trust the NHS figures.

(PS this is really just England and Wales - Scotland has a different system.)

The NHS did just revise it's H1N1 projections. I don't know about the infection rate, but their worst case mortality figure dropped from 65,000 to 19,000. Worst case. I can't emphasize that enough. Whenever you see these ranges, like from 3,000 to 30,000, everyone always latches onto that big number and then starts thinking that that's the number to expect.

Fancy tools for tracking the flu:

http://blogs.wsj.com/health/2009/09/02/fancy-tools-for-tracking-the-flu/

So.
How many of us have had the swine flu so far?
I can't be sure without actual testing but I think I know three people who were sick with it.

Not me.

My 7 yr old nephew in Richmond, Virginia is just getting over it. His parents sent him to school yesterday because he didn't have a fever the evening before (they had been giving Tylenol which probably supressed his temp). Anyway, he had a fever when he got to school and lasted there about six seconds before he was sent home. The school had some choice words for the parents. I think the lesson is - wait 24 hrs after no fever and no medicine that might lower fever.

Someone who has gotten the flu recently probably had H1N1. It's a highly infectious bugger. As is typical with pandemic strains, it tends to squeeze out any of the other seasonal flu strains.

There was that experiment with ferrets reported the other day. Interesting results. One result was that ferrets co-infected with H1N1 and a seasonal strain would only pass along the H1N1 infection to other ferrets. So, not only do pandemic strains out compete other strains by being more infectious, they seem to also block other strains from getting passed along.

Well, the bigger bit of news from that same experiment was that there was no evidence of any co-mingling of genetics info (aka mutating) within the ferrets co-infected with two different strains. That's where the various headlines about "No evidence of superbug" came from recently.

That said, it's always hit or miss to know whether you've had the flu since many other bugs can produce similar symptoms. But it was probably H1N1.

I saw something on TV a week or two ago that got me to wondering. For those of you with kids, do your kids' schools have a full-time "school nurse"? Especially with budgetary cuts, it seems that many schools are without one, or at least share one nurse among many schools.

Many schools will "send children home" (or more accurately, call the parents to pick them up) if they are showing flu-like symptoms, but if you don't have a school nurse, who makes that determination? Just the teacher? That might seem natural at the elementary school level where teachers are more like surrogate parents, but seems more unusual at the junior and high school levels where kids are shuttling around to different teachers every hour.

I'm just curious how schools are handling this situation.

Not a whole lot on the H1N1 topic recently except the vaccine seems to be coming along and looks like it will only require one jab, not two. However, depending on who you ask, the autumn H1N1 peak could be over by the time there is enough vaccine to roll out sometime next month. But H1N1 is hitting us very early this year, so there's still enough winter months left for a third wave of H1N1 before next spring.

An interesting tidbit I just read about how long someone with H1N1 is infectious. The standard advice we've been hearing recently is to stay home for at least 24 hours from when your fever breaks. However, people with H1N1 seem to remain infectious for a lot longer than seasonal flu. That's just going to make it harder to avoid catching, unless everyone can take off even MORE time from school and work to recuperate.

Can read about this latest news here.

Our schools have a nurse at each facility, but she is overworked to the Nth degree. That makes the entire system a PIA. Our kids just text us with a request to come home if they do not feel well. We then call in and check them out. DS is 17 and drives himself. DD is 14 and we still have to go get her.