Sex, Drugs, and Public Health

July 25, 2009

First the Numbers, now the Patients

Filed under: Uncategorized — cbmosher @ 4:24 am

When this epidemic first popped its head above the ground in Mexico, Paricutin – like, it was, of course, impossible to know if it would be a fizzler or The Big One or something, as was most likely, in between.

So we Public Health detectives watched the numbers like raptors following their prey, observing, tracking its path, trying to project where it would go.  Anticipating its behavior so we could pounce on it at the right place.

We are beyond that now.  Numbers have told us all they are gonna reveal.  They told us that the virus spreads efficiently from person to person.  That it will spread over the entire globe.  That, (darn!) it will continue to spread in places experiencing summer, like North America and Europe, which is abnormal Flu behavior, while simultaneously spreading in winter climes like Australia, New Zealand and South America (poor Argentina’s hit hard).

Now we have turned to question #2.  How will the virus behave in the human body? Like Seasonal Flu? Or something more aggressive?  To answer this question, we are now analyzing individual cases.

A 78 year old woman  became ill with Influenza-Like-Illness (ILI) on Monday, was hospitalized on Friday with bacterial pneumonia superimposed on confirmed H1N1 infection, and died on the following Wednesday.  She had underlying heart disease and emphysema.

Pretty much like Seasonal Flu.

A 39 year old rodeo athlete took a break from calf roping when he developed ILI on a Saturday. As he sickened, he consulted his physicians. He died at home the next Friday.

Definitely not like Seasonal Flu.

Ten people were admitted to the University of Michigan’s advanced care ICU during June for severe complications of the H1N1 infection.  Their chest X-rays showed “white-out,” i.e. lungs full of fluid.  A couple of them were coughing blood.  They all needed ventilators to breathe for them.  Two were placed on heart-lung bypass machines to try to keep their oxygen levels up.  Only seven of them survived.

Interestingly, bacterial pneumonia was not evident in any of these patients – it was the virus doing it all. And, of importance were their ages. The youngest was 21 and the average age was 42. The time it took for these patients to go from first symptoms to hospitalization was as short as one day.

Another interesting case is that of a sixteen year old from San Francisco who was found to have  H1N1 which was resistant to Oseltamivir (also called Tamiflu). Similar cases of resistant virus have been found in Europe and Japan.

It was only a month ago that every  H1N1 strain tested was sensitive to this drug – one of our major weapons in this fight.

A picture is emerging from these and similar case stories being reported from across the globe : the majority of cases of H1N1 are as mild as routine “Seasonal” Flu, largely a mild illness of a few days. Some ( the very young, the very old, and those with serious medical problems) get seriously ill, also like Seasonal Flu. But with this new virus, an unlucky few can get horribly ill with a viral pneumonia, with fluid in the lungs blocking oxygen uptake, and other complications (including blood clots and hemorrhage).  The mortality rate in this group is high.

And now the virus shows us that it is evolving very quickly, changing its genetic make-up to, at the very least, become resistant to our anti-virals. We do not yet know what other changes it is creating deep within itself.

This picture is typical of a genetically “shifted” Influenza virus – and it is a typical Pandemic pattern. Just read accounts of the 1918 and 1957 Pandemics and compare. The major difference from those earlier Pandemics will be the intensity (and professionalism) of press coverage. They’ll be all over this one. The epidemiologists will not be working alone.

First the numbers, now the Patients. The next interesting gauge of this Pandemic will be Society’s response. Watch for Public Health officials to close institutions. Watch for politicians to pontificate. Watch for comedians to mock the virus. Watch for religious gatherings to, contrary to their mission, discourage attendance. Watch for airplane ticket prices to fall. Watch, unfortunately, for counterfeit vaccine and Tamiflu to become available “ Now! For a short time only! ” on the Web. Watch for scary movies.

Wise old physicians and Public Health officials will shake their heads and wonder, as they battle this Pandemic, at how dramatically a mere virus will reveal the stuff of which we Human Beings are made.

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