27 April 2009

Swine Flu is the new SARS

I can testify that there were no cases of swine flu in my ER today.  I'm already sick of hearing about it.  Yes, no argument, it's a serious problem and could be awful.  The mortality rate is actually shockingly high for an influenza strain. 

I just hate hate hate the breathless hysteria of the media every single time a new "hot zone" bubbles to the surface.  Be it Bird Flu, SARS, Salmonella-flavored spinach, MRSA or what have you, it's panic first, think later.    I only wish I could program my browser to automatically mark read every article containing the word "swine."

On the advice of the Committee, the WHO Director-General decided on the following.

The Director-General has raised the level of influenza pandemic alert from the current phase 3 to phase 4.

The change to a higher phase of pandemic alert indicates that the likelihood of a pandemic has increased, but not that a pandemic is inevitable.

(h/t DemFromCT)


  1. At least it doesnt seem to have the same mortality rate as the last flu cases - although the ability to spread quickly is a concern.

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  2. I've been looking for a knowledgable person to comment on the WHO pandemic level. The chart you have provided seems very inconsistant with who WHO describes the stages.

    From the WHO site http://www.who.int/csr/disease/avian_influenza/phase/en/index.html:
    Phase 4 is characterized by verified human-to-human transmission of an animal or human-animal influenza reassortant virus able to cause “community-level outbreaks.” The ability to cause sustained disease outbreaks in a community marks a significant upwards shift in the risk for a pandemic. Any country that suspects or has verified such an event should urgently consult with WHO so that the situation can be jointly assessed and a decision made by the affected country if implementation of a rapid pandemic containment operation is warranted. Phase 4 indicates a significant increase in risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion.

    Phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short.

    Phase 6, the pandemic phase, is characterized by community level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in Phase 5. Designation of this phase will indicate that a global pandemic is under way.
    First, I don't understand how it was only yesterday that the WHO acknowledged "verified human-to-human", if they follow the criteria on thier website, it should be obvious to anyone that its been phase 4 since at least last thursday. Today, based on confirmed secondary transmission in the US and NZ, it sounds like we are at WHO stage 5.

    I don't know what USG or CDC stage we are at, but what is going on at the WHO?

    Also, USG 4 is a confirmed North American case... isn't the assertion of our position in that chart very conservative? I know the last thing anyone wants is panic, but isn't excessive fear of panic driving public health response equally dangerous?

  3. Canuck Med Student4/28/2009 6:43 AM

    The best you can do is take a look at the search trends on Google for the word "Swine" and it shows a pretty interesting pattern. It's bound to be interesting to watch over time, especially as the flu pops up in new places around the world.


  4. I sent out a mass email to acquaintances from my work address with the subject line, "Slow News Monday, or OMG SWINE FLU WE'RE ALL GONNA DIIIIIE!"

  5. I've been fielding many questions about swine flu in the last week. I'll just pass on the few bullet points that I've been making in the media:
    1. If you'd never heard of swine flu, and you are sick but not sick enough to feel you need the ER, you still don't need the ER after hearing about swine flu.
    2. Hand hygiene is important (and much more so than masks)
    3. We don't know what the virulence of swine flu happens to be, but it is likely that we'll find out by this fall.

    One of the difficulties in figuring out what the true mortality of this strain happens to be is figuring out how many people have been infected. If you don't know the denominator, you can't say if this is a more "deadly" strain of flu than the regular ones, which are deadly in 0.5 - 2 % of cases. The main reason is that diagnosis right now is limited to identification of the actual virus, which is only detectable for about 7 days. After that you need to rely on antibody testing, which is not yet available for swine flu. Wait a few months and it will be available.

    Oh, and 4. YOU CAN'T GET IT FROM EATING PORK!! (unless, that is, someone with swine flu sneezes on your pork chop before you take a bite)

  6. Oh, and just one more thing to really put your headline into perspective - the mortality with SARS was about 10%, at least 5 times higher than with any recent strain of influenza. The deadliest pandemic was the 1918 strain where the case mortality was about 4%, in the pre-antibiotic and pre-global monitoring era.

  7. OK, before someone else brings this up: I'm refering to common human-to-human spread influenza, which does not yet include the H5N1 Avian Flu, which does have a staggeringly high mortality rate of 60-80%. There have been a very few cases of human-to-human spread of the Avian flu, but it remains a weak virus from ease of contagion standpoint. Let us hope it doesn't combine with swine flu, which does have a high ease of contagion, apparently.


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