For The New Flu All The World's A Stage Published: June 21, 2009 June Print Edition by Beth Ingalls Click on images to view
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H1N1 Resources • Centers for Disease Control: cdc.gov/h1n1flu updates in English and Spanish, Twitter and RSS feeds. • World Health Organization: www.who.int offers daily updates in five languages. • Nevada County Public Health: mynevadacounty.com offers bilingual links. • California Department of Public Health H1N1 hotline: 1-888-865-0564 (English and Spanish) The mainstream media first picked up news of a potentially deadly flu strain on April 19 and quickly fanned the flames. Almost overnight, the airwaves were exploding with headlines about swine flu. The disease was causing an alarming number of deaths in Mexico, the flu’s alleged country of origin, and seemed to be crossing the border with unsuspecting spring break travelers returning from holiday. The swine flu was labeled as a possible pandemic with the capability of sweeping the globe and spreading massive death and destruction in its wake. Now, almost two months into the outbreak, the number of cases has grown to nearly 30,000 and a pandemic has been officially declared, but media hype subsided when the death tolls didn’t materialize. Is our complacency appropriate given the similarities between this flu and the 1918 pandemic and are public health officials content to throw money at a cure without looking more deeply into the cause? When the World Health Organization issued its first statement on the influenza outbreak on April 24 and President Felipe Calderon declared a state of emergency in Mexico, what followed was a preponderance of video news segments depicting Mexico City as a virtual ghost town, with businesses shuttered, public gatherings cancelled and residents darting around in blue surgical masks. CNN’s resident medical expert, Sanjay Gupta, was already on the road with camera crews interviewing weary families through translators and roaming dusty streets in the Mexican state of Vera Cruz, where the outbreak was thought to have originated. As April ended, New York City became a high profile epicenter for the disease outbreak with a cluster of sick schoolchildren in Queens, forcing school closures and a flood of patients clogging local emergency rooms. Officials in Europe began advising travelers to cancel non-essential travel to the U.S. and Mexico and airlines soon began screening passengers for symptoms. Vice President Joe Biden suggested travel in any confined space was a bad idea, but quickly “clarified” his remarks, saying travel was only a bad idea if one was already feeling sick. As the media frenzy continued, government officials and scientific experts seemed to be reacting in kind and simply trying to keep up, while the public was getting the reiteration of a basic mantra that mothers have been drilling into children since the beginning of time – “cover your mouth when you sneeze and wash your hands every chance you get.” On April 28, when President Obama asked Congress to approve $1.5 billion in supplemental funds to respond to the outbreak “out of an abundance of caution” and in order to “enhance our nation’s capability to respond to the potential spread of this outbreak,” the economic reality and importance of government preparedness in dealing with a true pandemic began to hit home. (On June 3, he requested an additional $2 billion to allow “the maximum flexibility to allow us to address this emerging situation.”)
The first warnings of an unusual respiratory illness outbreak in La Gloria, Mexico, were sent to the Center for Disease Control by Veratect (a corporation that specializes in the detection of emerging threats) in late March. The CDC didn’t begin tracking the virus for several weeks and meaningful information about the flu from the highest levels and authorities remained scarce. Health and Human Services Secretary Kathleen Sebelius announced in a press conference on April 30 that the “swine flu” was being officially renamed the “2009 H1N1 flu,” partly because scientific evidence indicated that the new strain was not entirely made up of pig genes, but primarily out of deference to the enraged pork industry. According to a press release from the American Meat Institute issued on their website that same day, “the name change was meant to address a common misperception that the illness was in pigs or pork, which has not been shown to be true. Despite the fact that the disease has not been found in swine and has only been found to spread from human to human contact, the U.S. has lost 10 of its pork export markets.” AMI pointed out that the ban on pork products could cost the industry roughly $13.6 million per week. Smithfield Farms, with sales of $12 billion annually, is the world’s largest processor (6 billion pounds per year) and marketer of pork products and raises nearly a million pigs each year through a subsidiary, Carroll, on several massive farms outside rural La Gloria, Mexico. Smithfield stated on April 26 that it “found no clinical signs or symptoms of the presence of swine influenza in the company’s swine herd or its employees at its joint ventures in Mexico.” While the company reports it has tested its herd (coming up negative for the flu), some experts say the hand-picked sample of 30 hogs was too small and others say Smithfield is in cahoots with the Mexico government officials that ran the tests. Locals living daily with the stench and filth that emanate from enormous excrement lagoons on the perimeter of the farms also don’t accept Smithfield’s words of appeasement. Almost half of La Gloria’s 3,000 residents were sick with an unusual respiratory illness throughout February and March and in early April they even staged a protest about conditions. One resident, Ofelia Olmos, said in a Times of London story that the industrial pig farm “has been making us ill for a long time. Sometimes the flies cover the whole roof of your house. In March maybe 60 percent of the community was sick. I don’t know what the tests said but the symptoms were the same as the little boy.” While a young boy in the town was being touted as the world’s first positive case of swine flu, the majority of those who had been sick were never properly tested. Since many of the area residents travel to Mexico City and its environs for work on a daily basis, the spread of the disease from there is logical. RG Wallace, author of the book “Farming Human Pathogens,” commented on his blog about the Smithfield scenario saying, “With public health officials, reporters and PR flacks burying leads and manufacturing diversions in their stead, the rationale for investigating the roles confined animal feedlot operations play in the emergence of pandemic influenzas may – poof! – disappear. The next few months may very well demonstrate that being a well-connected global conglomerate means never having to say you’re sorry no matter the damage caused. It is, after all, the kind of protection for which the hog industry has paid.”
While there has been no definitive acknowledgement about the origin of the virus and still some disagreement about the actual ratio of genes within the novel H1N1 virus, most scientists agree that it’s a “quadruple reassortment” of swine, human and avian genes. Like any virus with pandemic potential, it’s a new recombinant strain and humans don’t have immunity to it. On June 11, Margaret Chan, Director General of the WHO, announced that the 2009 novel H1N1flu had been categorized as global pandemic (Level 6), the first such declaration in 41 years. Chan went on to say that “no previous pandemic has been detected so early or watched so closely, in real-time, right at the very beginning. The world can now reap the benefits of investments, over the last five years, in pandemic preparedness.” As Chan expressed confidence in early detection and tracking systems and awareness of the flu’s patterns among population demographics, critics argue that government resources have been too heavily invested in studying avian influenza over the past five years, when recombinant strains of swine flu have been a ticking time bomb waiting to explode and wreak havoc on the world scene. While we don’t know how the pandemic will play out, we do know it’s a relative, or subtype, of the H1N1 virus that caused the global pandemic commonly referred to as the Spanish Flu that struck from 1918 to 1920. That virus killed 500,000 Americans and more than 30 million people worldwide, first sweeping across the United States in the spring of 1918. The Spanish Flu was also relatively mild that first spring and also affected younger, healthier populations more severely. Another similarity between the two is virulence among pregnant women and young mothers. As we move forward from here, all we really know for sure is that the numbers keep growing. At the time of the June 11 announcement, there were 28,774 confirmed cases of swine flu in 74 countries around the world, including 144 deaths. The WHO is asking drugmakers to speed up production of a swine flu vaccine. Locally, there have been no reported cases of H1N1 in Nevada County and only one confirmed illness in Placer County, and health officials are focusing their efforts on prevention, planning and improving the dissemination of information to the public. Even though health department and hospital districts have practiced for the kind of patient surges that could occur with a serious outbreak, they acknowledge that it’s very difficult to prepare fully for a real pandemic. As WHO Director Chan said in her statement on June 11, “The virus writes the rules and this one, like all influenza viruses, can change the rules, without rhyme or reason, at any time.”