Scott McPherson's Web Presence

Well, it was an interesting weekend.  It all started Friday afternoon, as the day was winding down.  I got a call from my daughter, Mailin, who teaches fifth grade at a local private school.  She was suddenly feeling quite ill after an otherwise uneventful day, and had gone to the school clinic.  Her temperature: a hair under 102 degrees F.

What should she do, she asked?  I told her to immediately go home and go to bed.  I then called my wife and told her to get a box of Tamiflu from our strategic reserve and place it in her room and to start her on Tamiflu immediately.

When our daughter got home, she actually misread the directions and took two Tamiflu capsules (this may factor in later in the story), and went straight to bed.  My wife prepared chicken soup and gave a heaping portion to her, along with two Advils.  She complained of headache; a very sore throat; body aches; she had suddenly acquired a nasty-sounding cough; and she was in extreme fatigue.

I, of course, sprung into immediate action, and went straight to the football stadium to call the Lincoln High football game (a 28-3 win over Daytona Beach Spruce Creek).  On the way home, I stopped at Wal-Mart and bought out their remaining supply of N-95 respirators along with an extra box of disposable gloves.  When I returned home, my wife and I "masked up," donned gloves and entered her bedroom, now referred to as her "bubble."  My wife took her temperature while I pulled "solid surface detail," cleansing every possible solid surface she had touched in her bathroom and bedroom with Clorox wipes.  Her fever had reduced to just over 101 degrees F.

I also suggested to my wife, who is a recent chemotherapy patient, that she should start on Relenza immediately as a preventative.

The following morning, her fever had returned, registering nearly 102 degrees F again.  We immediately "masked and gloved up" and repeated the previous evening's work.  Since she had taken twice the normal dose of Tamiflu the day before, she had not had any Tamiflu since around 4PM Friday.  So my wife gave her the first Tamiflu of the new day, while I cleaned and cleaned and cleaned some more.

Now I am reminded of what Jesus Christ said about being a prophet in one's own country.  To paraphrase, being a "flu expert" in one's own household means getting a second opinion.  So my wife called our family doctor and left a message.  Soon enough, a call came from one of the nurses on duty.  My wife Marta relayed all the symptoms.  Additionally, she conveyed the results of a phone call received that morning from another teacher at the school.  A child in Mailin's class had tested positive for swine flu.  Marta also disclosed that we had placed our daughter on Tamiflu.

Yes, the nurse said, that fits the bill for swine flu.  Keep Mailin on the antiviral.  Also, she instructed us to both go on Tamiflu as a preventative.  Marta hung up the phone and looked at me.  I, of course, being the loving husband I am, took every opportunity to remind her that the doctors completely agreed with my diagnosis and treatment.  She, in turn, refused to go on Relenza but did start on Tamiflu, one capsule a day -- the same dosage I had recommended.

Now Relenza is an interesting medication.  I knew it used an inhaler but had never worked the damn thing before.  I always thought it worked like an asthma inhaler.  Wrong!  Theory is one thing; practice is another.  Fortunately, Glaxo has a full-color, photo-filled set of instructions so complete that even a middle-aged dude who hates to read the manual can follow along.  Pull off the blue cover to the mouthpiece.  OK.  Now pull out the mouthpiece until it clicks.  Now pinch the little doobers and withdraw the full apparatus.  WTF!  Now open the cylinder that came with the inhaler and withdraw the disk with the four little bubbles on it, looking like the bottom of the UFO from The Invaders.  Place the disk into the slot, bubbles down.  Now close it all back up.

But wait, as the late Billy Mays would say, there's more!  Now lift up this lever and lift it until it is completely perpendicular to the inhaler.  KEEP EVERYTHING LEVEL or you'll spill the medicine!  Okay, okay!  Now return the lever to its original position and exhale as much as you can!  Now INHALE DEEPLY while keeping the inhaler level, but DON'T COVER THOSE LITTLE HOLES ON EITHER SIDE OF THE MOUTHPIECE!  Okay, okay!  Now hold your breath and let the medicine get deep into your lungs!

I held my breath and kept the air in my lungs as long as I could, taking care not to cough and expunge all that medicine.  All this reminded me of some questionable activity I engaged in way back in my youth, when holding stuff in the lungs was de rigeur,if you catch my drift.  Then I had to exhale and pulled out the mouthpiece, which turned the disk one quarter turn, prepping the next dose of Relenza.  I lifted the lever, puncturing the next blister, and re-inhaled.

That afternoon, our daughter ate some more, and in the evening, her fever had stabilized.  She took her evening Tamiflu and stayed in bed.

Sunday, we repeated the exercise.  She began feeling somewhat better and was very thirsty.  Today, she is doing much, much better.   She asked, When can I come out of my bubble! Once we know she is fever-free for 24 hours without the assistance of fever-reducing medications, she should be able to return to her teaching duties.

I have been doing this Relenza regimen for three days now, two puffs a day.  My wife is still on Tamiflu and I credit her with making a sound decision.  The  inhaler for Relenza is a bit of a bother! 

Here are some takeaways from my experience:

First, having a private stockpile of Tamiflu is very beneficial.  Not everyone can have as sympathetic a doctor as I, but having the stuff on hand meant she did not have to wait an extra minute for antivirals to be purchased.  That, in my opinion, was a huge advantage.  Otherwise, she would have had to wait until a prescription was called in.  And what if the local pharmacy had been sold out of Tamiflu?  We would have been forced to do what Australian mothers did last year; namely, drive across their cities in a vain search for antivirals.

And with my daughter's cough, there was no bloody way she was going to be able to take Relenza deep enough into her lungs.  No way.

Second, being well-versed in the symptoms of influenza was absolutely important.  Knowing when to pull the trigger was based on sound diagnosis and making quick decisions.

Third, Tamiflu is an amazing substance!  We know a family whose child's temperature reached 105 degrees F. until it began to subside.  Contrast this with the shortened fever cycle experienced by our daughter.  I am all about Tamiflu!  I agree with the late Graeme Laver that it should be an over-the-counter medicine today.  My daughter (she is 26) has had zero side effects.  Neither has my wife. And neither have I with Relenza, save for some issues with lung capacity. ;-)

Fourth, you can't find enough solid surfaces to clean.  Light switches, door handles, sink knobs, toilet flushers, toilet seats, and on and on and on.  But you've got to hit them all, to make sure you nailed the virus.

Fifth, we are still monitoring our daughter's cough.  If it gets worse, or doesn't get better very soon, off to the doctor she will go.  As we all know, pneumonia -- both bacterial and viral -- is a persistent side effect of this flu (or any flu, really).  So we are very sensitive to that cough and what it could still turn into.  That is also, quite frankly, why she did not return to work today. That, and the desire to ensure completely fever-free behavior for 24 straight hours.

Sixth, it is absolutely amazing how quickly this virus hits.  The day before, she was fine and full of vigor.  This reminded me that she had been shedding virus for at least a day or two prior to the onset of symptoms, and meant my wife and I had both come into contact with the virus.  We won't know if our ages or the antivirals (or both) might have warded off this virus, but ordinarily both of us should have been stricken with the flu by now.  The fact that three days have passed (even more when you factor in the incubation period) and we are not feeling sick is testament to quick preventative use of antivirals.

Seventh, I cannot help but wonder if "doubling up" accidentally on the initial dosage of Tamiflu was beneficial.  We having double the amount of antivirals a huge kick, like doubling the first dose of antibiotics? 

All in all, it was a unique chance to put theory to practice and to apparently come out of it none the worse for wear.

So how was your weekend?

The newspapers are positively aglow with the recent studies which seem to indicate the H1N1/2009, (aka swine flu) vaccine can confer immunity with one shot, and after only ten days. And justifiably so!  For the news is good.

Previously, scientists and researchers postulated that it would take two jabs, spaced three weeks apart, in order to deliver enough attenuated inert virus  to confer immunity to swine flu.

So this study, on the surface, is decidedly good news.  The ramifications of this are nothing short of spectacular.  First, it means the entire seed virus-to-vaccine chain performed surprisingly well and was also surprisingly nimble.  As you recall, initial seed virus stock was very slow to grow, and the CDC and WHO had to whip up a faster-growing batch of seed virus stock to send to vaccine manufacturers.

Second, there had to be enough eggs, and those eggs had to be free of cross-contamination.  So as Earl Butz, late of this earth and the Ford Administration famously said, the roosters of America did their duty.

It also means very little virus "drifted" during manufacturing, and it speaks volumes about the research and quality control that the vaccine industry has undertaken since the debacle of 2004-05's flu season.  For more information and a superb primer on vaccine manufacture, read the book "A Warning Shot: Influenza and the 2004 Flu Vaccine,"by Timothy Brookes and the staff at Johns Hopkins. 

The US government ordered 195 million doses of the new H1N1/2009 monovalent vaccine.  The calculus performed was that most Americans would need two jabs, as I said earlier.  Now if these initial test results hold firm, it means we will now have double the available vaccine than we thought we had a month ago.

The projected available vaccine doses equals 62% of the American population.  I dare say that if we were to vaccinate everyone in the high-risk groups, plus virtually all school-age children under 25, we stand a very good chance of reaching the Holy Grail of Herd Immunity. Herd Immunity is when enough people are vaccinated against a virus, that virus can no longer gain a beachhead in a community.  It fails to achieve the critical mass necessary to sustain human-to-human transmission.  Herd Immunity means the virus cannot infect enough hosts in a chain, and the chain breaks.  Think a viral chain mail/email scheme that breaks due to unwilling participants.

Same thing:  The virus' chain of transmission is broken when enough people are vaccinated, predominantly the young.  It is the young -- schoolchildren and college students -- who pass this virus (and all flus) on to their family members and then on to the community at large.  You break that chain, you break the pandemic.

So the Quest for Herd Immunity against a pandemic virus is within the reach of Americans.  It decidedly does not mean the same for persons within developing nations, however.  And I would not be the least bit surprised if persons such as Supari of Indonesia and others begin clamoring for vaccines, since everyone thought it would take two jabs anyway. It might be appropriate for the favored nations to siphon off some of their vaccine to the WHO for use in developing nations. 

Even if we were to siphon off some vaccine, the goal of herd immunity against H1N1/2009 could be within reach.  Let us hope that the final test reports confirm the initial speculation.  We could use some good news now!

CIDRAP stands for the Center for Infectious Disease Research and Policy at the University of Minnesota.  Its director is the world-famous Dr. Michael Osterholm.  Dr. Osterholm advises everyone from the White House to Oprah on infectious disease.  Dr. Mike is also an expert on bioterrorism and has advised DHS many times on lethal bio-engineered pathogens.  He wrote a book, Living Terrors: What America Needs to Know to Survive the Coming Bioterrorist Catastrophe. I should point out that Dr. Osterholm wrote this a year before the anthrax attacks of October, 2001.

The upcoming summit is titled "Keeping the World Working During the H1N1 Pandemic -- protecting employee health, critical operations and customer relations."  Its focus is on those final steps that corporations, businesses and governments need to take to ensure they do not implode when the second and third waves of H1N1 traverse the globe.

Brazil has just passed the United States in the number of confirmed deaths due to H1N1(2009)V Skyhook swine flu. Or whatever the Heck we are supposed to call it these days.

Anyway, the number down there is 557, compared to 522 in this nation. This is a race we do not need to win. Argentina is third, with 439 deaths.

The bad news within the bad news is that South America leads the world not just in the sheer numbers of swine flu deaths, but in overall mortality.This is further reinforcement of the blog I wrote a few weeks ago, talking about just how hard South America got hit with H1N1v.

Here's the AFP story:

Brazil tops global swine flu toll with 557 deaths: officials

(AFP) – 17 hours ago

SAO PAULO — Brazil now has 557 swine flu deaths, making it the country with the highest number of fatalities in the world from the disease, according to figures announced by the health ministry Wednesday.

The toll puts it ahead of the latest count from the United States, which as of August 20 had 522 swine flu deaths, according to the US Centers for Disease Control and Prevention.

Brazil's health ministry said in a statement the government was freeing up one billion dollars to buy 73 million doses of a new vaccine being developed against swine flu, as well as Tamiflu stocks, hospital equipment and diagnostic gear.

It added that the infection rate appeared to be diminishing in the country, which is about to exit the southern hemisphere winter at the end of this month.

The ministry stressed that, as a ratio of its population of 190 million, Brazil's mortality rate from the virus ranked 7th in the world.

Argentina, Chile, Costa Rica, Uruguay, Australia and Paraguay all had higher rates on that basis, it said, referring to data from the European Center for Disease Prevention and Control.

The United States, which has a population of 300 million, came 13th on the list.

The Americas is the worst-hit region in the world in terms of swine flu deaths, accounting for more than 90 percent of the global count given by the World Health Organization.

After Brazil and the United States, Argentina is the country to suffer the most, with at least 439 swine flu deaths.

Over the past three days, it has been my pleasure to bring you the journal of the South American swine flu ordeal suffered by FSU law student Christin Foster.  She documented concisely her negative experiences in Argentina, along with her successful diagnosis and treatment in Chile.  She concluded the series with a comparison of her experience with her friend Malady, who had to suffer both the virus and the Argentine government's incompetence and mishandling of the entire incident.  My words, not hers.  But can any rational person conclude otherwise?

So what are the lessons learned from this South American onslought?  Plenty. 

First, treat people as thinking individuals who can withstand news, as bad as it might get.  I am so sick and tired of hearing "We have to be careful not to induce panic or incite panic."  It is the absence of reliable information that incites panic, not the presence of it!  Those who would withhold information for the sake of reducing panic are the same people who think people cannot think for themselves.  That line of thought is encroaching into the national health care debate, with predictable results. 

Tell people the truth.  If it's bad, tell them it's bad.

Second, prepare for inconsistencies before they happen.  Try to anticipate these things.  Look at the mishandling of the Tamiflu situation in Argentina.  That government's inept decision-making borders on the criminal.  Imagine withholding Tamiflu until the flu is typed, a process that took more than two weeks!  I guaran-damn-tee you people died because of the Argentine government's outright stupidity.

Third, the buck stops at the top.  Harry Truman said it, and leaders will not find easy nor willing scapegoats if this pandemic is worse than the one they planned for and told the people to expect.  Presidents and prime ministers need to take note of this.  Sacking some lackey will do little to fix the situation, especially if people are dying.

And we know that people will die in this pandemic in far greater numbers than we have seen so far.  I will address this in a future blog; suffice it to say that the easier this virus gets to catch, the more people will die, and that law applies even if the virus does not return more lethal.  It's simply the law of large numbers.  This virus is already more destructive than seasonal flu simply because the elderly are not dying from it; the young are.  There is a huge psychosocial difference between 40,000 old people dying of seasonal flu and 40,000 people ages 1-40 dying, especially if 6% of those are pregnant women.

A recent study has already theorized this virus is up to 100 times more virulent than seasonal flu, which I will address in that future blog. 

Telling people not to worry, or (worse) not telling them the honest truth in some vain attempt to forestall "panic," just won't cut it.  I have spent the better part of my life in public service and dealing with the press at a very intimate level.  My experience has told me to trust people and respect people enough to give them the truth.

Fourth, do not automatically believe the health care establishment knows what they are doing.  Let me relay a personal anecdote:  My wife is currently undergoing chemotherapy, her second time around on this carousel.  Her last treatment was last Friday.  Another person in the "chemo room" asked a nurse about the H1N1 vaccine.  The nurse could not tell her anything about the vaccine, nor the virus itself, and actually began confusing it with the seasonal flu vaccine!  She knew nothing about the CDC target groups; otherwise, she would have responded authoritatively that she needed to get her H1 vaccine as soon as it was available.

I found this so distressing as to bring it up to the head nurse as we left the facility.  Chemo patients will be at the top of the vaccine priority list, along with pregnant women, I emphasized to her (she herself is pregnant).  But that vaccine is not the seasonal shot; it probably won't get here until late October; and people will either need a doctor's note or will need to go to a special facility to receive the two shots in the first place.

I asked the on-call oncologist (the regular oncologist was at the hospital) about interactions with Tamiflu.  He said Yes, my wife could take Tamiflu.  But he counseled not to begin taking the drug until flu was confirmed.  Doctor, I said, they are not encouraging testing anymore!  But it only takes five minutes, he told me.  Yes, doctor, but five minutes in a crowded waiting room, or ER, and the test kits might be all gone!  Not to mention further exposure to the virus.  But it only takes five minutes, he again replied.

So is it any wonder, then, that a recent Hong Kong study said that 50% of the health care establishment there will refuse -- refuse -- to accept the H1 vaccine into their arms?!?!

The Argentine government's dangerous and inept bureaucracy regarding the dispensing of Tamiflu created shortages and facilitated deaths.  Contrast that with Chile's comparatively calm approach to diagnosis, treatment with antivirals and reasonable measures to isolate or quarantine suspected patients.  Other than looks of apprehension from hotel staff and others (reread the passage in Part Two about the Chilean hotel proprietor who doused Ms. Foster with Lysol!), the treatment of Ms. Foster was worlds ahead of the Neanderthal treatment experienced by her friend Malady back in Buenos Aires. 

Note the "apprehension" was not limited to Chilean or Argentine persons, in case you were about to utter some statement about backward South Americans.  Note that Ms. Foster's own husband was on the receiving end of the same looks and distancing from his American co-workers.  This, weeks after anyone would have reasonably been declared virus-free.

Clearly, we have a lot of work to do. 

I hope you enjoyed the series.