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Swine flu, Obama, vaccine shortages, BioCryst, national emergencies and a feeling of unease

First off, let me apologize for my lack of blogs the past FIVE WEEKS.  As I always say, however, I will not blog if I do not have something to say.  There are others (Mike Coston, Crof, Revere) who get the job done day in and day out, and so I leave them to do their thing.

I have actually had plenty to say recently, but I flat out have not had the time to write.  So let me catch you all up on events in the McPherson household:

Wife is recovering from her chemo.  Daughter is fine and long-over The Swine.  However, son came down with H1N1 at his school in Long island, Stony Brook (Go Seawolves!).  I might add, they are 4-4 and are battling for the conference title, and my boy is contributing nicely as a D-lineman. 

Fortunately, I had delivered some Tamiflu for him (and his girlfriend) on our last visit.  Knocked it out of him within 36 hours.  Tamiflu is really amazing.  He also did the "double dose" on the first treatment, and I am more convinced than ever that this is an excellent way to go.  TomDVM agrees, as you might have read on a previous comment.

Work has also conspired to keep me occupied.  So now you are caught up.  However, within the past ten days there have been several news stories which I will attempt to take on with a sweeping (rambling?) monologue.

First, the issue of H1N1 vaccine shortages.  Why is everyone so worked up about these manufacturing delays?  Because someone(s) set the bar too high to begin with.  May I refer back to my previous blogs regarding the delays experienced by vaccine manufacturers in the late spring.  The seed stock was not efficient enough, and the virus was growing ever-so-slowly in eggs.  So the CDC, or the WHO, or whomever does these things, grew new seed stock and sent it out to the vaccine makers (all six of them, or however many there still be).

What is apparent from these delays is that the problem of slow-growing virus never truly went away.  And it would be very interesting to know exactly why the vaccine is moving so slowly down the pipeline.  Was the virus drifting during manufacture?  Was there just not enough yield?  Was the virus killing the eggs (which we have seen in H5N1 vaccine manufacturing)?  If the latter is true, then that is a cause for future concern.

Or were some policy-spinners in DC just too damn quick with promises of ample vaccine in the month of October?

One thing is for sure:  State and county health departments are having enormous difficulties in scheduling mass vaccination programs based on delivery assurances from Washington that are ringing hollow. 

Which leads us to the weekend declaration from President Obama that H1N1v has become a National Emergency.  Now before everyone gets too worked up about this, be assured that sometimes one has to move to this level in order to circumvent certain existing rules and policies that can combine to slow the treatment of patients. 

The declaration does several things.  First, it allows more flexibility in federal reimbursements for triage centers that may be set up hundreds of yards away from the hospital property, say in an elementary school cafetorium.  Second, it allows more rapid movement of people and stuff.  And third, it does re-focus attention on the existing problem of H1N1v.

So don't make too much, nor too little, about the presidential declaration. 

Now on to the BioCryst antiviral, peramivir.  Loyal readers of this Blogsite have followed my blogs about this Birmingham, Alabama-based company for years.  And it seems that, finally, it is positioned at the right place in the right time.  The FDA has given its approval for the emergency use of its injectable antiviral peramivir to very seriously ill H1N1 patients.  And none too soon, as both H1N1v cases and deaths continue to increase.  If they can keep enough medicine in the pipeline, we could have a very powerful weapon in the flu arsenal.

Now for my feeling of unease.  Here in sunny Tallahassee, we have seen a spike in the number of flu cases, followed by a lull, and then another recent spike.  In Florida, we are seeing an average of ten deaths per week directly attributable to "lab-confirmed" swine flu.  Who knows how many other deaths we have missed; that will be worked out by the statisticians later on.

But I just don't feel like we have seen everything this virus can deliver yet.  I am looking at the latest Florida statistics as I write this.  Leon County (Tallahassee) is currently not reporting widespread flu activity, a trend that seems to be repeated throughout the urban areas.  In the meantime, the virus is considered widespread in southwest Florida, a haven for retireds and winter residents.

What really distresses me are the Florida flu map's shaded areas that signify "no report."  There are about a dozen "serial non-reporters," county health departments who have not reported their status the last two weeks in a row.  Most of these are in the Panhandle and the "Big Bend" area that joins the Panhandle to the peninsula.  Don't they know there's a pandemic on?  If they are not reporting their status, how do we know if they have recorded any deaths attributable to flu? 

Rant over; now back to the issue at hand.  I am likening my feeling to the calm that precedes the storm.  This virus, I believe, is still far from having finished seeding itself across the globe.  Nor do I believe the virus has finished its first wave across Asia.  It moved so quickly across the industrialized world, then resumed its regular pace (or has seemed to me to do so) as it crossed those areas where transportation is basically unchanged from what it was fifty years ago. 

For much of the developing world, the first "seed" wave is still upon them, even as we move into what will certainly be known as the pandemic's second wave in the Americas.  Just how long it will take for this virus to emerge from Asia, and what form it will take once it does so, is the subject of much speculation.

And while schoolchildren are understandably getting a lot of attention as victims of this virus, here in Florida, look at the faces of death over the past three weeks:

A 20-year-old female in Alachua County, a 52-year-old female in Baker County, a 24-year-old-female in Citrus County, a  49-year-old female in Miami-Dade County, a 78-year-old male in Miami-Dade County, a 53-year-old female in Hernando County, and a 15-year-old male in Volusia County. A 49-year-old female in Broward County, a 49-year-old female in Miami-Dade County,  a 67-year-old female in Miami-Dade County, a 50-year-old female in Duval County, a 47-year-old male in Lake County, a 37-year-old female in Manatee County, a 35-year-old male in Pasco County, a 43-year-old female in Pinellas County,
a 50-year-old female in Pinellas County, a 56-year-old female in Polk County, a 58-year-old male in Volusia County, and a 10-month-old female in Sarasota County. a 51-year-old male in Brevard County, a 55-year-old female in Charlotte County, a 62-year old female in Desoto County, a 51-year-old female in Hillsborough County, a 30-year old female in Lee County, a 55-year-old male in Monroe County, a 33-year-old female in Okaloosa County, a 45-year-old male in Pasco County, a 64-year-old female in
Pinellas County, and a 45-year-old male in St. John’s County.

That is an average age at death of 46 years.  It will be interesting to see just how far upward the average age at death is trending nationwide.  But in Florida, where the average living age is older than most states, it appears as though the virus is taking a wider swath of victims -- and what that may portend for the coming months is unsettling. 

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