Scott McPherson's Web Presence

Avid readers,

This is as much for my own benefit as it is yours. I have been "out of pocket" with family medical matters for the past two weeks, and as you can tell, my blogging and Tweeting volumes have suffered. It is important for new readers to know (and especially to my followers on Twitter) that I do not blog or Tweet unless I have something to say that I think will help the cause or further debate.

OK, here's what we know. Swine H1 has exploded across the globe, which we all suspected would take place. It is everywhere, and the cases are too numerous to count, despite attempts to actually count them (more on that later).

It is also kind of futile to simply track the number of cases actually testing positive. As Ian Holm said in The Day After Tomorrow, "That time has come and gone, my friend." In the Internet Age, and with all the powerful real-time surveillance tools at our disposal, we still have no earthly idea how many positive swine H1 cases we have in our own municipalities, let alone the world. So counting is best left to the historians.

Is it any wonder then that we constantly mark up the number of dead from the 1918 pandemic? What started with some 20+ million dead from authors Beveridge and Crosby has grown to 50-100 million with Barry and Kolata. Personally, considering the later historical reports from China and India, I lean toward the latter numbers. I also say this because I know John Barry (The Great Influenza) and his research methods are beyond question.

So how many people have swine H1? According to the CDC, we should not be surprised if upwards of 100,000 are currently infected. I estimated just about that number a couple of weeks ago. It is an algorithm that one can work quickly in one's head -- or gut, more appropriately. It is a gut feeling that if we had, say, 4,000 positive results, many times that are actually infected. And considering how far behind all the public health agencies are in testing, we are actually constantly looking backward, rather than looking forward with these estimates. It's like steering by one's own wake, or driving via the rear-view mirror. We need to stop looking behind us and start looking forward again.

Los Alamos in New Mexico specializes in such algorithms and estimates. The CDC has probably been on the horn with them many, many times since the first outbreaks in Mexico, asking what the Big Board would look like in a few weeks.

What is equally clear is that we are now seeing what we did not see three weeks ago:sustained chain human transmission in this country and abroad. Japanese teenagers are dropping like flies from this malady. So are American teenagers. A recent Washington Post article showed where the virus is hitting hardest: young people ages 5 to 24. According to the article,

Compared with seasonal outbreaks, all flu pandemics cause a higher percentage of severe cases and deaths in younger groups. Although the overall mortality rate from the current swine flu is low, this trend is already apparent.

Last Thursday, when Fukuda announced that the global death total was 65, he noted that "half of them are healthy people who have no predisposing conditions. This is a pattern different from what we see with normal influenza."

There have been too few deaths in the United States to draw any conclusions. But of the 173 people who have been sick enough to be hospitalized, more than half are in the 5-to-24 age group.

Also, of great interest to this blogger, is the reference to the "mini-pandemic" of 1977. I have referred to this many, many times over the past three years, and it is gratifying to read confirmation of same in a newspaper as respected as the Post:

A variety of H1N1 strains circulated from 1918 to 1957, then disappeared for two decades. In 1977, however, an H1N1 strain surfaced that was nearly identical to the previous one, so much so that scientists suspect it was an accidental release from a lab freezer. It caused a pandemic -- Russian flu -- that was largely limited to people younger than 25, whose immune systems had never experienced H1N1.

The lab accident theory behind the 1977 epidemic is not universal, but anything is possible.  If you search this blogsite for the ongoing series "When labs attack," you will become convinced such things are indeed possible.  I believe it was Dr. Edwin D. Kilbourne, the Pope of Influenza before Webster inherited the vestments, who offered a contrary opinion that the virus was ID'ed in China prior to its typing in the Soviet Union.  Kilbourne is still with us and still offering counsel, as evidenced by the Post article.  that is excellent:  We need All Hands on deck for this almost-certain pandemic.

In fact, a dust-up of a sort occurred when veteran retired (I mean a veteran who is now retired, not a veteran of being retired) influenza researcher postulated openly that swine H1 was another accidental lab release into the wild.  Or a release that quickly reassorted with another strain.  Both the WHO and CDC are unconvinced, and have denied its plausibility.  Considering who the man was (Dr. Adrian Gibbs) and who the man worked with (Drs. Robert Webster and the late, great Graeme Laver), he was absolutely qualified to venture his hypothesis.  Gibbs had worked on the research that ultimately led to the development of Tamiflu itself.  Gibbs, Laver and Webster all swabbed birds' buttholes on an Australian beach, collecting influenza samples that they used to write the research that led to the breakthrough.

Gibbs' point was not that some costumed supervillain was conjuring up rogue flu viruses in a lab; believe me, no one is that good.  Only nature/God is capable of such randomness that could lead to a new flu virus.  Gibbs' point is that influenza for vaccines is still grown in eggs, like they did sixty years ago.  And these influenza strains can "drift" during the manufacturing process.  Think how hard it is to mix paint at your local hardware store if even a single extra drop of color seeps in.  Well, as flu grows, its RNA makes bad copies of itself, and the virus can mutate -- or "drift" -- beyond the target specified by the WHO.  Many, many batches of flu vaccine may be, and have been, destroyed each flu season as the virus drifts beyond the specs listed for that seasonal strain by the WHO. This also happened in 1976 during the development of the first swine flu vaccine. 

Gibbs also postulated that influenza grown for research purposes might have done the same thing.  the key here is biosecurity.  How much or how little is the question.  Again, refer to my "When labs attack" series for background.

So back to the issue at hand: We must not be focused on the minutae of positive test results. We need to start looking at, and tabulating,absenteeism in schools and the workplace. That is the indicator of where the virus has gone and the extent of its penetration into our communities.

That is also the logic behind the Google project to track pandemic developments by the number of targeted "hits" on Websites dealing with the treatment of influenza. Of course, you need to develop a baseline, and have a way to eliminate "chatter" that might come from people who read this blog, for example. But the possibilities are there, and any method of surveillance is helpful if it can be proven to be helpful. I guess Google will get back to us on that one.

There has been a lot of hand-wringing over the issue of closing schools and borders and such, both in the US and abroad. Everyone needs to remember that these steps, in the aggregate, are nothing more than delaying actions -- like a rear guard action in combat, which this surely is. We are trying to slow the advance of the virus, not stop it in its tracks. It is flat-out impossible to stop influenza in its tracks. The virus is just too good at what it does.  Only influenza can stop influenza.

There is a group of persons who were calling upon the world health community to allow this new virus to burn its way around the globe quickly, hypothetically allowing it to confer immunity while it was still relatively mild. This theory is interesting but ultimately does not hold water. Here's why not:

First, delaying the spread allows us precious time to study the virus, to try and understand its genetic makeup, and to prepare a vaccine candidate.

Second, because seasonal H1N1 holds the dreaded Tamiflu resistance gene, (and you should know from reading my recent and past blogs exactly what that is), the faster swine H1 does its Magellan impression, the more likely it is to pick up that gene more quickly. that would render the world's entire stockpile of Tamiflu useless against a new pandemic.

Already, CDC and WHO are recommending the use of Tamiflu only to treat those in high-risk groups: The immuno-compromised (chemotherapy patients, HIV/AIDS patients, COPD, pregnant women, etc.). And maybe or maybe not the elderly. This is being done in an effort not to over-prescribe Tamiflu, which scientists fear could lead to Tamiflu resistance. But as we know today, the acquisition of the Tamiflu resistance gene has absolutely nothing to do with the overprescription of Tamiflu itself. If it did, Japan would be completely lost, because doctors there (who profit from prescriptions they write) prescribe Tamiflu like American doctors prescribe Motrin. Why do you think the Japanese discovered the possibility that youthful sufferers of influenza, dosed with Tamiflu, might jump off buildings? because they had such a large statistical sample to work with.

Third and finally, hastening the circumnavigation of the world by a new pandemic virus ruins any chance we might have to re-educate the masses on pandemic preparedness. Slowing the spread allows precious time to plan, to educate, to train and to prepare. Of course we should have been doing those things already. But people and organizations procrastinate.

I wanted to return to the topic of Tamiflu-related suicides among Japanese teenagers (Google it if you are unfamiliar). This is why Roche created Childrens Tamiflu, which is available in a smaller dosage than adult Tamiflu. If you have a young child who is diagnosed with swine H1N1, you should ask your doctor about Childrens Tamiflu as an alternative to regular Tamiflu. I am not aware of any Childrens Tamiflu in the Strategic National Stockpile, because the Stockpile began before Roche began the manufacture of the kids' dosage. Again, check with your doctor if you have a child under the age of 16 who is swine H1-positive.

OK, I think I/we are all caught up now.