H3N2 exhibiting troubling tendencies as epidemic worsens and young, healthy people die

Posted on Monday, January 22, 2018 at 11:08AM by Registered CommenterScott McPherson | CommentsPost a Comment

One of the key differences between seasonal flu and pandemic flu is panflu's atack on the healthiest people. Whereas seasonal flu largely takes its aim on very young children and very old adults, pandemic flu sets its sights on teenagers through adults in their prime.

The reason for this is what was first detected in 1918.  It is known as the cytokine storm.  Cytokines are the Paul Reveres of infection-fighting.  In normal circumstances, this is (Christian Bale as Batman voice) good, good. They inform infection-fighting cells that something is very wrong, and they need to do something about it.

But when a virus comes along that ramps up so quickly inside a human, those cytokines go nuts, releasing so much information to so many infection-fighting cells that they overwhelm a patient's ability to absorb the battle raging within.  Simply put, the cure kills the patient.  The patient's own body kills it.

If you look back at the 1918 H1N1 Spanish Flu pandemic, you will see that the overwhelming majority of those killed by the virus were young, virile, healthy teens and young adults. Soldiers who got sick in the morning were dead by sundown.  Remember, this occurred all over the planet.  I refer you to John Barry's seminal work "The Great Influenza" and urge you to read this if you never have, or to re-read it if it's been awhile. Barry's work also is a great history of how American medicine came out of the snake oil and sorcery era to become a world-class deliverer of health care.

But I digress. We are seeing way too many cases of otherwise healthy adults and children felled by this H3N2 virus.  Now, medical people will tell you that H3N2 is a much nastier virus than H1N1 today, and they are right.  But this year's epidemic appears to be much worse than normal, putting it on par with the 2014 flu season (also an H3N2 substrain).

In the recent days, news accounts of the deaths of several young people all over the country have been reported. Pennsylvania. Ohio. California.  Arizona. California againConnecticut (a very healthy 10-year old boy). And in Alabama, a young adult, father and Crossfit participant, lies in a medically-induced coma, fighting for his life.

We are going to read, see and hear more such stories.  There is irony in this year's flu season.  The irony is that a seasonal flu that evolved from a pandemic flu with the lowest mortality rate of any of the 20th century's pandemics -- the 1968 Hong Kong Flu, H3N2 -- would be exhibiting tendencies one would think would be more closely related to 1918's pandemic H1N1 Spanish Flu.

This obviously does not mean that H3N2 is (re)evolving into a pandemic strain, as H1N1 did back in 2009.  At least not now. What it does mean is that conventional triage regarding flu -- that it hits the really young and the really old the hardest, and the ones in the middle will be fine -- needs to be re-evaluated.  Healthy, young, and non-immuno-compromised people are dying from the flu.  We don't know yet if the numbers of deaths of these people are above average, below average, or right on par with other flu seasons. We do know it is a nasty season, with no signs of abatement, despite the CDC's proclamation of last week. By the way, the CDC has admitted this year's flu has hit epidemic status -- which I predicted several says before the issuance of the statement.

We cannot assume anyone -- anyone -- is safe from the most severe effects of this flu.  This would absolutely extend to those who are fit as a fiddle and could wrestle a bear.  We are seeing the cytokine storm claim otherwise healthy, young adult victim after victim. If you have a loved one who fits that category, and he/she is sick with flu and not responding to treatment, assume nothing.   

US Health Care Earns an "F" for poor flu supply chain practices

Posted on Wednesday, January 17, 2018 at 10:32AM by Registered CommenterScott McPherson | CommentsPost a Comment

America's struggles with a major flu epidemic (my words, but I will be borne out) have produced several revelations.  The first is the complete lack of institutional memory when it comes to pandemic supply chain preparations. If I taught this mantra once, I taught it a hundred times, in a hundred lectures and seminars, from coast to coast, over a period of eleven years:  Check your upstream and downstream suppliers for their pandemic preparedness. If they are unprepared, find new or secondary suppliers. 

This is not just a health care warning.  It is intended for any organization that does anything, makes anything, or services anything.  If you search my blogsite, you will find previous references to this need.  I have spoken to people all over America about it.  I have had conversations with organizations as large as 3M  -- and people as well-known and important as Michael Dell -- about pandemic supply chain management.

In my lectures, I also point out that Nature has a way of piling on disasters.  For instance, 75% of all flu pandemics occur outside of flu season.  We are coming up on the 100th anniversary of the 1918 Spanish Flu pandemic, the worst flu pandemic in recorded history.  It is commonly believed to have started on a farm in Kansas in the spring of 1918.

Well, Nature really piled on this time.  Difference is, it piled on in ways we were not thinking about.  Puerto Rico used to (pre-Hurricane Maria) manufacture the overwhelming majority of IV bags that are used in American hospitals.  I am sure you have read, heard or seen the news stories. Because those facilities are only now getting their power back, there are severe shortages of those IV bags everywhere.  Here are two stories:

http://wgntv.com/2018/01/16/iv-bag-shortage-has-hospitals-scrambling-to-treat-flu/ 

http://www.cnn.com/2018/01/16/health/iv-bag-shortage/index.html

But the warning signs were there, as early as last October.  My friend Dr. Michael Osterholm of CIDRAP and one of the world's leading experts on infectious disease said as much.  In a Newsweek story dated October 12, 2017:

Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota tells Newsweek that the United States relies on foreign trade for many medical needs. About 30 essential items, these include hospital supplies like IV bags and everyday drugs, are made outside of the U.S. A pandemic in India or China could keep people home from work, which would impact manufacturing.

“If anything happens to disrupt the supply, we wouldn’t have any of it,” Osterholm asserts. “We would suddenly see a tremendous amount of collateral damage,” he warns, stressing that it’s not the flu infection itself that could be deadly, but rather the consequences that follow. “The flu will accentuate all of the other health problems that we have.”

Bingo, Mike.  As usual, you hit the nail on the head.  Another warning shot was fired in October by Modern Healthcare, http://www.modernhealthcare.com/article/20171004/NEWS/171009964 . An excerpt:

Sodium chloride and dextrose are vital drugs used every day in hospitals around the country, said Chris Snyder, drug information pharmacist at Cleveland Clinic who manages shortages and recalls.

"We're talking about two manufacturers that support nearly the entire U.S. and one of them is out and the other manufacturer doesn't have enough supply to make up for it," he said. 

While the Cleveland Clinic has the benefit of a drug compounding facility on-site that will partially insulate it from the shortage, Chief Pharmacy Officer Scott Knoer said he is waiting for the other shoe to drop as other suppliers are exhausted.

"The whole country will be scrambling," Knoer said. "I'm waiting for the cascade effect of this. This has major implications for hospitals everywhere."

The latest shortage is 
one of many in recent years resulting from manufacturing delays. Experts blame a lack of competition among drug manufacturers, which are increasingly consolidating to offset high production and compliance costs. 

Baxter and ICU Medical—which 
acquired Hospira from Pfizer in February—provide the bulk of IV fluids, while B. Braun provides a much smaller share. 

We knew we were going to have shortages of IV bags two full months before this year's flu epidemic erupted.  And yet the wheels turned slowly in Washington, with only recent movement toward permitting the importation of IV bags and saline from nations such as Switzerland.

But the hospital industry is suspiciously sounding like the Claude Rains character from Casablanca.  They are shocked -- shocked! -- to find there are supply chain problems with IV bags, blaming others (perhaps accurately) while not accepting a measure of blame themselves for allowing such conditions to thrive.  No one had a problem buying IV bags on the cheap from Baxter, manufactured in one location (what I call "castling oneself into checkmate").  That is, until Maria.  Putting all your IV bags into one basket was a terrible and possibly fatal strategy. 

Now we are also seeing spot shortages of antivirals such as Tamiflu and its generic equivalent. From WSB Atlanta:

http://www.wsbtv.com/news/local/dekalb-county/cdc-issues-new-warning-about-dangerous-flu-season/684623999

How we have drifted (flu people get the pun) from the razor-sharp pandemic preparedness mindset of 2006-2009 into the funk we are currently in today.  We had a pandemic in 2009, but it was not nearly as lethal as we feared.  For that we say Thank the Maker!

I thought we had retained that knowledge and those lessons and cautionary tales.  That is one reason why I ceased writing blogs about pandemic preparations.  Seems I was wrong.  We need a complete reboot of the awareness and education efforts from the last decade.

The effort begins anew for me, today.

 

Chikungunya Arrives in Tallahassee

Posted on Monday, June 23, 2014 at 11:10AM by Registered CommenterScott McPherson in , | CommentsPost a Comment

As Angelina would say:

"Well, well."

The Tallahassee Democrat is reporting that two cases of chikungunya virus have been detected in my town.  Both cases are "imported"; that is, the victims contracted the virus abroad and then returned to Tallahassee.

In one case -- communicated to me by one of my spies -- a faculty member of The Florida State University's geology department contracted chikungunya virus while in Haiti doing some field work. 

As of June 14th, there were 42 confirmed cases of chikyngunya in Florida.  All, apparently, imported.

Alabama DoH: "No new viruses, no new bacteria" in Dothan cluster

As I type this, the top Alabama health official is holding a press conference.  And a major tip 'o the cap to my buddy Mike Coston for giving me the link!

The health officer says there are three different agents at work in the cluster:  Rhinovirus (4), influenza (I missed the number), and (3) bacterial pneumonia infections. There were multiple and overlapping infections in several of these cases.

The hubub, this official states, is due to the heightened states of alert pertaining to H7N9 and MERS-CoV.

"A clustering of common organisms" is the reason why this group of disassociated illnesses was grouped together.

One death was aged 34; the other was age 55. 

According to this man, "WNL" means "Within Normal Limits," referring to tests.  He says it also means "We never looked," referring to the individual persons who fell ill.  It was the number of persons falling so ill, in such a short timeframe and in such a small area, and in such an environment as we are working in today with H7N9 and MERS, that prompted the closer inspection. 

I like his candor and his folksy demeanor.   Case closed.

However, the question is still out there on Houston.

Are Dothan, Houston mystery illnesses linked? 

The cases all come from nowhere.  They involve bright, energetic, athletic students.  They begin feeling feverish, exhausted, shaken. Then they experience violent seizures, are sent into a medically-induced coma.  And then, for two of the three afflicted students, they die.

The Houston Chronicle reports from early May are chilling.  Students 60 miles apart, with no apparent links, succomb to the same symptoms.

Now, in Dothan, Alabama, we are seeing a hauntingly familiar situation unfold.  With the exception of the seizures, the symptoms are strikingly similar. 

A television station much closer to the outbreak -- NBC affiliate WPMI, Mobile/Pensacola, is reporting that:

Doctors investigating the illness have not yet found a common denominator in the patients, whose ages range between the 20’s and 80’s, other than their symptoms. Doctors tested samples from the 7 patients at the state health lab to determine if there is from them to find “strain matching fingerprint” she added.

Doctors are analyzing those tests with investigators from the Centers for Disease Control & Prevention’s Atlanta office. State health officials, The Alabama Department of Public Health and the Centers for Disease Control Respiratory Laboratory are analyzing lab tests from all seven patients. Officials hope to have preliminary results on the samples back by Wednesday or Thursday morning.

Okee dokee, it is late Thursday morning.  What do we know?