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I was shocked -- shocked! -- to read the USA Today story of January 29th. I found the story on today's Drudge Report.  Apparently the US military has access to an adenovirus vaccine.  While AD4 is mentioned in the USA Today story, avid readers of this blog (there are still one or two of you out there, right?) will recall my many blogs from 2007 and 2008 about Adenovirus14, or Ad14.  Feel free to use my blog's search feature to get boned up; I'll wait.

OK!  Good to have you back.  Adenovirus can mimic flu in so many ways, and can help explain when people feel like crap but their flu test is negative.

Problem is, there is no rapid test for adenovirus. There is no civilian surveillance, either. But a sustained surge in cases among the military caused them to re-release the vaccine, and make it mandatory. Presto! Adenovirus cases dwindled.

From the article:

"The study, lead-authored by Adriana Kajon of the Lovelace Respiratory Research Institute in New Mexico, concluded that the "vaccine currently licensed for military use should be considered a potentially valuable resource to prevent disease in susceptible populations living in closed communities, such as college settings, summer camps, and long-term care facilities.""

The USA Today story references an NBC News story on adenovirus. It is worthwhile reading, especially the last paragraph:

"And adenoviruses are very hard to kill. Reports indicate they can survive on plastic and metal surfaces— think countertops and hospital tables— for a month. Some formulations of alcohol and chlorhexidine do not kill them easily, tests have shown, although chlorine does."

But we also have to respect this statistic.  Again, from the NBC News story:

"An outbreak of adenovirus killed 10 people in 2007. Kajon’s team tested college students at one campus during the severe 2014-15 influenza epidemic and found 13 out of 168 students who came in for flu treatment had adenovirus infections."

Now this is but one college campus, and the numbers are unscientific and could easily be explained as an outbreak, sequestered on this one campus or region, and not indicative of numbers spread over a larger grographic area during a national epidemic.  Nonetheless, in this location, we can determine that nearly 8% of sick people had adenovirus and not flu.  That's significant. 

It would be a good thing if some of the Congressional muscle that is focused on pushing the CDC to do what it already is doing, could be redirected toward increasing awareness of adenovirus and in pushing to make that vaccine available to everyone!

My return to flu blogging last week was about the nationwide shortage of IV bags for flu patients (and everyone else who needs an IV bag).

Now, we are seeing spot shortages nationally of flu test kits.  You know, the ones that go down your nose all the way to Belize. Even though their effectiveness has been the subject of much debate, it is generally said that these kits are better than no tests at all. 

Northeast Florida is running out of test kits. The Channel 4 Jacksonville story includes this segment:

"Oceanway Medical Center’s Diana Medina said there’s so much demand that the kits are on back order and clinics have to conserve their supplies.

"“We have to make sure before we are just running all these tests on every single patient that comes in with a runny nose,” Medina said. “We swab the patient’s nose on both sides and then we send it off to the lab and within 15 minutes we have a result.”"

https://www.news4jax.com/health/high-flu-infection-rates-in-northeast-florida-deplete-test-kits

Pittsburgh-area doctors and hospitals are running out of test kits. http://pittsburgh.cbslocal.com/2018/01/24/flu-season-supplies-shortage/

And now flu season (along with bomb cyclones) is/are being blamed for shortages of blood donations in the Northeast.  New England Public Radio has the story.

All of these have the same issue:  Serious misunderestimation (thanks, W) of the effects of flu upon the entire supply chain, but especially the flu supply chain. 

There is good news:  The FDA has taken steps to permanently allow the importation of saline IV bags from outside the US.  The Reuters story is here.

Unfortunately, it will take weeks to get this new product into the supply chain.  We still don't know why it took so bloody long for institutions to take action between when the alarm bells were sounded in October by Dr. Mike Osterholm and others (see last week's blog), and now.  Again, saline bags are on the way.  Hopefully, in time.

Two Dallas-area school districts just re-opened yesterday after shutting down for a week due to the raging flu epidemic. Two reasons: To disinfect each and every desk, bus seat, and classroom; and to try and break the chain of infection.

Here is the Dallas Morning News story.

The CDC made it official today: This year's flu epidemic has crossed the 2014 flu epidemic's threshold, and has become the worst flu season since 2009's H1N1v "swine flu" pandemic. Similar stories began cropping up this week in trade publications.  The Pacific Northwest, in particular, has been hit incredibly hard.

By the way, I am sorry the WSJ story is behind a paywall.  If you work really hard, you might be able to read it; however, you may find it via other sources.

Also, NBC News last night ran a story confirming my blog of earlier that same day.  The NBC story confirms the "cytokine storm" as a leading factor in the deaths of young people from this flu. In yesterday's blog, I theorized that the cytokine storm was largely responsible.

And, contrary to every news story you read, heard or viewed last week:  The epidemic is getting worse, with no signs of abating.   The website vox.com has an excellent article regarding this year's flu season.  The chart above illustrated that this year's epidemic continues to climb, and has surpassed every year, save 2009, when we had the H1N1v swine flu pandemic.

Of particular interest in the Vox story:  H3N2 appears to drift (mutate) within eggs during the vaccine production itself!  Also, Australia's death rate from flu this season was more than four times higher than average. Since Australians are generally regarded as a heartier lot than Americans, and the virus circulating in the Northern Hemisphere is essentially the same as the one that circulated in Australia in the summer of 2017 (the Southern Hemisphere's flu season), and the Southern Hemisphere vaccine composition was identical to ours and ours remained unchanged for H3N2 since last year, we can safely assume similar outcomes will happen. Meaning, many more Americans will die of H3N2 than we have seen in a long, long time. More than 2009. 

Time Magazine in 2014 ran an excellent story on the origins of the 1918 H1N1 pandemic flu virus.  Back in 2014, researchers discovered the 1918 pandemic -- the worst pathogen attack ever to hit the world (to date) -- was an H1N1 swine virus that somwhow shifted by picking up a stray bird flu gene.  For more on antigenic shift and antigenic drift, search my blogs. Anyway, H3N2 is a purely avian flu -- the former 1968 Hong Kong Flu pandemic strain -- and packs a nasty punch. 

There is another H3N2, a swine variant, which is circulating in the Midwest -- but this is not this year's worry.  What I found fascinating is that, between 1880 and 1900, Americans were exposed to an H3N8 virus, and not an H1.   People prior to 1880 had been exposed to an H1N8 virus.  People exposed to an H1 fared much better than the people who were exposed to an H3.  By the way, H3N8 is commonly known as equine influenza.  Equine influenza made a 3pecies jump in the early 200s to dogs -- in Florida.  H3N8 is now also known as canine influenza, joined by H2N2 canine influenza, a cousin of what we are fighting this season, and first detected in Chicago a couple of years ago.  H3N2 canine flu is now available as a bivalent dog vaccine, along with H3N8.  

To summarize:  This year's flu season is the worst since 2009 -- a pandemic year. It is still circulating and still infecting.  We have not peaked.  Hopefully, we will peak, and soon. 

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 again. Connecticut (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.