While the virus does reveal some novel traits, so far most symptoms are not out of the ordinary.
With spring in high gear and summer just down the road, doctors thought we’d left another year’s influenza season in our collective rearview mirror. All of that changed late last week when the national Centers for Disease Control and Prevention began reporting that people in the U.S. had tested positive for a novel strain of the influenza virus. So far the CDC has confirmed 40 cases in individuals ranging from children to middle-aged adults.
The CDC was quick in getting the public up to speed. Its basic message is sound. Keep an eye on this story and know the facts, which include:
- The infection originated in pigs and is known as the swine influenza A, H1N1 strain.
- While outbreaks of swine influenza are nothing new (there was a memorable one in 1976), this strain is novel in its genetic makeup, with RNA from four different sources: avian flu, human flu and swine strains from North America and Eurasia.
- Thus far, Mexico has been hit the hardest, with 1,400 to 1,600 suspected cases and somewhere between 80 to 100 suspected deaths (although only about 20 of those fatalities have a laboratory-confirmed diagnosis of swine flu).
- The CDC was reporting seven cases in Texas and California late last week, but now the number has jumped to 40, including 28 in New York City. Cases were also reported in Kansas, Ohio and Canada.
Although it’s nice to have those facts on the table, nothing tests a healthcare system more intensely than an infectious outbreak. Viruses are mercurial little pathogens. They spread and mutate with great speed. That’s especially true of the influenza virus. Each year it mutates and lures us into a game of “stump the doctor,” as we race to create a vaccine for the most likely strain. Most years, including this one, the strains don’t change significantly. Doctors call these minor mutations antigenic drift, which means we get a useful vaccine. In very rare cases, as in 1918, there’s a major mutation (a more significant antigenic shift). Then all bets are off. At its worst, as in 1918, an antigenic shift can lead to a pandemic.
This outbreak has taken everybody by surprise and, in its initial description, appears to be a significant antigenic shift. There are other quirks as well. First, this swine flu showed up in the middle of spring; flu season is usually between about November and February. Second, we’ve observed some nontraditional infections. For example, most cases of influenza affect the elderly and the very young (which is why we try so hard to vaccinate those groups first). However, in this case, those affected in the U.S. are older kids and middle-aged adults. Another mystery with this virus is why it’s been so severe in Mexico yet so mild here.
In fact, the whole story about what’s happened south of our border is still murky — the numbers of how many have been infected and killed are still fluid. Among the possible explanations for the differences between the U.S. and Mexico are that another virus has co-infected people, making them sicker; that the lack of access to healthcare for many Mexican citizens has led to a more severely affected population; and that it may even be an accounting error, where the Mexican government has counted only the very ill and not tracked the less severe cases. Regardless, we appear to have a lot of work to do before we have any real answers.
Despite the level of uncertainly, the CDC and World Health Organization appear to have a coordinated plan of action. Both old and new media have so far done a good job in communicating with professionals and ordinary folks in need of advice.
As for doctors, we’re expecting a lot of calls this week from patients with questions and concerns. Phrases like “outbreak” and “epidemic” are as medically loaded as they get. And while nobody can predict what’s going to happen, there are always some basic steps you can take.
First and foremost, while you should take this news seriously, please don’t panic. So far, symptoms of swine influenza are similar to other strains of influenza: fever, chills, aches, cough and congestion. The only thing that’s being reported as out of the ordinary is some vomiting and diarrhea as well.
So, as you did last January, wash your hands and cover your mouth with the crook of your elbow if you cough or sneeze. If you get sick, yes, call your doctor, but treat yourself with rest, fever reducers (not aspirin for children) and plenty of fluids. We always have to worry about the very young and old, but again, we haven’t seen swine flu in these groups yet. We also have to worry about our patients who have some chronic medical problems like cancer, which can compromise their immune system. However, this, too, is nothing new.
You may have more cause for concern if you recently traveled to Mexico and then got ill, but the CDC is keeping doctors up-to-date on how to test patients. Also, while swine flu can be treated with the antiviral drugs zanamivir and oseltamivir, demanding them or stocking up on them is going to cost you (and our fragmented healthcare system) lots of money for very little benefit at this point. The government already has ample stockpiles of antiviral drugs that can help beat this bug should the outbreak get worse.
While it’s true that the Homeland Security Secretary Janet Napolitano declared a “State of Emergency” over the outbreak, she stressed that it isn’t anything more than a procedural move to free up resources for those who may need them. So with thoughtful preparedness and surveillance by health agencies, local awareness among citizens and doctors, and more than just a little luck, we can all hope this will pass fairly quickly.
More Rahul K. Parikh.
More Related Stories
- PA governor "can't find" any Latinos to work in his administration
- Glenn Beck: "The American people have just been raped"
- London machete attack could be linked to terrorism
- Naomi Watts, "Argo," "Wonderstone" among bizarre Teen Choice Awards nominees
- Conservative group blames military sexual assault on "Don't Ask, Don't Tell" repeal
- Marc Maron on Twitter feud with Michael Ian Black: "We have an understanding"
- Is Pittsburgh the next Portland?
- "Original Coca-Cola had a very small amount of cocaine"
- Imprisoned Pussy Riot member declares hunger strike
- Tornado survivor to Wolf Blitzer: Sorry, I'm an atheist. I don't have to thank the Lord
- The camp-free "Behind the Candelabra"
- Justin Bieber will destroy you if you live-tweet his parties
- Corporations accused of wrongdoing win battle to keep identities secret
- Weak, incompetent Democrats blow another one
- Lois Lerner, IRS disaster
- Cyber attacks could cause the next world war
- "Girls Gone Wild" creator Joe Francis to jury: "You should be euthanized"
- Donald Rumsfeld worried that marriage equality will lead to polygamy
- Experts: Fox News spying scandal a game-changer
- Biden cracks Obama teleprompter joke
- San Francisco Giant Jeremy Affeldt apologizes for homophobic past
Featured Slide Shows
The week in 10 picsclose X
- 1 of 11
Lisa Montgomery embraces her nephew Thursday after a tornado tore apart her home in Cleburne, Texas. The twister killed six people and destroyed entire swaths of the North Texas town.
Credit: AP/LM Otero
Jack McMahon, the defense attorney for abortion doctor Kermit Gosnell, speaks outside the Criminal Justice Center in Philadelphia Tuesday. His client was convicted of killing three babies in his clinic, and will serve multiple life sentences.
Credit: AP/Matt Rourke
A photo taken Monday captures Vice President Joe Biden's response to a Milwaukee second-grader's innovative proposal to end America's epidemic of gun violence. This guy!
Credit: AP/Jenny Aicher
Sen. Rand Paul, R-Ky., flanked by a grouper-eyed Michele Bachmann, addresses the IRS' admission that it targeted Tea Party groups in advance of the 2012 election. In an op-ed for CNN Thursday, the Kentucky senator slammed the president for his faux outrage.
Credit: AP/Molly Riley
Ousted IRS chief Steven Miller is sworn in on Capitol Hill Friday. Miller testified before the House Ways and Means Committee on the extra scrutiny the agency gave conservative groups applying for tax-exempt status.
Credit: AP/J. Scott Applewhite
Attorney General Eric Holder pauses as he testifies on Capitol Hill before the House Judiciary Committee Wednesday. Holder is under fire, among other things, for the Justice Department's gathering of phone records at the Associated Press.
Credit: AP/Carolyn Kaster
O.J. Simpson sits during an evidentiary hearing at Clark County District Court in Las Vegas, Nev., Thursday. Simpson, who is currently serving a nine-to-33-year sentence in state prison for armed robbery and kidnapping, is using a writ of habeas corpus to seek a new trial.
Credit: AP/Las Vegas Review-Journal/Jeff Scheid
Major Tom to ground control: On Sunday astronaut Chris Hadfield recorded the first music video from space, a cover of David Bowie's "Space Oddity."
Credit: AP/NASA/Chris Hadfield
When it rains it pours. President Barack Obama speaks during a news conference Thursday with Turkish Prime Minister Recep Tayyip Erdogan, inexplicably inspiring an #umbrellagate Twitter meme.
Credit: AP/Jacquelyn Martin
A smoke plume rises high above a road block at the intersection of County A and Ross Road east of Solon Springs, Wis., Tuesday. No injuries were reported, but the the wildfire caused evacuations across northwestern Wisconsin.
Credit: AP/The Duluth News-Tribune/Clint Austin
Recent Slide Shows
- 1 of 11