Pig Fever
The sudden outbreak of the human mutation of swine flu in Mexico is actually a cause for concern. Particularly as it may already be in New Zealand. Interestingly, given the absurd hysteria that accompanied the far less risky bird ‘flu “pandemic that wasn’t”, the authorities seem considerably more blasé about it. The Minister of Health Spokesperson seems almost laid-back about it – commenting on the flight from Mexico on board which several people had flu-like symptoms:
“He said at this stage other passengers on the flight were not being sought and the next step would depend on what the tests showed.
““We don’t believe at this point that there is a need for that.
““We might get no positives, we might get one, we might get all of them. It’s a pretty big step to be taking (and) it’s something that would be considered.””
Presumably part of that casualness is due to the fact that New Zealand currently has a large stockpile of Tamiflu (from the bird flu scare) and the current strain is susceptible to Tamiflu. Perhaps he’s thinking “at least we’ll get rid of those stocks before they expire”…
Unfortunately, while the Borg may consider that “resistance is futile”, viruses have different ideas. It is very conceivable that a simple mutation may render Tamiflu ineffective, so complacency is not an option. There are warning signs that this particular flu is potentially far more dangerous that bird flu:
- The spanish flu epidemic of 1918 that killed 20 million people worldwide was also thought to have originally shifted from pigs to humans.
- This particular flu transmits directly from human to human. At no time did bird flu become human to human transmissible. This puts it a WHO Alert 4 or 5 (6 is a pandemic). Note: WHO still have their alert notification on their web site set at 3. They seem to have taken this to a committee to monitor. Worry.
- So far the mortality rate seems to be about 6%. Expect this to be considerably lower in countries with better access to medicine than Mexico and considerably worse in the third world.
So, according to the information at my disposal, this flu scare is considerably more worrying that the bird flu fiasco, yet authorities everywhere seem unconcerned. The possibilities are:
- They know something I don’t (eminently possible).
- They are afraid of looking as stupid as they did in the bird flu scare
- They really are that stupid
- They have lulled themselves into a false sense of security by stockpiling Tamiflu.
- Engaging conspiracy mode, they might be encouraging a good solid flu epidemic to blame it for the coming economic meltdown.
- Engaging complete paranoia mode, they may be trying to reduce the world population to combat global warming.
Now, I’m just popping out to buy some Tamiflu…
Disclaimer: I have no shares in Roche, the makers of Tamiflu.
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Apr 26 09 10:21 pm
People have been going down with the same symptoms around Tauranga for about the last two- three weeks. Lasts about 48 hours and then goes away. Might be the same, might not.
That’ll be ordinary flu. Pig flu is fairly localised to Mexico at the moment
Apr 26 09 11:06 pm
Are this years flu shots any use in this case?
Utterly useless. Wrong strain
Apr 27 09 1:02 am
Perhaps not entirely useless in that your immune system has had a bit of a wake up call. This hypothetical assumption revolves around the premise that any execise must be good for you !
True, but you would have been much better off actually contracting flu, particularly an H1N1 strain.
Apr 27 09 7:34 am
check out the ministry website – nothing there
girlytwirly’s last blog post..SWINE FLU
I’m amazed you expected anything…
Apr 27 09 10:08 am
Hmm. I wonder if there’s a bit of a “boy who cried wolf” response going on (as you also suggest).
Also, given the spike in demand for Tamiflu at the height of the bird flu scare, I wonder of the authorities are trying to downplay this one deliberately so the general public doesn’t respond in an over-the-top manner. The (potentially tragic) irony in that being that if that’s what they’re doing, by the time health officials and the Government decide a little panicking (and I use the term loosely) by the general public is a good thing, it’ll be too late.
The flip side is – and here I’m not trying to be snarky – what would you recommend, MD? It seems to me that actual quarantine measures – as opposed to just monitoring sick people – are expensive and unpopular. Maybe officials are doing the right thing by saying, essentially, “we’re keeping an eye on it and we’ll ramp up our response if it looks like we need to”.
I suppose one option would have been to haul all passengers on the flight in for testing. Not rhetorically, how feasible would that have been?
I would have immediately quarantined everyone from that flight and all flights from Mexico until I knew that either the passengers did not have flu, or that the flu strain was easily treatable and not as dangerous as it currently appears.
Apr 27 09 12:09 pm
yet authorities everywhere seem unconcerned. The possibilities are:
Well the interviews with public health officials i’ve seen give the impression that the planning they did when bird flu was an issue should be just as effective now as then – i suspect they’d be a little more ‘panicked’ if they didn’t have much/any systems in place…
Getting much more traffic today then Doctor?
Apr 27 09 12:42 pm
StephenR: Well the interviews with public health officials i’ve seen give the impression that the planning they did when bird flu was an issue should be just as effective now as then
Ah, Yes. This would be the planning that hasn’t seen the light of day for the past 4 years. Cue the sound of dust being blown off ring binders and the scurrying of administrators trying to find all that equipment that was “reassigned” after the SARS scare was over…
Getting much more traffic today then Doctor?
Heaps, thanks. Now that I have the attention of the blogosphere with my alarmist, worst case scenarios and paranoid visions, I present a more considered response today.
Apr 27 09 12:47 pm
Cue the sound of dust being blown off ring binders and the scurrying of administrators trying to find all that equipment that was “reassigned” after the SARS scare was over…
Ah, that’s something to ponder…care to expand? (though i did say bird flu, not SARS – bird flu was the most recent wasn’t it?)
Good work with the ‘mongering.
Apr 27 09 12:59 pm
It’s fearmongering until the worst happens–then it becomes prescience.
kg’s last blog post..Shock/Horror – Shooting at pirates works!
Apr 27 09 1:17 pm
StephenR. Hospitals hired shipping containers as makeshift isolation units and recommissioned old ventilators – now all gone. Any newer ventilators will have gone back to the theatres and ICUs. Stocks of resuscitation drugs will have all expired. Ambu bags will have been recycled to EDs.
It is expensive to maintain isolation facilities that you are not using. I suspect most DHBs are running around getting their stuff back together even as I type.
And, of course, most of the doctors and nurses will be unfamiliar with the pandemic procedures and will need reminding. But, as Key says, at least we have a plan…
Apr 27 09 2:59 pm
I would have immediately quarantined everyone from that flight and all flights from Mexico
You do realise the “flight” in question was NZ1?
And to quarantine all similar flights would close off all basically all eastwards air travel from NZ?
Bye bye to what’s left of the economy: Phil Goff would be really really please if John Key did that!
Apr 27 09 3:30 pm
Sinner: You do realise the “flight” in question was NZ1?
Yep. Note that I only suggest Mexico flights and that only temporarily (for no more than a week or so), long enough for us to get more data and properly quantify the risk. Currently everyone seems to be guessing (including me – but at least I am guessing conservatively).
Apr 27 09 8:24 pm
Hi Macdoctor, could you talk a bit about the usefulness of Tamiflu in the face of this potential pandemic? The wiki page on Tamiflu (or Oseltamivir) is really not very flattering at all about its efficacy.
It states, “After following WHO protocols in treating 41 victims of the H5N1 bird flu virus (19% of the worldwide cases of bird flu reported to date), Nguyen Tuong Van, MD, who runs the intensive care unit of the Center for Tropical Diseases in Hanoi, Vietnam concluded that Tamiflu, the drug most widely stockpiled around the world to combat a potential bird flu pandemic, is “useless”.[5] According to this article, the WHO confirmed Van’s experience stating that Tamiflu has not been “widely successful in human patients”, but speculated the drug has not been administered until late in the disease in many Asian countries”.
Can you explain why the WHO believe that the swine flu responds to Tamiflu given the above?
Also from the same wikipage, “In March 2007, Japan’s Health Ministry warned that oseltamivir should not be given to those aged 10 to 19”, due to incidence of “dangerous psychological, neuropsychiatric side effects including self harm in some users. These dangerous side effects occur more commonly in children than in adults”.
The FDA had amended the label on Tamiflu in November 2006 to include the possible side effects of delirium, hallucinations, or other related behavior, after they received 103 reports of this occurring between August 29, 2005 and July 6, 2006, mostly for Japanese patients.
If any of the above statements have any substance, I think the real horror story here is that those teenagers from Rangitoto college were offered Tamiflu as a preventative treatment for swine flu, and that the media is promoting the stuff like it’s our last hope when everything goes pear-shaped. What is your considered opinion on Tamiflu? Thanks
Apr 28 09 12:41 am
JohnnieBoy:Tamiflu has a large number of nasty side effects and is effective only against some strains of the influenza virus. The Mexican doctors say that it works on the current swine flu strain – meaning it reduces the severity of the illness and shortens the duration somewhat. It may also be useful in preventing the disease in contacts.
Because this strain of swine flu has a moderately high mortality (about 6%), it is worth taking Tamiflu. It is not worth it for standard flu and definitely not worth it for colds. However, Tamiflu is no substitute for good disease control measures. What if the virus mutates to a resistant form? What about those countries that have little or no access to antivirals?
The mantra of disease control is Quarantine, Isolate, vaccinate, eliminate. I don’t see the word Tamiflu in there.
Apr 28 09 10:17 am
MD, NZ1 originates in LA, not Mexico, Sinner is correct in that to isolate all flights originating from places that might have passengers from Mexico on would eliminate all Eastward travel. Difficult. Perhaps one should specifically isolate those who have been to Mexico, not sure if US Citizens would have documentary evidence of such travel in passports.
Also a note for Andy C, a possible reason why this strain, like the 1918 pandemic strain, kills mostly young otherwise healthy people in late teens to early 30’s, is that the over reaction of the bodies immune system is the cause of the pneumonia that actually kills.
And just as a sort of interesting fact, my mother-in-law is one of what must be a very small group of people still alive who actually caught and survived the 1918 influenza, although she was very young at the time.
Apr 28 09 4:41 pm
Thanks for your reply. However, it seems a moot point to me that Tamiflu doesn’t appear to form part of our disease control plan. It appears that under the Health Act if an epidemic notice is issued we could all be directed to submit to whatever preventative treatment the Medical Officer of Health prescribes for us (s70(1)(h)), so in the absence of a vaccine, we will probably all be submitting to Tamiflu injections as a preventative measure, don’t you think? I think that would make the issue quite relevant, and I wouldn’t mind a little peace of mind!
Also, do you think that the word of mexican doctors who are saying that Tamiflu is reducing the severity of the swine flu really holds any water? Does any medical professional in NZ really care about the clinical findings of a mexican doctor? From a layman’s perspective, I think it is really a stretch for those doctors to make a statement like that- unless Tamiflu has quite obviously brought people back from the brink of death, and I would have thought that you as a doctor would have been even more sceptical, based on the terrible prior performance of Tamiflu.
Also, isn’t the resistance of Tamiflu a secondary issue, as no-one should care about the swine flu developing resistance to an ineffective drug?
I also think that here in NZ it is easy to see that only vague platitudes have been made regarding the usefulness of Tamiflu as a preventative treatment for a possible pandemic. It seems that people are content to rely on the weak 3rd hand experience of mexican doctors and the WHO, and also to apply that anecdotal evidence to our NZ situation without much regard to context.
The facts are that we don’t have swine flu here, and if those people who came back from Mexico do have it, then we adults have nothing to worry about as the disease couldn’t even give pause to the immune systems of a bunch of teenagers. We simply have not been exposed to that 6% morbidity rate here, and therefore I think that the obvious risks of prescribing Tamiflu even to potential contacts will significantly outweigh the preventative benefits for us, just as it has in the past.
Apr 28 09 7:19 pm
Johnnieboy: Tamiflu is a course of tablets, rather than an injection. It is also a treatment rather than a vaccine. While it may prevent a contact from getting the swine flu, there is no way you can be forced to take it. Public health have the right to isolate you, but not to enforce treatment. They can not force you to be vaccinated, either.
Also vaccination is only an option if this disease becomes pandemic AND remains as deadly as the Mexican strain.
Apr 28 09 8:26 pm
Well, in case someone might want to shed further light on this legislation, here it is:
Health Act 1956
Part 3: Infectious and notifiable diseases
70 Special powers of Medical Officer of Health
(1) For the purpose of preventing the outbreak or spread of any infectious disease, the Medical Officer of Health may from time to time, if authorised to do so by the Minister or if a state of emergency has been declared under the Civil Defence Emergency Management Act 2002 or while an epidemic notice is in force,—
(f) Require persons, places, buildings, ships, vehicles, aircraft, animals, or things to be isolated, quarantined, or disinfected as he thinks fit:
(h) require people to remain in the health district or the place in which they are isolated or quarantined until they have been medically examined and found to be free from infectious disease, and until they have undergone such preventive treatment as he may in any such case prescribe:
Apr 28 09 9:40 pm
Johnnieboy: All that means is that the public health guys can put you into quarantine whether you like it or not. It is the same in any other country. Note that they can’t force you to take treatment or a vaccination without your consent.
Apr 28 09 9:59 pm
Hi,
will not repeat this info and only supply it as you’re one of the few good sources of medical info on the web in NZ:
Was at a NAMRU facility about a year ago and they assured me that Bird Flu was **not** the problem and instead were a bit worried about swine flu and old/new strains of spanish flu.
Current outbreak is awful, but Christ, its hard not to say I told you so since Profs and Scientists in our Dept and also the CDC have been so excessively fixated on bird flu (H5N1). NOW, they’re trying to spin this largely unrelated Swine Flu thing as I told you so as if it was bird flu. If only my job was that easy to justify.
Just letting you guys know that even the authorities on this are currently bamboozled and FOS
Thanks for the info, Squirrel. Can’t say I’m surprised.
Apr 29 09 12:46 am
Well, thank you, I appreciate knowing your opinion as a man in the trenches on this one who may have already dealt with this legislation in practice.
However what you are saying is contradicted by (h) above. If you take it literally (in the presence of an epidemic notice), the section gives wide powers to quarantine, isolate, and treat affected individuals, without specifying any limits as to the number of those individuals.
Informed consent doesn’t seem to enter into the equation as other parts of the Act make it an offence against the Act to neglect to carry out directives made by the Medical Officer of Health under the Act, and entitles the use of force to achieve the Med OH’s objective’s. It sounds pretty simple, & I think that it’s meant to be. However if somehow I’m reading it wrong, or public policy is out of step with the legislation or the above is impractical in real life and unlikely to be implemented then ok.
I’m only asking as I like to call a spade a spade, and want to know what could happen in future, and my rights in the brave new world, as we all do- Any ideas? Cheers.
Apr 29 09 1:10 am
Johnnieboy: Technically you are correct. But even in my most paranoid state, I can’t really conceive of one of my colleagues holding you down and vaccinating you or shoving you full of Tamiflu.
If you then sued him, he would have to prove in a court of law that you were, indeed, an unequivocal danger to public health. That would be harder than it sounds, as the burden of proof rests on the public health officer and the standard of judgement would be the same as a policeman shooting a criminal.
Apr 29 09 1:20 am
Well, yes, it does seem paranoid, but here is the legislation relating to personal liability under the epidemic notice…
s70
(3) In no case shall the Medical Officer of Health, or any Environmental Health Officer or assistant or other person, incur any personal liability by reason of anything lawfully done by him under the powers conferred by this section.
Whether we can conceive of being treated against our will or not, our rights appear to be crystal clear(?) It appears that in exchange for this liability waiver, citizens can sue for compensation (from the Crown?) under
s71
(2) Every person who suffers any loss or damage by the exercise of any of the powers conferred on the Medical Officer of Health by this section shall be entitled to compensation to be determined in case of dispute by a District Court, whose decision shall be final.
Apr 29 09 1:41 am
Johnnieboy: The wording is “incur any personal liability by reason of anything lawfully done by him under the powers conferred by this section”. Assaulting you with a vaccination needle without a really, really good reason would be very dubious legally.
Take it from me. I get similar powers “conferred” on me whenever I certify someone mentally unsound under section 21 of the Mental Health Act. I have only ever once had to “force” treatment on a patient under this act, and he was having a full-blown paranoid meltdown and was very dangerous. Every other time, we use persuasion.
I reiterate that this is not an unusual Act. Public Health Acts the world over confer these sorts of powers onto the public health officer. It is the only way to ensure that Public Safety is preserved in an emergency like an epidemic. There are always a few idiots who think they know better than the doctor and try to break quarantine, putting everyone at risk.
Apr 30 09 7:18 am
Hi Macdoctor. Thanks for an informative and balanced blog. I am teacher, and have just had an interesting parent teacher conference with an extremely paranoid parent demanding to know what the school’s response was to the FLu pandemic! I was possibly a bit to dismissive and suggested he research a bit more on the illness itself to ease his mind… After reading a bit more myself, I’m not sure he will feel any better! At what point will schools/ public institutions have to start thinking about any procedures at all?
Thanks
About your only response as a school is to insist that parents keep their children with symptoms home in isolation. Many will still try to bring them to school with the “it’s just a cold” story, so you will need a policy in place enforcing this.