Swine Flu: Current Status and Worst Case Scenario

My pseudonym is accurate. I am a practicing physician. As such, I thought I'd share my understanding of the emergence of this new "Swine Flu" outbreak. I'm not a virologist, nor an infectious disease specialist, but the story of this influenza outbreak seems straightforward enough.

Influenza viruses seem to percolate and transmit in animal populations such as birds (avian) and pigs (swine), and periodically acquire the ability to infect people (such as SARS). Viruses tend to mutate quickly, and this is why the flu vaccines we make each year change: the viral antigens (proteins or glycoproteins that our immune system can "see") change from year to year. So the vaccines have to change too, enabling our immune system to "be ready" for the mutated viruses.

On the other hand, sometimes totally new viruses emerge: new combinations of swine, avian, and human influenza viruses. When this occurs, as is the case now, no previous vaccine or previous infection will afford any protection from the new virus. The "Swine Flu" virus now spreading around the globe is a unique and novel combination of swine, bird, and human viruses.

Unlike SARS, which was an avian virus with relatively low human to human transmission, this new virus appears to readily transmit between humans. Fortunately, except in Mexico, this new virus has, so far, produced a relatively mild case of the flu. There is only one report of a hospitalization in the U.S., but no serious illness. Also, no increase in ER visits has been noted, which the CDC and local health departments monitor closely.

Fortunately, researchers report that this new virus does respond to Relenza (GSK) and Tamiflu (RHHBY.PK and GILD), the two anti-viral compounds that are readily available and in mass production. That's the good news, so far. A new virus that has produced a mild case of the flu outside of Mexico, but, does transmit easily from person to person.

The fear. The worst case scenario and the one that keeps some infectious disease specialists up at night is the so-called Spanish Flu of 1918-1920. Researchers are still unclear about the precise orgins of the Spanish Flu Pandemic, but it appears to have originated as an avian virus, done some genetic recombination in pigs, and acquired the ability to infect and transmit between humans around 1918. The Spanish Flu virus was highly contagious, and had a mortality rate of up to 2% of infected individuals. A typical flu has a mortality rate of about 0.1%.

Unlike a typical flu outbreak, which tends to have the highest rates of mortality in the very old and the very young, the Spanish Flu had the highest mortality in those that were the healthiest: young adults. Researchers believe that the Spanish Flu killed by a couple of different mechanisms, including direct viral destruction of the lungs, or, triggering a massive immune response against the virus in the lungs, or, by setting the stage for a secondary bacterial infection after the virus itself had faded (there were no antibiotics in 1918).

The morbidity and mortality of the Spanish Flu of 1918 was somewhat obscured by World War I at the time. But the world wide pandemic's effects were staggering: estimates of up to 50 million dead world wide, with some localities all but wiped out, striking even the most isolated villages in the Arctic and the South Pacific.

The current "Swine Flu" of 2009 appears to transmit readily from person to person, but, except in Mexico, has been mild and without mortality. The fear is that the virus could mutate into a far more virulent and potentially lethal form. Indeed, the Spanish Flu of 1918 had a "first wave" in the spring of 1918, as a fairly mild viral inflection that was noted in just a few newspapers at the time. It re-emerged in the Fall of 1918 as perhaps the most lethal human to human infection in recorded history.

The closest historical analogy to the human toll of the Spanish Flu of 1918 is the Bubonic Plague that killed about 1 in 3 Europeans in the 1300s. The Plague was caused by a bacterium transmitted from rodents to humans via fleas. The Bubonic Plague is treatable with conventional antibiotics and makes an occasional appearance in real life, as well as medical school exams and television shows.

It is too early to be able to write off the current "Swine Flu" as a non-event. The "Mexican Flu of 2009" is a novel flu that has resulted in some mortality in Mexico, and is spreading rapidly throughout the world. Hopefully, the virulence of the virus will remain low, a vaccine will be manufactured and distributed, and there won't be much more to it than that.

Disclosures: None currently

Comments

[User 403388:]

Whoa, Reuters linked to this.

I didn't even know they did that sort of thing.
www.reuters.com/articl...

Apr 28 06:42 AM

[redbaron:]

Well written and informative. Thank you for sharing your knowledge on the subject, Doctor.

Apr 28 07:01 AM

[mac123449:]

I heard this one has a 7% mortality rate in mexico this is going to turn into a pandemic almost is already just a matter of time it has to incubate in people here first takes about a week for deaths to show up just like mexico. deaths could be as high as 1 billion people dead wonder if CNBC will say but it's better then expected lol.

Apr 28 09:22 AM

[Vince$:]

mac123449 ,

The kids in NY have aready started recoving. Saw a couple interviewed saying it was mild, compared to what's going on in Mexico.
Why is it less harsh here in US? My guess is better hygene and better nutrition than in Mexico.

Apr 28 09:50 AM

[papagiki:]

Thanks for your objective report. Please keep us posted as data develops.

Apr 28 09:58 AM

[kelm:]

Good article. If we look at the number of cases reported in Mexico and the incidence of mortality then it appears that mortality is in the 7-9% range, but that is a very misleading way of looking at the numbers as we have no idea how likely someone suffering from mild flu symptoms in Mexico is to go to the doctor. If we applied the same 7-9% number to the rest of the world's diagnosed cases then it is almost certain we would have seen mortality elsewhere yet we haven't. Possibly there is some other risk factor that has not been identified.

Apr 28 10:42 AM

[Larrysyr:]

Thanks for the info.

The media can whip up a devastating worldwide crisis from the smallest piece of information. Every so often, such things happen, but not with the regularity we'd perceive just by watching the news.

I'll echo Papagiki - please keep us updated.

Apr 28 10:51 AM

[Trane250:]

I have personal experience of this type of illness. It was January, 1968. I was a college senior in excellent health. I was walking back to my room after my last Saturday class when I suddenly felt dizzy. Somehow, I made it back to my room downtown but within a short time, I couldn't even stand up. A fellow roomer helped me to the infirmary. I was there for 10 days but have very little recollection of what happened during that time. I do remember when the fever broke. They had to change the bed linens 3 times. It took me a month after discharge to regain my strength. I learned later that what I had was a stub of the 1918 Spanish flu. Let's hope that the Mexican swine flu is nothing like the Spanish flu of 1918 and 1968.

Apr 28 11:16 AM

[TLassen:]

Thanks for an informative and well written article.

Apr 28 12:18 PM

[Plan B Econ...:]

Always better to get this type of information from doctors, scientists and health-care researchers/workers rather than the media. A nice does of rationality feels good once in a while.

In most cases the media has no idea what it is talking about and either gravely overconfident or stupidly pessimistic.

Apr 28 02:42 PM

[Dr. O:]

Thank you for the kind remarks. It's nice to be able to contribute an article in my "comfort zone."

I had done some reading about the Spanish Flu, and was keenly interested when scientists sequenced the viral genome, and published it. Some people including myself thought that was a mistake, for obvious "bio-terror" reasons.

The Mexican flu appears to be a different subtype. The key factor is the "virulence" or the severity of human illness. The virulence of this flu virus may have diminished since its formation in Mexico, as viral genomes can mutate rapidly. Lets hope it doesn't mutate to a more dangerous form before a vaccine is available.

Apr 28 03:08 PM

[anarchist:]

I live in Mexico, thankfully a long way from the Capital. The schools have been closed, all public events in the near future have been canceled (at least in our city) so there is some efforts being made to stop the spread of the virus. As far as mortality goes I am guessing that the numbers of deaths is more accurate than the number of those infected (there bye giving a statistical lower % of deaths) since that would entail an exchange of medical information regarding symptoms from all parts of the country and the communications infrastructure for this kind of information gathering is not available.
Other than administering Relenza or Tamiflu there isn't much a doctor can do other than isolating the patient and that takes a lot of resources to isolate thousands of people which are not available here. Why the virus is more virulent here is an interesting question. I doubt that it has to do with nutrition but there must be some risk factor not recognized yet if indeed the virus is more virulent here.

Apr 28 03:28 PM

[MarvinMBA:]

This was extracted from the NNVC.OB board on Yahoo Financial
The drug is in development and will soon be moving to phase 1.

The media is awash in an influenza frenzy. There is a good chance that swine flu will continue to spread. In a worst case scenario where it has infected millions, do you think people will care whether or not cures have gone through testing? This drug works, their data says so. If you want it please feel free to contact their investor relations.

Regardless of 'bad' scenarios, try to find me one other company that has an anti-viral NON VACCINE cure for influenza, and you will find none. Even CVM's cure works in a vaccine capability.

Vaccines rely on the antibodies of the person infected to fight them off while nano-viricides target the influenza virus specifically.

Vaccines only work for the strain they are specifically developed for, because antibodies that get created by the body are very specific, and though two flu may have similar symptoms and dangers, the antibodies distinguish them based on their different strains.

nano-Viricides and other anti-virals target the virus specifically regardless of what strain it is. Nano-Viricides however has the benefit of being the first drug that is effective against flu. Other anti-virals are not.

This company has NO DEBT. The company is not in any danger of going bankrupt because of the importance and the potential profit of their drugs. Investors could easily be sought out, and I'm sure a company with such potential is constantly doing just that, looking for investors.

The movement that this stock is currently taking is as a result to global attention to the influezna pandemic currently taking place. Though the volume may fade, the importance of finding cures for dangerous pandemics will become much more of a priority as time goes by. The estimation for damages of the swine flu pandemic so far half a trillion dollars according to bloomberg. Investing in the only company that bodes positive data for a cure to influenza is not only the smart and profitable move at this level, but it is a reflection of the entire movement of global health to protect and support companies that can in the future protect such half trillion damages from taking place at all, by curing the virus.

Apr 29 10:34 AM

[ETFdesk.com:]

This story is still developing and will continue to do so. Keep in mind, during the Spanish Flu in 1918, the outbreak started relatively mild in the spring and was emerged in the fall to be extremely deadly. This will likely take a toll on Mexico as it is already struggling and such a calamity will hit it hard. As of now, it seems the economic effect in the US will be more about sentiment and the ancillary effect of Mexico's woes. That being said, there is still great potential for the virus and economic damage to spread.

Apr 29 12:35 PM

[safariman:]

Looking at recent epidemic modeling studies, I've learned that neither quarantine nor even significant world travel curtailment do much to affect the ultimate range or mortality of a disease. We don't have much of an idea yet whether the current swine flu will become a serious event or not. What does seem clear is that costly emergency preparedness procedures are ineffective, and significant travel restrictions will be counter-productive.

Disease spreads. More travel and commerce may makes it spread faster, but will not likely affect the range or mortality of the disease. No area of the world, no matter how remote, seemed to escape the Spanish Flu epidemic of 1918. Despite draconian public health regulations nearly everywhere.

Vaccines and antivirals seem the best, and less intrusive option.

Apr 29 01:45 PM

[Sandokan:]

A combination of swine, avian, and human influenza viruses resulting in the H1N1 virus that we experience now has high probability of it been hatched out in a laboratory & probable mishap has caused the pandamic we are in now......

Jul 17 02:56 AM