Effect Measure

The opportunistic flu virus

Mon, 06 Jul 2009 06:36:16 -0500

Flu virus is opportunistic. It takes advantage of any weakness. Seasonal flu picks on the very old and the very young, but pandemic flu has found us old folks tough and the younger amongst us quite tasty. No natural resistance seems to be a flavor enhancer. And pre-existing medical conditions? Quite delectable. So how full is the menu in the prime age range? CDC has just released one of their Quickstat summaries based on household interviews with a sample of the civilian, noninstitutionalized, adult U.S. population. The question the sample was asked was whether a doctor or other health professional had ever said they had any of a list of chronic conditions. If the answer to asthma was "yes," the follow-up question was, "Do you still have asthma?" Here are the results for young adults, those between the ages of 18 and 29 years old, also a prime age group for the swine flu virus:

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UK Health Minister: exponentially dumb

Sun, 05 Jul 2009 13:14:30 -0500

I have a lot of respect for civil servants. It's a noble task, nobler than what most of us do. But there are times when I just want to shake my head. The UK government has not exactly distinguished itself in the swine flu area, first putting pressure on WHO to hold off declaring a pandemic, then looking the other way when cases started to skyrocket in their backyard, and now . . . well, it just makes me want to shake my head:

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Freethinker Sunday Sermonette: when the winner is a loser

Sun, 05 Jul 2009 07:13:27 -0500

Turkey is supposedly a secular state but has been pitching toward theocracy in recent years. Whatever its military wants, much of its population is still fairly religious, so it's of interest that a bizarre new television game is about to debut there:

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Dependence Day: we're all singing from the same score

Sat, 04 Jul 2009 19:42:09 -0500

I don't know what's going to happen with swine flu. I do know that if there is a nasty flu season we'll all get through it better if we help each other, not run from each other. It's national independence day in the US, so I thought this clip of the crowd singing the National Anthem (hat tip, Paul Rosenberg at Open Left) at Boston's Fenway Park (home field of the Boston Red Sox baseball team) was appropriate. It was Disability Awareness Day and to recognize it the anthem was being sung by a handicapped youngster. When he got nervous, the entire ball park came to his rescue:

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Swine flu and auto accidents

Sat, 04 Jul 2009 06:38:10 -0500

The number of people who die from seasonal flu every year varies greatly from year to year. No one really knows what it is. The most frequently (mis)quoted figure is 36,000 deaths directly or indirectly, although this figure is a long term seasonal average of excess mortality correlated with flu season. We discussed this in more detail in an earlier post and for the purposes of this one, only the rough order of magnitude is pertinent. Let's just say it's in the tens of thousands -- roughly. Let's also agree on the several hundred thousand hospitalizations from flu or flu related illness -- on average. It turns out that this is roughly the annual mortality from motor vehicle accidents (41,000) and about half the hospitalizations from car accidents (around 500,000). There are roughly 4 million emergency department visits for motor vehicle related injuries (CDC). So with seasonal flu we are talking about a public health problem in the same league as another major issue, death and injury from car wrecks. As long as we are making the comparison, let's pursue some other similarities.

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Swine flu animal experiments

Fri, 03 Jul 2009 07:01:19 -0500

It's not even three months since the first H1N1 swine flu cases were diagnosed in San Diego, but already there is a significant amount of science published on the subject. Lots of genetic sequences from various isolates, clinical descriptions of hospitalized and fatal cases and now animal experiments. Two teams, one in The Netherlands and one in the US, have infected ferrets and mice with pandemic H1N1 isolates from Europe, the US and Mexico and compared transmissibility, virulence and pathology with seasonal H1N1 strains. The two papers were published yesterday in the journal, Science (papers here and here).

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Testing for swine flu

Thu, 02 Jul 2009 06:48:52 -0500

The first cases of swine flu were diagnosed in the US in San Diego in mid-April. The discovery was serendipitous, the result of out-of-season US-Mexican border surveillance and use of a new diagnostic test at the Naval Health Research Center. When the new test protocol showed infection with influenza A with undeterminable subtype, follow-up testing showed it to be an previously unknown swine flu virus. Detection of a second, apparently unlinked swine flu infection in San Diego got the outbreak (now pandemic) investigation rolling.

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Tamiflu and adverse effects

Wed, 01 Jul 2009 06:12:49 -0500

For reasons not revealed to anyone I know, WHO is saying the Tamiflu resistance in a Danish swine flu isolate is "isolated case." Could be, but I'd sure like to know why they think so, other than they don't have any other examples. Meanwhile WHO and CDC continue to advise prompt use of Tamiflu (oral oseltamivir) for treatment of swine flu in high risk patients. Which brings up the question of side effects.

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Swine flu and Tamiflu resistance

Tue, 30 Jun 2009 06:30:07 -0500

Currently the only antiviral drugs effective against the swine flu (novel H1N1) virus are the two neuriminidase inhibitors, oseltamivir (trade name Tamiflu) and zanamivir (trade name Relenza). Relenza is in active form at the outset and cannot be absorbed orally. It must be inhaled, leading to asthmatic reactions in some, ineffective dosage in those with breathing difficulties, and no drug at sites beyond the respiratory tract. Despite these drawbacks, it has so far produced little or no viral resistance. Tamiflu is absorbed orally and converted by the liver into the active form, so it gets to other organs and can be taken by people unable to inhale Relenza. But it has other problems. One is a tendency for the flu virus to become resistant to it. Until today, however, there have been no reports of Tamiflu resistance in swine flu isolates, although most flu experts were waiting for the other shoe to drop. Today may have been the day we heard it fall:

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Taking the measure of the swine flu pandemic

Mon, 29 Jun 2009 06:54:46 -0500

Crafting a message on swine flu is not easy, and it's easy to make missteps. I think CDC has gotten it pretty much right over the last two months, but not everyone has. We've written here since the beginning (some examples here and here) that describing any flu outbreak as "mild" is inapt. Flu always has the potential to be a serious disease and kill people, even in flu seasons termed "mild" by comparing them to flu seasons that are "bad." Even with virulent flu viruses many people have minimal illness -- in comparison to those who don't. But flu, even in its most common form of a self-limiting illness with complete recovery, is often a miserable affair during its acute phase and it can leave a person debilitated for extended periods afterwards. For some there's nothing mild or self-limiting about it. A bout with the flu becomes a mortal threat that can make good on its fatal potential.

Now the frequent use of "mild" by public officials to characterize swine flu is causing concern:

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More prepping for the swine flu pandemic

Sun, 28 Jun 2009 13:07:04 -0500

A few days ago we posted about hedge funds getting ready for a swine flu pandemic. At the time we wondered what other industries and businesses were getting ready. We don't know the answer, but we are seeing more signs the message has gotten through. Yesterday we saw this story about a regional airport in Arizona:

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Freethinker Sunday Sermonette: what I have against religion

Sun, 28 Jun 2009 06:20:30 -0500

There is a misconception that because I am an atheist and poke fun at religion in this space every Sunday that I must have contempt for religion for its own sake. It's true I find many of the pious contemptible, but not because they are pious. You can be stupid in all sorts of ways and that's just one of them. Nor do I go after religion and the religious because they believe in one of the many gods people have made up. There are a lot of ways to be irrational. Look at Wall Street. No, I go after religion because it represents a particularly nasty form of tribalism, a set of beliefs that distinguish some human beings that are in any meaningful way indistinguishable on the basis of what superstition they hold. It's like discriminating against people who carry a lucky rabbit's foot but a hundred times more consequential. If religious views were just some kind of personal enthusiasm, like an interest in knitting, I wouldn't care. No one says that non-knitters are inferior or should be killed or denied membership in your country club. But alas, religion isn't so benign. It erects artificial barriers between people and then attacks those on the other side of the barrier. As a form of tribalism, religion is frequently deadly and can't be broken of its vicious habits.

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Swine flu: to every thing there is a season

Sat, 27 Jun 2009 06:34:36 -0500

Early returns on what is happening in the southern hemisphere suggest that novel H1N1 is crowding out the expected seasonal strains, something that pandemic strains have usually done. In 1918 there was a pandemic with the H1N1 subtype that settled down as the dominant seasonal flu virus until the "Asian flu" pandemic of 1957 when it was bumped by H2N2. That subtype ruled the seasonal flu roost for only 9 years when a new subtype, H3N2 took its place in the Hong Kong flu pandemic of 1968. Both pandemics were much less severe than 1918 but still resulted in millions of excess deaths globally. In 1977 the pattern was interrupted with the return of H1N1, which didn't take the place of H3N2 but co-circulated with it. Since then we've seen mixtures of H3N2 and H1N1 each flu season, with sometimes one subtype much more prevalent, sometimes the other (a hybrid H1N2 made a sporadic appearance in 2002 but never gained a foothold and didn't represent a novel appearing virus to the population). Sometimes H1N1 and H3N2 would switch places at some point in the flu season, but those two, along with influenza B have made up seasonal influenza since 1977.

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Iran eats its seed corn

Fri, 26 Jun 2009 06:27:11 -0500

Science may know no borders but scientists have nationalities. Many live within the countries where they have citizenship, while many travel to where they can do more and better science. In the 21st century no nation can afford to squander its scientific talent. But some do it, anyway, either in small ways (failing to support science) or in Big Ways (oppressing free inquiry and free expression). No country is perfect, but some excel in this kind of stupidity. Even before the recent national uprising Iran's government was distinguishing itself in the irrationality and anti-science department (see here, here, here). Now we are seeing it in full flower:

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The politics of swine flu's origin

Thu, 25 Jun 2009 06:58:52 -0500

A story in yesterday's New York Times was headlined: In New Theory, Swine Flu Started in Asia, Not Mexico. That sounded pretty interesting. What's the new evidence? The answer? None. Just speculation. So what's going on?

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