WhiteCoat

When Pigs Fly

flying-pig-weathervane[I'm sure that everyone will be tired of hearing about the swine flu by next week, but I'll leave this post stuck to the top of the blog for a little while and will add links to the bottom so that those who are looking for more information can easily access it.]

Who ever thought that this phrase might be applicable to everyday life?

With the current swine flu having genetic components from N. American swine influenza A, European/Asian swine influenza A, N. American avian influenza, and N. American human influenza, it just goes to show you …

I’m not going to add any more pithy statements, but did want to give everyone a few resources to look at for more information about the swine flu.

First, EP Monthly just posted an excellent article about swine flu here. There are also several pertinent questions in the comments section of the article that are worth reading. One commenter notes that there is no Tamiflu left in the pharmacies in his city. The article will be updated when more information becomes available, so check back if you have questions or even consider posting a question in the comments section yourself.

Second, the government site for information regarding swine flu is here.

WebMD also has a swine flu center that is updated regularly.

UPDATE APRIL 29, 2009
Swine flu described as “uncontainable” – USA Today
First US fatality from swine flu is 23 month old Texas child – AP #1, AP #2
Vaccines for swine flu likely not available until November – NY Times.com, LA Times
Do masks help prevent swine flu? ABC Houston
Mexican government shuts all nonessential functions to fight flu – MSNBC

UPDATE APRIL 30, 2009
Thanks to James for this link – http://doihaveswineflu.org/
Don’t run to the ED with runny nose and cough – El Paso Times
“No safer place than home to avoid being infected with flu virus” – Felipe Calderon

UPDATE MAY 1, 2009
Hospitals swamped amid flu fear – LA Times
[quote from article: "The pressure has been to close excess beds and get lean," said Columbia's Redlener. "Lean is not your friend in a pandemic."]
Lack of funding affects hospital’s ability to respond to prolonged flu outbreak – San Jose Mercury News
Press release from American College of Emergency Physicians regarding swine flu – ACEP.org
Caring for influenza at home – CDC.gov
US sends Tamiflu to Mexico, purchases 13 million more courses of treatment from manufacturers – Reuters
More Tamiflu use = higher likelihood Tamiflu resistance – Bloomberg.com
—–

22 Responses to “When Pigs Fly”

  1. Susana says:

    We’ve been hearing about the swine flu constantly here in Mexico City and it seems we just can’t get enough of it. I find that when things get scary people crave information. Maybe because the cases in the US have been mild people are not as avid, but we’ve had quite a few deaths here.

  2. SeaSpray says:

    I’m not ready to embrace the idea of a flu epidemic.

    So..I am bypassing links for now.

    I do have one question though.

    We see pictures of people wearing masks to protect themselves.

    I thought masks are only effective for about 15 minutes.. or a short time?

    • WhiteCoat says:

      Since flu is spread by water droplets, masks serve as a barrier to prevent water droplets from spreading person to person.
      If someone sneezes in your face, it is likely that you will inhale some of the water droplets in that sneeze. If that person has influenza, it is likely that you will then be inoculated with influenza. If you were wearing a mask, it is much less likely (although not impossible) that you would inhale water droplets from the sneeze. If the other person was also wearing a mask, it is likely that the water droplets from his sneeze would be contained.
      Masks don’t control the surface to surface spread of disease. If someone with influenza wipes their nose with their hand and touches a doorknob, the next few people who touch the doorknob – even if wearing masks – will still have the virus on their hands.

  3. toni says:

    Any thoughts on why they released info on a toddler dying in Texas of the swine flu but then gave NO DETAILS! I think at the very least they could provide details about the state of health of the child prior to infection, delayed treatment, no treatment, or did they cross over from the border then die. It is a child but come on people are going to PANIC. Please let me know your thoughts. I am prone to panic cuz hello I work in the ER and I am sure that people are going to be coming in and coughing all over everything and everybody but perspective tells me that it still may be for nothing. This flu responds to antivirals, right? Some stats on how well it helps would be greatly appreciated.

    • WhiteCoat says:

      Probably little is known about the child at this point, but I’m sure that more details will be disclosed as more is learned.
      I also believe that there is some degree of hesitancy to disclose the virulence of this virus. If the news agencies started posting repeated reports of how people were dying of swine flu in the US, the public would panic and our whole economy would shut down.
      The flu does respond to antivirals, but the million dollar question is when to start taking the antivirals. At $15-$20 per pill, few people can afford to take Tamiflu indiscriminately.

    • k says:

      Toni, there are plenty of details in the San Antonio Express News. The child had underlying health problems prior to entering the US (as yet unspecified). He entered the US April 3, didn’t get sick until April 8, was hospitalized April 13, and died from pneumonia caused by flu April 27. No swine flu cases have been reported thuis far among the child’s close contacts.

  4. HyperAl says:

    More interesting is the case Notre Dame student who has no recent travel history but was positively diagnosed to have the Swine Flu. The facts on where and how he got it is not yet known. I’m sure having this information will shed more light to the nature and characteristics of this virus and hopefully help us contain the spread of this infection.

  5. Pink says:

    But, WC, don’t thousands of people die from Influenza B too? Seems like, at least what I have read, that A is not as debilitating as B. So what’s the big fuss?

    • WhiteCoat says:

      Approximately 30,000 people die from influenza each year in the US. Then again, I’ve read estimates where up to 30% of the US population catches the flu each year. On a percentage basis, then the number of people dying versus the number of people who contract the disease is quite low.
      The virulence of swine flu is much greater – more people who contract it will purportedly die. Most likely because no humans have built up immune defenses to the porcine or avian components of the new bug. The US hasn’t seen the percentage of deaths reported in Mexico — yet. But if there is a 30% infection rate (probably a low estimate) and 6% of people who contract the disease die (as they are reporting in Mexico), then we’re talking about 6-8 million deaths just in the US.
      That’s the big fuss. “Virulence” is key.

  6. WC, I ask again: do you have any knowledge regarding whether or not the swine flu vaccine I received in the 1970’s, probably around the time of your birth, is still effective against the current strain or is another shot in my future? You are my shortcut on the yellow brick road. Being the Gotama Buddha of such knowledge that you are and the limited time I have for research. I am seeking your assistance in this matter.

    Thank you in advance for your attention despite a myriad of other minor distractions (smile).

    • WhiteCoat says:

      I can say that I do not know for sure.
      However, my hunch is that you are not protected. It would have to be the same or similar strain of swine flu. Even if it the previous and similar strains were similar enough to afford immunity, then your immune system would still have to “remember” back that long – i.e. you’d have to have sufficient titers of antibodies in your system to recognize the virus now.
      Given that most immunization “boosters” are at about 10 years, I don’t think the 30 year window in your case would cut it.
      This is all speculation on my part, so if someone else with an immunology background can shed some light on the matter, please do so.

  7. Maybe if my spelling was more accurate I’d have a better response: “Gautama” not “gotama”, dammit.

    Bet-tuh.

  8. paul says:

    4/29 my first shift since the start of the swine flu media hysterics- instructed by my institution to only swab those with fever and respiratory symptoms.

    well i saw 5 people with cough, claiming to have been febrile at home but afebrile in the ED. protocol is to do a rapid flu swab, and if positive for A give a second sample to the cdc for specific testing for swine flu.

    5 people swabbed…. zero positive for A or B.

  9. paul says:

    4/30 in fast track today and as soon as i walk in admin tells me that flu swabs must now be restricted to patients that actually appear ill. which theoretically should not apply to anyone i see in fast track so it looks like i’ll be doing a lot of arguing today… first, to tell them they will get no flu swab. second, to tell them they will get no antibiotics for their viral uri. possibly third, to argue against tamiflu… *sigh*

  10. white coat, run do not walk to edwin leap’s take on the swine flu..it’s a classic. P.S. does bumping my head while making a burrito equal stat head ct, nasal swab and anti-viral? are you er guys feeling a double whammy between poor natasha and the swine flu?

    • paul says:

      yep. had my fair share of “i bumped my head and don’t want to die like that famous lady” cases the past 2 weeks.

      clinical skills go right out the window when that 1-in-a-million missed head bleed will take you to court, and besides i don’t have to pay for the cat scan anyway so who cares?

      managed to talk a few of them out of unnecessary scans using some data out there for the “head ct rules” and plain reassurance… but most would have none of it.

      when i was a resident i told a few people “you’re more likely to get a tumor from the radiation than for the scan to show an intracranial bleed” but i stopped because it mostly just pissed people off.

  11. k says:

    WhiteCoat, any opinions on good reasons to prescribe Tamiflu? In this economic climate, it seems that Tamiflu would encourage “presenteeism” rather than getting sick people to stay home. In the case of this particular flu, might it be better to use such drugs prophylactically in specific populations, e.g. ED physicians or primary care doctors?

  12. Ella says:

    I do like your good big website i read some others that are on vaguely the same subjets, sometimes its a bit difficult reading them as i dont speak very good english.

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