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Swine Flu update from a doctor

April 29, 2009
After I returned from a public health meeting yesterday with community leaders and school officials in Comal County , Heather suggested I send an update to everyone, because what we are hearing privately from the CDC and Health Department is so different from what you are hearing in the media. Some of you or maybe all of you know this, but I will just list what facts I know.

- The virus is infectious for about 2 days prior to symptom onset
- Virus sheds more than 7 days after symptom onset (possibly as long as 9 days) (this is unusual)
- Since it is such a novel (new) virus, there is no "herd immunity," so the "attack rate" is very high. This is the percentage of people who come down with a virus if exposed. Almost everyone who is exposed to this virus will become infected, though not all will be symptomatc. That is much higher than seasonal flu, which averages 10-15%. The "clinical attack rate" may be around 40-50%. This is the number of people who show symptoms. This is a huge number. It is hard to convey the seriousness of this.
- The virulence (deadliness) of this virus is as bad here as in Mexico , and there are folks on ventilators here in the US , right now. This has not been in the media, but a 23 month old near here is fighting for his life, and a pregnant woman just south of San Antonio is fighting for her life. In Mexico , these folks might have died already, but here in the US , folks are getting Tamiflu or Relenza quickly, and we have ready access to ventilators. What this means is that within a couple of weeks, regional hospitals will likely become overwhelmed.
- Some of the kids with positive cases in Comal County had more than 70 contacts before diagnosis.
- There are 10-25 times more actual cases (not "possible" cases -- actual), than what is being reported in the media. The way they fudge on reporting this is that it takes 3 days to get the confirmatory nod from the CDC on a given viral culture, but based on epidemiological grounds, we know that there are more than 10 cases for each "confirmed" case right now.
- During the night, we crossed the threshold for the definition of a WHO, Phase 6 global pandemic. This has not happened in any of our lifetimes so far. We are in uncharted territory.
- I expect President Obama will declare an emergency sometime in the next 72-96 hours. This may not happen, but if it doesn't, I will be surprised. When this happens, all public gathering will be cancelled for 10 days.
- I suggest all of us avoid public gatherings. Outdoor activities are not as likely to lead to infection. It is contained areas and close contact that are the biggest risk.
- Tamiflu is running out. There is a national stockpile, but it will have to be carefully managed, as it is not enough to treat the likely number of infections when this is full-blown. I don't think there is a big supply of Relenza, but I do not know those numbers. If I had to choose, I would take Relenza, as I think it gets more drug to the affected tissue than Tamiflu.
- You should avoid going to the ER if you think you have been exposed or are symptomatic. ER 's south of here are becoming overwhelmed -- and I mean that -- already. It is coming in waves, but the waves are getting bigger.
- It appears that this flu produces a distinctive "hoarseness" in many victims. The symptoms, in general, match other flu's; namely, sore throat, body aches, headache, cough, and fever. Some have all these symptoms, while others may have only one or two.
- N-Acetyl-Cysteine -- a nutritional supplement available at the health food store or Wimberley Pharmacy, has been shown to prevent or lessen the severity of influenza. I suggest 1200mg, twice a day for adults, and 600mg twice a day in kids over 12. It would be hard to get kids under 12 to take it, but you could try opening the capsules and putting it on yogurt. For 40 pounds and up, 300-600 mg twice a day, for less than 40 pounds, half that.
- Oscillococinum, a homeopathic remedy, has been vindicated as quite effective in a large clinical trial in Europe , with an H1N1 variant. You can buy this at Hill Country Natural Foods, or the Wimberley Pharmacy.