Swine Flu

Yeah: Looks Like I Got It!

I’ve been out of the office for the better part of a week, and am even farther behind on email and other work than usual. Last Thursday I drove with a friend to Reno, where we were both speakers at the Mensa “gathering” put on by a friend of ours there. I’ll have more to say about that later, but my talk went very well.

We drove back Sunday, through a couple of snow storms and a sand storm in the Utah desert, and again straight through — I only took over at the wheel for a few hours. (My medic buddy Norm is a road warrior!)

Monday I could feel my allergies flaring up from what I figured was a combination of the sand storm and heavy winds at home, but by Monday evening I realized that no, it was a virus that I picked up in Reno; we were at the biggest hotel there, and I was around a lot of people.

By Tuesday I was whacked by it: fever, body aches, horrible fatigue, and the most alarming of all: shortness of breath — the flu. The current presumption in North America right now is that if you have flu this early in the season, you most likely have Swine Flu. (And I did get the regular “seasonal” flu shot last month….)

Not Avoiding the Term

And yes, I am going to call it “Swine Flu” rather than the “H1N1 flu virus” — mostly because I refuse to bow to the panicking pork industry’s pandering to public ignorance. Yeah, some people actually think they might get “swine flu” by eating pork. It doesn’t happen like that, of course, but pork producers are having their own fever, body aches, and shortness of breath over it, and demand everyone say “H1N1” instead.

Pfui, as Nero Wolfe liked to say. The only way you could get influenza from pork is to eat infected pig meat raw, and that’s already considered a completely unhealthy thing to do.

And really: do any of you (outside the doctors!) have any idea what “H1N1” even means? Some of you may — I do, in part because I was on our county’s pandemic disease disaster planning committee two years ago after the Bird Flu, and I took the trouble of looking it up so I’d understand it.

Flu: Types vs Strains

“I love you, future bacon!” — how swine flu spreads. (No, not really!)

There are three common types: A, B, and C. [In 2012, a new type was identified that was dubbed D.]

Type A is most common, and crosses between humans and animals. Type B almost exclusively infects humans, and mutates more slowly, so it’s easier to build immunity until it mutates again, which means there are pretty much never pandemics. Type C is much less common still. So most of the time, the medical community is talking about Type A.

Those viruses are categorized according to two proteins found on the surface of the virus: hemagglutinin and neuraminidase — the H and the N. Each Type A strain is assigned an H number and an N number based on which forms of these two proteins the strain has; there are 16 H and 9 N subtypes known in birds, for instance, but only H 1, 2 and 3 — and N 1 and 2 — are commonly found in humans.

Animal Types

“Birds?” you might ask. You likely remember that “bird” (or “avian”) flu was supposed to be the big scare a couple of years ago. But this one is swine flu, right?

Well, sorta: genetic sequencing has shown that the current H1N1 pandemic virus is an amalgam of four different strains: North American swine influenza, North American avian influenza, human influenza, and a swine influenza virus typically found in Asia and Europe. In other words, half swine, a quarter bird, and a quarter plain ol’ human influenza — strains found around the world all mixed together. It’s that mix that helps make it so easily passed around.

(And when I sent out a note to some friends saying that I was recovering from Swine Flu, one of the wags, knowing the above, replied that it wasn’t pure swine flu, but one mixed with bird flu, and thus it was more properly termed “Flying Pig Flu”. Yeah: I like hanging around smart funny people. 🙂 )

Serious Stuff

The 1918 “Spanish Flu” pandemic, which killed as many as 100 million people in an age before jet travel, was also an H1N1 flu, but obviously it’s not exactly the same strain; thankfully the current one is much less of a killer.

The Spanish Flu also started with a mild version, but then came back much worse the next year. How did we know this year’s H1N1 wouldn’t do the same thing? We didn’t. That’s why it was so important to prepare, just in case it did.

We dodged a bullet; we may not be as lucky next time.

Ignorance Feeds Panic — and Ignorance

The media has done a poor job helping people understand all of this, and both apathy and panic has ensued. But frankly, it’s very difficult to get people to stop and pay attention to the important stuff without freaking them out, so I have a lot of sympathy for the task.

I’ve found most people don’t even have a clue as to what the difference is between an epidemic and a pandemic. An “epidemic” — from the Greek epi (“upon”) + demos (“people”) — is an infection that spreads rapidly and extensively and affecting many individuals in an area or a population at the same time. (The key is that limited area.)

A “pandemic” — from the Greek pan (“all”) + demos (“people”) — is an epidemic of infectious disease which spreads through human populations across a large region: like a continent, or worldwide. Medically it doesn’t really mean “all” people, as the Greek root implies, but enough so to be a major health problem.

The World Health Organization declared the current Swine Flu a pandemic on June 11, 2009 — the first global pandemic since the 1968 Hong Kong Flu, which killed about 2 million. (Even seasonal flu is a killer, though: it takes out up to a half-million people per year worldwide, about 36,000 in the U.S. alone — yeah: every year.)

My case was pretty mild, despite the shortness of breath. I have a blood oxygen monitor that I use on EMS calls, and I could see that I was getting enough; that was reassuring. It may just be that I’m getting older.

But then again, maybe not. Seasonal flu usually kills older people, but the current Swine Flu is killing the young more — aged into their 20s and 30s. The younger you are (and the more health problems you have, especially respiratory problems, like asthma), the more you need to get the vaccine.

What to Do

I’ve seen quacks on TV say that the shot will give you the flu (it doesn’t: the virus in it is dead), or that it will give kids autism (long ago disproved: the UK “study” that “proved” that was completely discredited). Those quacks are betting with your (and your kids’!) lives; don’t let them panic you. Get the shot.

If much of this is truly new to you, you haven’t been paying enough attention. See the Centers for Disease Control’s Flu page for basic and clear information that doesn’t take much time to read.

The bottom line: there truly is no need to panic. There is a need to pay attention to what’s going on, and make informed decisions about how you’re going to react. If I’m offered the Swine Flu shot, I’m going to take it — it’s possible that what I had this week wasn’t Swine Flu, and I’m not going to pay for a DNA test to make sure, since it doesn’t really matter.

I’ve made my decision; what are you going to do?

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24 Comments on “Swine Flu

  1. You said, “frankly, it’s very difficult to get people to stop and pay attention to the important stuff without freaking them out.”

    Yet that’s exactly what you did. I learned plenty, even though I have been keeping up with the media on this issue, and was fascinated by it all, not frightened. You proved that it simply takes a talent for explaining complex topics, which most journalists don’t seem to have anymore.

  2. Well, you can’t blame the pork industry, one can imagine how the sales will drop if people keep the idea that “swine flu” can be transmitted from eating pork.

    I actually didn’t know what the letters and numbers in the “flying swine flu” mean (that’s the way I’m going to call it since now), at least most people know the name of the virus here in Mexico. Elba Esther Gordillo Morales, leader of the National Educational Workers Union, called it the HLNL flu.

    Anyway you convinced me to get the vaccine as fast as I can, but then it seems that here the vaccine will be offered till November.

    BTW Hope you’re getting better now.

    I definitely don’t blame the pork industry, I just refuse to kowtow to their pulling a curtain over the reality of the problem. Did their mass production practices contribute to the problem? I don’t know, but wouldn’t be at all surprised to hear that’s the case. -rc

  3. I live in the midwest, and the news media calling “H1N1” something it is not (swine flu) has torn thru the ag economy. I’m surprised that you – a person who has medical training and took the time to write one of the clearest, most concise explanations of the disease – would take pride calling it something it is not. From my point of view, you’ve become your own “This is True” story.

    You’re too close to this to see it clearly, Mark. You think it’s being called “something it is not.” Yet look at the origins of the disease. Most of it is from pigs. There’s a reason it’s called “Swine Flu,” and it’s certainly more accurate than the still-accepted tag for the 1918 pandemic, “Spanish Flu”, which first appeared in the U.S. and swept into the rest of Europe before getting to Spain. The cure for the problems facing the pork industry isn’t to pander to ignorance and rename the flu something else when it is from swine, but to educate the public — which is what I did. Why isn’t the pork industry at least as proactive on this as I am?! -rc

  4. Another point to make is that “pandemic” does not necessarily mean “deadly”, which is what most people seem to think… The media is not helping at all (like with the housing market and the economy, they seem to be more interesting in carrying fuel to the fire than to enlighten).

    Excellent point. -rc

  5. You have the best description of pandemic vs. epidemic I’ve seen anywhere. And thank you for defining H1N1.

    But you left out the single most important defense to avoid the flu – wash your hands often. That simple advice will do more to prevent catching the flu than the flu shot will. (And yes, I received my flu shot yesterday. And no, the doctor was not truthful when he said I would barely feel it.)

    And I’ve learned, when attending events where there are lots of people with hand shaking going on (like conventions), carry hand sanitizer and use it after every handshake.

    Frankly, the kids have it right: fistbumps are better than handshakes. I wasn’t trying to cover every base, so thanks for covering that one: hand washing is critical. -rc

  6. The UK study was based on the MMR vaccine, not ALL vaccines. Note that I did NOT say that I think vaccines cause autism.

    Alarmists took that one flawed “study” (based, by the way, on only 12 kids) and extrapolated it to all vaccines being “dangerous”. The fact: the lack of vaccines is what’s dangerous. That faked study led to lower vaccination rates in U.K. children, and led to more disease that truly did harm children. That’s the tragedy of it all. -rc

  7. One thing to add, in the interest of education, is that there are meds now to shorten the duration of the flu if you get it, and as prophylaxis for those around you to keep them from catching it from you. Tamiflu (the best known and apparently harder to get) has been working against swine flu (a.k.a., novel H1N1) but not against the seasonal H1N1 virus. Relenza works against both. Either requires a prescription and you do need to start within 48 hours of showing symptoms if you’re the sick one.

    Key points are: you can do something other than suffer, and those around you need not catch the flu just because you did.

    True, but like antibiotics do with bacteria, such meds will increase the strength of the viruses over time. -rc

  8. I like your analysis, but I disagree with you on the naming. People are panicky, and mass pig slaughters have occurred due to swine flu. In Egypt, the government slaughtered all pigs within their borders, though Muslim bureaucrats don’t need much excuse to rid themselves of the “unclean”, it’s still a frightening image to the pork producers.

    Furthermore, many people use the precautionary principle to extremes, especially with food health. Not a single salmonella infected tomato was ever found in 2007, but it devastated the tomato industry with unsold produce and unnecessary recalls. Even tomato sauce was avoided, though salmonella cannot survive cooking.

    Back onto diseases, would you ever say that someone is infected with GRID? Gay Related Immunodeficiency Disorder was renamed to AIDS in order to make it clear that straight people could be (and were becoming) infected. Renaming diseases to prevent bad actions by the populace has historical precedent.

    I would consider the agricultural and medical industries foolish to NOT call it H1N1. Calling it swine flu has no benefits, and causes actions that harm industries to no benefit.

    We can pander to ignorance, like Egypt’s, or we can fight it. The fact is, the public knows it better as Swine Flu than “H1N1”. GRID isn’t the same: that’s simply incorrect since, as you point out, straight people can get it. Swine Flu did come from swine; the name accurate reflects its main points of origin. -rc

  9. In Israel, the first order of business for the Deputy Minister of Health (there is no Minister) when Swine Flu started making headlines was to find an alternate name for it.

    Why? Because swine/pig isn’t Kosher and the ultra-orthodox Deputy Minister was uncomfortable with the repeated mention of unclean pigs and swine in the media!

    I did hear about that, but then I pay unnatural attention to odd things in the news…. -rc

  10. Just wondering, Randy, because Swine flu is so contagious, did your wife, or assistant, catch it from you?

    Happily, no. My wife was out of town, and as soon as I realized I was sick I vacated the office (taking my laptop home). By the time my assistant arrives later today, it’ll be a full 7 days since onset of symptoms, and several days since they subsided, so she should be safe. The amazing part (to me): the friend I rode home with from Reno didn’t get it either! -rc

  11. A well-written, scholarly and sobering look at flu biology including observations about animal husbandry practices which likely contribute to the evolution of virulence in the flu:


    The book is available on paper, but the entire book is available to read on line as web pages on the website.

  12. Ray in Adelaide: that’s great! Nice & subtle… 😀
    Randy: Good to hear you got over it. I wonder if it *was* the current swine flu? The official numbers here in Oz aren’t fantastic – out of about 36,000 confirmed cases, 1 in 200 have died, 1 in 8 have required hospital treatment. There were a bunch of articles yesterday (I presume you saw the Reuters one) that suggest the number of flu-related intensive care admissions in Australia this flu season was 15 *times* normal levels. Even if the number of unreported cases was 2 or 3 times the confirmed ones, those are still scary numbers.

    Like you, I’ll be getting the vaccine – my wife had hers last week, with no adverse side effects at all (she also had a whooping cough vaccine – highly recommended for parents or those who are around young children, as apparently most kids get it from their mum!)

  13. The real tragedy is that the FDA has been sitting on an Emergency Use Authorization for six months for intravenous peramivir, the ONLY intravenous antiviral available to treat dying kids and others in the ICU. FDA granted an Emergency IND for peramivir in mid-June because they know from Japanese and US testing (the latter paid for by HHS) that it is safe and effective. But they never told the ICU doctors about it, never added the information to their antiviral recommendations, and forbade the manufacturer, BioCryst Pharma, from telling doctors about it. Hundreds of Americans have suffocated to death, including dozens of children, since mid-June. The FDA STILL has not issued the Emergency Use Authorization that would add peramivir to the National Stockpile and get the drug into hospitals, where it is vitally needed. What Katrina was to FEMA, thie EUA is to the FDA. I hope for the sake of the critically ill that this disgusting delay ends soon, and for the sake of responsible government that Secretary Sebelius and numerous others are forced to resign. This is an incredible, needless tragedy. See http://seekingalpha.com/instablog/128006-michael-murphy/28294-what-katrina-was-to-fema-swine-flu-deaths-are-to-fda-buy-biocryst

  14. I often wonder if there is any correlation between amount of flu shots given prevent the flu, and the ever numbering new types of resistant flu. As an example, we now know that giving antibiotics like candy actually causes or creates more and more antibiotic resistant bacteria.

    It seems that every year, there is a new flu, and we have to develop a new vaccine for it. Do you think that we might be handing out flu shots the way we did antibiotics many years ago before we knew that that was actually exacerbating the problem?

    No, this is definitely not the same situation as with antibiotics. It is natural for flu to mutate and change year by year. -rc

  15. Randy, your article is, indeed, interesting and a good example in many respects:

    1. You are hinting that you have got THE flu (whatever name you’d like to use for it) and, should any doctor come to see you, he’d reported you as a new case of H1N1. On the other hand, you state that you’re not keen to pay for a lab test to see whether it was, indeed the H1N1. While I don’t see any reason you would pay for the test (it’s over anyway), I also don’t see any scientific grounds to report this as a H1N1 case; but, most likely, your case will inflate the stats. Not your fault, but it seems that’s the way it goes and should be kept in the back of our heads any time we’re getting scared of the proportions of this pandemic.

    2. Name: you don’t like to call it H1N1 and think “swine flu” is more appropriate. Why not “mexican flu”? After all, we had “Spanish”, “Asian”, “Russian” (twice!) and “Hong Kong”. It’s suddenly not politically correct anymore to call it from the region first reported it? Or (the heck with political correctness!) does it not make sense? Granted, H1N1 is not very descriptive, both Spanish and one Russian were also H1N1, so which one are we talking about? [virologists have ways of naming it unequivocally, like “A/California/7/2009 (H1N1)v-like strain (X-179A)” for the present one but that’s only a tongue breaker]

    3. Pandemic: I thought each winter the world is facing more or less a flu pandemic, with people from China through Europe to the US having flu. Few know that the EMEA (the european FDA) “fast track approval” for the vaccine has a condition: the vaccine can be used ONLY if WHO or EU declare a pandemic or EU-wide epidemic. [Might be a similar condition in the FDA paperwork, haven’t seen it, can’t comment]. So, this looks to me like a real incentive for GlaxoSmithKline, SanofiAventis, Baxter &Co to “raise the WHO awareness” over the pandemic status.

    (EMEA paperwork to download at http://www.emea.europa.eu/humandocs/Humans/EPAR/pandemrix/pandemrix.htm )

    4. “Raise the WHO awareness” [about Hepatitis] is, apparently, the way a salesman for EngerixB (a Hepatitis vaccine) was expressing himself, not my expression.

    5. Vaccines and autism: maybe the organic mercury in the vaccines leads to problems in some kids, since not all of us are born equal, when it comes to ability to rid ourselves of toxins; let’s not just refute it. But an interesting study to read (just as food for thought) might be this one:

    “When evidence-based mediicne (EBM) fuels confusion: multiple sclerosis after hepatitis B vaccine as a case in point” http://www.medicalveritas.com/manGirard.pdf

  16. While I like the Flying Swine Flu name, your analysis of the source is incomplete. I had to go back to my microbiology texts to confirm this–all of the Type A influenza started in birds. The portions you attributed to swine have been commonly found in swine, and probably merged into the current form in swine, but the origin is avian. Just another bird flu.

    I can understand not wanting to use the name Swine Flu. In my area there are several counties with orders of magnitude more swine than there are people. The industry is currently in as bad of shape as the auto industry so they are trying to minimize anything that makes it worse. Of course I can’t think of a better name. H1N1 just doesn’t make it.

  17. “… all of the Type A influenza started in birds.” — Gregg, Minnesota
    The dinosaurs want their planet back and they’re not above using germ warfare to do it.

  18. “The dinosaurs want their planet back and they’re not above using germ warfare to do it.”

    I thought the dinosaurs became birds!

  19. Randy wrote: “No, this is definitely not the same situation as with antibiotics. It is natural for flu to mutate and change year by year. -rc”

    They why has the seasonal flu mutated to become 99% resistant to Tamiflu in only three years? 2007-2008 flu season showed 16% of the virus samples were resistant. 2008-2009 showed about 50% were resistant. The CDC says this year, 2009-2010, is showing 99% resistant.

    This IS exactly the same situation as antibiotics, except viruses mutate faster than bacteria.

    You have taken my comment out of context. Dan in Virginia pointed out there are meds that reduce flu symptoms, and I replied “True, but like antibiotics do with bacteria, such meds will increase the strength of the viruses over time.” Then Marcie in California asked, “It seems that every year, there is a new flu, and we have to develop a new vaccine for it. Do you think that we might be handing out flu shots the way we did antibiotics many years ago before we knew that that was actually exacerbating the problem?”, to which I replied, “No, this is definitely not the same situation as with antibiotics. It is natural for flu to mutate and change year by year.”

    Yes, flu mutates, and it will, over time, become immune to Tamiflu and its ilk. But it is not because of Tamiflu that they have to develop a new vaccine every year. They’ve had to do that anyway, year after year, because flu mutates so fast on its own. That’s very different from bacteria, which are mutating in response to antibiotics. -rc

  20. Randy wrote: That’s very different from bacteria, which are mutating in response to antibiotics.

    While the general statement is true (administering antibiotics/antivirals is not the same as vaccines), there’s one “important detail” which is wrong.

    Bacteria do not mutate in response to antibiotics. It depends on how is interpreted. If it is read (and meant) as “bacteria [actively] mutate and generate an antibiotic resistance mechanism”, then it’s wrong. What happens is that mutations are already present in the (bacterial/viral/cancerous cell) population. If one of these mutations enables the OFFSPRING of this organism to better survive in the presence of the drug, then this offspring will have more offsprings and will pass on the acquired mutation (or “gene”, if you wish). However, this mutation existed prior to the contact of the organism with the drug and, should we not have used the drug, the mutation would, most likely have vanished from the population by being diluted out.

    So, in short, we are actively selecting bacteria/viruses which happen to be resistant to whatever drugs we use to fight them and not the bugs mutate in response to the antibiotics. I’d say this is an important point, especially since it’s a pretty nice example of Darwinist evolution firsthand.

    [as a side note: it seems that bacteria can, under stress situations, generate more mutations, probably an active mechanism to generate more diversity and, with a bit of luck, a resistant offspring]

    Yes, I necessarily had to simplify. Bacteria don’t mutate in response to antibiotics, but their offspring survive due to mutations when their “parents” survive the antibiotic, such as when the person “feels better” and stops taking it early, before the infection is fully killed off. The details are interesting …and detailed. And indeed it’s evolution at work right in front of our eyes. -rc

  21. The “flying pig flu” is a nicely-crafted amalgamation of (a) recognizing the “avian” component of the flu and (b) employing the paronomastic of “when pigs fly” (i.e.: “swine flew”). My physician was intrigued to learn that the word “influenza” is Italian for “influence,” as in the influence of celestial bodies that were once presumed to be somehow responsible for the condition. In a similarly whimsical tone I might suggest that we can refer to the Hemagglutin/Neuraminidase virus as “honny-nonny” (H o-ne – N o-ne).

  22. I’ve had the flu as well, no idea which one. Over here it is called the mexican flu (swine flu here is used for a disease that only pigs get). I read in the newspaper that the mexican tourist board complained to our government about the name because they fear loss of tourism. It made me laugh because we are such a small country and Mexico is very far away from here I don’t think that any drop in tourism from the Netherlands to Mexico will have any impact on their economy.

    I was wondering where the numbers of people suffering from this flu come from. The dead and hospitalized I can understand, but over here you do not need to inform your doctor or any official organization when you have the flu. The official advice is; stay home, drink plenty of fluids and take an aspirin, it will be over in a week and do not visit your doctor (this to prevent infecting others). So how can the figures be reliable as to the number of infected people?

    They can’t. But they can be estimated by the numbers of people who do come to their attention, such as in the emergency room, hospitalized, dead, etc. Still, it’s only an estimate, with some level of error. -rc


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