Health Spectator

A recent paper in the journal Nature¹ published by University of Wisconsin (and University of Tokyo) virologist Yoshihiro Kawaoka implies that a high death toll from swine flu is a greater danger than first thought. Still, not all authorities agree that the symptoms caused by the so-called “novel” A(H1N1) virus are worse than those from seasonal flu.

It is important to realize that Kawaoka’s experiments were conducted in mice, ferrets, macaque monkeys and non-human primates; however, his lab and others have used these animals before in an attempt to analyze and predict the behavior of flu viruses in humans.

Kawaoka’s lab used a version of the novel A(H1N1) virus referred to as CA04 because it originated from a patient diagnosed with H1N1 swine flu in California on April 9 of this year. Kawaoka states that “CA04 causes more severe lung lesions in non-human primates than does a contemporary human influenza virus” and further, that “in all three mammalian models tested, CA04 seemed to be more pathogenic than a contemporary human H1N1 virus, KUTK-4.”

Severe lung lesions

In other words, the novel H1N1 virus appears to do more damage to the lungs in non-swine mammalian hosts than a typical seasonal flu virus.

Kawaoka’s lab also tested the swine flu virus on miniature pigs and found they showed no symptoms of infection, despite the efficient spread of the virus among them. This finding may provide a clue as to why no swine flu outbreaks had been noticed in pigs before the virus was transmitted to humans.

The study also found that people exposed to the deadly 1918 influenza appear to have antibodies that neutralize swine flu. This may explain why relatively few elderly people have died in the recent H1N1 outbreak. However, such immunity appears to be limited to those born before 1920—a dwindling portion of the population.

The good news—Kawaoka also found that the H1N1 virus was susceptible to a range of anti-viral or anti-flu drugs known as neuraminidase inhibitors, an example of which is Tamiflu.

Meanwhile, one of Kawaoka’s erstwhile critics, Scott McPherson, seems to be in agreement with Kawaoka at least on the currently underestimated potential virulence of the A(H1N1) strain. Following reports by the BBC about H1N1’s case fatality rate (CFR) and the predicted number of dead in Great Britain from the H1N1 swine flu, McPherson had this to say:

Using the 30% [rate of population infection] figure, the British government expects 18,283,000 or so [Britons] to be infected, and around 9 million to be seriously ill. The 65,000 dead equates to a case fatality rate of .003, or .3 percent. This is in contrast to the current USA CFR of .0056 and the global CFR of .0045.

So the British are expecting two things to occur: First, they fully expect this virus to gain rapid and extremely efficient methods of human-to-human transmission. Second, they are hoping for a moderation of the lethality of the virus as it gains increased communicability. Both are reasonable assumptions.

Contrast this dire British warning with the decided lack of vocal response from the American government. Considering that seasonal flu kills nearly 40,000 Americans a year, and assuming a current CFR of half a percent, why isn’t anyone in Washington using the same dire (and realistic) warnings? This is yet another example of poor risk communication. The same people who are preaching transparency (and absolutely not practicing what they preach) are at great risk of blowing it in preparing Americans for a second, more powerful wave of pandemic flu.

McPherson is not a virologist. Indeed, his main qualification appears to be that he is a formerly elected Republican in Florida (elected to the Florida House of Representatives in 1980) which he followed up with a career as a technology and communications consultant, which landed him back in politics (he became Director of Information Technology for the Republican Party of Florida, 1995, then served under Florida governor Jeb Bush in various capacities, including Y2K preparedness).

Our point here is that McPherson might be expected to criticize the current administration’s handling of the H1N1 pandemic on the basis of politics alone. Still, he seems to be making valid points in his pandemic analysis, and predicts about 400,000 deaths in the U.S. from swine flu in a recent posting:

The published global CFR in late June was plugging along at .002, while the US CFR was at .0045. Now, the US CFR is .0056, and the global CFR is at .0045. So the world has caught up with America in terms of its death rate, and the figure of .0045 places this pandemic squarely within the HHS Category Two pandemic status. But the threshold to Category 3 status is .0051. For the past two weeks, the US CFR has exceeded the Category 3 benchmark. Like the hurricane that spawned this HHS analogy, those winds — and deaths — have to be sustained. The next few weeks will tell us if we are seeing a drop in the CFR, or if the numbers are holding steady. That may also signal the waning of the pandemic’s first wave.

In a more recent posting still, McPherson recalculates the CFR and finds that it has at least temporarily entered into CDC Category 3 status:

all I will say is that the CFR is increasing, now to an aggregate .006475. This means that of every thousand confirmed or suspected cases reported to the CDC, 6 people died. At the end of June, the CFR was .0045. Of course, I agree that we are still talking about early and relatively small numbers. But the CFR has increased nonetheless, or has remained very consistent, however you might define it…. this pandemic may have crossed the threshold into Category 3 status.
Category 3 is no small threshold to cross. It changes things. First, it means that we are looking at a much stronger pandemic than the media and the decision-makers would have you believe. Second, while the number of reported cases is declining (as the WHO declares swabbing should cease if only done for purposes of determining infection and not for collection of viral samples), the death toll is not also declining. The deaths attributable to swine [A(H1N1)] are accelerating.

It is worth noting that McPherson’s calculations of CFRs does not take into account the presumed high number of people who contract swine flu and never so much as see a doctor, thereby reducing the number of reported cases vs. the number of reported deaths from swine flu. However, since he appears to be using published numbers from the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) his method is consistent. We cannot propose a better method, but one must realize that the increase in case fatality rates may be apparent rather than real.

If the apparent increases are real, however, there is cause for alarm. Certainly Kawaoka’s findings of lung damage as opposed to mere invasion of the nasal passages and pharynx by seasonal flu could explain a higher mortality rate from the new swine flu.

Profit motives cited

For the most part, public statements by such health authors as Dr. Joseph Mercola have emphasized the apparent profit motive behind any hyping of swine flu dangers. (Health Spectator too has noted some of these early indications.) Vaccine manufacturers are about to make another killing, Mercola and others warn, and it’s best not to be taken in by them. Some say it is best to avoid the flu shots altogether once they finally become available. Vaccinations may be linked to autism, Guillain-Barré syndrome, Alzheimer’s Disease and other serious disorders.

Our modern obsession with vaccines and their use of adjuvants (see our swine flu posting from May 30) and other additives certainly may pose a health threat in its own right, particularly for infants, children and the elderly. Infants are currently required to have 24 vaccinations by age one and that number will nearly double by the time they go to school.²

A common viewpoint is that the actual antigens involved might not pose a problem (we’re constantly bombarded by pathogens in our environment anyway) but modern vaccines tend to rely heavily on adjuvants, which are additives that arouse the immune system to assure that antibodies will be manufactured by the body against the relatively small sample of antigen injected. This is where the pro- and anti-vaccine camps part paths.

This constant inflammation caused by arousal of the immune system, and particularly of the brain’s microglia (immune cells) may be a major contributor to Parkinson’s and Alzheimer’s diseases.

Vaccination immunity not permanent

However, Russell Blaylock, MD points out that while previous infection confers a permanent immunity, vaccination does not.³ Furthermore, natural infection by most pathogens does not occur by injection of the pathogen into the muscle of the arm. There is even a growing body of evidence that some vaccines may do more harm than good.

The Internet is currently swarming with links to a video of a 1979 60 Minutes report by Mike Wallace on the consequences of the mandatory 1976 flu vaccinations that left dozens dead and hundreds injured, many from the Guillain-Barré syndrome.

Still, the situation of public health officials who must deal with the current crisis is utterly unenviable. Various outcomes could make them appear foolish or negligent. And so long as there is any possibility of a pandemic with even an average death toll, vaccine manufacturers have the upper hand in negotiating not only price, but concessions such as responsibility for death and injury resulting from the vaccines themselves.

Certainly the worst fear of all concerned is that the H1N1 virus could mutate into something resembling one of the current strains of avian flu such as H5N1, which has killed 50-60% of the humans it infected. Currently, H5N1 shows none of the infectious ability of H1N1 in human populations, but were that to change—as through a genetic recombination that combines the worse of both pathogens—the nightmares of those who fear the worst could be realized.

In light of all this, some may choose to heed Kawaoka’s warning:

In fact, the ability of CA04 to replicate in the lungs of mice, ferrets and non-human primates, and to cause appreciable pathology in this organ, is reminiscent of infections with highly pathogenic H5N1 influenza viruses, as acknowledged in a recent report by the World Health Organization (http://www.who.int/wer/2009/wer8421/en/index.html). We therefore speculate that the high replicative ability of [H1N1 swine flus] might contribute to a viral pneumonia characterized by diffuse alveolar damage that contributes to hospitalizations and fatal cases where no other underlying health issues exist. In addition, sustained person-to-person transmission might result in the emergence of more pathogenic variants, as observed with the 1918 pandemic virus. Furthermore, [H1N1 swine flus] may acquire resistance to [Tamiflu] through mutations in their [neuraminidase] gene (as recently witnessed with human H1N1 viruses), or through reassortment with co-circulating, [Tamiflu]-resistant seasonal human H1N1 viruses. Collectively, our findings are a reminder that [swine flus] have not yet garnered a place in history, but may still do so, as the pandemic caused by these viruses has the potential to produce a significant impact on human health and the global economy.

[View the Mike Wallace 60 Minutes video regarding the 1976 swine flu vaccine.]

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This entry was posted on Thursday, July 23rd, 2009 at 11:33 am and is filed under CDC, WHO, swine flu (H1N1). You can follow any comments for this entry through the RSS 2.0 feed.

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