Health Spectator

Americans will have some serious thinking to do as the time approaches to get vaccinated against the H1N1 swine flu, which is expected to resume its ravages here in the fall.

On the one hand, judging by the flu’s sojourn in South America, it could be getting worse. It has infected turkeys in Chile, which is not a good sign. The flu could pick up virulence if it combines with one of the nastier bird flus such as H5N1, which has been making the round of flocks in Asia.

So all we need is a bit of commerce between Asia and South America—or for that matter, simply someone coming into contact with birds in both places—and we could be seeing a nastier version of the bug coming at us once the leaves are gone.

On the other hand, the vaccine itself would appear to have little to recommend it.

In America we tend to put immense faith in these meager protections offered up by the health care industry. We just assume—until proven otherwise—that flu vaccines work and are outraged when presented with evidence that they do not. And we are all the more outraged when we or one of our loved ones winds up stricken with some unforeseen illness resulting from their use, some of which can be life changing—such as Guillain-Barré, for example.

Guillain-Barré syndrome is one of those afflictions you can live without—believe me. At its most severe, it kills by paralysis—the victim is simply unable to breathe. Given prompt care (and, if indicated, the use of a ventilator) one has the possibility of full recovery—or not. Some patients end up quadriplegics, some with the partial use of their legs—it all depends. On what, no one knows.

Unfortunately, the way the game is played, at the first sign of a possible epdemic—pandemic, in this case—the Health and Human Services (HHS) Department has the option of providing incentives to drug companies for developing vaccines. There’s the rub.

In this case, HHS Secretary Kathleen Sibelius gave it all away at the first breath of national emergency: there will be no penalities for drug firms who kill or maim either with the swine flu antigen itself or with the accompanying adjuvant. Unless you can prove they deliberately tried to kill your child or loved one, you can’t touch them.

Good luck with that.

So, the full responsibility for whatever happens will be on you. No one to sue, no recourse. And unless by some miracle the Democrats grow a sense of purpose and actually push through a single-payer healthcare package, your insurance probably won’t cover the consequences, either. So you’re on your own.

Better weigh the known severity of the flu carefully before even considering that shot. Unless it starts killing a sizable percentage of those afflicted and you happen to fall into a category that is particularly vulnerable, taking a pass may be the best option.

Even if you catch the flu, chances are it will be no worse than flus you have had in the past—an unpleasant experience for several days, perhaps even a few weeks—but then, forgotten.

At present, despite seemingly high numbers, the flu has not really been all that virulent. We’ve seen 522 confirmed deaths in the U.S. as of August 20, but given more than a million estimated cases, that isn’t a huge number.

We personally have little faith in a rapidly devised vaccine for which the manufacturers aren’t willing to take full responsibility. Most of the swine flu vaccines we’re being promised will employ adjuvants (additives designed to inflame your immune system to heighten immune response) that are either already known to be dangerous or have not been approved by the FDA for regular use. They’re permitted only under the emergency provisions of HHS/FDA regulations.

So paying close attention to your diet—lots of fresh organic vegetables, wild-caught fish and pasture-grazed meats—should keep you at your best. Make sure you take adequate vitamins A, C, D, B6, magnesium, zinc and selenium. (For men especially, don’t overdue the selenium.) A healthy immune system is always your best response to the possibility of infection.

Remember that vaccines, in the end, do nothing more than use your immune system to prevent disease.

We think nature’s way of going about that may be just as good or better.

Turkeys in Chile have been infected with the H1N1 pandemic swine flu, news services have confirmed. The good news is that the effects on the turkeys are mild; they will be processed as usual for their meat and should be safe to eat.

But the spread of swine flu to birds is a step we have not wanted to see, particularly at this early stage of the game before more humans have had the chance to develop an immunity to the disease themselves. Once the disease becomes widespread in birds, it would seem to be only a matter of time before a more virulent strain emerges that is increasingly fatal to humans. Avian flu has consistently been the most dangerous to humans, and having a strain of flu that has already started making the rounds in humans also spread to birds does not promise good things for the future.

Chile’s health ministry said earlier today that it ordered a quarantine of two turkey farms outside the port city of Valparaiso. Health Spectator has been unable so far to determine if there are pig farms in the area, but we suspect there are. Modern factory farming practices tend to cluster pig and poultry farms in close proximity to each other, and Chile has long been a member of the factory farming club. We have also located photographs of a huge Chilean pig farm operation with a caption indicating that it is owned by Super Pollo (a company name that means Super Chicken).

As we noted in a story published earlier today (Factory farming is key to swine flu epidemic, below) factory farming practices have created a global situation in which new diseases evolve and spread more rapidly than previously possible, endangering both human and livestock populations.

Also earlier today, University of Missouri agricultural economist Ronald L. Plain said that since April, when the flu outbreak was first recognized in Mexico, hog producers have lost $500 million in revenue just because of the monniker “swine flu.”

In a previous post, we noted the recently published research of Yoshihiro Kawaoka, the eminent Japanse virologist, in which he recorded the fact that he had infected miniature pigs with H1N1 swine flu, and they were asymptomatic, though readily infected. He also pointed out that other mammals (and apparently humans) suffer significantly more lung damage from swine flu than from seasonal flus, in stark contrast to the lack of symptoms in his pigs.

We also commented in that previous article that everyone’s worst nightmare about the swine flu A(H1N1) was that it might turn into something more virulent but just as contagious by merging with bird flu:

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 worst of both pathogens—the nightmares of those who fear the worst could be realized.

Scott McPherson’s blog points out that just such a situation could be emerging in Vietnam, possibly to be replicated shortly in China and Indonesia:

The deputy director of the Department of Preventive Health in the central province of Ha Tinh, Nguyen Luong Tam, confirmed on 26 Jul 2009 that a 30-year-old man died of bird flu at the General Hospital. The man had been rushed to hospital the previous day with pneumonia, high fever, headache, muscular and joint pain, cough, breathing difficulty, and vomiting. Doctors diagnosed him as having avian influenza and isolated him. They found his lung to be seriously damaged. He died on 26 Jul 2009. Health workers later found diseased poultry at the man’s house. He also had contact with a female relative, a teacher at Ngo Thoi Nhiem private High School in District 9, where 73 students and 5 teachers have contracted swine flu [that is, influenza pandemic (H1N1) 2009 virus infection].¹

So the human population in Indonesia has brought both avian flu and swine flu into close proximity, to the point where members of the same family may be infected with each type of virus. An isolated incident such as this does not guarantee there will be crossover between the two strains because they have come into close contact, but once this scenario has been repeated enough times, the odds mount.

Recombination typically occurs when the same cell becomes infected with two different strains of virus. Then the genetic materials have the opportunity to rearrange at will, resulting in mutations.² Accordingly, the Vietnamese health authorities are watching that situation closely.

Why Egypt slaughtered all the pigs

Something we haven’t yet mentioned, and which we also owe to McPherson’s website is the explanation of why the Eqyptians slaughtered all those pigs. (Swine flu: Why Egypt wants to kill all the pigs.) It’s worth a read on McPherson’s blog, as he does a good job of elaborating the story. We’ll try to give the short version here.

Those who follow influenza outbreaks are well aware that the dreaded avian flu (H5N1 virus) has made a home in Indonesia, where it has been jumping from birds to humans often enough to put a dent of 57 or so deaths in the human population. But less known to most Americans is that Egypt has also had problems with the bug. In fact, Egypt has the highest avian flu prevalance outside of Asia.

Avian flu infections in Egypt have appeared steadily since 2006 and have killed at least 26 people there. Meanwhile, as of August 19 there have been 509 cases of swine flu reported in Egypt.³ So, for those who fear the combination of H1N1 and H5N1 virus strains, Egypt is as likely a melting pot as Vietnam or Indonesia. And, like Vietnam, it has both outbreaks occurring in the human population.

What Egypt also had until recently was a large pig population—300,000 give or take a few—despite being a Muslim country where eating pork is forbidden to all but the occasional stray Christian. As Thacker and Janke note,

pigs would be the ideal mixing vessel for the creation of new avian/mammalian influenza viruses capable of causing novel diseases with the potential for producing pandemics in the human population. Whether this will happen easily, however, is less clear, although it is apparent that, in the US swine industry, transmission of influenza viruses between swine and humans is fairly common and is bidirectional. The pandemics of the past appear to have involved the introduction of whole or partial avian influenza viruses into a human population directly, rather than through swine.^{4 5}

So the World Health Organization (WHO) and many Egyptians had been worried for some time that the strains of swine flu and bird flu already present in that country might take advantage of the pig population—which in Egypt, apparently, lives not only in close proximity to humans, but within the cities rather than in the country—to recombine into something very contagious and very, very deadly.⁶

The pigs had to go.

Meanwhile, the event WHO and other health organizations around the world had been preparing for was the next big avian flu outbreak. This seemed likely to arise in Asia, given the high dependence on poultry for food there and the close proximity of human and poultry populations, since many Asians still raise and slaughter their own birds.

Avian flu a killer

Speaking of poultry, we should examine briefly one of the reasons why humans currently do not catch avian flu all that easily. Hemagglutinin is the portion of the virus’s outer coat that enables it to attach to a host cell and gain entry. The substance gets its name from its ability to cause red blood cells to clump and is often a primary source of the virus’s toxicity. Avian flu incorporates one type of hemagglutinin and human flu another.

Why does that matter? Because human and avian cell surface receptors differ significantly. Think of these receptors as functioning like locks on the exterior of the cells. Each takes a different shape of key (the hemagglutinin). But unlike birds or humans, pigs have both types of hemagglutinin receptors, so their cells open to both types of keys; they seem to catch avian, swine and human flu with almost equal ease.

In this country, the population doesn’t pay much attention to avian flu, presumably because it hasn’t been a problem here. The rest of the world is not so naive. Studies performed on the 1918 pandemic flu, moreover, show that it was an avian flu that jumped to humans.

Indeed, the 1918 influenza pandemic is generally considered to be the worst viral outbreak the world has ever seen. It killed millions, probably more than the Black Death (bubonic plague, a bacterial infection) of the Middle Ages. What public health officials fear the most is just another such outbreak.

So, if you were going to design your own influenza virus and you wanted it to be as virulent as possible, you might take some avian flu genes and put them in a swine flu package. That way, you would get maximum transmissibility from the swine flu and maximum killing power from the avain flu.

Resurrection

In February 1997 or 1998, depending on the account,⁷ a forensic pathologist named Johan Hultin recovered samples of the 1918 influenza from the frozen corpse of a Native Alaskan woman buried near Brevig Mission, AK.⁸ Hultin took his samples to the CDC and the Armed Forces Institute of Pathology (AFIP). There they were reconstituted and injected into mice.

The 1918 pandemic flu resurrected in 1997 bears an uncanny resemblence to the avian flu that first appeared in Asia in 1998. (Were it equally contagious among humans, we’ll venture to guess, it would bear an even stronger resemblence.)

While Asia was having problems with avian flu, in the United States a new version of swine flu emerged in a herd of pigs in North Carolina. This H3N2 virus was composed of avian, human, and swine influenza virus genes—just the sort of mix we have been talking about. This new swine flu quickly became the predominant strain within U.S. swine. It was the precursor to the current pandemic swine flu.

Swine flu in pigs?

Meanwhile, three recent outbreaks of pandemic swine flu have been reported—of all strange places—in pigs. (We hope you can see the irony.) The first incident, in Alberta, CA, we reported on May 6 and May 8. Initial reports were that a Mexican worker returning from a vacation in Mexico had infected the pigs. Subsequently, the Mexican worker and other humans on the farm tested negative for H1N1 flu virus, apparently ruling out that immediate human source of the pig infection.

In that particular incident, the infected pigs were eventually culled (slaughtered) because they were being kept in quarantine and were part of a larger population of 2200.

This left, of course, the question of how the pigs became infected in the first place. It would appear, as we suggested in our previous article, that the novel H1N1 virus was quietly making the rounds in pig populations, aided by the growing tendency of the American food industry toward a set of techniques known as factory farming.

Flash forward to July 24 of this year when authorities in Canada confirmed another outbreak of pandemic H1N1 influenza in pigs on a Quebec farm. In this case, the pigs have “completely recovered.” Pathologist Dr Alain Laperle of the Quebec Agriculture, Food and Fisheries Ministry (MAPAQ) states that the first clinical symptoms in the pigs began the end of June. Meanwhile, no symptoms of swine flu have been detected in any of the humans living on or visiting the farm.

Further denials

Nevertheless, Laperle told the Quebec farmers’ newspaper La Terre de Chez Nous on July 28 that the “most probable hypothesis” is that the H1N1 reached the farm through a human carrier.

Now we change hemispheres. On July 17, Argentina announced a nationwide animal health emergency when a herd of pigs was found to be infected with H1N1. At that point, the H1N1 epidemic had killed 137 people in Argentina. Once again, we are told that the pigs in question must have been infected by humans.

But why is it more logical to assume that humans have spread the infection to pigs rather than to assume the pigs have been spreading it among themselves all along? Or at least, as is most likely, that the human carriers were carrying the infection on their boots or other clothing, rather than spreading it because they themselves were infected? And doesn’t it seem strange that when referring to a disease known as swine flu, the official sources react with apparent disbelief—even outright denial—that it could actually occur in pigs?

We agree that humans are far more likely than pigs to hop on a plane to travel long distances, so the notion of spread by humans has some innate appeal. But it clearly is unlikely that anyone would be searching for H1N1 virus in pigs were it not already wreaking havoc in the human population. For the past 10 years its presence in pigs has been ignored by everyone who doesn’t make a living studying such things.

Indeed, it is not the policy of any agency within the United States to keep track of the flu infections in swine populations. But that doesn’t mean H1N1 wasn’t spreading through hog herds all along.

Factory-farmed hogs get to travel

And it turns out that pigs raised on factory farms get to travel long distances. In 2001, 27% of U.S. pigs traveled across state lines. At that time, 72% of them were raised on factory farms. And that figure was up from 10% factory-farm raised in 1994. We can only guess how high that percentage has risen since. But we do know that in 2005, more than 25 million live pigs were traded internationally. That’s more than 2 million pigs every month.⁹

CDC’s current chief virologist, Ruben Donis, has confirmed that the pandemic strain of flu virus was first detected in the Midwest in 1998 in swine. Although it does have avian and human flu components, it has existed among pigs for more than a decade. “One little detail,” Donis told his interviewer, “is [that] these Midwestern viruses were exported to Asia. Korea and many countries import from the U.S. Swine flu is economically not such a big deal, [so] many countries don’t check for it.”¹⁰

The problem with the official story that all these pigs are being infected by humans is that no one has yet confirmed that any human has infected any pig. It’s really just a denial by the pork industry trying to portray a flu of swine origin as a human flu. Nor have we forgotten that the initial outbreak of novel H1N1 in humans occurred in Mexico in February next to a huge hog farm.¹¹ Local press reports at the time detailed how massive swarms of flies were believed to have caused a local respiratory outbreak in La Gloria, in which two babies died and about 60% of the population was infected. Town folk later recognized the symptoms they had as being the same symptoms attributed to swine flu once its existence was announced.

Then a blood sample that had been taken from a four-year-old boy involved in the La Gloria outbreak came back positive for swine flu.

True, two children in California had been infected with what was later determined to be swine flu in March, but that was well after the outbreak in La Gloria.¹² So that puts ground zero in La Gloria right next to the Granjas Carroll (Smithfield) pig farm.

Smithfield factory farms

And Smithfield has not had a sterling record even here in the United States:

Smithfield, which is led by pork baron Joseph W Luter III, has previously been fined for environmental damage in the US. In October 2000 the supreme court upheld a $12.6m (£8.6m) fine levied by the US environmental protection agency which found that the company had violated its pollution permits in the Pagan River in Virginia which runs towards Chesapeake Bay. The company faced accusations that faecal and other bodily waste from slaughtered pigs had been dumped directly into the river since the 1970s.¹³

Mexico is almost certainly more lax in its environmental requirements—at least at the local level—than the United States.

So accounts local to the Smithfield Granjas Carroll plant in Mexico, just 12 miles from La Gloria, about the swarms of flies that bred in the pig waste lagoons until local officials came and sprayed are quite believable.

“According to state agents of the Mexican social security institute, the vector of this outbreak are the clouds of flies that come out of the hog barns, and the waste lagoons into which the Mexican-US company spews tons of excrement,” reported Mexico City newspaper La Jornada.¹⁴

Why deny it?

Why, you might ask, if it is indeed a swine flu, does the pork industry go to such pains to claim it is not? Why perpetuate this shell game in which industry and governments alike pretend to be astonished that the pigs have infections everyone knew they had all along? Well, initial liability might be one issue. If the strain did jump from hogs to humans at the Smithfield plant because of poor sanitary conditions, there might be legal ramifications. Two children died in that outbreak, and many have died since.

But if you owned a large hog farm with tens of thousands of hogs, what would be your worst nightmare? Probably that a situation such as that in Egypt would arise—that you might be forced to slaughter all your hogs in the name of protecting the human population from swine flu. Even more so if your holdings included numerous such farms, as it does for the major producers today.

Cottoning to the Egyptians

But that particular genie is already out of the bottle. It no longer does any good to slaughter hogs to save humans, because the flu has already spread to humans. Unless—but wait—could it be? Contrary to what we have been told, could the Egyptian thinking really make sense?

Could it be that pigs, which have not shown much reaction to swine flu all along because they have been its home for more than a decade, might become the breeding ground for the much-feared combination of avian, human and swine flu, a blend of H5N1 and H1N1 with all the worst features of both?

Smithfield and local authorities have maintained all along that the Granjas Carroll pigs have not had swine flu, but local press accounts report that the specimens delivered for testing from farm pigs were delivered by farm personnel. Local Mexican authorities never have been known for their incorruptibility and candor.

And Smithfield has tried to cover up similar swine flu outbreaks in Romania, where the local officials are not so easily bought:

“Our doctors have not had access to the American farms to effect routine inspections,” deplores Csaba Daroczi, assistant director at the Timisoara Hygiene and Veterinary Authority. “Every time they tried, they were pushed away by the guards. Smithfield proposed that we sign an agreement that obliged us to warn them three days before each inspection. These people have never known how to communicate with the public authorities.”

The swine plague epidemic, discovered August 3, [2008] revealed an embarrassing situation for the American company. Of its 33 farms, 11 had no authorization from the sanitary authorities and had to close their doors. Moreover, Smithfield lacks manpower because of its low salary policy. Four of the nine Romanian employees at the Cenei farm have left, their 500 lei (160 euros) salary inadequate to assure their everyday needs.

Cenei’s inhabitants are shocked by the American company’s methods. In mid-July, hundreds of carcasses of pigs killed by the heat wave were left lying around for about ten days. “We couldn’t breathe any more,” relates Gheorghe Olarov, an adviser at the Cenei town hall. “I live a kilometer away from the farm, and at night I had to close the windows to sleep. The Americans have made our village a hotbed of infection.”

….

“We’ve established a crisis center to confront the problem,” declared Timisoara Sub-Prefect Zoltan Marrosy. “The Smithfield farms are quarantined. The police are assuring this region’s security, so as to prevent the transport of animals and stop transmission of the virus. Smithfield has behaved aggressively: we asked them to stop breeding pigs and transferring them from one farm to another, but they paid no attention to our instructions.” The fine of 130,000 euros to which the American company was sentenced had no impact.¹⁵

With the scales of production involved, this is no surprise. The Granjas Carroll plant alone produces approximately one million hogs for slaughter annually. The income from that will support a high level of corporate arrogance. The swine population in the United States is on the order of 60 million. Most of these are raised in lots of 10,000 or more. The amounts of money to be made dwarf the impact of fines that would bankrupt a smaller operation.

The use of factory farming techniques has been accelerating rapidly. Those familiar with the issues believe it is just this rise of intensive farming that is causing the spread of increasingly virulent forms of disease.

And while fear of the loss of livestock to an emergency slaughter may haunt industry mavens, there is yet another aspect of the saga we have yet to mention: the fall from favor of pork as a food because of the bad publicity presented by swine flu. The U.S. is involved in a vast marketing effort to export pork to other parts of the world. So long as there is the merest suspicion among foreign consumers that pork might not be safe, sales are going to suffer.

The industry has preferred to keep a lid on such information, though, and scarce press has emerged detailing the extent of the market decline.

On May 1, 2009, the New York Times reported that

as more cases of the new influenza emerged on Tuesday, deepening worries about a possible pandemic, several nations slammed their borders shut to pork from the United States and Mexico. Wall Street analysts predicted a sharp decline of pork sales in grocery stores, and some consumers began steering clear of pork chops.

Several countries on Tuesday announced that they were banning some or all pork products from the United States, angering trade negotiators and hog farmers. To date, countries including the Philippines, Kazakhstan, Ukraine and Ecuador have banned pork from the United States, with Mexican pork exports also covered by most of those bans.

China banned pork from certain states, and Russia banned all meat imports, not just pork, from certain states.¹⁶

So the pork industry is taking a big hit by association with the swine flu, which is ironic because they do appear to be to blame for breeding the flu in the first place and then for permitting its outbreak to humans. Yet no source we have seen whatsoever alleges that you can actually get swine flu from eating pork.

Heard a lot on the news about that lately?

Not so much?

We just can’t think of a bigger irony.

Karen Hays died July 17 from complications to swine flu.

A 51-year-old nurse in Sacramento, CA became that state’s first health-care worker to die of swine flu. Karen Ann Hays died July 17 of a severe respiratory infection, pneumonia and H1N1, according to her death certificate. She also had methicillin-resistant Staphylococcus aureus (MRSA), a staph infection that is resistant to many antibiotics.

The Sacramento Bee reported the death on July 31. Hays was a triathlete, skydiver and marathon runner—not the typical sort of person to die of the flu, one might think.

“It’s not surprising for an otherwise healthy person to die of H1N1,” said Dr. Glennah Trochet, Sacramento County’s public health officer in a statement to the Bee.

“Nationwide all along there have been people who have died who did not have underlying medical conditions” such as obesity or pregnancy, she said. “When a disease is common enough and circulates enough, you will see all kinds of deaths.”

The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) have both said that health-care workers should be among the first to receive vaccinations against swine flu.

British health authorities reported July 14 that Dr. Michael Day of Bedfordshire, north of London, died from complications of the flu, becoming the first physician known to have died in the pandemic.

As of Thursday, August 6, 2009 the CDC has reported 436 deaths in the U.S. attributed to swine flu out of 6,506 cases reported. These figures were posted on the CDC website today.

One thing clearly different about this flu compared to the so-called “seasonal flu” that people have previously been exposed to is its relative virulence during the summer months. The chart below from the CDC shows the percentage of influenza-like illnesses (ILI) compared to the total number of illnesses reported by outpatients during the seasons 2006-2007 (blue line) 2007-2008 (green line) and this year (red line). While the winter spike from the 2007-2008 flu season (green) was a higher percentage of total cases reported than this year’s (red), this year’s level has remained higher during the summer months.

Chart of influenza-like illnesses as percentage of total illnesses. Source: CDC

According to a posting by the Associated Press penned by Frank Jordans with the dateline Geneva, “U.S. health officials estimate the United States has passed the 1 million case mark.” The story is an interview with World Health Organization (WHO) second-in-command, Keiji Fukuda.

The wording of that story took many readers by surprise. It gave us pause, too. Finally we realized.

Health Spectator initially reported on June 25 that mathematical modeling by Lyn Finelli, an official with the CDC had projected that there might be one million swine flu infections in the U.S. at that time. So the AP and other sources are just trotting out this old figure. It does not represent a new set of figures released by any U.S. health officials, as the story seems to imply.

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.]

Surprisingly, the Centers for Disease Control and Prevention’s swine flu tally for all 50 states plus the District of Columbia, Puerto Rico and the U.S. Virgin Islands does not appear to have changed much since the last time we looked. This week, the CDC changed its normal schedule of updating the figures on Friday in honor of the Advisory Committee on Immunization Practices meeting yesterday. Yesterday’s figures, which are the final figure for the week, were effective as of 7:00 PM Thursday, June 25 EDT.

The U.S. is reporting 27,717 confirmed or probable swine flu cases with 127 deaths confirmed to be the result of swine flu. Wisconsin continues to lead the states with 4,273 cases reported and 4 deaths. Texas and Utah have 10 deaths apiece, while New York has 35, California 16, and Illinois has 12.

A story by AP reporter Michael Stobbe says one U.S. official has estimated that more than one million Americans may have become infected with the novel H1N1 swine flu at this point.

Stobbe attributes the estimate to Lyn Finelli, an official with the Centers for Disease Control and Prevention (CDC). Finelli gave a presentation at a meeting of the vaccine advisory committee in Atlanta on Thursday. (more…)

First pandemic declared in 41 years

Acceding to a global rise in A(H1N1) infections, the World Health Organization today raised its pandemic alert level for swine flu to level 6—its highest level.

Asking member nations not to impose restrictions on travel or anything that might interfere with commerce, the organization stressed that the alert level reflects the widespread nature of the flu—its “unstoppability”—but not the severity of its symptoms or the number of its fatalities, which so far appear to be below the levels posed by so-called “seasonal” flu.

Indeed, WHO recommends that drug manufacturers stay on track with producing their annual allotments of seasonal flu vaccines before switching over to produce vaccines for swine flu.

In a report early last week, Health Spectator had reported that the novel H1N1 epidemic had technically achieved pandemic status according to WHO’s guidelines just by virtue of its rapid spread in Australia. The outbreak began in North America, and WHO guidelines specify a pandemic level 6 when the infection has achieved uncontrolled human-to-human transmission in more than one part of the globe.

There have been 28,774 infections reported in 74 countries to date, including 144 deaths, according to WHO’s latest tally of laboratory-confirmed cases.