Will Influenza A (H1N1) (aka "swine flu") grow into a pandemic in 2009 as feared?

I want to know if case zero is some dude, who after bangin' some pigs and chickens, celebrated by kissing people on the cheek and shaking their hands...

Señor Cerdo, la primera persona al contacto esta enfermedad, es el dueño y el marido muy ricos de muchos verracos y puercas.

I think the media is bored, health officials are finally happy to be getting some headlines, and we really have nothing else to talk about. 68 people dead in Mexico City, a city of 20 million, is like a hiccup. Still no reported cases in the north of the country.

This question will NOT be settled by bored health officials. It is a question of whether there is spread or not of this virus, which seems to be (possibly) a new strain of flu virus.. To what extent it can (and does) spread. If our countries get on top of it before it spreads too far, then maybe it can be stopped. If not, then it may spread before people can isolate themselves.

One good news (i think) is that summer is coming on (in northern hemisphere), and usually flu spreads during winter. I am betting on the flu initially, since I think it already has spread to new york (they think-- don't know yet, but it is some kind of flu -- needs further testing to ID its being swine flu or not)..

Anyway, I like questions that are clearcut -- settlement does not depend on someone reading the tea leaves..

in 6 different states...2 cases confirmed in kansas, 8 suspected in new york, massachusetts and minnesota also have some suspected bringing total to 6 states if all confirmed

I thought it was not necessarily swine flu, just SOME kind of flu. The report i heard is that it needs to be sent to CDC before it is decided what kind of flu it is..
in any case, I think officials (not necessarily through boredom), but rather cautiousness, will tend to err on the side of caution -- raising the threat level so, it things get worse, they can be said to have taken the necessary steps quickly. I cannot say i disagree with this type thinking (for this case)..

nice question SQLman

Not sure I stated my thoughts clearly enough.. I think the epidemiologists (sp?) would want to move ahead of the curve, so they can stop the disease in its tracks (BEFORE it spreads). The point is that issuing warnings, changing threat levels , etc. does little good AFTER the spread.. Then, one needs much stricter quarantines, etc.
just let the disease "burn itself out".

Anyway, this is the way I am betting, but I am very happy to be wrong on this.

By the way, this page lists the stages of pandemic alerts, so they go by a fixed set of criteria, surprisingly, not just by the seat of their pants.

http://www.who.int/csr/disease/avian_influenza/phase/en/index.html
info here - (but table does not print).. it looks like they may not aim "to be ahead of the curve, as I would", but
I am not one of these guys, and may not appreciate how scary it is to raise the alert level, so my proactive stance mentioned may not be best, with everything thrown in together.. .. I hope they are doing the right thing..I AM sure they know a LOT more about flu than I do. (me little, them lots)

-- WHO global influenza preparedness plan

Experts at WHO and elsewhere believe that the world is now closer to another influenza pandemic than at any time since 1968, when the last of the previous century's three pandemics occurred. WHO uses a series of six phases of pandemic alert as a system for informing the world of the seriousness of the threat and of the need to launch progressively more intense preparedness activities.

The designation of phases, including decisions on when to move from one phase to another, is made by the Director-General of WHO.

Each phase of alert coincides with a series of recommended activities to be undertaken by WHO, the international community, governments, and industry. Changes from one phase to another are triggered by several factors, which include the epidemiological behaviour of the disease and the characteristics of circulating viruses.

The world is presently in phase 3: a new influenza virus subtype is causing disease in humans, but is not yet spreading efficiently and sustainably among humans.

I am so going to game this! I'm headed down to Mexico City, going into every hospital I see for the weekend, then flying to every city around the world.

As of 7:30 EDT, there were 11 confirmed laboratory cases in the U.S.: 7 in California, and 2 each in Texas and Kansas (are http://www.cdc.gov/swineflu/investigation.htm).

@Bigken: you mentioned flu season being over, or nearly so...but I think that's one of the things that has folks worried: this flu is spreading despite the fact that flu season is done with. More worrisome is that fact that it's not targeting the flu's normal victims--the very old and the very weak--but rather healthy individuals in the prime of their life.

@candelario: there's too much going on in the world today for journalists to sensationalize something like this. (Ask me: I'll give you a list.) Yeah, all or most of the confirmed U.S cases have been mild and far from lethal. But as the WHO puts it: "Because there are human cases associated with an animal influenza virus, and because of the geographical spread of multiple community outbreaks, plus the somewhat unusual age groups affected, these events are of high concern. The Swine Influenza A/H1N1 viruses characterized in this outbreak have not been previously detected in pigs or humans. The viruses so far characterized have been sensitive to oseltamivir, but resistant to both amantadine and rimantadine."

The CDC also says--rather ominously, I think--that with the flu popping up in Mexico and the states mentioned above, as well as Minnesota and New York (both just suspected for now), it may be too late to even try containing the spread of the virus.

Yet another worrisome bit: people appear to have no immunity whatsoever to the virus, which presents itself like other swine flus. "It appears to be able to transmit easily between humans,” Eberhart-Phillips [of the CDC] said. “It’s something that could potentially become very big, and we’re only seeing, potentially, the very beginning of a widespread outbreak.”

I'm certainly not trying to hype this up for some reason. But the fact that the WHO is even considering raising their flu alert level to 4--something they haven't done for a really long time--is a little unsettling, don't you think?

Sqlman:
Great job on putting this question together.
I was quite scared when a similar outbreak of Bird Flu seemed imminent.
Hopefully this too will pass, with more hype than harm.

Frogchop: Don't you dare. . . ;-)

Thanks, chatarra. :-)

For those of you wondering: here are the flu alert levels used by the WHO

Interpandemic period

--Phase 1: Low risk - No new influenza virus subtypes dangerous to humans detected in humans or animals.
--Phase 2: New virus - A new circulating animal influenza virus subtype poses a substantial risk of human disease but no new influenza virus subtypes have been detected in humans.

Pandemic alert period

--Phase 3: Self-limiting - Human infection(s) with a new subtype, but no human-to-human spread, or at most rare instances of spread to a close contact. Even without human intervention it would be self limiting among humans.
--Phase 4: Person-to-person - Small cluster(s) with limited human-to-human transmission but spread is highly localized, suggesting that the virus is not well adapted to humans. An epidemic is possible but has not yet happened.
--Phase 5: Epidemic - Larger cluster(s) but human-to-human spread still localized, suggesting that the virus is becoming increasingly well adapted to humans, but may not yet be fully transmissible (substantial pandemic risk).

Pandemic period

--Phase 6: Pandemic - increased and sustained transmission in general population.

They say it is in phase 3, but the evidence seems to support 4 at least. The strange aspect of this rating scheme, is that , if they are effective and stop it, then it goes back down, but that is more a function of how they are behaving than how virulent it is.. So, it is not a measure of hte disease spread itself, well thats the bottom line, i think...

http://news.bbc.co.uk/2/hi/talking_point/8018428.stm

I work as a resident doctor in one of the biggest hospitals in Mexico City and sadly, the situation is far from "under control". As a doctor, I realise that the media does not report the truth. Authorities distributed vaccines among all the medical personnel with no results, because two of my partners who worked in this hospital (interns) were killed by this new virus in less than six days even though they were vaccinated as all of us were. The official number of deaths is 20, nevertheless, the true number of victims are more than 200. I understand that we must avoid to panic, but telling the truth it might be better now to prevent and avoid more deaths.
Yeny Gregorio Dávila, Mexico City

[More at the link...]

This seems to have wormed its way over to New Zealand as well :(

http://www.stuff.co.nz/national/health/2364487/Ten-influenza-results-confirmed

Bad news: According to the WHO, there "may be hundreds if not thousands of as-of-yet-undetected cases around the globe already, cases which will come to light at the end of the incubation period."

Good news: According to the CDC, scientists have already developed a genetically-identical "seed stock" to be used as the basis for a vaccine if/when the government decides mass vaccine production is necessary. (Though keep in mind, because of A/H1N1's oddly recombinant mixture of human, avian, and swine flus, doctors have no idea whether any vaccine will work. Also keep in mind that the last round of swine flu vaccine caused hundreds to be afflicted by the highly debilitating Guillain-Barré Syndrome.)

It's very possible that a rapid worldwide response to this will clamp things down early enough that the damage will be minimal, and we'll never see any of the higher flu alert levels. The SARS viros from a few years back was prevented from spreading too far. I suppose that modern technology's ability to help rapidly distribute a virus also works to disseminate news, preventive measures, and cures.

When the time comes, I'll keep my nose and mouth covered, my hands clean, and my fingers crossed...

Thanks sqlman,

I am coming here to get the news.
It's not great if the news is "filtered" so as to not let people make their own decisions, about how best to protect themselves and their families.. A little down time, and/or wearing facemasks are not such horrible things, and if large scale gatherings (concerts, football games, etc.) are stopped till this thing dies down, we can live with that..

It is worth it, to have a few weeks "off" from the frenzy of the world, if we are in a era where a large scale disease might spread... .. They landed all the planes during 9 11. Surely (of course only if it warranted)., this could be done NOW too.. This has the potential to kill or cause gross illness in a LOT more people than 9 11. So, I hope OUR govt. does something about it , rather than wait for WHO .. (i hate to say it, but it reminds me of the old Abbott and Costello jokes -- who's on first. But of course this IS serious).

You're welcome, Ken! A quick update (8:30AM):

CONFIRMED:
Mexico (multiple)
United States (Texas, California, and Kansas; suspected in New York)

SUSPECTED:
New Zealand (http://www.emaxhealth.com/1/74/30640/how-did-swine-flu-reach-new-zealand.html)
France (http://www.calgaryherald.com/business/fp/Swine+epidemic+fears+grow+world+alert/1535878/story.html)
Israel (http://www.khaleejtimes.com/DisplayArticle08.asp?xfile=data/international/2009/April/international_April2085.xml§ion=international)

REJECTED:
England (http://uk.reuters.com/article/usTopNews/idUKTRE53P0M820090426)

9:46 Am EDT: Now possibly also Spain. http://www.google.com/hostednews/ap/article/ALeqM5g-G1kSAM9yaH00eBrXD2S5s-3ZhgD97Q5KVO0

FYI, not all doctors are convinced a pandemic is imminent:

"Dr. Marc Siegel, associate professor of medicine at New York University School of Medicine, said the current outbreak was unlikely to become a pandemic. "Swine flu could cause the next pandemic, but it is not likely that this thing is going to erupt and take over the world," he said. Even though the virus is being transmitted human-to-human, "that's a far cry from becoming a pandemic," he added. Dr. Martin J. Blaser, chairman of the Department of Medicine at New York University Langone Medical Center in New York City, also believes it's unlikely the outbreak will trigger a pandemic." (http://www.forbes.com/feeds/hscout/2009/04/26/hscout626462.html)

fyi pandemic does not mean it is killing a LOT of people. In fact, the disease spreads "better" (for it), if it does not. If the disease kills people then they stop spreading it. This is why AIDS is so bad, because it incubates for such a long time..Hence it spreads a lot before an individual stops spreading it.

This disease, unlike AIDS has a fairly short incubation period, which is good for us, as cases can be caught early. However, I heard some doctors saying (on tv), not to report every sniffle, etc. I think we (as a society) need to get on top of these things, and if people are feeling ill, it is better for society, for them to get it checked out....(IMHO)

the definitions of pandemic is as follows --pan⋅dem⋅ic
   /pænˈdɛmɪk/ Show Spelled Pronunciation [pan-dem-ik] Show IPA
-adjective
1. (of a disease) prevalent throughout an entire country, continent, or the whole world; epidemic over a large area.
2. general; universal: pandemic fear of atomic war.
-noun
3. a pandemic disease.

confirmed in NYC and the news in ohio says there's one confirmed case here

I did not mean to say this shouldn't be taken seriously. But put in perspective, I just read that 250,000 people die from some kind of flu every year. By most reputable accounts we're still talking about less than 100 people in Mexico.

UPDATE 1:15PM EDT:

CONFIRMED:
Mexico (multiple)
United States (California; Kansas; New York; Ohio; Texas) (http://www.cdc.gov/swineflu/investigation.htm)

SUSPECTED:
France (http://www.calgaryherald.com/business/fp/Swine+epidemic+fears+grow+world+alert/1535878/story.html)
Hong Kong (http://www.nytimes.com/2009/04/27/world/27flu.html?hp)
Israel (http://www.khaleejtimes.com/DisplayArticle08.asp?xfile=data/international/2009/April/international_April2085.xml§ion=international)
New Zealand (http://www.emaxhealth.com/1/74/30640/how-did-swine-flu-reach-new-zealand.html)
Spain (http://www.google.com/hostednews/ap/article/ALeqM5g-G1kSAM9yaH00eBrXD2S5s-3ZhgD97Q5KVO0)

REJECTED:
England (http://uk.reuters.com/article/usTopNews/idUKTRE53P0M820090426)
---------------------------------------------------
The United States has just declared a public health emergency.
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@cancelario: the vast majority of those who die from the flu are very old, very young, or very weak. This strain of the swine flu has been taking healthy young- and middle-aged adults.

Now confirmed in Canada, as well (http://www.boston.com/news/world/australia/articles/2009/04/26/who_tries_to_come_up_with_swine_flu_plan/)

My unscientific (and, I hope, non-fatalistic) guess is that by May 15, there'll be confirmed cases in more than half of all U.S. states, and more than 30 countries.

So globally people are catching a new strain of flu, but only the people in Mexico have suffered fatalities and even then, we're looking at what? 20 confirmed deaths with a possible 61 more?

My first question would be A) doesn't this happen somewhere every year? and B) has anyone asked the good folks at Ft. Detrick what they've been working on lately?

I think I should create a Q over which pharma company will be the 1st to develop and peddle a vaccine....and maybe another that speaks to whether any Gov't will make the damn thing mandatory for any of it's citizens...and yet maybe a 3rd Q that asks how many people inoculated will suddenly have 'something else happen'....

First of all, as far as creds go, I am not a medical Dr. , but have a ph D. in physics. Concerning the the aspect of a LOT of people coming down and dying from flu each year, that's a good point. Nevertheless, this is whole new kettle of fish, because it is a NEW strain, so,just like the concern over bird flu, it is worrying, because being a new strain with new species , it means it can pass not only from people to people, but between different species!!!

This means it can get into, for example pigs, and then infect people who work on farms, and then spread more generally, so such a virus can then infect larger portions of the population and will be harder to eradicate, etc...
Please correct me , if i am wrong...

So far everything I've read says that it responds well to several existing anti-viral medications. I won't say that it doesn't sound scary and the possibility for big time bad is still there, but I think some of this is a little unnecessarily alarmist. Here's one of the more reassuring articles I've read on the topic: http://www.reuters.com/article/topNews/idUSTRE53N4PB20090424 and one of the funnier ones: http://gawker.com/5228286/

One of the most interesting things is that people here in Mexico are dying from this while people in the States are not. My own theory about this is that Mexicans can buy antibiotics over the counter. Oftentimes, when people here get sick, they don't go to the doctor -- they go to the pharmacy, tell the cashier they have a bad flu, and pick up a box of amoxicillin or whatever. If you did that with the swine flu, you might in effect be doing nothing and waiting around to get better as the symptoms get worse until the grim reaper steals you away. It's just a theory.

My other thought is that with the easy availability of antibiotics here, and people taking them for everything from a headache to a common cold, it may be that many Mexicans have weakened immune systems. Again, not a doctor. But both ideas seem to make Some sense.

Getting back to comparative numbers, 250,000 people die of the flu each year, 90 percent of whom are older than 65. That means 25,000 people who die of the flu each year are younger than 65. Let's assume that 20,000 of those are 50-65 or under 18 years old. Make it 23,000, just to be generous with numbers. That still leaves 2,000 adults of a robust age dying each year from the plain, old flu.

Here in Mexico, we're now at 81 deaths (20 confirmed to be from the Plague to end All Plagues or whatever we're calling it), with most in Mexico City, the neighboring State of Mexico, and the central state of San Luis Potosi.

I just hope that the 1 person who's still alive on New Years Day will be able to settle this question

candelario, I was wondering the same thing...about the availability of antibiotics.

candelario, those numbers are worldwide, correct? Because CDC says 20,000 die from the flu each year in the US, 100,000 hospitalized.

candle and emmag, as i was saying earlier, it is not the numbers that are scary.
As you say, the numbers from this recent new flu are very, very small at present. IT is just
that it is a new form of flu, so can spread in new ways, has a new incubation period, etc. etc. ,
so it may be worse, or maybe NOT. (it has been spreading in the spring, whereas most flus spread in the winter.. what till this be like when winter comes? There is just a LOT we do not know about it.. so fear of the unknown..

The worldwide numbers I saw were between 250,000 and 500,000 depending on the year. It's also worth considering that every flu season, there are new strains of the flu. Again, I'm not downplaying what could be a serious situation. But we're still talking about 80-something dead people so far.

It's true that 20,000 peope Americans die from the flu every year. But those are generally unrelated cases of known flus. This one, on the other hand, is different---and possibly very different.

Tens of thousands of Americans die each year in automobile crashes; those things are always going to happen, so it's not headline news. But if historically safe drivers began killing themselves in inexplicable crashes all over the country, and in a spreading pattern, believe me: it'd be on page 1.

Anyway, here are many of the things that have epidemiologists worried:

1) This strain appears to be a subtype not seen before in humans or pigs, with genetic material from pigs, bird and humans, according to WHO. Unlike most cases of swine flu, this one can spread from person to person.

2) Pigs were the "mixing bowl" for this virus. Birds can't pass bird flu to people. But pigs are uniquely susceptible to getting flu viruses that infect birds. Experts have long worried that a pig would catch a bird strain of the flu and then the virus would mutate inside the pig to a form that could also infect other mammals. That may be what happened in this case. Pigs can also be infected with more than one influenza virus at a time, allowing the viruses to share genes, called "genetic reassortment," creating new and potentially much more virulent viruses.

3) There is currently no vaccine for this strain, but government scientists could try to create one, according to the CDC, whose scientists don't know if this year's flu vaccine offers any protection.

4) While this strain does appear sensitive to the antiviral drugs Relenza and Tamiflu, it's not to amantadine, or Symmetrel, and rimantadine, or Flumadine.

5) Off the record, many American doctors say they don't trust the information coming out of Mexico. It's not that they would intentionally lie, but their methods of record collection and dissemination may be making the situation appear better--or, yes, worse--than it actually is.

6) The genetic make up of this virus has influenza experts scratching their heads. One of the things that has them worried is that this could be a virus that could continue to make mischief during the warmest parts of the year. That would be a big thing; for a respiratory virus to be active during the summer months would be very unique.

7) Given the current spread of the virus, containment is no longer an option.

8) If this is a virus that is sufficiently new--and that has not been entirely determined yet--people may need two doses of any vaccine to get protection, which would put additional strain on the vaccine production and delivery services.

9) If work were to begin on a vaccine today, it would likely not be ready until at earliest mid-October.

----------------------------------------------

I want to reiterate what I said earlier: even if this outbreak turns into a pandemic, that doesn't necessarily mean there'll be any more deaths than usual. This market is only asking whether this flu will spread fast enough and far enough to be listed as a pandemic by the WHO and/or CDC.

Candle....you may be onto something with that OTC treatment by individuals in Mexico. Given you can enter the local pharmacy and get antibiotics on demand....well, do that often enough and you are going to develop an immunity to their effectiveness. That can also happen to a person whose been drinking milk from cows treated with rBGH, the bovine hormone shot.

I'm REAL curious though....you guys are saying Tamiflu works, eh?

Isn't that the drug that the US Gov't bought by the truckload a few years ago?

Ahhh...and here comes the philanthropist Robert Zoellick and the World Bank to loan 200 million to Mexico to deal with this problem because they are all heart. Wonder which testicle Mexico just sold down the river for this aid....

Homeland Security Secretary Janet Napolitano said roughly 12 million doses of the drug Tamiflu will be moved from a federal stockpile to places where states can quickly get their share. Several governors requested medication and masks

@C2R: did you know the word avocado is from the Nahuatl* word āhuacatl, which means "testicle" (for the shape of the fruit)? So maybe Zoellick et al. just want a little fresh guacamole...

* - Language of the Nahua people of central Mexico.

Me encanta el guacamole, no tanto ya pesar ahora. :P

Well thank you for that very Cliff Clavin like tidbit, Sqlman.....I'm guessing that Zoellick won't be satisfied till he's swimming in every impoverished nations guacamole....what I wouldn't do to HIS āhuacatl's given the opportunity....

Its a good thing it seems treatable, cos it seems to travel a lot quicker than the bird flu did - it was in auckland yesterday now they think its in 4 different provinces. We didnt even get the bird flu - this one seems to be spreading a lot quicker. Having said that, the kiwis dont seem too worried, here's a comment posted on our online newspaper site i liked:

"Much ado about nothing: if I see my pet pig cough, sneeze and wheeze - I just administer, Porky, a shot of Ventolin from the medihaler, we both share. Simple as."

A clear case of pigs might fly.

hi sql, and others
thx much for your informative news on the aspects of this disease..
I think that spells it out better than i did , why this is of more concern than the normal flu, even though, the #s are still insignificant.
Hopefully, with good handling of cases, etc. and/or the manner in which the disease spreads , it will remain minimal. and become a "fond" memory. :)

if not , we may have to kill pigs en masse, like they do, when animals get communicable diseases..

It's now confirmed in the EU:http://news.bbc.co.uk/2/hi/americas/8020552.stm

Thanks, bigken. The thing is, though, now that the virus s in the human population--and seems to be able to jump from person to person without need of a porcine host or intermediary--killing all the pigs would do nothing. Well, other than give the world a reason to hold the biggest pork barbecue in the history of mankind. :)

We're all gonna die.

"We're all gonna die."

Well, that's a certainty, with or without the swine (or any other) flu... :-)

Great image of our man of LoonyTunes, Mr. Porky Pig. Very prescient catchphrase he has.
On with the show this is it.

I think that OTC antibiotics would have little effect on something like this, because the flu is a virus and not bacterial - thus is unaffected by antibiotics. Viruses are completely different from bacterial infections and work in different ways and require different medications. One of the difficult things about viruses is that they cannot be killed as easily as bacteria, making it much more difficult to medically intervene.

Thanks, Jake, for that explanation.

Yep, Jake is spot on. I just finished a microbiology class last year and anti-viral drugs (which are few and far between) work completely differently than antibiotics. Viruses are unresponsive to anti-biotics. Apparently the Swine Flu is responding well to some anti-viral drugs, which are now being distributed nationwide in the US as part of the response. Whether Mexico has the resources available or not has yet to be seen. The IMF just gave them $200 million for combating the virus, so at least the money is now available.

http://www.cdc.gov/swineflu/swineflu_you.htm
Are there medicines to treat swine flu?
Yes. CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with these swine influenza viruses. Antiviral drugs are prescription medicines (pills, liquid or an inhaler) that fight against the flu by keeping flu viruses from reproducing in your body. If you get sick, antiviral drugs can make your illness milder and make you feel better faster. They may also prevent serious flu complications. For treatment, antiviral drugs work best if started soon after getting sick (within 2 days of symptoms).

Bacteria have cell walls, and are often killed by attacks on the cell walls. Viruses on the other hand , are raw dna type molecules typically (or can be rna) and usually have a protein coating, and can live even in the absence of water. Bacteria die, as far as i know,if they get dry (dessicate). Viruses, however, can live for awhile in dry air, however, they need a host cell to grow in. They use the host's energy to duplicate. So, they are like a trojan horse, taking advantage of the host for their own purposes. Viruses are many times smaller than bacteria.

UPDATE 4/27 @ 2:12 EDT:

CONFIRMED:
Canada: http://www.boston.com/news/world/australia/articles/2009/04/26/who_tries_to_come_up_with_swine_flu_plan/
Mexico: 2000+ cases suspected in 19 or Mexico's 32 states; 149 confirmed dead
Spain: http://www.timesonline.co.uk/tol/life_and_style/health/article6178618.ece
United States: 40 confirmed cases in California, Kansas, New York, Ohio, Texas; dozens of widespread suspected cases: http://www.cdc.gov/swineflu/investigation.htm

SUSPECTED:
Britain: http://www.usatoday.com/news/health/2009-04-27-flu-global_N.htm
France: http://www.calgaryherald.com/business/fp/Swine+epidemic+fears+grow+world+alert/1535878/story.html
Hong Kong: http://www.nytimes.com/2009/04/27/world/27flu.html?hp
Israel: http://www.khaleejtimes.com/DisplayArticle08.asp?xfile=data/international/2009/April/international_April2085.xml§ion=international
New Zealand: http://www.emaxhealth.com/1/74/30640/how-did-swine-flu-reach-new-zealand.html
Scotland: http://www.guardian.co.uk/world/2009/apr/27/swine-flu-scotland
Sweden: http://www.usatoday.com/news/health/2009-04-27-flu-global_N.htm
Switzerland: http://www.usatoday.com/news/health/2009-04-27-flu-global_N.htm

Nothing being reported in Asia or South America yet, huh?

Comparisons between this flu outbreak and the 1918 Spanish Flu:

"The 1918 Spanish flu pandemic began with a fairly mild wave of infections in the spring, but the virus returned a few months later in a far more virulent form."
(Just because the cases in the U.S. thus far have been mild, that doesn't mean it won't get worse)

"Another oddity was that this influenza outbreak was widespread in summer and fall (in the Northern Hemisphere). Typically, influenza is worse in the winter months."
(People have been saying that it's odd that this new flu strain has started spreading now, when flu season should be ending)

"The influenza strain was unusual in that this pandemic killed many young adults and otherwise healthy victims; typical influenzas kill mostly infants (aged 0-2 years), the elderly, and the immunocompromised."
(From what I've read, this seems to be the pattern of the swine flu)

Nothing confirmed in South America, but there are a suspected cases in Colombia and Peru (and Costa Rica, too). As of 3:26 PM EDT, there are confirmed cases in 5 countries now, and suspected cases in 14 others. New Zealand is the closest to Asia for now, though...

...make that 16 others. It's like this:

COUNTRY: suspected cases / confirmed cases / confirmed deaths

MEXICO: 1995 / 26 / 149
UNITED STATES: 100+ / 40 / 0
CANADA: 20+ / 6 / 0
UNITED KINGDOM: 14 / 2 / 0
SPAIN: 35 / 1 / 0

New Zealand: 111 / 0 / 0
Colombia: 12 / 0 / 0
Australia: 7 / 0 / 0
Belgium: 6 / 0 / 0
Sweden: 5 / 0 / 0
Switzerland: 5 / 0 / 0
Denmark: 4 / 0 / 0
France: 3 / 0 / 0
Germany: 3 / 0 / 0
Ireland: 3 / 0 / 0
Norway: 3 / 0 / 0
Czech Republic: 3 / 0 / 0
Israel: 3 / 0 / 0
Costa Rica: 1 / 0 / 0
Poland: 1 / 0 / 0
Peru: 1 / 0 / 0

thanks for the informative insightful posts here

Thats the first leaderboard I've seen New Zealand topping for a while...

The WHO just raised the Pandemic Flu Alert Level to 4 (Sustained Human-to-Human Transmission) (http://www.who.int/csr/disease/avian_influenza/phase/en/index.html)

@cookietime: <bad-duh-BUMP>

@kida: don't forget: the Spanish Flu pandemic which killed up to 100 million people was also, as with the current flu, A/H1N1. One thing that's not the same: the Spanish Flu had a mortality rate of about 2.5% (that is, 25 our of every 1000 people infected by the virus died). So far, the mortality rate in Mexico has been around 7%. (Though to be honest, some of that may be due to the fact that many in Mexico with the symptoms may not be seeing doctors, which would tend to artificially hold down the number of infected.)

RE comments 5, 21, and 39...... is that the 4D of ancient hubdub lore??????

I was wondering as well if pics4d was the one and same from days gone by

huh...what?....hey meandering...yeah i'm the same, i lost my internet for awhile, but i got a laptop with my tax refund so i'm back on now...i was wondering if u were still here...it's nice to see u again

Time to stock up on some shotgun rounds, just in case dead swine flu victims rise from the dead and attempt to feast on the living

Keep this in perspective my fellow comrades. 30-40,000 people die in the US from the regular flu every year, mostly elderly. I do pray for those of have died or are sick.

Just 20 cases in the US does not necessarily represent that the sky is (HDS Janet N.) falling chicken little. The vaccine can cause as many 1000 of deaths from a vaccine as it did in 1976.

Panic can kill and cause more harm than the flu itself. Don't necesarily beleive the proganda that the HDS is putting out. Where is the US Surgeon General or do we have one?

I place my bets on some are looking for a diversion from this goat rope stimulas package being forced down our throats by Congress. They are more of a threat than the Arnold the Pig.

@ijn316: In the words of the fictional Jules Winnfield: "Allow me to retort."

"30-40,000 people die in the US from the regular flu every year, mostly elderly."

Key word: elderly. Millions of the elderly die every year. It's what the elderly do. But this swine flu is targeting healthy individuals...one of the hallmarks of a pandemic.

"Just 20 cases in the US does not necessarily represent that the sky is (HDS Janet N.) falling chicken little. The vaccine can cause as many 1000 of deaths from a vaccine as it did in 1976."

Yes, in cases, the vaccine can be bad, and--as you point out--worse than the virus. However, there is no vaccine for A/H1N1, and even if one is started on today, it won't be ready until October.

Having said that: it's not 20 cases in the United States. It's 48 confirmed, and 239 more (as of this writing) suspected. And as the CDC said today in their press conference, there are almost certainly many more cases that haven't come to light yet, but will.

"Panic can kill and cause more harm than the flu itself. Don't necesarily beleive the proganda that the HDS is putting out. Where is the US Surgeon General or do we have one?"

I'm really only paying attention to the CDC and the WHO, physican-operated organizations that have the singular goal of educating and warning the public. And they're worried.

"I place my bets on some are looking for a diversion from this goat rope stimulas package being forced down our throats by Congress. They are more of a threat than the Arnold the Pig."

Funny, I guess, but you know what's even funnier? That back in February, congressional Republicans--goaded on by anti-patriot Karl Rove--single-handedly stripped all but $50 million of the $900 million the White House had asked for for "pandemic influenza preparedness" from the American Recovery and Reinvestment Act.

Oh, wait: that's not funny... :-|

In reference to the above comment, in the interest of fairness I should note that most of the $900 million was later restored, and, in fact, some bandwagon-jumping, weak-kneed Democrats at the time trumpeted the $900 million as pork. But it was those Rove-lead congressional Republicans who bragged about taking the funds out in the first place as though it was a great and heroic thing.)

yes, that is sad. wonder if Stewart and Colbert will cover this travesty... there must be some clips of that cut made and argued against.

What is really sad, is that our current administration has no Surgeon General at this time of crisis. Maybe the budget doesn't have room for a Surgeon General to be on the payroll.

Fortunately, we have Aunt Janet (Homeland Security Secretary Janet Napolitano) on the case.

Reuters reported that the United States is not currently screening or testing the passengers coming from Mexico into the country. Reuters went on to report that Homeland Security Secretary Janet Napolitano announced today that ". . . right now we don't think the facts warrant more active testing or screening of passengers coming in from Mexico." She later replied that they are asking passengers if they feel OK, and if passengers say they are sick, then those passengers are being asked to travel at a different time.

I can tell that she is really tough - NOTHING gets past that woman!
I feel so much safer with her in charge - NOT.

I am also waiting for MSM to make a single mention of "illegal immigrants". Political correctness of the mainstream media prevents saying something that might offend somebody.The ugly truth is that many more undocumented new residents come across the porous border than enter US via airways. Does she think that the wave of illegal immigrants from Mexico are coming via first class travel with laptop computers and Gucchi purses?

4/27 @ 21:51 EDT:

The current WHO phase of pandemic alert is 3 (sustained human-to-human transmission)

COUNTRY: suspected cases / confirmed cases / deaths
---------------------------------------------------
MEXICO: 1995 / 26 / 149
UNITED STATES*: 212+ / 48 / 0
CANADA: 28+ / 6 / 0
UNITED KINGDOM: 21 / 2 / 0
SPAIN: 35 / 1 / 0

New Zealand: 56 / 0 / 0
Australia: 19 / 0 / 0
Colombia: 12 / 0 / 0
Brazil: 11 / 0 / 0
Switzerland: 5 / 0 / 0
Denmark: 4 / 0 / 0
Ireland: 4 / 0 / 0
Czech Republic: 3 / 0 / 0
Poland: 3 / 0 / 0
France: 3 / 0 / 0
Guatemala: 3/ 0 / 0
Israel: 2 / 0 / 0
Argentina: 1 / 0 / 0
Costa Rica: 1 / 0 / 0
Peru: 1 / 0 / 0
Russia: 1 / 0 / 0
South Korea: 1 / 0 / 0

* - U.S.: confirmed in NY, CA, TX, KS, OH; suspected in SC, NJ, ID, NC, IN, MA, SD, MI

Our savior, Obama, the anointed one, gave us Aunt Janet because she understands borders: "And here's the future. The future is we have borders." - Aunt Janet

Be thankful and believe!

Really appreciate the updates here, sqlman...it's just so much easier to come here to chart how this is progressing.

Whether Mexico has the resources or not is almost immaterial. The Mexican government, and this administration in particular, is so inept that if Christ himself returned to start healing people one at a time, they'd find a way to screw it up. Read.

http://news.yahoo.com/s/ap/20090428/ap_on_re_la_am_ca/lt_swine_flu_mexico;_ylt=AlepNE1jjxIf8st18a2gj9is0NUE;_ylu=X3oDMTJrZWVyYjBvBGFzc2V0A2FwLzIwMDkwNDI4L2x0X3N3aW5lX2ZsdV9tZXhpY28EY3BvcwMyBHBvcwM3BHNlYwN5bl90b3Bfc3RvcnkEc2xrA21leGljb2ZhY2VzYw--

chatarra - no secretary of health either.

The Obama administration declared a "public health emergency" Sunday to confront the swine flu — but is heading into its first medical outbreak without a secretary of Health and Human Services or appointees in any of the department's 19 key posts.
http://www.twincities.com/politics/ci_12236685?source=rss

sqlman - in case you forgot the dems the control congress and wrote the "American Recovery and Reinvestment Act." anything cut or put back in was done with their approval. the evil republicans was shut out of the process. :)

http://www.hubdub.com/m21225/Will_we_see_a_global_influenza_pandemic_in_2009
Another market on the topic of flu.

1) Now confirmed in Israel and New Zealand, meaning it's now confirmed on North America, Europe, Asia, and Oeania. The only populated continents with no confirmed cases are South America (conformation likely today) and Africa (which hasn't reported a single suspected case, but given the state of medical reporting there, that's not surprising).

2) Now 50 confirmed U.S. cases in 5 (NY, CA, TX, KS, OH), and suspected in 10 others (SC, MS, NJ, ID, WI, NC, IN, MA, MI, AL)

3) The WHO says they may raise the pandemic alert level to 5--the last pre-pandemic stage--later in the week if things continue developing at the rate they currently are.

4) Pharmacies in affected areas are reporting mild runs on the prescription antiviral medications Tamiflu and Relenza. This has officials worried, because, while there are adequate supplies for now, they're fearful there may not be enough to go around if/when this thing gets truly out of hand.

5) Up until now, countries with suspected cases have had to send samples to the U.S. for testing. Yesterday, however, the CDC began sending virus testing kits to countries around the globe, which will allow each nation to do rapid testing on its own. This is expected to fuel a rise in the number of confirmed cases.

6) Demonstrating possibly misplaced priorities, Israel's Deputy Health Minister says the name "swine flu" is offensive to both Judaism and Islam, and thus should be changed to "Mexican Flu", as that's not offensive at all. :-| (http://www.google.com/hostednews/ap/article/ALeqM5ieHZRubAS3lyjn2GBiCPkXkHrXwwD97QROAG0)

7) ...and along similar--though more logical--lines, The U.S. pork industry says that name is hurting their business, as some ignorant individuals (and nations) are staying away from The Other White Meat out of misplaced fears.

Now confirmed in South Korea (http://news.xinhuanet.com/english/2009-04/28/content_11274969.htm)

About point 6 in comment #80 - I was a lot younger back then, but I don't remember anyone making comments about the name "swine flu" when it broke out in the mid 1970s...

Maybe people are more offend-able now (or my memory is going fuzzy)

During the last outbreak of swine flu decades ago, there was very little if any outrage or connection made to "swine flu" and it being execrable.

This is where things start to get really interesting...

http://news.yahoo.com/s/ap/20090428/ap_on_he_me/med_swine_flu

By ANDREW O. SELSKY, Associated Press Writer Andrew O. Selsky, Associated Press Writer - 16 mins ago
MEXICO CITY - The swine flu epidemic crossed new borders Tuesday with the first cases confirmed in the Middle East and the Asia-Pacific region, as world health officials said they suspect American patients may have transmitted the virus to others in the U.S.
...
But confirmation that people had become infected outside Mexico would indicate that the disease was spreading beyond travelers returning from the country, World Health Organization spokesman Gregory Hartl told reporters on Tuesday in Geneva.

Fears of a Clown
http://www.time.com/time/photogallery/0,29307,1894059_1875312,00.html

And the beat goes on:

The current WHO phase of pandemic alert is 4 (sustained human-to-human transmission)

COUNTRY: suspected cases / confirmed cases / deaths
---------------------------------------------------
MEXICO: 1995 / 172 / 152
UNITED STATES*: 255 / 68 / 0
CANADA: 19 / 13 / 0
NEW ZEALAND 43 / 11 / 0
UNITED KINGDOM: 40 / 2 / 0
SPAIN: 32 / 2 / 0
ISRAEL: 2 / 2 / 0
COSTA RICA: 0 / 1 / 0

Australia: 91 / 0 / 0
Brazil: 20 / 0 / 0
France: 20 / 0 / 0
Chile: 13 / 0 / 0
Colombia: 12 / 0 / 0
Argentina: 10 / 0 / 0
Switzerland: 9 / 0 / 0
Norway: 8 / 0 / 0
Poland: 5 / 0 / 0
Hong Kong: 4 / 0 / 0
Guatemala: 3 / 0 / 0
Honduras: 3 / 0 / 0
Venezuela: 3 / 0 / 0
Germany: 2 / 0 / 0
Iceland: 2 / 0 / 0
Austria: 1 / 0 / 0
Dominican Republic: 1 / 0 / 0
Italy: 1 / 0 / 0
South Korea: 1 / 0 / 0
Uruguay: 1 / 0 / 0

* - United States reports confirmed cases in NY, CA, TX, KS, IN, OH; suspected cases in WI, SC, NC, ME, MS, TN, AL, NE, NJ, AZ, CT, ID, MA, MI, FL, OK, NH

For those keeping track: that's confirmed in 8 countries on four continents, suspected in 20 others; confirmed in 6 states, suspected in 17 more

The death toll, according to official sources, seems to be slowing in Mexico, God knows why because the government surely isn't doing a very good job of handling this. Wait and see. Wait and see.

And it's not just the death toll in Mexico that's slowed in Mexico; the number of new cases has dropped over the past three days, as well: from 141 on Saturday to 119 on Sunday and 110 on Monday. We'll have to see if that trend continues, or if--as the WHO seems to believe--these are just temporary, statistically-normal lulls...

The US has its first swine flu death (a 23-month-old in Texas). The count as of now:

Confirmed cases in 9 countries on four continents
Suspected cases in 22 other countries
Confirmed cases in 6 US states
Suspected cases in 19 other states

http://news.yahoo.com/s/ap/20090429/ap_on_he_me/swine_flu_world

closer to pandemic

Thanks, coolkraft. Yeah, a pandemic declaration is doubtless coming soon; we're now up to:

Confirmed cases in 11 countries on four continents
Suspected cases in 24 other countries on six continents
Confirmed cases in 10 US states
Suspected cases in 18 other states

WHO's Pandemic Alert Level now at 5...one away from a full-blown pandemic Phase 6 (and settlement of this market). (http://news.bbc.co.uk/2/hi/americas/8025931.stm)...

lot of stores here in Florida have sold out of masks

News here is reporting that those masks have a 'psychological' benefit only?

http://www.miamiherald.com/1484/story/1024433.html

may be in Florida now

http://www.bloomberg.com/apps/news?pid=20601087&sid=apn2W3VyUbrI&refer=home

further

Not surprising; with the amount of Latin American traffic going through MIA, it was only a matter of time. Anyway, here's the evening's last update:

189 confirmed cases in 11 countries on five continents
3490 suspected cases in 28 additional countries on six continents
93 confirmed cases in 11 US states (TX, NY, CA, ME, MA, KS, AZ, IN, MI, OH, NV)
557 suspected cases in 25 additional states

people buy the masks to feel better....they do not prove to be effective for this particular flu

Actuallyy, Coolkraft, you are talking bollocks; a proper ssurgucal face mask, that contains a filter, will stop almost any virus, inclusing any strain of flu. It is the cheap ones the do not work.

Who says pandemic imminent;

http://news.stv.tv/home/91509-world-health-organisation-says-swine-flu-pandemic-imminent/

From tomorrow, NZ is going to be the only country in the world where you can go and buy Tamiflu over the counter at the pharmacy, without a prescription...only problem is no one's allowed to pick it up for you, you have to be sick and displaying obvious symptoms otherwise the pharmacist can't give it to you. Strangely the pharmacists aren't too keen on the idea...

4/30 @ 7:23 EDT:

239 confirmed cases in 13 countries on five continents
3794 suspected cases in 26 additional countries on six continents
94 confirmed cases in 11 US states (TX, NY, CA, ME, MA, KS, AZ, IN, MI, OH, NV)
642 suspected cases in 30 additional states

Abstain from risky behaviour... don't sleep with swine. If you sleep with a pig, you sleep with all of the swine that hog slept with.

@f_o_f:

Kids are taught some other important information in the best selling book "If You Give a Pig a Pancake" (available, I'm sure, at fine bookstores everywhere)

@heretic
http://www.abc6.com/home/related/43789002.html

Singapore raises pandemic alert to Orange

Good news: Mexico's top health official says the the flu is stabilizing in his country as the number of new cases and deaths has leveled off, signs that a potential pandemic may be averted. :-)

Bad news: the WHO--and most epidemiologists elsewhere, including in Mexico--state that such starts and stops are an intrinsic part of any pandemic, and are therefore to be expected. :-(

"A swine-flu patient in Spain who hadn’t traveled to Mexico may signal a new front of the outbreak, potentially heralding the first influenza pandemic in 41 years...The World Health Organization [yesterday] raised its six-tier alert to 5, the second-highest, and said a pandemic declaration may come soon. It urged countries to make final preparations to deal with a virus that may sweep across the globe."

http://www.bloomberg.com/apps/news?pid=20601082&sid=aIHcy7rxdvpI&refer=canada

Oh, yeah: the WHO has stopped calling it the 'Swine Flu'; it's now simply "Influenza A (H1N1)" (http://www.who.int/csr/disease/swineflu/en/index.html)

4/30 @ 2154 EDT:

439 confirmed cases in 14 countries on five continents
4040 suspected cases in those and/or 28 additional countries on six continents
135 confirmed cases in 19 US states (AZ, CA, CO, DE, GA, IN, KS, ME, MA, MI, MN, NE, NV, NJ, NY, OH, SC, TX, VA)
694 suspected cases in those and/or 25 additional states

Public Service Announcement

Brought to you by the TOTUS as orated by the POTUS
“Keep your hands washed, cover your mouth when you cough, stay home from work if you are sick, keep your children home from school if they are sick”

The recent "leveling" of the number of new cases has been slowed in large part because the WHO has decided to stop releasing numbers of 'suspected' or 'probably' cases from around the world; they are now instead only announcing laboratory-confirmed cases. This means, of course, the number of new cases may be (and most likely are) growing, but we're no longer hearing of them through WHO...and confirmation of the virus from trans-oceanic countries can take a week or longer.

Stay tuned... :-)

THERE is a "tiny, tiny risk" of the swine flu mutating from its present form into a more virulent virus, one of Ireland's top scientists said yesterday.

Prof Luke O'Neill, of the Institute of Molecular Medicine, Trinity College Dublin, said the risk was so remote "it would be difficult to get any odds on it".

But the risk exists and there was no harm in "wearing a crash helmet if you are riding a bicycle", he added.

Prof O'Neill was among a number of experts who delivered a public lecture on the swine flu threat at the Science Gallery in Trinity College.

If it was to mutate and become more virulent, people would be at risk of dying before getting antiviral drugs, he said. But he stressed the public needed to know that the virus as it currently existed was treatable with antiviral drugs, and one of the reasons the World Health Organisation declared a stage five threat awareness level was to put pressure on governments to stock up on medicines.




http://www.independent.ie/national-news/tiny-tiny-risk-of-virus-becoming-more-infectious-1725705.html

The executive branch has equated closing the border with the barn door.
"At this point, they have not recommended a border closing. From their perspective, it would be akin to closing the barn door after the horses are out" BHO

Wheeler says
"There are fancy barns ... but, when the windows and doors are closed, there is no fresh air,"

Blackburn:
There are many reasons to use sliding doors... a sliding door doesn't need to be closed when you take a horse out.

From their perspective, it would be akin to closing the barn door after the horses are out" BHO
Does this mean that Americans are trying to visit Mexico in mass numbers?

5/2 @0600 EDT: "Number of confirmed H1N1 cases worldwide soars" (http://www.cnn.com/2009/HEALTH/05/02/swine.flu/)

"The number of confirmed H1N1 cases worldwide soared to 615 on Saturday with the World Health Organization reporting 15 countries were infected with the virus commonly known as swine flu."

There is a growing backlog of cases from around the world, as at this point it's taking five and six days to get many suspected samples tested. In addition to many suspected/probable cases in countries which already have confirmed cases, the WHO is awaiting results on suspected cases of A/H1N1 in the following countries: Brazil, Sweden, Ireland, Australia, Colombia, Chile, Italy, Czech Republic, Argentina, Bahamas, Honduras, Poland, Peru, Belize, Taiwan, El Salvador, Guatemala, Singapore, Venezuela, India, Barbados, Russia, Norway, Bolivia, Japan, Panama, and Uruguay. (That list is ordered by the number of suspect/probable cases, led by Australia's 95 and Brazil's 41.)

In addition, the virus is now confirmed in 22 US states, and probable/suspected in 22 others. With this in mind, and rumors of A/H1N1 cases appearing in Africa--there's growing speculation that the WHO will raise the pandemic alert level to 6 "sometime over the next several days".

Dr. Susan Poutanen, a microbiologist and infectious disease consultant at Mt. Sinai hospital in Toronto, says she "would be very surprised" if the pandemic alert doesn't go to Phase 6, the highest level of the World Health Organization's warning. She said employers should expect about a quarter of their workforce will fall victim to the virus and that the outbreak could include several waves spread over a number of months.

WHO discussing raising alert to level 6: "[Hawaii] Gov. Linda Lingle says the World Health Organization is considering raising the pandemic alert level to phase 6, the highest level indicating a global outbreak of the swine flu...She says it is not an indication that the outbreak is more severe, or more people are getting sick or dying. It means the geographic distribution of the virus has widened...Hawaii's adjutant general and head of state civil defense says the alert level could be changed this weekend." (http://www.mlive.com/newsflash/health/index.ssf?/base/national-10/1241232303247520.xml&storylist=health)

(Various sources)

WSJ 5/2 @ 1011 EDT (http://online.wsj.com/article/SB124126480414780235.html?mod=googlenews_wsj):

'A growing number of cases in Spain, New Zealand and other countries -- where travelers brought the disease home and could be spreading it to others -- means that sustained transmission of the disease is likely to take hold soon in more countries, Scott Dowell, head of the Centers for Disease Control and Prevention international team, said in an interview Friday. That development -- community outbreaks in more than one region of the world -- would fit the World Health Organization's criteria for its highest global alert level, phase 6. "It's going to happen imminently," he said."

@ chatarra
It depends if Mexico is the barn or if USA is the barn. Either way it is not a problem because all "the horses are out"

http://www.cnn.com/2009/HEALTH/05/02/swine.flu/index.html

latest

"WHO still believes flu pandemic is imminent"

Michael Ryan, WHO Director of Global Alert and Response, said it remained probable that the alert level would be raised from its current level of 5 to the top of the 6-stage scale. "At the present time I would still propose that a pandemic is imminent, because we are seeing the disease spread," Ryan said. "At this point we have to expect that phase 6 will be reached..."

02 May 2009 @ 15:55:36 GMT (http://www.alertnet.org/thenews/newsdesk/L2710434.htm)

"WHO still believes flu pandemic is imminent"

or

"WHO still believes flu pandemic is imminent?!"

;-)

so what happens if the pandemic is declared on a mutated version of the original virus?

I doubt they'd differentiate; even a mutation--and not a new variant--would still be A/H1N1.

"WHO chief prepares for pandemic" (http://online.wsj.com/article/SB124135130674780783.html)

No meeting scheduled to review pandemic level - WHO
Sun May 3, 2009 11:27am EDT

GENEVA, May 3 (Reuters) - The World Health Organisation's (sic) emergency committee has no meeting currently scheduled to review the global pandemic level, a WHO spokesman said on Sunday.

"WHO head indicates full flu pandemic to be declared" (2009-05-04 09:53:10 GMT - http://www.forexpros.com/news/forex-news/update-1-who-head-indicates-full-flu-pandemic-to-be-declared-50884)

"The World Health Organisation is likely to raise its flu alert to the top of its six-point scale and declare a pandemic, its director-general indicated in an interview published on Monday. In remarks setting the scene for another alert increase, but without saying when, WHO chief Margaret Chan warned against over-confidence following a stabilisation in the number of new cases of the H1N1 strain that has proved deadly in Mexico. "Level 6 does not mean, in any way, that we are facing the end of the world. It is important to make this clear because (otherwise) when we announce level 6 it will cause an unnecessary panic," she told Spanish newspaper El Pais."

A friend of mine, who was quite sick for about three days last week with FLU (and is doing fine now after Tamiflu), offers this suggestion:

What is the possibility that the so-called swine flu mutated from our financial crisis? The REAL PANDEMIC has been a massive global final recession, but the press has become totally distracted with the possibility of a swine flu pandemic. Financial bad news has been quickly placed on the back burner...

Could the swine flu pandemic, a late spring outbreak of flu, possibly be a very "handy" way to distract the public from global financial panic? While everyone has worried about flu, what has happened financially in the last week? Chrysler is supposed to have intermingled somehow with FIAT. GM is doing goodness-knows-what in the background avoiding a June 1st bankruptcy. No one has mentioned Ford at all in a while. The banks get their preliminary stress test results TODAY, Tuesday (which may or may not be leaked to the public). The public officially gets the bank results on Thursday, IF THEY ARE PAYING ATTENTION and worrying less about the flu...

AND THE PUBLIC HAS BEEN COMPLETELY DISTRACTED BY THE FLU.

Is there any merit in this idea?

Sorry, that should read: "..The REAL PANDEMIC has been a massive global financial recession.."

Agreed....looks like a whole lotta 'CYA' to me.

May 5, 2009

CNN Warns Swine Flu Could Continue Through Sweeps -
Scary Reporting Spreads to MSNBC



CNN reported today that its reporting of the swine flu story could spread significantly in the days and weeks ahead and might continue throughout the all-important May sweeps rating period.

CNN said that its early reporting of the swine flu story had been contained to one or two hours a day but had recently increased to all twenty-four hours.

"This is an alarming spread in the reporting of this story," said Carol Foyler, a CNN spokesperson. "We have seen swine flu spread from primetime to all the other day parts."

Ms. Foyler said that in recent days CNN had identified several cases of "increasingly scary graphics and fonts" about swine flu during its news programs.

"These scary graphics are popping up everywhere in greater and greater numbers," she said. "These are signs that the swine flu coverage is growing more intense and virulent."

The CNN spokesperson said that news host Lou Dobbs had even taken time out from fear-mongering about immigration to fear-monger about swine flu: "This is an unprecedented development."

Even as CNN reported that its broadcasting of the swine flu story was on the rise, there was evidence that intense cases of swine flu reporting had spread from CNN to MSNBC.

"We have also seen several cases of panic-inducing graphics and terrifying fonts," said MSNBC spokesman Terry McTate. "I don't want to frighten people, but we haven't seen a story this scary since Y2K."

http://www.borowitzreport.com/

@Erik: that's funny, I guess, but it does serve to highlight one of the more common cognitive/memory biases I've heard trotted out lately: that the A/H1N1 "scare" is "just like the whole Y2K" thing.

I work in the IT field, and we programmers/developers were talking about what could happen on December 31, 1999, if we failed to change the millions of two-digit, single-byte dates stored in legacy applications in most every industry, and we were talking about that long before the media got ahold of it. The thing is, though, what in hindsight appear to be "scare" stories served a vital purpose: they helped goad many budget-strapped organizations into making changes that would help prevent a Y2K catastrophe...changes, as it turns out, that worked. The current A/H1N1 thing is similar, I believe; the media made people aware of it, those people took precautions, and the spread of the disease has--so far, at least--been relatively slow to occur. It's easy now to look back to last week and point fingers and laugh about how silly everyone was to make such a big deal out of something that--again, so far--hasn't killed thousands...but it requires a little more intellectual honesty to look back and realize that all the dire warnings are perhaps what has kept the virus in check.

It reminds me of the story about the man who was sold an expensive automatic fire sprinkler system for his home. His neighbors all laughed at him when he was having it installed; after all, there hadn't been a fire in the neighborhood since it had been built many decades before.

One night several years later, however, a raging inferno started outside of town and quickly spread through the tight neighborhood, destroying every home in sight...except for the one belonging to the homeowner with the fire sprinkler system.

The next morning, while walking through the ashes of his own burnt home, one of the neighbors came up to the man with the sprinkler system as that man sat in the shade on his uncharred front porch drinking a cold glass of lemonade. To his astonishment, that soot-covered and now homeless neighbor bent over with laughter.

"What's so funny?" asked the lemonade-drinking man.

"I bet you feel really foolish now, don't you?" asked the smoky neighbor when he could finally get out a word.

"Oh, really?" the drinker asked. "And why's that?"

"Because," said the neighbor, "you spent all that money on your fancy fire sprinkler--but your house didn't even burn!"

sql.....I don't liken it to the Y2K thing - More like the little boy who cried wolf.

Everyone is so busy covering their butts so they don't get hit with a Katrina label, that when something does get serious people will say, "Yeh right, just like the swine-flu scare."

Does WHO need to declare flu a full pandemic?
Thu May 7 7:27am EDT (http://www.reuters.com/article/newsOne/idUSTRE5462MN20090507)

"The United Nations agency's guidelines state that as soon as the virus starts spreading freely in two regions of the world, its six-point pandemic alert should be raised to the top notch. With infection numbers rising in Europe, public health experts are struggling to decide whether it is worth sounding the full alarm over H1N1, which is treatable with existing drugs and appears less severe than seasonal flu in most cases.

"Under the rules, just one country outside the Americas needs to have a community-level outbreak of the new strain to trigger a Phase 6 designation indicating a global pandemic is under way.

"Some experts believe Britain is especially vulnerable to a community-wide outbreak, given the flu strain is propagating inside some schools. Spain also has a relatively large cluster of infections, with 73 according to the latest WHO tally.

"No one country, however, is likely to want to be seen as tipping the scale toward a pandemic declaration, especially with discontent rising about whether public health experts have exaggerated the risks of the H1N1 strain. That leaves the WHO in a difficult spot, given many disease experts anticipate the new virus could rebound with a vengeance later this year when winter temperatures conducive to the spread of flu return to the populated northern hemisphere."

A quick May 8 update:

--Japan and Australia reported their first confirmed cases of A/H1N1 today; that brings the total to over 4000 cases worldwide, and on every continent but Africa (and there are a dozen suspected cases there awaiting confirmation).

--The number of confirmed cases in the U.S. has surpassed those in Mexico, and more are being added nearly every hour; the U.S. total will be somewhere around by 2000 tomorrow. The virus has now been confirmed in 43 states plus the District of Columbia; it's expected to be in all 50 states by this time next week. Sustained human-to-human transmission has and is occurring.

--A young woman today became the first Canadian to die of the flu.

--Brazil confirmed its first domestically transmitted case today (that is, a confirmed case that didn't happen as a result of someone travelling to North America).

--Spain, the hardest hit of the EU countries, has over 100 confirmed cases now, many of them domestically-transmitted

--The World Health Organization announced yesterday that up to 2 billion people could contract the flu within the next 18 months.

--12 crew members on the United States Navy vessel USS Dubuque have been diagnosed with the virus.

--The WHO is waiting for sustained human-to-human transmission in a WHO region other than North America before declaring a pandemic. Estimates as to when this may happen range from next week to never. A growing number of health officials think there are two reasons the current outbreak will wind down in the coming weeks. First, cases of influenza tend to dwindle when the weather gets warmer. Second, the 2009 H1N1 virus outbreak in Mexico has reached its peak, and numbers there are going down; it is expected that same pattern could happen in the United States. That's the good news. The bad news? The three outbreaks in the last century that were caused, as now, by new viruses--in 1918, 1957 and 1968--started with a mild wave followed by more severe waves months later.

We'll see...

05/09: For those interested, here are a few excerpts from today's CDC press conference (featuring Dr. Anne Schuchat of the CDC):

--"The virus has moved into the southern hemisphere, where influenza season is just beginning, and could mix with circulating seasonal flu viruses or the H5N1 avian influenza virus to create new strains. 'This is a very unusual circumstance,' Schuchat said."

--"We think this virus is in most of the United States," Schuchat said. "The individual numbers are likely to be a very great underestimate."

--"More Americans are seeing doctors for influenza-like illnesses at a time of year when such visits are usually on the decline."

--"It would be futile to try to stop the virus in the United States because it was only identified after person-to-person transmission had taken place for weeks before it was identified. 'Our indications are that it is still accelerating,' Schuchat said. Mexican officials have said outbreaks there are on the wane but Schuchat disagreed. 'In some parts of that country they may see a decline,' she said. But fresh outbreaks were occurring in other parts, she said."

--"'This particular virus has all of the hallmarks that we look for with a possible pandemic,' Schuchat said. It's a new strain capable of spreading easily and killing people."

-----------------------

In other flu news:

--Thailand reported its first case of A/H1N1 today. That comes on the heels of Japan and Australia, which both confirmed their first cases yesterday.

--There was a death in Costa Rica from the swine flu announced today, making that country the fourth with a confirmed fatality from the virus.

--Nearly 4,400 cases of the virus are now confirmed in 29 countries on five continents, with the EU the hardest hit after North America. That number is up 4,500% in the past two weeks.

--Cases in the U.S. continue to grow; the virus has been confirmed by the CDC in 43 states, and probable cases are awaiting confirmation in at least four others.

Stay tuned...

05/11 A/H1N12 Update:

--The CDC says that the number of cases is growing too quickly to count, and that there are many more cases than have been reported. "I think the cases we’re confirming are the tip of the iceberg,” said Dr. Anne Schuchat of the CDC. (http://www.msnbc.msn.com/id/30398682/)

--This year's virus is, according to epidemiologists, a bit more dangerous than the one that caused the last pandemic (in 1968). Those same scientists also speculate that somewhere in the vicinity of 32,000 people already had the virus in Mexico before the end of April when the global community became aware of it. (http://www.alertnet.org/thenews/newsdesk/N11538600.htm)

--In a normal year, about 10% of the population gets sick with the seasonal flu; scientists project that this virus--which is "substantially more transmissible" than seasonal flu "clearly has pandemic potential", and may eventually infect two to three times the average number (http://www.timesonline.co.uk/tol/tools_and_services/mobile_times/swine_flu/article6269046.ece)

--The WHO says that the virus has "potential" for pandemic. "Most cases in Europe, Asia and South America are linked to travelers bringing the virus home with them, but there is a possibility the disease will become established there too," said WHO's flu chief Keiji Fukuda. (http://www.pr-inside.com/who-potential-for-swine-flu-spread-r1244908.htm)

--Worldwide, the number of confirmed cases of the flu "nearly doubled" over this past weekend. (http://www.un.org/apps/news/story.asp?NewsID=30761&Cr=+flu+&Cr1=)

--In La Gloria, Mexico, where the virus was first found running rampant, reasearchers believe the virus was transmitted there over 14 to 73 generations. That is, one person infected another, who infected another, and so on, up to 73 times. (http://www.alertnet.org/thenews/newsdesk/N11538600.htm)

--So far, at least, A/H1N1 is spreading at a more or less logarithmic pace, doubling in the number of confirmed cases roughly every four or five days. If the current rate of sperad were kept up, there'd be more than one million cases somewhere around the last few days of June. (http://en.wikipedia.org/wiki/File:Influenza-2009-cases-logarithmic.png)

the tip of the iceberg --
of course, that is why the cases keep growing...
once the case becomes severe that people go to dr. it gets reported..
in the meantime they have infected others...(and these take awhile to incubate)..

05/12: Professor Neil Ferguson of the World Health Organization (WHO) said today that a study just completed by a group of scientists at London's Imperial College hints that A/H1N1 possess "full pandemic potential", and will "likely spread around the world in the next six to nine months." (Or, in the breathless headline screaming from The Sun, "Swine flu will 'rip through globe!'")

http://news.sky.com/skynews/Home/World-News/Swine-Flu-First-In-Depth-Study-Of-H1N1-Says-One-Third-Of-World-Could-Be-Infected/Article/200905215280099?lpos=World_News_First_Home_Article_Teaser_Region_4&lid=ARTICLE_15280099_Swine_Flu%3A_First_In-Depth_Study_Of_H1N1_Says_One_Third_Of_World_Could_Be_Infected
http://www.redorbit.com/news/health/1686994/london_study_maintains_flu_has_full_pandemic_potential/
http://www.thesun.co.uk/sol/homepage/news/article2424699.ece

Place your bets... :-|

5/13 Influenza A(H1N1) - update 27 (from WHO website http://www.who.int/csr/don/2009_05_13/en/index.html)

13 May 2009 -- As of 06:00 GMT, 13 May 2009, 33 countries have officially reported 5728 cases of influenza A(H1N1) infection.

Mexico has reported 2059 laboratory confirmed human cases of infection, including 56 deaths. The United States has reported 3009 laboratory confirmed human cases, including three deaths. Canada has reported 358 laboratory confirmed human cases, including one death. Costa Rica has reported eight laboratory confirmed human cases, including one death.

The following countries have reported laboratory confirmed cases with no deaths - Argentina (1), Australia (1), Austria (1), Brazil (8), China (3, comprising 1 in China, Hong Kong Special Administrative Region, and 2 in mainland China), Colombia (6), Cuba (1), Denmark (1), El Salvador (4), Finland (2), France (13), Germany (12), Guatemala (3), Ireland (1), Israel (7), Italy (9), Japan (4), Netherlands (3), New Zealand (7), Norway (2), Panama (29), Poland (1), Portugal (1), Republic of Korea (3), Spain (98), Sweden (2), Switzerland (1), Thailand (2), and the United Kingdom (68).

I am relieved that the current version of the H1N1 influenza outbreak is pretty tame.
Very contagious, but not extremely lethal.
While I do not have the clout that the WHO has, it is apparent that this outbreak will not become the death knell that was predicted earlier.

For some perspective, please note the estimated population of the world is:
6,790,062,216 (July 2009 est.)
This equals approximately 1 case per 1 million people.

If the WHO calls Pandemic, it will hurt their credibility, much like the boy who cried wolf too often.

@chatarra: I, too, am relieved that--at least for now--we're not seeing the many deaths from A/H1N1 that were forecast a few weeks ago. And it's true that, as of now, there has been about one case per million in the global population as a whole. But consider this:

--a week ago that ratio was one case per 3.3 million
--a week before that the ratio was one case per 26.7 million
--a week before that, the ratio was one case per 452 million.

The thing is, the spread of this virus, while mostly in North America, has been and still is logarithmic. In a week, the ratio is likely to be somewhere around 1:500,000, and 1:250,000 in two weeks, and so on.

(Of course, if the estimated 22,000 unreported cases in Mexico were tossed into the mix, we'd already be at 1:225,000, but that's another story.)

Because of pretty rigid restrictions, the EU has managed to keep the number of new cases relatively low (even though it's now been found in 16 EU nations). However, the EU's percentage of cases which are in-country--that is, home grown, and not imported from North America--has been growing at a pretty good clip, an indication that things are starting to slip through their fingers. Two weeks ago, that number was in the single digits; last week it was about 12%; this morning it's at 28%. Of course, that'll have to really grow into the 100s of percent for WHO to call a pandemic, but things certainly appear headed that way. At least that's what the doctors say.

Update 29 (from WHO website http://www.who.int/csr/don/2009_05_15/en/index.html)

As of 6:00 GMT, 15 May 2009, 34 countries have officially reported 7520 cases of influenza A(H1N1) infection.

Mexico has reported 2446 laboratory confirmed human cases of infection, including 60 deaths. The United States has reported 4298 laboratory confirmed human cases, including three deaths. Canada has reported 449 laboratory confirmed human cases, including one death. Costa Rica has reported eight laboratory confirmed human cases, including one death.

The following countries have reported laboratory confirmed cases with no deaths - Argentina (1), Australia (1), Austria (1), Belgium (1), Brazil (8), China (4), Colombia (10), Cuba (3), Denmark (1), El Salvador (4), Finland (2), France (14), Germany (12), Guatemala (3), Ireland (1), Israel (7), Italy (9), Japan (4), Netherlands (3), New Zealand (7), Norway (2), Panama (40), Poland (1), Portugal (1), Republic of Korea (3), Spain (100), Sweden (2), Switzerland (1), Thailand (2), and the United Kingdom (71).

Update 30 (from WHO website http://www.who.int/csr/don/2009_05_16/en/index.html)

As of 07:00 GMT, 16 May 2009, 36 countries have officially reported 8451 cases of influenza A(H1N1) infection.

Mexico has reported 2895 laboratory confirmed human cases of infection, including 66 deaths. The United States has reported 4714 laboratory confirmed human cases, including four deaths. Canada has reported 496 laboratory confirmed human cases, including one death. Costa Rica has reported nine laboratory confirmed human cases, including one death.

The following countries have reported laboratory confirmed cases with no deaths - Argentina (1), Australia (1), Austria (1), Belgium (2), Brazil (8), China (4), Colombia (11), Cuba (3), Denmark (1), Ecuador (1), El Salvador (4), Finland (2), France (14), Germany (14), Guatemala (3), Ireland (1), Israel (7), Italy (9), Japan (4), Netherlands (3), New Zealand (9), Norway (2), Panama (43), Peru (1), Poland (1), Portugal (1), Republic of Korea (3), Spain (100), Sweden (2), Switzerland (1), Thailand (2), and the United Kingdom (78).

http://www.nytimes.com/2009/05/17/opinion/l17swine.html
W.H.O. and Swine Flu
Re “Managing a Flu Threat With Seasoned Urgency” (front page, May 10):

As the co-discoverer of one of the key enzymes of the influenza virus and as someone who has written extensively about H5N1 avian flu, I do not count myself among the “flu experts” who believe that the World Health Organization and Dr. Margaret Chan, its director general, “performed well” during the current outbreak of H1N1 swine flu. They were overly alarmist and precipitate: in particular, the decision to raise the pandemic flu threat to the penultimate Level 5, “Pandemic Imminent,” was unwarranted.

A warning system based solely on how widely a virus has spread but that does not consider the nature of the illness it causes is intrinsically flawed because it is prone to false positives: it would classify as “pandemics” the frequent but largely inconsequential outbreaks of virus-caused colds and gastroenteritis.

Dr. Chan does seem to have “been guided in her recent decisions by her experiences” with the 2003 outbreak of SARS — toward excessive risk aversion.

Henry I. Miller
Stanford, Calif., May 11, 2009

The writer, a medical doctor and a fellow at the Hoover Institution, was at the National Institutes of Health and the Food and Drug Administration from 1977 to 1994.

The good Dr. Miller is a member of the very conservative Hoover Institute--and a friend of the cigarettes-are-really-great-and-there's-no-such-thing-as-global-warming-but-even-if-there-is-it's-not-as-bad-as-everyone-says-but-even-if-it-is-man-didn't-cause-it Heartland Institute--who believes, among other things, that the long-banned chemical DDT was a really great thing that should be revived in the U.S. for mosquito control, and that genetically-modified foods should be allowed to be released with no federal regulation whatsoever because that's just liberal, tree-hugging, bureaucratic red tape intended to stop mega-farms from making money.

Uh-huh. :-)

At any rate, when the WHO raised the pandemic level, they had to; had they not done so, countries likely wouldn't have reacted as they did, and the flu would have spread quicker. Better safe than sorry, you know? And even the 'milder' strain of the flu we're seeing so far would be bad if it were to go pandemic. If one third of the global population gets the disease, and just one person in a thousand who gets it dies, that's still 2.2 million extra dead people...and who wants that on their hands? Not the WHO.

Fortunately, for me, I have a busy morning and cannot take time to verify your claims.
I will accept them at face value, because I am an "open minded" individual. :-)
Noting: hmmmmm - calling Hoover Institute & therefore Stanford University, a bastion of conservative (read: evil) movement - hardly :-)

Here is the mission statement of the Hoover Institute:

http://www.hoover.org/about/mission
"This Institution supports the Constitution of the United States, its Bill of Rights and its method of representative government. Both our social and economic systems are based on private enterprise from which springs initiative and ingenuity.... Ours is a system where the Federal Government should undertake no governmental, social or economic action, except where local government, or the people, cannot undertake it for themselves.... The overall mission of this Institution is, from its records, to recall the voice of experience against the making of war, and by the study of these records and their publication, to recall man's endeavors to make and preserve peace, and to sustain for America the safeguards of the American way of life. This Institution is not, and must not be, a mere library. But with these purposes as its goal, the Institution itself must constantly and dynamically point the road to peace, to personal freedom, and to the safeguards of the American system."

In a brief search for credentials for the esteemed Dr. Miller, here is what I was able to find and source:

http://www.hoover.org/bios/miller_h.html
Henry I. Miller, M.S., M.D., is a research fellow at the Hoover Institution, where his research focuses on public policy toward science and technology. It encompasses a number of areas, including pharmaceutical development, the new biotechnology, models for regulatory reform, and the emergence of new viral diseases.

Miller joined the Food and Drug Administration in 1979 and served in a number of posts. He was the medical reviewer for the first genetically engineered drugs evaluated by the FDA and was instrumental in the rapid licensing of human insulin and human growth hormone. Thereafter, he was a special assistant to the FDA commissioner, with responsibility for biotechnology issues, and from 1989 to 1993 was the founding director of the FDA's Office of Biotechnology. During his government service, Miller participated frequently on various expert and policy panels as a representative of the FDA or the U.S. government. While a government official, Miller was the recipient of numerous awards and citations.

Since coming to the Hoover Institution, Dr. Miller has become well known not only for contributions to scholarly journals but also for articles and books that make science, medicine and technology more accessible to nonexperts.

Miller was short-listed in 2006 by the editors of Nature Biotechnology as one of the personalities who had made the "most significant contributions" to biotechnology during the previous 10 years. Miller serves on numerous editorial boards and is an adjunct scholar at several thinktanks.

http://environment.ncpa.org/about/henry-i-miller
Dr. Henry I. Miller is an academic researcher, author and commentator. He graduated from the Massachusetts Institute of Technology with a Bachelor of Science degree in Life Sciences and attended the University of California, San Diego, receiving the M.S. (Molecular Biology) and M.D. degrees. After completing his clinical training in internal medicine as a Clinical Fellow in Medicine at Harvard Medical School, Dr. Miller spent almost three years as a Research Associate at the National Institutes of Health, using and helping to refine the recombinant DNA (“gene-splicing”) techniques that were then emerging.

Dr. Miller is currently at Stanford University, where he is a fellow at the Hoover Institution. His research focuses on the relationship between science and regulation, the costs and benefits of government regulation, models for regulatory reform, and federal and international oversight of biotechnology. Other research areas include various aspects of bioterrorism and the need for better oversight of nutritional supplements.

Dr. Miller is the author of more four hundred articles in scholarly and popular publications. He is a regular commentator on ABC radio and writes frequently for such publications as the Financial Times (London), Wall Street Journal, Los Angeles Times, Chicago Tribune, Washington Times, Biotechnology Law Report, Trends in Biotechnology, and Nature Biotechnology. He is the author of Policy Controversy in Biotechnology: An Insider’s View (R.G. Landes Co. and Academic Press, 1997) and “To America’s Health: A Proposal to Reform the Food & Drug Administration” (Hoover Institution Press, 2000).

Aw, now c'mon; I never said either the Hoover Institute or Stanford University were evil; I merely made note of the fact that Dr. Miller has A) taken a stand against the majority of scientists everywhere and B) at the same time closely aligned himself with Big Pharma, Big Oil, and Big Tobacco. There's nothing wrong with 'A', so long as one's motivations are pure and in the interest of truth; some of our best science has come about because of such rebellion. But the 'B' part sort of makes Dr. Miller's motivations and thus his pronouncements seem, at the very least, questionable.

(In much the same way, you've provided info in your latest comment that comes straight from the NCPA--the National Center for Policy Analysis--itself a conservative think tank peopled by [here we go again] folks working in Big Pharma, Big Oil, and Big Tobacco...and a number of people deeply involved with the good ol' Heartland Institute.)

I suppose that if the bread crumbs are followed deeply enough into the forest, everyone's "dirty"--and therefore uncredible--at some level. But with Dr. Miller, one needn't go deep at all.

BTW:in regards to this market, there's a very good chance the WHO will raise the influenza threat level to 6 later this week, thus declaring a pandemic. Just thought you might want to know...

Alright - since we are friendly adversaries, I will renounce my inclusion of the word "evil" as you never indicated "that" in your previous messages.
As for his bio - I think it stands for itself and does not need interpretation for thinking men and women everywhere.

I think the WHO is in a quandary. If they declare A1N1 to be a pandemic, they will be diagnosed as having "Chicken Little" syndrome. Compared to the 36,000 deaths that the typical influenza causes every year, this ourbreak of A1N1 will hardly be seen as a crises afterward. Just a very contagious version of influenza, that did indeed cause a few deaths, but was not a worldwide crises and in fact was less harmful than the typical flu we face every year.

...in your latest comment that comes straight from the NCPA--the National Center for Policy Analysis--itself a conservative think tank peopled by [here we go again] folks working in Big Pharma, Big Oil, and Big Tobacco...and a number of people deeply involved with the good ol' Heartland Institute.)

The reference I provided from http://environment.ncpa.org/about/henry-i-miller only provides facts, not opinions.
How can that be biased?

I originally quoted his letter from NYT, which has a long storied history of liberal bias,
but even they were impressed enough with his credentials to post his letter.

(back to straightening up the garage - boy, what a mess. . . )

That's true...assuming the case fatality rate stays below, say, 0.001% and the number of cases doesn't skyrocket. But epidemilogists of every stripe are saying 2,000,000,000 or more cases of H1N1 by the end of next year isn't at all unthinkable, and even if the novel flu doesn't cross with, say, the avian flu or some other bug, making it far nastier, and instead maintains its apparent current rate of mortality, upwards of 2,300,000 people could die from this in the next 18 months.

If the sky truly had been falling, Chicken Little would look, in hindsight, like a heroic genius. Don't you think? :-)

So, yes: the WHO will be careful about raising the level all the way. But if the flu takes hold in another WHO region aside the Americas--which it appears, for now, to be doing in at least two areas--they'll have no choice but to call it anyway.

@chatarra: sorry; I cross-posted my last comment with yours.

That website--ncpa.org--may be giving facts, but it's not providing all of them. That's okay; the NCPA--the National Center for Policy Analysis--is a conservative group whose aim it is to forward the agenda of big business. From their own website:

AGRICULTURE: "The market, not government, would better serve the environment, consumer and future generations. The world must continue to seek higher more sustainable farm yields. This means embracing cutting edge technologies."

(In other words, bring on the gene-splicing, radiation, and chemical modifications, and get the government out of the way of big business, which would never do anything to hurt anyone.)

ENERGY: "The U.S. government should remove barriers to the domestic production and delivery of energy"

(In other words, drill here, drill now, and let the energy companies--who've always been great stewards of the land with their strip-mining, mountaintop removing, high-polluting ways--decide what's best for the country.)

REGULATIONS AND RISKS: "All too often, environmental policy is driven by mistaken perceptions of risk, which result in regulations that are based on fear rather than sound science. Such regulations retard environmental improvement and can cause greater harm to persons and the economy than they purport to solve."

(In other words, don't listen to those pesky environmentalists; they only want to cost you money. Let Big Business handle things. We'll be gentle. we promise.)

WILDLIFE ISSUES: "As with so many other environmental issues, threats to wildlife most often stem from the lack of property rights."

(In other words, the forests belong to the timber companies and everything else belings to the oil companies; if they want to kill every last polar bear on their property, they need to be given free reign to do so.)

WASTE AND RECYCLING: "Government should not dictate the method by which citizens or communities dispose of waste."

(In other words, if a mine company wants to dump arsenic-laden tailings in the twon's water supply, that's their business; the law should butt out.)

AIR PROBLEMS: "Regulations too often hinder rather than foster technological change and air quality."

(In other words, polluters don't cause pollution; regulations do.)

GLOBAL WARMING: "NCPA scholars believe that while the causes and consequences of the earth’s current warming trend is still unknown, the cost of actions to substantially reduce CO2 emissions would be quite high and result in economic decline [and] accelerated environmental destruction."

(In other words, we're not sure what causes global warming, so let's keep pumping CO2 into the skies as that's probably not the cause, and anyway making us stop would only make us pollute more.)

Do you still trust Dr. Miller? :-)

In 1976, a small group of soldiers at Fort Dix were infected with a swine flu virus that was deemed similar to the virus responsible for the great 1918-19 world-wide flu pandemic. The U.S. government initiated an unprecedented effort to immunize every American against the disease. While a qualified success in terms of numbers reached-more than 40 million Americans received the vaccine-the disease never reappeared. The program was marked by controversy, delay, administrative troubles, legal complications, unforeseen side effects and a progressive loss of credibility for public health authorities. In the waning days of the flu season, the incoming Secretary of what was then the Department of Health, Education and Welfare, Joseph Califano, asked Richard Neustadt and Harvey Fineberg to examine what happened and to extract lessons to help cope with similar situations in the future. The result was their report, The Swine Flu Affair: Decision-Making on a Slippery Disease.

The new electronic edition of this report, The Swine Flu Affair, is dedicated to the memory of Richard Neustadt, and available for download by the public.


http://www.iom.edu/CMS/AboutIOM/4081/65926.aspx

World Health Organization May Raise Alert Level as Swine Flu Cases Leap in Japan - "The number of swine flu cases in Japan soared over the weekend, raising the likelihood that the World Health Organization will soon have to raise its pandemic alert level to 6, the highest level."

http://www.nytimes.com/2009/05/18/world/asia/18flu.html

Dear Sqlman,
You ask rhetorically: Do I still trust Dr. Miller? :)
Yes, I do. 

This is where we find (again) irreconcilable differences.
I could go through their website as you did and interpret their philosophy into language that everyone would understand and embrace, as you did, but I won't.

Or paraphrasing like you did earlier - (7 different times).
In other words, I do not want to live in a Nannyistic state, where the ideal philosophy says: Even if it would save just one life, wouldn't it be worth it?"
My answer is a short and not so sweet NO!

Free enterprise benefits those who work harder than the rest of the population. Obama’s philosophy benefits those who trust the government more than the rest of society. I was not happy with the way our government under Liberal former President Bush was leading my life and our country, but now, the government is out of control. Obama’s philosophy caters to the lazy masses, at the expense of business - big and small everywhere.

I can hardly express the sadness I find at having a populace who needs big brother to make the hard decisions in life. What has happened to self direction and hard work to bring the financial rewards of having inventive and new ideas? That was capitalism at its best. Now success if penalized and failure is rewarded - with bailouts.

I believe that you will win this wager, because W.H.O. will probably declare a pandemic, and spend billions of tax payer dollars to create a swine flu vaccine, that will not be useful, effective, or even needed.

And all the drones will live safer afterwards in our newfound nanny state formerly called the United States of America.

Yeah for the WHO there is a risk of credibility if they go to level 6 but on the other hand there is a financial reward too... they just need to figure out a way to minimize the one and maximize the other. I am sure some of the best minds in the organization are working on that right now!

Talk about moving the goal line: the World Health Organization had previously been stating--nearly ad nauseum--that in order to declare H1N1 a pandemic, they had only to see sustained human-to-human transmission in a WHO region apart from the Americas, and the severity of the flu wasn't even a factor. Well, that has happened, of course, with Japan now reporting nearly 300 cases after seeing its first case just last Friday. Until Monday, that was enough to cause WHO to raise the alert level.

Almost.

But then on Monday, many nations pleaded with WHO to not raise the level, as it would be bad for tourism, bad for business, and bad for the economy as a whole. And today in Geneva, the head of the WHO, said the following: "For Phase 5 to Phase 6 I need to satisfy myself that this is a global phenomenon...I [need to] see more signals coming from the virus itself or the spread of the disease, including severity." She's reportedly going to be "...looking for signs of sustained spread in the Southern Hemisphere first".

Upshot? The pandemic call will almost certainly come...though it may not happen for some time. These markets may yet be open for a while...

(It's also come to the attention of WHO that some nations have been intentionally underreporting their case numbres as a way to hold onto tourism dollars. Whether that will be a factor is anyone's guess.)

(P.S. - I posted this on the big three H1N1 markets this morning, so you'll likely see it again.)

WHO's hesitance to raise the pandemic alert level to 6 is more political than scientific, practical, or semantic.

"...[While] the situation in Japan now seems to satisfy the WHO's current definition for phase.", the WHO's Margaret Chan put forward a new reason for hesitating to declare a pandemic. "One of the things we're not seeing is the same spread in the Southern Hemisphere that we've seen in [Mexico, the U.S., and Canada]," she said, according to Agence France-Press.

Politics, politics. Always politics. :-)

http://www.npr.org/templates/story/story.php?storyId=104384015

And here's an article that sums it up very nicely: http://www.nature.com/news/2009/090521/full/news.2009.501.html

Mexico, meanwhile, intentionally overstated its numbers in order to get US aid. So far we've got 88 dead people on a planet of what? 4 billion? Let's get real and start looking at real health problems.

That's funny; I've heard that Mexico intentionally understated the numbers to prevent a loss of business and tourism...just as the EU has done, and Japan is doing, and the U.S. is doing, and so on.

"Let's start looking at real health problems"? I'd agree that there are more vicious killers lurking in some corners of the globe...but whether WHO declares H1N1 a pandemic or not, the possibility of it affecting 2,000,000,000+ people--and killing "just" 2-3 million of them--makes it a real health problem, if you ask me. IOW, just because the case fatality rate isn't as high as originally feared is no reason to hold ticker tape parades and prematurely declare the thing over and done with.

Here's an interesting look at the politics behind the redefintion of the word pandemic: http://timestranscript.canadaeast.com/lifetimes/article/675179

"WHO's [current] criteria for a pandemic deliberately don't take severity into account, focusing instead on spread of a new virus to which a large portion of the population has no immunity. Severity, the WHO says, will likely vary from place to place, depending on the vulnerabilities of different populations. As well, it could change over time as a new virus spreads in waves around the world. By the WHO's [current] definition, a virus crosses the pandemic threshold when there is evidence of spread in the community in two WHO regions. With the virus galloping through schools in Japan, many observers believe the call is imminent -- if the WHO does not bow to pressure to change the rules."

Re: Let's get real and start looking at real health problems.
Re: Forthcoming Pandemic Declaration from W.H.O.

Even if it would save just one life - wouldn't it be worth it?
Nooooooooooo!!! - We do not need big government to save us from everything that might become dangerous at some point.

I agree, Candelario

OK ... so .... what happens to this and the other s/flu questions if WHO changes the definition of Stage 6 (pandemic)?

Void and start over?

Not sure about the other questions, but this one still stands: if WHO moves to phase 6 and declares a pandemic before January 1, 2010, this will settle as 'Yes' regardless of any change in criteria...

...but then again, I suppose it depends on what WHO does, and how the rules are rewritten. There are a few different scenarios:

1) The current 6-phase system stands, but WHO changes the criteria for raising to the highest level. For now, that's sustained human-to-human transmission in at least two WHO regions...and we've got that already (or very nearly so). There's talk that the new criteria would be that the CFR (case fatality rate) would need to be over a certain percentage. At any rate, that would seem to leave this market viable.

2) There's talk that WHO might further subdivide phase 6 into different degrees based on CFR. A First Degree Phase 6 pandemic might be about where we are now; Second Degree might be akin to the 1957 and 1968 pandemics; and a Third Degree pandemic might be similar to the 1918 Spanish Flu one. (Of course, a Fourth Degree pandemic would be like something from I Am Legend, The Stand or 28 Days Later.) In such a case, anything in phase 6 would still be a pandemic, so this market would still seem to be viable.

3) There's talk that WHO might just add additional higher phases atop the current system: a Phase 6 pandemic would be what we have now, Phase 7 would be like 1957 or 1968, and Phase 8 would be like 1918. (And Phase 9 would be from a Hollywood horror/disaster flick.) Here, again, Phase 6 would still be a pandemic, so this market would still stand.

4) Against the advice of physicians, WHO may continue to cave into requests from its member states by stating that a pandemic is really only a pandemic when a politician--not an epidemiologist or virologist--says it is. That would keep this at Phase 5 for many, many months, even to the point of infecting a few billion people while killing "only" 2 to 3 million. That would leave this market intact.

5) WHO could just entirely scrap their current 6-phase plan and go with something entirely different. If that were to occur, that would make this market unviable, and likely call for a void (though not necessarily).

I reckon we'll see...

(FWIW: Encarta says the word pandemic means "having widespread effect: existing in the form of a widespread epidemic that affects people in many different countries." Merriam-Webster says "occurring over a wide geographic area." Oxford says "...a disease prevalent over a whole country or large part of the world.")

and it's curious that the CDC hasn't declared a US "stage 5" - "spread throughout United States" - but maybe the CDC acts only in response to a WHO stage 6. Anyone know anything about the CDC "response stages" (for that matter, where is the CDC's official current "response stage" actually posted?).

Somewhere around the first week of April the U.SD. CDC stopped showing their current response stage (http://www.pandemicflu.gov/plan/federal/fedresponsestages.html). As you can see, U.S. stages 3-6 are concurrent with WHO Phase 6. There are many problems with that, the least being that the CDC plan made the (xenophobic?) assumption that any pandemic would reach our borders from overseas, which obviously didn't happen. Anyway, as you can see from the CDC chart, we're actually in a non-declared Stage 5 ("Spread throughout the United States"). How very parochial... :-)

Hi sql,

All this is very confusing. As far as I see it, the United States' CDC follows WHO, so as Abbott and Costello said "WHO's on first". :)
ken

Ha! Now remember, this market has all along stated that either the US CDC or WHO can call a pandemic for purposes of settlement, so even if WHO changes their criteria, if the CDC says it's a pandemic and raises the federal level to five, this wold still settle as 'Yes'.

Did I make that clearer? :-)

So ... at this point, the CDC has stopped issuing the updated federal "response stage"? Anyone able to find any information otherwise?

I've not been able to. I wish I had kept some screen captures from four weeks ago; at the time, the federal page (http://www.pandemicflu.gov/plan/federal/fedresponsestages.html) maintained the current level, which was 2 at the time. By design, the US stages were to move in lockstep with WHO's own phases (http://www.doi.gov/pandemicflu/concept.html or http://www.doi.gov/pandemicflu/appendix/appE.html or http://www.doi.gov/pandemicflu/appendix/appD.html).

From today\'s WSJ - http://online.wsj.com/article/SB124346642019860251.html\\r
\\n\\r
\\nOver the next several months, the new H1N1 flu virus is likely to continue to spread around the world, reaching into the southern hemisphere along with winter, then possibly staging a resurgence in the northern hemisphere come fall.\\r
\\n\\r
\\nHundreds of thousands of people could fall sick, and some will die. Public health officials will scramble to minimize the damage, as governments and drug makers continue to invest millions of dollars in a potential vaccine.\\r
\\n\\r
\\nYet the public, after an initial spasm of fear and concern, has turned its attention away from a strain that seems less serious than first advertised. The complacency is increasing the challenge for health officials who are trying to track and limit the spread of a disease that can still make people seriously ill even if it isn\'t deadly for most.\\r
\\n\\r
\\nAs of Wednesday, the virus had sickened at least 13,398 people in 48 countries from Argentina to the U.S., and 95 people have died, according to the World Health Organization. In the U.S., 7,927 probable and confirmed cases in 47 states and the District of Columbia have been reported to the Centers for Disease Control and Prevention, with at least 11 dead. Officials believe thousands more -- at least 100,000 in the U.S. -- have had the virus, but weren\'t tested or sick enough to visit a doctor.

Anyone able to find any information otherwise? \\r
\\nNope - I looked over the site thoroughly. It must have been scrubbed clean

I had written several days ago speculating as to what change(s) in WHO\'s Pandemic Alert Level might be forthcoming. (WHO says in \"a week or two\" they\'ll make any such changes after comsulting a large number of high-level epidemiologists and virologists.) One of the schemas I talked about was maintaining the current six-phase program, but subdividing one or more phases--especially Phase 6, aka \"The Pandemic Phase\"--into smaller and more logical chunks.\\r
\\n\\r
\\nAt the time I wrote that, I wasn\'t aware of the US CDCs \"Pandemic Severity Index\", which--as it turns out--was pretty much exactly what I had in mind. This index--the PSI--breaks down pandemics into five distinct categories based on CFR (case fatality rate), along with the number of projected US deaths:\\r
\\n\\r
\\nCategory 1 Pandemic: CFR < 0.1% / Projected deaths: < 90,000 (yellow)\\r
\\nCategory 2 Pandemic: CFR 0.1% - < 0.5% / Projected deaths: 90,000 - < 450,000 (orange)\\r
\\nCategory 3 Pandemic: CFR 0.5% - < 1.0% / Projected deaths: 450,000 - < 900,000 (red)\\r
\\nCategory 4 Pandemic: CFR 1.0% 0 < 2.0% / Projected deaths: 900,000 - < 1,800,000 (purple)\\r
\\nCategory 5 Pandemic: CFR >= 2.0% / Projected deaths: >= 1,800,000 (black)\\r
\\n\\r
\\nBased on current projections, the H1N1 outbreak would be classified as a Category 2 pandemic. Seasonal flu is a yearly Category 1 pandemic (really), the 1957 and 1968 pandemics were Category 2, and 1918 was a Category 5. (The US has had no Category 3 or 4 pandemics in the past 110 years.)\\r
\\n\\r
\\nThe question is, then, will WHO adopt a similar scheme? That is, will they indeed keep their six-level system but subdivide Phase 6? If they decide to do so a week or so from now, they would likely call a pandemic fairly quickly, given the rapid spread of the virus in the Southern Hemisphere.\\r
\\n\\r
\\nIt\'ll be interesting to watch. (Here\'s a great article from the New England Journal of Medicine*: http://content.nejm.org/cgi/content/full/NEJMp0904380 And you can read about the PSI here: http://www.pandemicflu.gov/plan/community/community_mitigation.pdf) (PDF)\\r
\\n\\r
\\n* - That 1918 flu was a doozy; note the part where it\'s stated that the number of reported cases doubled every three days. Yikes!\\r
\\n\\r
\\nP.S. - I\'m cross-posting this on the three big H1N1 markets.

05/28: WHO chief Dr. Margaret Chan said today the world is moving closer and closer to a pandemic. \"We need to look at whether or not the criteria for phase 6 is met,\" she said.\\r
\\n\\r
\\nhttp://news.xinhuanet.com/english/2009-05/29/content_11451166.htm

sql, she said we are\" closer now than last week\". \\r
\\nHow astute.. we are a week closer.. :) (if that\'s the way it is going.) If not , then not.. of course.

Ha! Well, that\'s a slight mischaracterization of what Dr. Chan said. \"...we are not in phase 6 yet. But we are closer to phase 6 today than we were last week...WHO is following very closely the development of the A/H1N1 flu situation in Europe, in Asia as well as in South America.\" (South America, of course, especially the southern hemisphere, has seen a near explosion of cases in the last several days, along with Australia\'s rapidly-growing case count.)

Yes, I was just trying to make a joke, so had to quote her out of context.. We, in the field, call it artistic license.

06/02: Here's some interesting news: according to the well-respected Bloomberg, WHO plans to change the pandemic alert level to Phase 6 sometime in the next two weeks.

"The Geneva-based agency, sometime in the next 10 days, will declare the first flu pandemic in 41 years, said the people, who spoke on condition of anonymity because the WHO’s deliberations are private. WHO is using the time before the announcement to help member states prepare...Following yesterday’s discussion, [WHO Director Dr. Margaret] Chan is considering changes that would allow the agency to describe the situation as pandemic phase 6a, leaving the WHO two more levels -- b for moderate and c for severe -- if a more deadly bug emerges, according to the people familiar with the organization."

http://www.bloomberg.com/apps/news?pid=20601087&sid=aT9sIzRoUnNo&refer=home

http://www.bloomberg.com/apps/news?pid=20601124&sid=ay7hxxrfAcIU

further

Australia is now officially reporting "sustained community spread" of H1N1 - technically, that should be sufficient to meet the WHO criteria for an official "pandemic" announcement

http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/news/jun0309australia.html

The World Health Organization said Tuesday a spike in swine flu cases in Australia may push it to finally announce the first flu pandemic in 41 years. It also expressed concern about an unusual rise in severe illness from the disease in Canada.

"On the surface of it, I think we are in phase 6," or a pandemic, said Margaret Chan, WHO's director-general. Chan said it was important to verify the reports that the virus is becoming established outside North America before declaring a pandemic. "The decision to make a phase 6 announcement is a heavy responsibility, a responsibility that I will take very seriously, and I need to be convinced that I have indisputable evidence," she said. [She] said she will hold a conference call with governments Wednesday in order to verify some of the reports she has received before making a formal announcement. "Once I get indisputable evidence, I will make the announcement," she told reporters in Geneva.

http://www.google.com/hostednews/ap/article/ALeqM5jTkkEKE5LtPih_5Jcc-3MpD0gOYQD98NDCQ80
---------------------------

So: Australia's case load has exploded to more than 1,000; Chile's has more than doubled in just two days to nearly 1,000 itself; the EU announced 184 new cases today (including a number of cases with patients who had no known exposure to anyone with A/H1N1), its biggest one-day increase in cases since the outbreak began; cases in the Southern Hemisphere are growing at a more rapid rate than cases in the Northern Hermisphere, a good sign that the disease has taken hold; today the WHO's assistant director stated at a news conference that "we are really very close" to declaring a pandemic; and now the director herself has stated that she's only waiting on "indisputable evidence" to make the call...and there's a lot of such evidence.

IOW: the call may come as early as tomorrow (06/10) or Thursday (06/11).

It certainly looks as though tomorrow (06/11) is most likely the day the pandemic alert level will be raised. Dr. Margaret Chan--director of the WHO-- talked with health officials from several of the hardest hit nations today, and has called an emergency meeting of the WHO's influenza experts committee for 10:00 GMT tomorrow. Dr. Chan previously met with that committee before raising the pandemic alert level to phases 3, 4, and the current 5.

06/11: WHO director Dr. Margaret Chan is holding a press conference at 6:00 PM Geneva time (noon EDT) today at which she will almost certainly announce a move to Phase 6 and officially declare A/H1N1 a pandemic.

http://www.thaindian.com/newsportal/health1/who-concludes-emergency-meeting-pandemic-declaration-expected_100203728.html