Porcine flu A_H1N1

By the ides of June 2009, the swine flu AH1N1 affliction is declared a full blown pandemic spreading globally without a severity scale, the Philippines is a frontrunner in incidence. When it comes to infectious disease, preparedness is good, but ill-informed preparedness is a waste of time and resources, and there's a lot of ill-informed preparedness going on right now with the swine flu. The Department of Health is bustling to stay on top of its developments, if not its curtailment, prompting some critics to bewail the feeble proactive efforts of the DOH honcho. I am inclined to agree.

Some pertinent but vital questions have not been addressed. The emphasis in hampering the spread of the disease is hand washing in running water, but was silent on rinsing with stagnant water in a basin, the tendency in remote areas where water is scarce and must be arduously fetched. Another is the matter of social distancing mantra -- the church frowns on holding hands at mass, DOH advises to keep 3 feet away from each other -- not so practical with passengers rubbing elbows in jeepney rides, when paying fare or when accepting the wafer at communion.

But there are practical ways to contain the disease that the DOH can disseminate to the public,  beyond the admonition not to panic

Doorknobs and push buttons, convenient devices in everyday life, are also convenient means for the virus to seek more victims, and these invisible buggers are not choosy. Gender, age, rich, poor, any human will do. So to frustrate and infuriate the invisible enemy, disinfect their bridges to the hands ---  the doorknobs, pushbuttons and many other items touched routinely by many people (ATMs, computers, coins). Alcohol, if one can afford it, is a favorite and convenient disinfectant. In a bind, even the 80-proof intoxicants will do as substitute for rubbing alcohol.

Outsmarting the Flu Virus with Chlorine Bleach

Although viruses require live host cells to multiply and spread, they can live on inanimate surfaces for up to two hours or more, giving them a convenient window of opportunity to be picked up by unsuspecting organisms, namely, us. Likely points of infection are commonly touched surfaces: doorknobs, desks, counters, dials and handles. Managing the viral populations on these surfaces is an effective way to cut down on the spread of flu. Chlorine bleach is a logical germ-busting, readily available product to turn to for this task. It works by penetrating the protective shells of viruses.

A dilute solution of regular laundry bleach (1/4 cup of bleach in a gallon of cool water) is an effective and inexpensive all-purpose disinfectant, used commonly in homes and healthcare facilities. Some keep spray bottles of chlorine bleach solution on hand for use to disinfect exercise equipment. The active ingredient in chlorine bleach, sodium hypochlorite, is one of the chlorine disinfectants routinely added to municipal drinking water to control waterborne disease.

A study by the National Institute of Nursing Research showed that hot water and bleach are more effective in reducing viral infections than antibacterial products. This is because antibacterial products work only on bacteria, whereas bleach destroys both viruses and bacteria.

Masks Are Useless at Protecting Wearers from Swine Flu

Many air travelers have been seen wearing mouth and nose protection of one type or another in recent days. Most were wearing face masks, which are loose-fitting and designed largely to help stop droplets from spreading from the person wearing the mask. They also protect the wearer's mouth and nose from cough and sneeze aerosols. They are not created to protect the wearer from breathing in very small particles.

Case in point: All those people buying surgical masks. They think wearing a mask protects them from swine flu. The mainstream media perpetuates the myth, broadcasting images of people wearing the masks, all while talking about people "protecting themselves" from swine flu. If it wasn't a potentially life-and-death situation, it would be amusing.

 Did you ever notice that the surgeons and medical staff in a surgery room are all wearing surgical masks that are very similar to the face masks being used by people afraid of swine flu? Did you ever wonder WHY they are wearing those masks? Are they wearing those masks to protect themselves from the patient's germs? Not so. They're wearing those masks to prevent their own germs from infecting the patient!

Respirators, on the other hand, are made for just that. They are similar in appearance to the relatively inexpensive face masks but are designed specifically to protect the wearer from breathing in such particles. These masks, known as N95 for its filtering ability, fit more snugly on the face than face masks so that most air is breathed through the filter material. They work best if they are fitted specifically to the person wearing the mask.

A respirator that fits snugly on the face can filter out small particles that can be inhaled around the edges of a face mask. But it's easier to breathe through a face mask than a respirator over a long period of time, said experts at the Centers for Disease Control and Prevention.

Are there treatments?

As of now, the new virus is killed by two antiviral medicines—oseltamivir and zanamivir. Based on experience with other flu viruses, treatment would be most effective if given within 2 days of the onset of symptoms. As long as this current swine flu virus is infecting people, it is likely that health authorities will recommend that people with more severe illness take these medicines.

On the other hand, there is no proven benefit from using the medicines before symptoms develop, and there is proven harm: unnecessary widespread use of these drugs could produce drug-resistant viruses.

There is no vaccine yet for the new virus, (Drug firm Novartis claims a new vaccine available for distribution by November) and the Centers for Disease Control and Prevention (CDC) has expressed doubt that this year’s regular flu vaccine will offer protection.

Vast Majority Won’t Have Access To Antivirals In Pandemic, But Generic Drugs Could Help Prevent Deaths

ScienceDaily (June 15, 2009) — Almost 90 per cent of the world’s population will not have timely access to affordable supplies of vaccines and antiviral agents in the current influenza pandemic, but it is possible that inexpensive generic drugs that are readily available, even in developing countries, could save millions of lives.

That’s the conclusion reached by an extensive review and analysis by immunization expert Dr David Fedson, published online by Influenza and Other Respiratory Viruses within hours of the World Health Organization declaring a pandemic.

Dr Fedson points out that seasonal flu resistance to antiviral drugs like Tamiflu may make them ineffective in the pandemic and maintains that without effective drugs some countries will have to rely on 19th century public health measures to see them through the outbreak.

He is calling for urgent and sharply focused research to determine whether drugs that reduce inflammation or modify the host response - the way that the body responds to infection or injury - could be used to manage the pandemic. And he believes that a lot could be learnt from the work done on these commonly available generic drugs - which include drugs to lower cholesterol and treat diabetes - by scientists not involved in influenza research.

“Despite the best efforts of influenza scientists, pharmaceutical companies and health officials, the stark reality is that although studies of the molecular characteristics of influenza viruses have been enormously informative, they have failed to explain the system-wide effects that flu has on people who contract it.

“For example we still don’t understand why so many young adults died in the 1918 pandemic, while the death rate for children was much lower. I believe this is because researchers have focused on studying the actual virus rather than how these particular hosts – the children and young people – responded to the virus. 

“Most of the world’s population lack realistic alternatives for confronting the next pandemic and urgent research is vital. Otherwise people everywhere might be faced with an unprecedented public health crisis.”

Dr Fedson maintains that experiments by non-influenza scientists have defined common cell signalling pathways for acute lung injury caused by different agents, including the inactivated H5N1 influenza virus (bird flu).

“Research suggests that giving patients anti-inflammatory and immunomodulatory agents such as statins, fibrates and glitazones could help to regulate the cell signalling pathways in patients who have suffered acute lung injury, a common problem with influenza” he says. “They can also help to reverse the cellular dysfunction and cell damage that accompanies multi-organ failure.

“Cell signalling pathways play essential roles in the ability of cells to perceive and correctly respond to their microenvironment. They form the basis of development, tissue repair, immunity and normal tissue function.

“Statins are commonly used to lower cholesterol and prevent heart disease - but have also been shown to be effective in reducing hospitalizations and deaths from pneumonia. Fibrates modify fatty acid metabolism and glitazones reduce blood glucose levels in type 2 diabetes. All of these drugs modify the cell signaling pathways involved in acute lung injury and multi-organ failure. Moreover, they are affordable generic drugs that are widely available even in developing countries.”

Dr Fedson points out that there is currently no logistical plan to distribute supplies of pandemic vaccines to the non-vaccine producing countries that contain 88 per cent of the world’s population. “In all likelihood, people in these countries won’t be able to obtain supplies of pandemic vaccines or they will get them too late” he says.

“Many health officials have placed their hopes on stockpiles of antiviral agents, but resistance to the most widely stockpiled agent, Tamiflu, in seasonal flu outbreaks, has prompted concerns that similar resistance could develop in any pandemic virus. 

“It’s estimated that countries that do not produce influenza vaccines will only have enough antivirals to treat one per cent of their combined populations.

Influenza and Other Respiratory Viruses is the first journal to specialise exclusively on influenza and other respiratory viruses. It is the official journal of the International Society for Influenza and Other
Respiratory Virus Diseases (http://www.isirv.org), an independent scientific professional society promoting the prevention, detection, treatment, and control of influenza and other respiratory virus diseases.

The journal is providing all of its content free online at http://www.influenzajournal.com and fast-tracking the publication of articles to help clinicians stay up-to-date with the latest research and expert commentary.

Where can more information be obtained?

For updated information from the CDC, go to: http://www.cdc.gov/swineflu or visit Harvard Health Publications’ Flu Resource Center.

Cleanliness Habit

Primary schoolers prior to WW2 were taught a ditty: I have two hands, the left and the right; hold them up high, so clean and bright … DepEd should inculcate the value of clean hands. The advent of the swine flu pandemic is scary, but could bring about a benefit:  the awareness that hygiene and sanitation are vital to staying healthy, and could persist as a habit.