Not quite yet

Today the tally of swine flu cases reported and confirmed by the WHO increased to 3,440 confirmed cases in 29 countries, with 48 deaths from the sickness. Just yesterday there were 2,500 confirmed cases in 25 countries.  In the United States, the total number of confirmed cases was 1,639. Today swine flu count stands at 2,254 confirmed cases and 722 probable cases in 44 states, with 104 hospitalizations.  I am pretty sure all of these numbers are a significant underestimation of the real numbers, the WHO is very conservative and slow in confirming case load.

There is little doubt that this virus has learned how to travel from human to human with ease, not to mention the occasional dog leg to re-visit a swine herd in Alberta, Canada.  As the map put out by the WHO shows, this virus has already spread far and wide.

At the moment the percentages of infected people who need hospitalization and eventually die of H1N1 is reassuringly low. Does that mean we can forget about this as the latest horror perpetuated on a gullible public by hyperactive news media? If you ask me, not quite yet.  This virus may yet learn new tricks than can be very dangerous. Here is a quote that worried me:

Bird flu kills more than 60 percent of its human victims, but doesn’t easily pass from person to person. Swine flu can be spread with a sneeze or handshake, but kills only a small fraction of the people it infects.

So what happens if they mix? This is the scenario that has some scientists worried.

We are more at risk

The sober scientists at the WHO and CDC estimate as many as a third of the people of the world are likely to get infected with this virus before it is all over.  That is many billions of people!  Even with very small percentages of people actually dying from it, the deaths become horrendous when we are talking of billions of people infected.

What I find more troubling is the fact that people with prior vulnerability to pulmonary infections – such as people with asthma, COPD etc – are more likely to develop aggressive viral pneumonia if infected with the swine flu.  The New York Times has a good article on the subject today.

And as I have said a million times before, CLL patients seem to be exceptionally sensitive to all sorts of pulmonary infections.  Pneumonia and pulmonary infections are the single biggest cause of death in CLL patients. 

The Southern Strategy

The WHO and other similar organizations are following what I call the Southern Strategy.  The southern hemisphere is just entering their annual flu season.  Every year the authorities monitor what is happening in Australia and New Zealand to see what they can expect by way of the annual flu six months later in the USA, Europe and rest of the northern hemisphere.  This year the watching is much more intense. You might say Aussies and Kiwis are the canaries in the coal mine.  Oh yes, South America and parts of Africa are there too, but they do not count since many countries there do not have adequate surveillance and reporting systems.

If the present H1N1 virus follows the pattern established in the great 1918 flu pandemic, there is a chance that this summer’s flu infections and deaths are just a mere taste of what is to come in the fall.  If this virus learns new tricks as it goes through the human populations in the southern hemisphere, hang on to your hats gentlemen, we are in for a rough ride come this fall.

Anti-viral drugs and drug resistance

At this point the H1N1 is sensitive to Tamiflu and Relenza, two powerful anti-viral drugs available to treat patients who come down with the H1N1.  It has already been shown to be completely resistant to amantadine and rimantadine, two older and cheaper viral medications. 

I have no doubt that Australian and New Zealand patients will be covered with a blanket of Tamiflu and Relenza in order to protect them, there are no other choices.  The million dollar question is this: will the virus have learned resistance to both of these drugs by the time fall time rolls around and it is flu season for folks in the northern hemisphere?  The single biggest route to drug resistant viruses is heavy usage of the drugs.  The more we use the drugs, the more likely the virus will learn ways to get around them.  Heck, that is not news to us, we know all about developing drug resistance strains.

Vaccine to the rescue

A lot of hope is placed in timely development of an effective vaccine against the swine flu – in time that is, for the major population centers of the northern hemisphere.  The South is on its own, no hope of any vaccine before they are hit in the next few weeks and months.

And how much of a help is the vaccine likely to be for CLL patients?  I do not see any reason to hope that our guys will respond to this vaccine any better than they respond to any other vaccine.  The percentage of CLL patients who respond adequately to the annual flu shot and therefore get some benefit from it is less than 5%.

Our hope lie in what is called “herd immunity“.  If everyone around you is protected by the vaccine and therefore healthy and free of the swine flu, you can hope to escape unscathed as well.  And if you are smart, you will try to improve on this by practicing good social distancing skills. Unless you are a politician looking to get re-elected, stop shaking hands with sick people and kissing all those babies with drippy noses! Here is a very useful link to the Citizen’s Guide that has a lot of very useful information (hat tip to Peter and Jane Carpenter!)

I am convinced it will be several months before we can safely declare this crisis over.  I am equally sure that if indeed it becomes a full fledged and lethal pandemic, our best defense is going to be smart thinking, pre-planning and keeping brain in gear at all times. I will try my best to keep you up to date without going over the top and freaking you out.  OK?