Influenza is on the list of potential bioterror agents, so it's certainly in the realm of possibility. But it looks like the virus is a reassortant of 2 swine strains, with no human or avian components. So it's really not that unusual or unexpected. There is no question that there are nutjobs out there working on bioweapons. This current virus wouldn't be a very smart choice though.

I thought they should have skipped 4 and gone straight to 5. But they didn't ask me. :D

Here are WHO pandemic stages: Because of H5N1, there has been a huge emphasis on pandemic planning. The stages of a pandemic were clearly defined several years ago, along with what type of response goes along with each stage. You'll notice that numbers (how many cases, how many deaths) aren't used to determine levels. Instead, they look at patterns of disease and how it is spreading. Here is the definition of a pandemic: So it would be possible to have a pandemic with very few deaths, but it would still be a pandemic. For the past few years (until a couple days ago) we were at level 3, because of the H5N1 virus. That's where everyone was looking, although public health has said all along that the next pandemic could be from a completely different virus.

Cuz people buy it.:D

We've known for years a few things about flu: Pandemics originate in animals (pigs or birds) and jump to humans. This is different than the usual seasonal flu, which just keeps circulating in humans but changes gradually over time. Pandemics range in severity from a little worse than usual seasonal flu to devastating. If we had a flu similar to the 1918 flu, it would be devastating. That flu originated in either pigs or birds, depending on whose research you read. The 1918 flu especially liked to kill people age 20 to 40. That is very unusual. In a typical year, less than 5% of flu deaths are in people under age 65. When this situation started, we saw too many similarities to the 1918 flu. It appears to have come from pigs. It started at the end of the usual flu season. It was killing people almost exclusively ages 20-40. In the first days of any epidemic, there is lots of confusion. There are political pressures and issues, different agencies are getting different and often conflicting information, and it's impossible to really ascertain what is happening until you get a bunch of feet on the ground and start collecting data and doing lab analyses. That all takes a considerable amount of time. The initial information indicated that this flu was acting similarly to the 1918 flu. Naturally, public health needed to act swiftly. In the last couple days, things are looking a bit more reassuring. We are getting a better sense of the numbers, and the case fatality rate may not be as bad as was initially feared. While people continue to die in Mexico, that isn't happening in the US and elsewhere. Why? No one knows yet. Different risk factors, different climate, different strain- those things will eventually be figured out. The flu virus is unpredictable. It may be that this will turn out to be similar to the seasonal flu, and we will discover some risk factor unique to Mexicans that we can address. It could be that the virus will follow the pattern of the 1918 Spanish flu, with a second wave coming later that will be drastically worse than this initial wave. Or it could die out, never to reappear. So in a nutshell, it's because of the initial similarities to the Spanish flu, and the potential for a repeat of 1918 that has public health taking this so seriously.

Keep in mind that in order to be effective, it has to have a concentration of 60% alcohol or higher. Many store brands have less than that, and are basically useless. NYT article

IIRC, only about 50% of those who are infected with influenza virus become sick. So there are definitely asymptomatic cases. It's unlikely that they are contagious though- or if they are, they wouldn't be shedding nearly as much virus as someone who is symptomatic.

Well, you're right that where the child acquired the flu is more important than where he died. The death will be recorded as a US death, because that's just the way tracking is done- it would be impossible to track every case and figure out where the person became infected. It's not a perfect system; there will always be some misclassification, but it's the best we can do. I don't watch TV, so I don't know what they're saying about it. If they're indicating things have changed significantly because of this child's death, that isn't accurate. As far as we know right now, there is not a "Mexican strain" and an "American strain". The preliminary info is they are identical viruses, although I don't think they have the whole thing sequenced yet. So it is a mystery why Americans aren't dying and Mexicans are.

I'm not sure if vinegar is effective against influenza viruses, but a bleach solution will definitely disinfect surfaces.

N95 masks are supposed to be single use, but realistically that isn't practical. We'd run out overnight if people discarded them that quickly. Here is some helpful information about reusing the masks. Influenza viruses can probably survive outside the body for up to 48 hours, depending on the surface and environmental conditions. They last longer in cool dry air, and on hard surfaces like countertops and doorknobs. Hanging used masks in the sun for several days sounds like a good idea.

Have you moved? Is there an Urgent Care Center? County health department? If it were my family, I'd want to have them tested. But I don't know if I'd make a 1.5 hour drive for it.

CNN

We'll find out more soon, I'm guessing. Reporters are all over this stuff. ;)

More about masks... This is a pretty good article about the use of masks.

It seems accurate that there are 7 confirmed deaths in Mexico. Those are laboratory confirmed deaths, where they have done some fairly sophisticated testing on the virus. Technically, to be absolutely sure it is SIV (Swine influenza virus- I'm getting tired of typing it out) you would have to do that. But there is no possible way they can do this on everyone who gets sick, and it isn't necessary. Instead, you can make a presumptive diagnosis based on other things. If a patient has symptoms of the illness, with known exposure or risk factors (i.e. recent travel to Mexico), has a positive screening test (meaning a test showing they have *some* influenza A subtype), and further testing shows that it isn't one of the seasonal flu types, you can presume it's swine flu. There are hundreds of those. While Ms. Allan has her numbers right, this is highly misleading. The fact that they're not all laboratory confirmed doesn't mean these people aren't dying of flu.

That seems very strange to me. I don't know who Vivienne Allan is, but she doesn't appear to even have anything to do with influenza. I wonder if WHO even knows she's talking to the media. It doesn't usually work that way.

Is it the Gallery of Regrettable Food?

CDC I posted about this earlier-- I'll copy here:

There is an informative post up about quarantine and isolation at Effect Measure. I agree with Revere; any large scale quarantine in the current situation would be counterproductive.

Those flimsy facemasks probably aren't helpful at all. The N95 respirators I posted about elsewhere do give some protection. They are most effective when worn by an infected person, to prevent them spreading the virus to others. But they do offer some protection to an uninfected wearer as well, as long as you are careful to not touch the mask and then your face. You can buy them at Menards, Home Depot, etc. You have to adjust them so they make a good seal around your face to be effective.

Maybe. Have a look at this map. Cozumel is a long way (looks like 600 miles or so) from the nearest cases. That map could look very different in a couple days though.

The Department of Defense has a very large surveillance program, collecting samples from designated sites worldwide. DHHS also runs the National Influenza Surveillance System, which has a number of different components. It depends largely on clinics and physicians who have agreed to participate in the system as part of the "Sentinel Provider Network". These are scattered throught the country and are entirely voluntary. State and county Public Health departments may also do surveillance. From a clinical perspective, there is no need to do anything more than an office based rapid flu test. Knowing which strain of flu a patient has won't change treatment in any way, so further analysis is costly and unnecessary. The purpose of surveillance is to understand what is going on with influenza in populations, rather than an individual.

It is possible that the virus has been around for awhile. We have surveillance programs that test samples from around the country on a regular basis. It gives a good idea of what subtypes and strains are going around, and helps predict future epidemics and determine what the components of next year's flu shots should be. But obviously the great majority of people with flu are never seen by HCWs, and only a tiny fraction of those that are seen have their virus identified. So if there have been low numbers of swine flu cases they would be missed. If it were common, though, it likely would have been found via surveillance. All it takes is ONE sample of a swine flu, and CDC is all over it. The best guess is that there were some cases prior to the first identified case in California on April 13, but probably no epidemics. As far as differences in health care- I don't know enough about health care in Mexico to comment. I don't know why young people are dying, but I am very hesitant to blame poor health care. If the deaths were a result of poor care, we should be seeing many magnitudes higher death rates in the elderly and very young, and we aren't. Apparently, they have plenty of antivirals, so that isn't the problem either. Even if the flu is related to issues like nutrition, overall health, and access to health care, much of the world is a lot worse off than Mexico is.

There is the possibility of some cross-protection between any strains of the same subtype (antibodies to one H1 virus may protect somewhat against a different H1 strain, but antibodies to an H3 are useless against an H1). It depends on how similar the strains are. There are very complicated phylogenetic trees that show how influenza viruses are related to each other, based on the number of amino acid changes. The more changes in the protein, the less protection you get. Unfortunately, this virus seems to be quite different from last year's seasonal flu. However, you are probably better off than if you'd never had the flu at all. One of the reasons the 20-40 year olds were hardest hit with the Spanish flu (H1) in 1918 is that there were no H1 viruses in existence since 1890. In 1889-1890 an H2 virus pandemic began and it completely replaced the H1 virus that had been circulating before that time. People born after 1890 had absolutely no protection to H1 viruses. Most of those born before 1890 had been exposed and had H1 antibodies floating around. While the pre-1890 H1 virus was very different than the 1918 H1 virus, it seemed to induce enough protection to give partial immunity. The H2 virus that those born after 1890 had some immunity to offered no immunity at all to the 1918 H1 virus. Short answer: You may have a little cross protection. Not a lot.

My responses in red below.