My responses in red. The whole situation is very confusing. The flu virus can be very unpredictable. No one knows what's going to happen, but we have to look at historical information to try to make predictions. Right now, it's not looking so good. On the other hand, if it turns out that the virus truly isn't that transmissible, it could die out and disappear.

We do lots of camps Here are our tentative summer activities: Dd14 Drivers Ed Poms (school team) Pom camp and competitions Dance intensive College 4 Kids (a local academic camp) Dd12 Dance intensive Dance competition College 4 Kids Swim team Golf lessons One week of overnight camp through YMCA Ds 11 Swim team Skating lessons Skating camp Hockey camp RAGBRAI with his dad Week long Nature day camp We always do a little school every day, and will travel some. There still seems to be plenty of time to hang out at the pool and do other fun stuff.

Because of the wave patterns of past pandemics, we might be better off getting the virus now, instead of 6 months from now. But I am having visions of chicken pox parties, where people deliberately expose their kids, and I wanted to be clear that I wasn't suggesting anything like that. But extreme isolation, which may just delay infection until the virus becomes more lethal, may also be a bad idea. For now, I'm going with common sense- wash hands frequently, avoid obviously sick people, avoid crowded spaces.

Ft. Dix: 12 cases of respiratory illness 1 death 230 with asymptomatic infection 22 days never spread outside Ft. Dix Current swine flu 1000 sickened and 68 (or 81, depending on the source) dead in Mexico Probably many more with asymptomatic infections 20 cases in US, 5 states Confirmed cases in other countries (New Zealand, Canada) Probable cases elsewhere (France, Spain) Sustained human to human transmission occurring I don't think they are similar at all. Update: new numbers: Health ministry says 1,614 are hospitalized, 103 dead.

Actually, nausea, vomiting and diarrhea have been common symptoms of the American variant of the current swine flu. Human flu viruses bind to receptors found mostly in the respiratory tract, causing mainly respiratory symptoms. Avian influenza viruses bind to those in the GI tract, and swine flu viruses can bind to both respiratory and GI receptors, causing both respiratory and GI symptoms. GI symptoms of seasonal influenza do occur occasionally in kids, as well. But both swine flu and avian flu cause more GI symptoms than the usual flu.

Has he ever tried ice skating? My son also has a problem "getting" the rules. The sport that finally worked out fabulously for him is figure skating. He took a couple group lessons but then started working privately with a coach. It's one-on-one, so he doesn't have to deal with the jerks (there have been plenty in other sports), and there are no team rules to remember. So far we haven't encountered any jerky figure skaters. Our rink offers week long summer camps for all skill levels. Figure skating is not cheap though.

Sorry, I didn't see your post, and I just posted something similar above. You are correct.

Well, that stinks. It's hard to know what to do. There is an issue that hasn't been raised here yet but will probably eventually be discussed in the MSM. With the Spanish flu, there were three distinct waves of illness, as the virus underwent genetic changes. The first wave caused lots of illness but very little death. The second wave was highly fatal, and the third wave was less lethal. Other pandemics have occurred in waves, but the differences in mortality weren't as dramatic. If this is the beginning of a pandemic, it is possible that if the case fatality rate is low, it would be better to catch the illness in the earlier waves rather than later. I am not recommending anyone deliberately get themselves or their kids infected! But avoiding infection at all costs may actually be detrimental in the long run. On a personal level, I don't know what to do. Unless mortality is high, I don't plan to go to any extreme measures to isolate ourselves. But things are happening quickly and I may feel differently tomorrow.:confused:

It is possible that the death rates aren't all that elevated. In order to determine how "deadly" this flu is, we need to know the case fatality rate (CFR= # of deaths/# of cases). To determine CFR, you need to know how many cases there are, and that requires epidemiological studies. If many, or most, of the cases are mild, there will be many undiagnosed cases, and the CFR will be low. But no one has any of that information yet, so it's too early to make any comparisons with other epidemics. While we wait for better data, there are other reasons to be very concerned. In the Northern Hemisphere, the flu season should be ending in March. Instead of dropping off to almost no cases, there was a sharp increase in cases, which is (almost) never seen in a typical year. The first cases occurred as large clusters in 2 separate geographical locations, and then began to spread. That is not what you'd expect as the flu season should be winding down. It is what you see at the beginning of an epidemic though. This is clearly a new virus. There is no question that this is not something that has been circulating before. Whenever there is a new virus, there are immunologically naive people and you see higher death rates. Even though we don't know what the rates are yet, it is NOT typical for only those 20-40 years old to be dying. The only time we have seen this pattern is during a pandemic, as far as I know. I haven't heard anything yet about causes of death. That information will be very helpful once they release it.

Nooooo! You have lots of great information. Keep answering!

They are prescription only, but if the flu becomes widespread they may be distributed by public health agencies. I don't know much about how that works but will try to find out.

double post

That looks like a reputable site with good information. One other recommendation: If this becomes widespread, you may want to wear masks. If you decide to purchase masks, the N-95 respirators are better than regular facemasks. They are available at home supply stores like Menard's and Home Depot. We bought a box of 20 for about $15.

There have been different strains of H1 flu viruses circulating in humans for about 30 years. There is possibly some cross-protection between different strains, but it depends on how similar the viruses are to each other. Preliminary information is that this year's vaccine isn't offering any protection, but it's really to early to say.

I've heard 1-2 days, but there is some conflicting information. It does seem to be less than 3 days.

The main causes of death were bacterial pneumonia and cytokine storm. Here's a current explanation of cytokine storm related to influenza. Another reason for the peculiar age distribution of mortality with the Spanish flu has to do with "immunologic memory". People aged ~15 to 40 were "immunologically naive" meaning their bodies had never before seen an H1 virus, and they had no immunity at all. Prior to 1899, an H1 virus was circulating, and most people were exposed to it. In 1889-1890, a pandemic from an H2 virus began, and H1 viruses disappeared. So those born after 1890 would have had no immunity at all to an H1. It doesn't really explain why those younger than 15 weren't severely affected though. Young kids do have some immunity from maternal antibodies, but that only lasts a year or so. Did that make any sense? It's complicated but I'm in a hurry and don't have time to explain further. Maybe I can elaborate when I get home tonight.

It's an interesting idea, but it was simply a hypothesis put forward in a letter to the journal editor. There isn't really any evidence for it. It would be nice if it were true though, because we can treat strep.

Worried? Yes, but not panicked. I just had dh pick up a box of N-95 masks on his trip to Lowe's. :) Things are happening very fast. That is always worrisome. OTOH, it could fizzle out and disappear. It's impossible to predict right now. Things should become more clear over the next few days, as they get a better handle on how easily it's spreading between humans and how extensive the spread is. The difference between the clinical presentations of the Americans vs. the Mexicans is puzzling. It doesn't seem to be related to a difference in medical care; the Americans have had a milder illness. Pandemics have occurred every 10-40 years for at least the last century, so it's inevitable that we'll have another one. It's been over 40 years since the last real pandemic, so we are due for one. While a pandemic usually results in elevated rates of severe disease and death, typically the elderly are affected disproportionally and children and adults don't usually die. What has everyone so nervous about the current situation is that all the deaths have been in young adults, which is similar to the pattern seen in the 1918 flu. But like I said, it's too early to really know what's going on.

I'm trained as an infectious disease epidemiologist, and my past research included swine and avian influenza in people with occupational exposures to pigs and birds. I'm not working now though.

Influenza viruses are classified by two major surface proteins: H (hemagglutinin) and N (neuraminidase). Almost all viruses in humans are H1N1 and H3N2. There are 16 known H types, and 9 known N types, and all of them are found in waterfowl. It's thought that migratory waterfowl are an important source of transmitting viruses over large geographic areas. This is described well elsewhere, so I'm just going to copy it: EVOLUTION OF INFLUENZA A VIRUSES IN WILD BIRDS1 Robert G. Webster2,3, Scott Krauss2, Diane Hulse-Post2 and Katharine Sturm-Ramirez2 Also see Ecology of Influenza Viruses

Flu viruses change through two mechanisms: antigenic drift, and antigenic shift. Drift means the genes are changing gradually in small ways. It occurs constantly, and is the reason we have different flu shots every year. It takes about that long for a virus to change enough so that the immune system doesn't recognize it any more. Shift means there is a sudden, large change in the genes. One of the ways it can change is by reassortment, when the virus swaps a gene with a different strain of influenza. For example, say a pig, infected with a common swine virus, becomes infected with an influenza virus from a duck (the ecological reservoir for all influenza viruses is waterfowl) and a human. The three viruses mix, and can exchange genes, creating a novel virus with a mixture of genes. Most of the time, these new viruses don't spread eeasily from human to human. But if they acquire this ability, it's a formula for a pandemic. This viral mixing seems unlikely, but it really does occur. It's thought that the reason pandemic viruses historically come from Asia is that humans, pigs, and waterfowl live in such close proximity to one another- often in the same house. It's a setup for viral mixing. Influenza is fascinating. I wrote my dissertation on zoonotic flu. Here are some resources. CDC Wiki

It's actually not that unusual for flu viruses to reassort, or exchange genes. There are many examples, particularly in pigs and birds, of viruses with genes from different species. What is unusual about this situation is that the viurus is capable of being transmitted from human to human.

Also, they can't close borders yet, but when (possibly today) they change to pandemic level 4, the WHO can issue travel advisories. It's unlikely that limiting travel will make that much difference at this point. Almost a million people cross the US-Mexico border every day, and this has been going on for a month.

It's too late for closing the borders. The first known case in Mexico was on 3-22-09. It's already incubating globally.

Effect Measure is an excellent blog for those that want the latest information on the swine flu situation.