by ilene - February 8th, 2010 1:54 pm
Swine flu has been moving away from the spotlight recently, leading commentators to suggest that the threat was exaggerated and has now passed. Dr. Henry Niman disagrees. As I’ve been routinely visiting Dr. Niman’s website for updates, I asked him what he thought of articles such as these in TIME and Huffington Post, and he replied that he had been writing a response. Here are his thoughts. – Ilene
Courtesy of Dr. Henry Niman, Recombinomics Commentary
The level of disinformation in the media and internet continues to grow. The latest disinformation campaign has now started calling the 2009 pandemic an epidemic. This follows disinformation on the end of the pandemic, which follows reports questioning the existence of the pandemic. This frequent and common disinformation is leading to serious confusion in the general population, which will lead to needless deaths by those who shun the pandemic vaccine and those infected by those who shun the vaccine.
The existence of the pandemic was an easy, but decidedly late, call. A flu pandemic is simply a novel strain that spreads worldwide. The detection of swine H1N1 in two children in southern California in March/April strongly suggested that the pandemic had begun. The children had no contact with swine or each other and were over 100 miles apart, indicating the detected infections represented thousands of cases in southern California, including symptomatic relatives and contacts. When the “mystery illness” that was hospitalizing and killing 100’s in Mexico was confirmed in April to be the same swine H1N1, it was clear that the pandemic had begun. The original phase 6 definition of sustained transmission of a novel strain of influenza had been met.
The swine H1N1 contained flu genes that had been circulating in swine since the 1990’s and most of the flu genes had been in swine since the 1930’s or earlier. Thus, the H1N1 was novel and the vast majority of the world’s population had no immunity, setting the stage for rapid spread worldwide. Although jumps of swine H1N1 to humans happen multiple times per year, prior jumps generally had a direct link to swine exposure and transmission was limited to family members of close contacts. The most extensive spread was in 1976 at Fort Dix in NJ where one soldier died and 200 were infected. However, the virus…
by ilene - December 31st, 2009 1:58 pm
Watching and Waiting
Dr. Niman vs. WHO, ECDC and CDC
Watching and Waiting
While the numbers of new cases of swine flu have been declining in many regions, including the United States, it is too early to know whether or not there will be subsequent waves of disease.
"Based on my experience with new diseases and the lessons learned from past pandemics, I think we should remain cautious and observe the evolution of the pandemic over the next six to 12 months before declaring victory," World Health Organization Director General Margaret Chan tells Swiss newspaper Le Temps. (World Health Official Says Swine Flu Still a Threat)
Although the WHO is remaining "cautious," changes in the virus’s genome that increase its virulence and resistance to Tamiflu are becoming more common. Dr. Henry Niman, expert in flu virus evolution, believes another wave of illnesses will occur in early 2010. In addition, he believes resistance to Tamiflu will become "fixed," similarly to how this genetic change evolved in the seasonal H1N1 virus. (See Flu Update: Tamiflu resistance and Ukraine update, and Efficacy of Roche’s Flu Drug Tamiflu In Doubt, by David Phillips.)
The World Health Organization warned government health authorities to remain vigilant on the H1N1 swine flu pandemic, saying the virus could mutate before vaccines can help it dissipate.
The World Health Organization is confident that the H1N1 swine flu pandemic will be under control in a year’s time – however, WHO officials warned global governments to remain vigilant for any mutations in the troublesome bug.
Dr. Niman believes this wave will be more severe than the previous two--but not due to random mutations. Rather, this will result from the process of recombination. Due to recombination, increasingly greater transmission of aggressive variants (D225G, D225E and D225N) and Tamiflu-resistant viruses will occur.
I’ve reprinted two recent articles at Recombinomics, with my comments in blue.
The WHO Surprise on D225G / D225N H1N1 Fatalities, Recombinomics Commentary
After considering the current available virological, epidemiological and clinical findings and following discussions on an earlier draft with WHO and its European-based
by ilene - December 11th, 2009 11:35 pm
Since early November, cases of H1N1 have continued to decline nationwide, and scientists keeping track of the numbers say that as pandemics go, 2009 H1N1 may turn out to be a mild one — at least for the time being.
The question now on health officials’ minds is: Will there be a second wave of cases in the new year? The answer depends on whom you ask. "We took an informal poll of about a dozen of some of the world’s leading experts in influenza," Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention (CDC), told reporters recently. "About half of them said, Yes, we think it’s likely that we’ll have another surge in cases. About half said, No, we think it’s not likely. And one said, Flip a coin."
It is an accurate reflection of how unpredictable the influenza virus can be. Although flu activity has been waning for the third week in a row, health officials warn that there are still four to five months left in the official influenza season, plenty of time for the virus to make its rounds and find new hosts. "The story of pandemics, and the story of H1N1 in general, is the story of persistent uncertainty where we never quite know what we are going to get or when," says Dr. Irwin Redlener, director of the National Center for Disaster Preparedness at the Columbia University Mailman School of Public Health.
How severe the current H1N1 pandemic seems depends on what you use as a measuring stick. Compared with previous pandemics, like the 1918 Spanish flu, which killed 20 million people and infected up to 40% of the world’s population, or even the far less deadly 1957 and 1968 bouts with a strain of H1N1 influenza similar to the 2009 strain, things don’t seem as bad this time around. Fewer people are getting severely ill when infected, and fewer have died or required hospitalization from the flu than in previous pandemics.
Marc Lipsitch, an epidemiologist at the Harvard School of Public Health, and his colleagues studied the course of the 2009 H1N1 pandemic last spring in two cities — New York and Minneapolis — and determined that 0.048% of people who developed symptoms of H1N1 died, and 1.44% required hospitalization. Based…
by ilene - November 15th, 2009 12:17 am
Cliff Notes for “Swine flu: One Killer virus, three key questions.”
Brendan Maher and Declan Butler, authors of a recently published Nature article “Swine flu: One killer virus, three key questions,” set out to answer three questions about the H1N1 virus. Here’s what they found.
How does it kill?
Sherif Zaki, head of the infectious-disease pathology branch at the Centers for Disease Control, discusses his team’s observations from their pathological studies.
1. The H1N1 virus penetrates deep into the alveoli (the terminal air sacs in the lungs). In contrast, the seasonal flu viruses tend to infect cells higher in the upper airways. This deep penetration is reminiscent of the action of the H5N1 avian flu virus. Zaki commented: “[H1N1] is like avian flu on steroids.” Why might this be?
Zaki says that his observations fit well with recent research looking at the mechanism of infection. A group led by Mikhail Matrosovich at Philipps University Marburg in Germany and Ten Feizi at Imperial College London studied sialyl glycans, glycoproteins that the flu virus binds to in order to gain entry to human cells. Although seasonal strains of H1N1 bind mostly to versions of the glycoproteins known as α2-6, the researchers found that the new pandemic H1N1 can also bind to a version called α2-3, which is found in greater proportion in the lower respiratory tract.
2. In patients who have died, co-infection was common with H1N1. Zaki’s group observed infection with bacteria such as Staph aureus or Streptococcus pneumoniae in about a third of the fatal swine-flu cases. However, in the remaining two thirds of fatal cases, the virus was lethal alone. The damage seen in the lungs is characterized as ‘diffuse alveolar damage,’ reflecting a very difficult to treat state of respiratory distress syndrome. According to Zaki’s research, about 90% of the fatal cases had some underlying medical condition.
Zaki expects the number of flu cases to increase as the flu season “ramps up.”
How does H1N1 spread?
Brendan Maher visited Peter Palese’s laboratory at Mount Sinai School of Medicine where testing for how the viruses spread is being carried out. Researchers John Steel and Anice Lowen compared the transmissibility of H1N1 to that of seasonal flu using a guinea pig model. Their data indicate that the H1N1 virus transmits as efficiently as seasonal flu viruses, which is consistent with real-world data showing…
by ilene - October 29th, 2009 3:06 pm
Vaccines: where does science end and profit motive begin? Maia Szalavitz argues, and I agree, that these are scientific questions and we need to conduct scientific research – not rely on preconceived views—to answer the questions. – Ilene
Just in time for the national roll-out of the new H1N1 flu vaccine, Wired Magazine and the Atlantic have weighed in on the ongoing vaccine war: Wired has a profile of Paul Offit, a vaccine researcher and pediatrician who has consistently spoken out in favor of vaccination and pointed to the lack of evidence linking vaccines and autism; the Atlantic checks in with a piece questioning the science suggesting that flu vaccines and antiviral drugs prevent people from dying.
Both articles have elicited heated debate all over the Web: Amy Wallace, who wrote Wired’s piece, excerpted below, has received vitriolic criticism and attacks from vaccine opponents, setting records for page views.
Describing death threats and attacks on Offit, Wallace writes:
So what has this award-winning 58-year-old scientist done to elicit such venom? He boldly states — in speeches, in journal articles, and in his 2008 book Autism’s False Prophets — that vaccines do not cause autism or autoimmune disease or any of the other chronic conditions that have been blamed on them. He supports this assertion with meticulous evidence. And he calls to account those who promote bogus treatments for autism — treatments that he says not only don’t work but often cause harm.
While the Wired article has been attacked by advocates, the Atlantic’s article has been slammed by several blogs written by scientists. The authors, Shannon Brownlee and Jeanne Lenzer, reply to their critics here (scroll down). The scientists take issue with their argument that the scientific evidence does not support the use of the flu vaccine and antiviral medications like Tamiflu, detailed below
Brownlee and Lenzer ask:
… what if everything we think we know about fighting influenza is wrong? What if flu vaccines do not protect people from dying—particularly the elderly, who account for 90 percent of deaths from seasonal flu? And what if the expensive antiviral drugs that the government has stockpiled over the past few years also have little, if any, power to reduce
by ilene - October 27th, 2009 8:14 pm
I found this at Barry Ritholtz’s The Big Picture’s "H1N1 (swine flu) Fatality Rates: Overreaction?" and had a few comments:
1. The chart compares death rates in persons infected (or known to be infected) with various pathogens. The total numbers of people who are or will be infected with these diseases are different. For example, in the U.S., the percentage of people infected with HIV is much smaller than the percentage of people who contract the flu each year; i.e., the chart shows the death rate per infected person, not death rate per person in the population.
2. The death rate reflects virulence, but is not a measure of transmissibility – or contagiousness.
3. The course of the swine flu hasn’t played out yet, so we don’t know what’s in store. Hence, to answer the question, "overreaction?" – perhaps "we’ll see" is the best answer. – Ilene
by ilene - October 24th, 2009 3:07 pm
President Barack Obama declared the swine flu outbreak a national emergency and empowered his health secretary to suspend federal requirements and speed treatment for thousands of infected people.
The declaration that Obama signed late Friday authorized Health and Human Services Secretary Kathleen Sebelius to bypass federal rules so health officials can respond more quickly to the outbreak, which has killed more than 1,000 people in the United States. (See how the H1N1 virus works.)
The goal is to remove bureaucratic roadblocks and make it easier for sick people to seek treatment and medical providers to provide it immediately. That could mean fewer hurdles involving Medicare, Medicaid or health privacy regulations.
"As a nation, we have prepared at all levels of government, and as individuals and communities, taking unprecedented steps to counter the emerging pandemic," Obama wrote in the declaration, which the White House announced Saturday.
He said the pandemic keeps evolving, the rates of illness are rising rapidly in many areas and there’s a potential "to overburden health care resources."
Because of vaccine production delays, the government has backed off initial, optimistic estimates that as many as 120 million doses would be available by mid-October. As of Wednesday, only 11 million doses had been shipped to health departments, doctor's offices and other providers, according to the Centers for Disease Control and Prevention officials said.
The government now hopes to have about 50 million doses of swine flu vaccine out by mid-November and 150 million in December.
The flu virus has to be grown in chicken eggs, and the yield hasn’t been as high as was initially hoped, officials explained.
Swine flu is more widespread now than it’s ever been. Health authorities say almost 100 children have died from the flu, known as H1N1, and 46 states now have widespread flu activity.
Worldwide, more than 5,000 people have reportedly died from swine flu since it emerged this year and developed into a global epidemic, the World Health Organization said Friday. Since most countries have stopped counting individual swine flu cases, the figure is considered an underestimate.
by phil - September 21st, 2009 8:29 am
Just when you thought it was safe to invest in Asia!
Today’s shocker came out of a World Health Organization meeting yesterday where officials estimate 20% to 30% of Asia’s population - or between 448 million and 672 million people will be infected by
swine flu H1N1 this season. Hong Kong had their 15th death this weekend and eight more people are in critical condition. 492 new cases were confirmed over the weekend, bringing the official count in Hong Kong alone up to 22,054 infections. According to the WHO: "China may not be in a situation of what we call extensive local transmission, which Hong Kong is in now." Once it does happen, we can see a lot of severe cases."
It’s ironic that the G20s efforts to put lipstick on this pig of a global economy may all be derailed by a pig’s disease. Despite skipping testing and relaxing safety regulations (which will, of course lead to other problems) in order to get tens of millions of doses of vaccines out for mass-inoculation programs, the WHO estimates that China, at best, will be able to inoculate just 5% of the population (65M people). We went through our last major swine flu scare last April and, here at PSW, we turned it into a half-dozen very successful picks – so let’s look at a few more who should do well in this next round of the crisis:
- SVA is the primary vaccine maker in China and you can buy that stock for $8.88 and sell the Jan $7.50 puts and calls for $4.50, which is net $4.38 with a call away at $7.50 (up 71%) if they hold that level through Jan 15th and the break-even to the downside (where you would be assigned the puts) is $5.94, 33% lower than today’s price. I’m not one to jump on disaster plays usually but this one has pretty good odds.
- BCRX has Perimavir in late-stage trials and the FDA is considering a "pre-emergency use authorization review," of the drug, which would be great for BCRX if it goes through and bad if it doesn’t. As BCRX is already up a lot, the way I would play this one is buying the 2011 $10 calls for $4.10 and selling the 2011 $12.50 calls for $3.60, which is a net .50 entry with a 500% return if BCRX hits $12.50 in 15 months (now $10) and it shouldn’t cause too
by ilene - August 25th, 2009 2:22 pm
A new headline-grabbing report from the White House claims that swine flu could plausibly infect up to 50% of Americans, causing flu symptoms among some 60 to 120 million of them, and leading to as many as 1.8 million hospitalizations and 30,000 -90,000 deaths.
Where, exactly, do numbers like these come from? The new report was put together by the President’s Council of Advisors on Science and Technology. It turns out the predictions are based on just a couple key facts:
- The virus seems to be transmitted from person to person at the same rate as in previous flu pandemics — a rate that’s much higher than that of the regular seasonal flu. Rapid transmission suggests that the total number of infections could be very high.
- The death rate for people who catch H1N1 seems about the same as that for seasonal flu. The White House advisors estimate that, so far, between 1 in 1,000 and 3 in 1,000 people who have needed medical help then end up dying. Assuming that this normal death rate continues during flu season, the total number of deaths is projected to be much higher than normal because of the higher number of infections.
And that’s basically it. The Council’s report notes prominently and often that, even though the up-to-50%-infected scenario is plausible, it is by no means certain. That’s because both of the basic facts above — the infection rate and the case fatality rate — are still a little fuzzy. They’re hard to measure in the first place, and it’s not totally clear whether they’ll change as the pandemic progresses.
So why all the fuss if the estimates are still murky? As Homeland Security head Janet Napolitano put it yesterday in a statement: "It is not possible to predict how the 2009-H1N1 influenza virus or the upcoming influenza season will play out, but it is best that we plan and prepare for a resurgence of H1N1 flu." Things may not develop the way the White House advisors suggest, in other words, but given available evidence it’s still a fine idea to brace ourselves.
by ilene - June 11th, 2009 2:04 pm
Swine Flu is now widespread enough to be called a pandemic.
From the WSJ:
The World Health Organization declared an H1N1 flu pandemic Thursday — the first global flu epidemic in 41 years — as infections in the United States, Europe, Australia, South America and elsewhere climbed to nearly 30,000 cases.
The long-awaited pandemic announcement is scientific confirmation that a new flu virus has emerged and is quickly circling the globe. WHO will now ask drugmakers to speed up production of an H1N1 flu vaccine. The declaration will also prompt governments to devote more money toward efforts to contain the virus.
WHO chief Dr. Margaret Chan made the announcement Thursday after the U.N. agency held an emergency meeting with flu experts. Dr. Chan said she was moving the world to phase 6 — the agency’s highest alert level — which means a pandemic, or global epidemic, is under way.
“The world is moving into the early days of its first influenza pandemic in the 21st century,” Dr. Chan told reporters. “The (H1N1 flu) virus is now unstoppable.”
On Thursday, WHO said 74 countries had reported 28,774 cases of H1N1 flu, including 144 deaths. Chan described the virus as “moderate.” According to WHO’s pandemic criteria, a global outbreak has begun when a new flu virus begins spreading in two world regions.
The agency has stressed that most cases are mild and require no treatment, but the fear is that a rash of new infections could overwhelm hospitals and health authorities — especially in poorer countries.
Still, about half of the people who have died from H1N1 flu were previously young and healthy — people who are not usually susceptible to flu. H1N1 flu is also crowding out regular flu viruses. Both features are typical of pandemic flu viruses.
If you’re like me you probably thought this was over and done with. We’ll have to see how this plays out but it probably will take a bite out of economic recovery.
And by the way, start washing your hands again.