HUMANUNDERGROUND ALERT STATUS RED
CDC Confirmed U.S. Human Cases of H1N1 Flu Infection, PHAC Confirmed Canadian Human Cases of H1N1 Flu Infection, World Health Organization situation updates, FluTracker map tracking H1N1, GenBank sequences from 2009 H1N1 influenza outbreak, pandemicflu.gov, ready.gov, FightFlu.ca
This is a Center for Disease Control file photograph of the H1N1 (swine) virus 2009. Data suggests the human version of the virus A(H1N1) is a genetic combo containing a human subtype, an avian subtype, and at least two swine subtypes, including North American and Eurasian swine subtypes. Hispanic populations seem to be more strongly affected by infection. Research suggests lives may be saved by the proper identification and treatment of the cytokine storm response (hypercytokinemia) associated with infection.
"All countries should immediately now activate their pandemic preparedness plans." Dr. Margaret Chan W.H.O.
"All theories of containment are moot at this time ... We are acting as if things were at PHASE 6" Janet Napolitano D.H.S.
Los Alamos National Laboratory
DHS Sets Guidelines For Possible Swine Flu Quarantines
The U.S. Department of Homeland Security has sent a memo to some health care providers noting procedures to be followed if the swine flu outbreak eventually makes quarantines necessary.
DHS Assistant Secretary Bridger McGaw circulated the swine flu memo, which was obtained by CBSNews.com, on Monday night. It says: "The Department of Justice has established legal federal authorities pertaining to the implementation of a quarantine and enforcement. Under approval from HHS, the Surgeon General has the authority to issue quarantines."
McGaw appears to have been referring to the section of federal law that allows the Surgeon General to detain and quarantine Americans "reasonably believed to be infected" with a communicable disease. A Centers for Disease Control official said on Tuesday that swine flu deaths in the U.S. are likely.
Federal quarantine authority is limited to diseases listed in presidential executive orders; President Bush added "novel" forms of influenza with the potential to create pandemics in Executive Order 13375. Anyone violating a quarantine order can be punished by a $250,000 fine and a one-year prison term.
...
McGaw's memo on Monday also said that the federal plan to respond to pandemic influenza was "in effect."
The Bush administration released the National Strategy For Pandemic Influenza in November 2005; it envisioned closer coordination among federal agencies, the stockpiling and distribution of vaccines and anti-viral drugs, and, if necessary, government-imposed "quarantines" and "limitations on gatherings."
A Defense Department planning document summarizing the military's contingency plan says the Pentagon is prepared to assist in "quarantining groups of people in order to minimize the spread of disease during an influenza pandemic" and aiding in "efforts to restore and maintain order."
CDC urges personal preparations
Health officials are concerned about a new influenza virus of swine origin that’s spreading from person to person. Officials are acting to combat this threat, but the outbreak might grow. So be prepared.
Store a two-week supply of food and water. Have two weeks of your regular prescription drugs at home. Keep health supplies on hand, including pain relievers and cold medicines.
For more details, visit www.cdc.gov/swineflu or call 1-800-CDC-INFO.
A message from HHS.
Australian plan urges personal preparations
Plan says to stockpile but officials say don't panic
Kate Benson Medical Reporter
May 1, 2009
AUSTRALIANS have been advised to stockpile food and water after the World Health Organisation raised its swine flu alert to phase five yesterday, indicating an imminent pandemic.
The Federal Government's pandemic plan, a 132-page manual issued to medics, media and the public, insists that once the world reaches phase five, Australians should stock their pantries with food and bottled water to last 14 days, check on elderly neighbours and put emergency numbers by the phone.
But yesterday a spokesman for the Department of Health and Ageing called for calm, saying the Government did not want to spark panic buying - ignoring its own plan, already issued to hospitals across the nation.
"I agree that is it confusing," the spokesman said, admitting he had not read the pandemic plan despite being employed to answer questions about it from national media. "The manual may say people should be preparing but we don't want a run at the shops," he said.
Subject: Flu Update from Dr. Gitterle
After I returned from a public health meeting yesterday with community leaders and school officials in Comal County, Heather suggested I send an update to everyone, because what we are hearing privately from the CDC and Health Department is so different from what you are hearing in the media. Some of you know some or maybe all of this, but I will just list what facts I know.
- The virus is infectious for about 2 days prior to symptom onset
- Virus sheds more than 7 days after symptom onset (possibly as long as 9 days) (this is unusual)
- Since it is such a novel (new) virus, there is no "herd immunity," so the "attack rate" is very high. This is the percentage of people who come down with a virus if exposed. Almost everyone who is exposed to this virus will become infected, though not all will be symptomatc. That is much higher than seasonal flu, which averages 10-15%. The "clinical attack rate" may be around 40-50%. This is the number of people who show symptoms. This is a huge number. It is hard to convey the seriousness of this.
- The virulence (deadliness) of this virus is as bad here as in Mexico, and there are folks on ventilators here in the US, right now. This has not been in the media, but a 23 month old near here is fighting for his life, and a pregnant woman just south of San Antonio is fighting for her life. In Mexico, these folks might have died already, but here in the US, folks are getting Tamiflu or Relenza quickly, and we have ready access to ventilators. What this means is that within a couple of weeks, regional hospitals will likely become overwhelmed.
- Some of the kids with positive cases in Comal County had more than 70 contacts before diagnosis.
- There are 10-25 times more actual cases (not "possible" cases -- actual), than what is being reported in the media. The way they fudge on reporting this is that it takes 3 days to get the confirmatory nod from the CDC on a given viral culture, but based on epidemiological grounds, we know that there are more than 10 cases for each "confirmed" case right now.
- During the night, we crossed the threshold for the definition of a WHO, Phase 6 global pandemic. This has not happened in any of our lifetimes so far. We are in uncharted territory.
- I expect President Obama will declare an emergency sometime in the next 72-96 hours. This may not happen, but if it doesn't, I will be surprised. When this happens, all public gathering will be cancelled for 10 days.
- I suggest all of us avoid public gatherings. Outdoor activities are not as likely to lead to infection. It is contained areas and close contact that are the biggest risk.
- Tamiflu is running out. There is a national stockpile, but it will have to be carefully managed, as it is not enough to treat the likely number of infections when this is full-blown. I don't think there is a big supply of Relenza, but I do not know those numbers. If I had to choose, I would take Relenza, as I think it gets more drug to the affected tissue than Tamiflu.
- You should avoid going to the ER if you think you have been exposed or are symptomatic. ER's south of here are becoming overwhelmed -- and I mean that -- already. It is coming in waves, but the waves are getting bigger.
- It appears that this flu produces a distinctive "hoarseness" in many victims. The symptoms, in general, match other flu's; namely, sore throat, body aches, headache, cough, and fever. Some have all these symptoms, while others may have only one or two.
- N-Acetyl-Cysteine -- a nutritional supplement available at the health food store or Wimberley Pharmacy, has been shown to prevent or lessen the severity of influenza. I suggest 1200mg, twice a day for adults, and 600mg twice a day in kids over 12. It would be hard to get kids under 12 to take it, but you could try opening the capsules and putting it on yogurt. For 40 pounds and up, 300-600 mg twice a day, for less than 40 pounds, half that.
- Oscillococinum, a homeopathic remedy, has been vindicated as quite effective in a large clinical trial in Europe, with an H1N1 variant. You can buy this at Hill Country Natural Foods, or the Wimberley Pharmacy.
I will try to keep everyone posted if I have any new information. Meanwhile, don't be afraid just avoid infection. The fewer people infected the easier it will be for our public officials to manage it.
Marc Gitterle, M.D.
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