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Miscellaneous thoughts and ramblings
Monday, October 17, 2005
How scary is the avian flu?
I get frequent emails from Mother Nomad regarding various viruses and bacteria that are out there ready to destroy mankind. I even posted an early article on the bird flu last Feburary here. Before the bird flu, Mother Nomad would send me SARS stories and so on.

While I do find these stories unsettling, I've been reluctant to get carried away with the fear. My thinking is that, maybe things are just different enough today to make another 1918 flu pandemic an entirely different event. Things I ponder include:

--how many of the deaths in 1918 were directly due to the flu, and how many were due to secondary bacterial infections? If bacterial infections played a prominent role in the mortality, then the discovery of antibiotics will greatly mitigate this aspect in a future outbreak.

--how has medical protocol changed since 1918 that might also have a positive impact. I remember reading somewhere that cholera used to be a terrible threat in much of the Third World, because medical treatment didn't focus on simple hydration therapy to combat it. Millions died of dehydration, brought on by cholera, when providing simple fluids would have saved many of them. Are there corresponding changes in the treatment of common viruses that will have similar mitigating effects?

--what role, if any, will over-the-counter anti-inflammatories and anti-fever drugs play in reducing mortality. Do the effects of these drugs help to mitigate the effects of the illness beyond merely reducing the tangible symptoms?

--will better standards of living, improved sanitation, and better general health in the population mean a higher survival rate?

-- will a better understanding of infectious diseases, and corresponding steps by medical professionals to reduce spread in places like hospitals help to stifle an outbreak, once it starts?

Viruses are scary. They can and do kill. But, I'm skeptical about whether human beings (at least in the West) are as vulnerable as we were 90 years ago.

This bit on Instapundit is what made me want to put my thoughts down:



As a medical researcher, I want to make a gentle but sincere plea to the blogosphere to calm down this flu hysteria just a bit. The main way that flu kills is by predisposing its victims to "superinfection" by bacterial illnesses - in 1918, we had no antibiotics for these superimposed infections, but now we have plenty. Such superinfections, and the transmittal of flu itself, were aided tremendously by the crowded conditions and poor sanitation of the early 20th century - these are currently vastly improved as well. Flu hits the elderly the hardest, but the "elderly" today are healthier, stronger, and better nourished than ever before. Our medical infrastructure is vastly better off, ranging from simple things like oxygen and sterile i.v. fluids, not readily available in 1918, to complex technologies such as respirators and dialysis. Should we be concerned? Sure, better safe than sorry, and concerns about publishing the sequence are worth discussing. Should we panic? No - my apologies to the fearmongers, but we will never see another 1918.

Patrick Cunningham M.D.
Assistant Professor of Medicine
Section of Nephrology
University of Chicago
Pity we can't get it to mutate into 'liberal flu" that affects only the left. Maybe something that is easily removed by bathing.
That's not nice.
People are freaking out unnecessarily. I'm getting calls every day now for Tamiflu, just like I got calls a few years ago for Cipro during the Anthrax scare. I'm saying "no" and patiently trying to explain that there won't be a shortage and that if they get the flu or are exposed to the flu, I'm available 24/7 and will be happy to prescribe it to them. But to prescribe it to everyone ahead of time will (1) cause the shortages that these patients are worried about (2) cause the vast majority of the medicine to be wasted and (3) will have many of the patients take it for wrong indications, like if they get a cold.

Everybody take a big breath in. Let it out. Ahhhhhhh. That's better. Be calm. Everythings going to be OK.
According to predicted trajectory, it's supposed to hit the Middle East, rather than the United States, next.
Speaking of the avian flu hitting the Middle East, can Dr. Bean send me 60 tablets?
Western Word: Good to see you. You don't really want Tamiflu. You want some beef sausages from Jeff's. That probably protects from the flu also.
That's an interesting quote from Dr. Cunningham. I agree we will not see another 1918 for the reasons he outlined. But those of us who have seen people sick with "just" influenza pneumonitis who are not apparently superinfected by bacterial illnesses will tell you that it can still be very ugly. I've had patients ask me for Tamiflu too, and I usually just tell them it isn't being recommended by the Centers for Disease Controls and refer them to the website (www.cdc.gov).

The interesting thing is that Tamiflu and the other drug, Relenza, have never been proven to treat (or prevent) avian influenza and their efficacy at this point is primarily theoretical. I agree with Bean.
I too also agree with Bean. I'll tell you when it's time to panic.
Maybe you should just be dispensing Xanax to deal with all the anxiety?
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