Medicine and microbes are engaged in a constant arms race. We develop a new treatment they counter with a mutation that defeats the treatment. The war never seems to end. Whether at some distant date, human ingenuity will triumph over blind dumb natural selection is problematic. Of course we may lose.

The latest outbreak is a new variant of swine flu (A H1N1) which combines elements of swine virus with those from human and avian viruses. Strictly speaking a virus is not a living organism; rather it’s a piece of genetic material that closely resembles computer code. It gains entry to a cell and alters the workings of that cell such that the cell makes more copies of the virus which in turn spreads and may harm or kill other cells.

The current flu infestation seems to have started in Mexico but is now showing up in the US. I’m not aware of any American fatalities thus far, but a number of Mexicans have succumbed to the disease. Worrisome is that prior contact with pigs does not seem to have occurred in some of these cases. Person to person spread seems the vector.

What can we do to prevent spread of the disease? In all honesty, not much. What’s recommended is not coughing in other people’s faces, hand washing, and staying home when you seem to have the flu. This will give people a certain sense of control and purpose but is unlikely to have any real effect on a flu epidemic or pandemic. I was walking through a teaching hospital a few years ago with one of the country’s best infectious disease specialists and we both observed one of the myriad signs in all hospitals urging doctors and nurses to wash their hands. He smiled, shrugged his shoulders, and said, “We live in an ocean of microbes.” Regardless, the current recommendations can’t hurt so you might as well follow them. Also, sneezing or coughing in someone’s face is never a good idea.

What will be dispositive is the virulence of the virus, the ease with which it spreads, whether the current flu vaccination given to millions of Americans has any preventative effect on this strain of virus, and the effect of treatment.

There are flu outbreaks every year and many people die from the disease. Typically they are the very young, the very old, and the already sick. Some of the deaths in Mexico have been in young apparently healthy people. This is what has alarmed many. The fear is a recurrence of the disastrous flu pandemic of 1918 which killed millions of people, many of them young and previously healthy. I suspect such a pandemic will not happen again, but this is just an educated guess. Most of the deaths in the 1918 pandemic were likely due to secondary infection; ie a bacterial infection superimposed on the viral infection. Antibiotic treatment was not available in 1918.

Also not available were antiviral drugs. Zanamivir and oseltamivir, based on very preliminary data, seem to work against this strain of the disease. To be effective they must be given early. Whether such treatment will be needed for this outbreak is not clear at present, also murky is the availability of these drugs should it be necessary to give them to millions of patients.

It’s too early to panic and go crazy over this disease. It probably wont be a great problem, but should it turn out to be more serious than I think I’ll alert you. Then panic and go crazy; doing so at the right time has a cathartic effect.

Here’s an informative podcast about the new flu from the CDC.

Addendum: Despite all warnings to the contrary it seems the world is determined to lose its collective head about the swine flu outbreak. To put this epidemic in perspective the CDC guesses that about 36,000 Americans die from the flu or its complications every flu season. Nobody much cares because it happens every year just like the 40,000 deaths from auto accidents that are also an annual event. If the swine flu causes 360 deaths, 1% of deaths from the closely related seasonal flu, there will be riot in the streets, on Capital Hill, and on Wall Street. Brace yourself for a period of madness similar to the Dancing Mania of the 14th century. Who’s to blame? The press of course can’t get enough of an epidemic and are too lazy or ill-informed to put this disease in perspective. Besides sobriety never sells.

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