June 2, 2009: First two official deaths in
California due to H1N1 documented, one in San Bernardino County and the other Los Angeles County.
Updates as of April, 2009:
The media is full of reports of the H1N1 International outbreak (popularly
referred to as "swine" flu). Below the ******* is a background piece on pandemic flu that we posted several years ago,
but which will give the reader a good, but simple, primer on the subject. Later, toward the end of this specific page,
we will provide some additional links, including the link to the definitions of the Pandemic Alert Phases for the World Health
Organization.
Please continue to read important background information, below the *******,
with the understanding that the current H1N1 virus is composed of one part avian, two parts swine, and one part human virus
strains. The avian strain H5N1 had already jumped independently into both swine and humans.
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Pre-existing post published for several years, formerly under
the title "avian flu":
Okay, you might be in for a surprise. Avian (bird) flu is not the
real topic of this page, although you will find information on the avian flu here as well. But you will also find information
here on pandemic flu, which is different than avian flu.
Avian flu came to be in the news at one point because of the concern
by the World Health Organization that it could become the source of the next pandemic outbreak. However, avian flu may
or may not end up being the actual source of a pandemic, even though a pandemic from some source is more or less inevitable.
Please try to keep the distinctions between avian flu (which affects primarily birds), and pandemic flu (from a yet unknown
virus strain, but centered in humans) in mind as you read the text below.
Although there have been very few people infected with avian flu in the
world as 2007, there has been almost a 50% lethality rate among those unfortunate enough to become infected.
So far, the majority of cases have orginated from direct contact with
infected birds. In many of the countries where there have been incidents, people live in very close contact with birds
much of the time, as they may be raising them for food or money.
The spread of the virus in birds has been rapid and the particular strain
of concern (H5N1) has been detected in countries in Europe and other locations outside of the Asian countries where it first
appeared. The USGS is already monitoring migratory bird patterns in Alaska, especially the Long-billed Dowitchers, and
Pectoral Sandpipers, who are most likely to have crossed paths with infected birds in Asia and Russia. Fortunately,
as of September, 2007, the virus has not spread through the migratory routes from Asia as expected. However, in the
meantime, infected birds have basically made it to the North American continent via the Atlantic route, having been indentified
on Prince Edward Island in Canada.
Authorities are concerned that the virus could mutate into a form that
would be capable of spreading through human to human transmission. As humans have not been exposed to this strain before,
and therefore have no immunities, there is a potential, should the virus develop that capability, to cause an epidemic or
pandemic.
Also, authorities believe that whether or not the H5N1 is the ultimate
culprit, the world is simply moving closer and closer to the day when some yet unknown virus will be so fast and aggressive
that it jumps from some carrier or another into humans, and is able to further jump to a capacity to create widespread human-to-human
infection around the world. The "pan" in "pandemic" refers to the world-wide aspect of such an outbreak.
A pandemic, if it occurs, will most likely not occur just once, but come
in a series of waves of several weeks each, with a temporary subsidence of two to three months in between waves.
The incubation period is expected to be between one and three days, and
if the potential for human-to-human transmission becomes real, it would be possible to receive the virus and become ill, from
contact with someone who does not appear ill at all.
The primary route of spread is usually said to be expected to be the
large droplets generated from upper respiratory problems like sneezing and coughing, although the aerosol droplets could also
become a problem. In fact, two recent research studies (posted on the WHO website) strongly suggest it is actually the
aerosol droplets because they attach to human cells deeper in the respiratory system and not in the nose and mouth.
No one really knows for sure.
It is thought that the virus will probably be able to live on common
surfaces, such as doorknobs, phones etc. for up typically about six to eight hours, but also potentially up to 24 hours.
Careful hygiene and frequent and thorough hand washing will be critical to prevent spread of this and other contagious diseases
should something occur.
The state of California Department of Health Services Viral and Ricketssial
Disease Laboratory in Richmond has sophisticated testing ability beyond the norm for local health departments. They
have already tested almost three dozen influenza cases from people who have traveled to California recently, and became ill
within the typical incubation period, and after known exposure to infected birds in other countries. Thankfully, all
thus far have had other strains of flu, other than the H5N1 for which there is such concern.
The World Health Organization is currently at Phase 3 (of 6), small
clusters with limited human-to-human transmission. In other words, in addition to the avian flu jumping from birds
into other animal species, it has demonstrated an ability to mutate and infect humans without the necessity of direct contact
with infected birds. The most notable recent cluster was in Indonesia, where seven of eight family members died.
The pandemic alert phases are numbered differently between the WHO, the
US government, and local agencies. In other words, they use differing numbers to indicate the same essential situations,
such as "small clusters with limited human-to-human transmission". So be careful not to get too hung up on the numbers.
The point is that some virus will eventually come along that is very aggressive, and will demonstrate an ability to quickly
adapt and spread within the human population.
A disturbing point for most people is also that pandemics tend to affect
the healthiest people in the 20 - 40 year age group even more than those typically vulnerable, such as young children and
the elderly.
In Los Angeles County we are currently in a Stage Three in monitoring
the progress of the threat. When Los Angeles County goes to Stage Four, we would be expecting some form of some pandemic
outbreak to potentially surface within a time frame measured in weeks or, at best, months.
In the meantime, now is the best time to stock up on N95 masks, which are
for use by people who are NOT sick. (Surgical masks are for the ill.) However, keep in mind that during the
SARS epidemic, the entire country stocked out of N95 masks. As of May 2006 the US federal government was stockpiling
100 million units with 87.2 million on order through September 2007, for use by first responders and government officials.
Demand for the masks will also likely increase in the private sector. Not only is the federal buying process on schedule,
but they have upped their quanitites, AND (despite "official" advice from LA County Public Health officials) the FDA has just
approved at least one N95 brand specifically for uses in a pandemic outbreak. However, all agencies state that they
are not sure that N95's will provide appropriate protection.
In any outbreak, it is best to practice good hygiene and to avoid exposure
to others by limiting times you are in contact with others as the first line of defense. If you have to go out, practice
what is called "social distancing" by avoiding handshakes and staying at least six feet from others.
If you choose to use an N95 in an attempt at additional protection,
you will want to plan on changing an N95 mask at least every four hours when out in public, and to change to a fresh one if
the mask becomes damp. It will be important to adjust the mask for best fit, and to use special care when removing and
disposing of the masks as the surfaces will be saturated with germs.
N95 masks are important for many kinds of emergencies, not just
a pandemic, and we believe they are an essential part of every emergency kit. We
currently have both availability of the masks and reasonable, below market pricing. For more information
on the N95 masks, click on the underlined link directly below:
