by Dylan » Tue 26 Jul 2005, 22:39:58
CanadaSue
Clueless in Canada
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Join Date: Nov 2004
Location: North of the Maple Syrup Line
Posts: 4,608
The Idiots' Guide to Flu
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I'm not calling anyone an idiot or dummy - far from it. Comments on some threads today have made me realize though that for those of us warped enough to follow this stuff as a hobby & I've been doing that long before H5N1 became a serious concern; it's easy to slip into the 5 dollar words & forget that not everybody else follows this stuff with the passion most reserve for favourite sports. We can talk about my appalling typos, dangling participles & run on sentences later...
We're getting a lot of new members who head straight here. Many may come form other sites where they've had lots of chances to learn the ins & outs about flu & potential pandemic stuff. Many may simply have stumbled onto this site or been shoved here kicking & screaming by 'born again flubies'. These folks may be trying to figure out why many here seem so freaked out over something that after all, hits every year & that we have shots against. Here's what I hope is a quick & dirty Coles' Notes version of why the idea of pandemic flu makes some of us long for an opportunity to bury ourselves under very big rocks for a time.
Flu is a virus. There are three TYPES of flu - A, B & C. The type we're concerned about here is type A. That is divided into SUB-TYPES seen as something like this: H3N2. The H & N are structures on the surface of the virus. The H gets the virus into your cells & the N helps it get out. There are 16 H & 9 N for a total of 144 sub-types of flu. Luckily, most don't make people sick. Until recently, most of the ones that did started with either H1, H2 or H3. In the past decade we've seen H5, H7 & H9 start doing that. Over time flu viruses change so that they 'learn' to infect people. Okay, they don't think, so they don't learn but through mutation & changing their genes they pick up the ability to get into people.
H1, H2 & H3 sub-types have been infecting people for a long time. Most of the ones which can make us sick change a bit from year to year because flu viruses mutate quickly. Because they change quickly, even if you had a whomping case of an H3N2 flu last year, you might get one this year. The good news is - it usually doesn't change THAT much so you won't get as sick. Our immune systems are pretty good that way - they recognize the H well enough to be able to fight it to some degree.
H5 is a flu that up until pretty recently only infected birds. It simply couldn't get into humans The H - if you think of it as a key, couldn't get into & turn the lock into human cells. It might get into human bodies but couldn't do a darned thing. Now it seems it's figuring out how to do that. We know that over 1 hundred people in southeast Asia have become sick with H5N1 & many have died. Uuhhh - why? After all, millions of people get the OTHER H kinds of flu every year & why they often feel like utter crap for a week or more, most recover. When a new H 'jumps' into humans & becomes good at spreading from person to person, it's got a captive audience. Our bodies have never encountered this H, up to now we know very few of the 6.4 billion people on the planet have. Our immune systems have little or no defence. So... more of us get sick. Those who get sick get sicker. Their bodies get so exhausted, so worn down by fighting the flu, they're more likely to pick up OTHER illnesses on top of the flu - a real double whammy. Their bodies are too wiped out to fight it & that's especially true to the elderly, the very young & those who may already have medical conditions which tend to make them sick. People with cardiac problems, respiratory problems, diabetes & any other illness that requires careful attention on their part & a fair bit of monitoring by their health care practitioners are at a higher risk.
In 1918, H1 learned to infect humans. We don't know exactly how it happened or how the virus became able to do that. We have no patient samples from back then that preserved the virus so we don't have all it's genes to study. The important thing is - it did. The war was coming to an end & a lot of people were travelling. Soldiers were being shipped back & forth & refugees & other displaced civilians were also on the move. These folks were pretty stressed out. The war alone was stressful & many were exhausted & worn down by years of fear, moving around, not enough food or the right kinds... a perfect scenario for flu.
The pandemic became known as Spanish Flu because the first news of it came out of Spain although it didn't start there. It raced around the world in just a few months. Then did it again & was even more dangerous. It did it again a third time, not as lethal as the second time but worse that the first time or 'wave' as we call them.
It was 'weird' for a flu. Often it didn't LOOK like flu. We're still not sure why but maybe that's because it WAS new to humans. It sometimes looked immediately like pneumonia or a hemorrhagic fever. Sometimes it looked like cholera, dengue fever, meningitis or encephalitis. In some cases, it might have been those things in a sense. Maybe patients got sick with flu so fast & were exposed to the bugs that caused those other diseases right away & came down with cases of them right on top of their first flu symptoms.
It hit people really quickly. You might be fine at breakfast & literally be taken off your tram car to work an hour later on a stretcher. You might be dead by supper time. There are a lot of stories from all over the world that describe such situations & a lot of them are probably true. Autopsies of some of the dead showed incredible damage to the lungs, heart & other body organs. It must have been terrifying.
We've never known a pandemic, (world wide epidemic) of flu that bad & haven't had anything that awful since - not that fast or that severe. To be honest, we don't know that H5N1 - the bird flu that's now starting to make some people sick - will do that. We sure hope not. But it might. But we're living in 2005 - why can't we get on top of it & beat it before it hits - if it's going to hit?
Frankly, we don't know nearly as much about flu & how it makes us ill as we'd like. For all we know about the body & how it reacts to illness, there's loads more we can only really guess at. Yes we can make vaccine against flu but not enough, fast enough. It takes 6 months to make a vaccine right now & we have to know EXACTLY what subtype is causing the illness. There are only enough vaccine plants in the world right now to make, for a pandemic strain of flu - roughly a billion doses of vaccine - in a YEAR. Because this one is brand new in humans, we'll each need 2 doses spaced a few weeks apart. So in a year as it is now, only half a billion people will be able to get vaccinated against a pandemic strain.
We travel a lot faster & more often than people were able to do in 1918. And there are a lot more of us living in very crowded cities where flu will spread quickly. By the time we make & give half a billion vaccines, the flu might already have gone around the world a few times - those who didn't get sick during the first passing may very well get it on the 'second trip'. Either way, an awful lot of people will be sick at once & with this H5N1 flu, it seems as though it can take a very long time to recover to the point where you can get out of bed for more than a few hours.
Imagine a scene where maybe 1/4 of the people in your area are actually sick with flu. Many of those will be those who work. Who will replace them? Many of those not sick will be busy trying to look after those who are sick. And they may not have a lot of help. This bird flu seems to make people very, very sick - they need to be in hospital. The US has less than 1 million hospital beds & most of those are already filled with patients. Even if you cancelled all elective surgeries & discharged as many people as you could early, there won't be nearly enough hospital beds to take all those with flu who should be in them. And those that do get beds - well, there isn't going to be a lot we can do for them.
Viruses have no treatments. There are a few antivirals out there but they don't work the way antibiotics do & not as well. We might be able to make sure people get enough fluids through IVs & some will have respirators & ventilators to help them breathe. There's not much else we can offer. If they get sick with other diseases on top of flu & if those diseases are caused by bacteria, we can give them antibiotics & hope we have enough of those. It could be more will need them that we have available. Don't forget - people won't stop getting sick for other reasons just because a really nasty flu bug shows up!
It could be a real mess. With the possibility of a lot of people sick at once, not enough to look after them, perhaps no one to 'replace them' at home, nobody to fill in at work, life could get pretty strange. If truck drivers are sick, who's delivering groceries to your local grocery store? Who's putting them on the shelves, pricing them & who's working the cash? Who's ploughing roads in winter & making sure ATMs have money in them?
It gets tougher when you realize that the flu virus can pass easily from person to person. If someone with flu coughs near you as you're inhaling, that's can be all that's needed for you to get sick. Worse, a person can have the virus & not feel sick yet & STILL be breathing out enough virus to make those around him sick - the so called 'silent transmission' period. That makes it next to impossible to stop flu from spreading. After all, how can you make everybody go home & stay there? Do they have enough food or medicine for day to day needs? What if they're working in a crucial job? You can't stop life that easily & unfortunately that just makes it easier for the virus to spread.
We don't know this H5N1 is going to do any of this. Maybe by the time it 'learns' to easily make people sick it will be a much milder disease. But we don't know that. I wish we did. We have had 2 flu pandemics since 1918 & they weren't nearly as bad. Many more died of flu & it's complications than do most years, but not nearly the number who did in 1918-1919. I hope we'll be that lucky but there are no sure bets.
The countries which have human cases of bird flu are, for whatever reason, not sharing what they know about it with the west. So we don't know how bad it is 'out there'. The few human cases from which we have medical details are more than scary - they're terrifying. But... do they represent just SOME bird flu cases or might we end up with a LOT of patients that sick and many dying?
Most of us here choose to 'plan for the worst & hope for the best'. And we hope all this discussion will prove to not be needed.
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Keep on rocking in the flu world...
I like that but I beg to differ back, at first I wasn't sure I thought you may be right (And still might be) but it was always my understanding they had to have the flu strain to make a vaccination with, and without the actual strain being out yet (It would have to be a varient of H5N1 to be highly contagious person to person) the best we could do was give people a vaccine to prevent them from getting the version from the chickens... About worthless really.
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