06 May 2009

Another swine flu: myths and realities

Alexey Yakovlev aka Russian doctor in the tropics

Here I returned to civilization and immediately plunged into another panic. This time it's swine flu.

I wonder why "pork"? In general, all known pandemics and epidemics of influenza, where the appearance of new reassortants of viruses transmitted from person to person was observed, originated from pigs. They're all pork! This is not news at all. We've been sick and we'll be sick, there's nothing we can do about it. But no one needs a vain panic, except perhaps for pharmaceutical companies, whose incomes have skyrocketed over the past week.

The first rule of journalism: not to argue with readers' prejudices, but to rely on them.
Alexander Cowburn. The first scientifically described, so to speak, pandemic of influenza A H1N1, the infamous Spaniard, claimed the lives of 40-50 million people in 1918-19.

The last major outbreak of H1N1 influenza, which also spread to humans from pigs, was recorded in New Jersey, USA in 1976. Localized outbreaks were recorded later.

The other 2 major influenza pandemics of the last century, the Asian H2N2 flu in 1957-58 and the Hong Kong H3N2 flu in 1968-69, claimed the lives of 2 and 1 million people, respectively. With each pandemic, there are fewer victims, which is explained by the development of modern medicine, i.e. more advanced drugs for the treatment of symptoms and complications of infection. So there is no need to wait for the apocalypse from this next flu, although there will certainly be victims, especially among weakened children and the elderly.

The good news is as follows:1) unlike the radically alien H5N1 avian flu, which has never learned to be transmitted from person to person, but was very virulent (a large percentage of the sick died – more than 50%), the current swine flu, although it is a new reassortant with new antigenic properties, is much less pathogenic, and the vast majority people recover on their own.

2) it seems that at the stages of human-to-human transmission, the virus is rapidly weakening, i.e. its pathogenic properties are decreasing (so, outside the primary focus in Mexico, only one 23-month-old child in Houston died, brought shortly from the same Mexico, as of 05/04/09); apparently, the virus will degenerate very soon in a normal human flu with a standard lethality.
3) today we have good drugs for the treatment of flu symptoms and complications, which the victims of the Spanish flu did not have.

Bad news: 1) the antigenic properties of the new swine flu and circulating H1N1 in humans are too different, and therefore last season's vaccine containing the H1N1 strain is not particularly effective here.

2) according to the most optimistic forecasts, the new vaccine will appear only in six months, but it will actually become available to Russian consumers only in November.
3) having reassorted into a pig, the new hybrid has learned to be transmitted from person to person, and therefore a mass epidemic (or even a pandemic) cannot be avoided.

A few myths:1) A favorite Russian myth from Onishchenko: It is necessary to ban all pork supplies from America and this will help something.

  • – It's funny even to comment. It's kind of hard to imagine that I'm going to start gnawing on a piglet that has just died from the flu. In short, you can't get the flu through pork. Especially cautious can avoid eating raw pork (with heat treatment above 70C, the virus dies instantly).
  • 2) Drink vitamins together, increase immunity.
    – Of course, it is important to eat fully, but vitamin supplements in food will not help to overcome the flu in any way. The diet should contain enough protein, which is much more important for immunity.
  • 3) Wearing a mask or cotton gauze bandage will protect me from the flu.
    – Nonsense. More or less protects the N95 type mask, but personally I can't stand it for more than 15 minutes. However, if you are sick yourself, sneeze profusely and cough, it is advisable to wear a mask in order to spray your mucus on others less. At worst, sneeze into a handkerchief (link)
  • 4) A popular myth from the special services and the bad Ministry of Health: Quarantine will save everyone!
    – Well, it is absolutely impossible to localize a respiratory viral infection with quarantine! Even the Spaniard instantly covered the whole world, but then people did not travel so actively, and there was no such killer population density! What's the point of catching and isolating patients coming off the plane if they have already infected all the passengers? It's just that the rest of the flu will develop (from mild to fatal) after the incubation period.
    Moreover, fans of putting everyone under lock and key forget that a flu patient becomes contagious already a day before the appearance of the described symptoms.
  • 5) A favorite myth from the sadistic special services of underdeveloped countries: Cut out all the pigs – stop the epidemic!
    – this flu is transmitted not from pigs, but from people. More precisely, there was such a first person in whom the final reassortant took root, but then the epidemic is already on people.

For advanced readers – a little theory Fig. The emergence of new pandemic reassortants from birds through pigs to humans.

As already mentioned, all global flus came to humans from pigs.

Initially, the flu is an avian infection. There are 15 variants of hemagglutinin (H1-15) and 9 variants of neuraminidase (N1-9) that regularly circulate in birds. Various combinations of these antigens create various subtypes of influenza A viruses. In humans, mainly combinations of H1-3 and N1-2 circulate. Pandemics with a large number of victims happen when new hybrids of bird subtypes with human ones appear. As a rule, it does not work out directly to hybridize in this way, and pigs become an intermediate link here. Pigs get sick with their pig subtypes H1,3 and N1-2, and people get sick with them very rarely (except for immunodeficient farmers). But on the other hand, pigs serve as an excellent testing ground for hybridization of human and avian influenza with their own. We are now faced with another such hybrid.

Fig. Natural flu hosts by antigen subtypesSymptoms of swine flu:

The same as for any other flu:
– the temperature jumps sharply to 39C and above
– throat turns red
– the eyes turn red, it is difficult to look at direct light, the head is cracking
– aching joints and muscles, sometimes upset intestines
– a dry cough may appear the next day
– on the third day, the temperature drops to subfebrile (37 with a little)
– on the 7th-10th day, a person recovers (if nothing is complicated).

Incubation period:

In 95% – 2-4 days, up to a maximum of 1 week. If you are not sick a week after the contact, you can sleep peacefully.

How to be treated: There is only one group of drugs effective against swine flu – these are neuraminidase inhibitors of the 2nd (zanamivir= Relenza) and 3rd (oseltamivir =

Tamiflu) generations. They inhibit the same N in viruses. Resistant strains will inevitably appear, but so far the drugs help quite well, especially if they are prescribed to contact people before the first symptoms appear or in the first hours of the disease (link)

All advertised bullshit like the leader of domestic sales of ocilococcinum, arbidol, intranasal interferon, cycloferon and everything else is absolutely useless. Rimantadine, unfortunately, also does not help anymore.

During flu epidemics, in no case should you knock down the fever with aspirin! Firstly, there is an increased threat of hemorrhagic complications, and secondly, potentially fatal reactions in children in the form of Ray's syndrome are possible. We bring down the temperature only with paracetamol (Panadol, Tylenol) or ibuprofen.

We drink more liquid (lemons, rosehip decoctions, honey and other popular remedies do not play any special role here, we just need H 2 O).

If the flu is severe (shortness of breath, hemoptysis, convulsions, etc.), call an ambulance (03 or 112 from your mobile). The Russian ambulance in each city is instructed where to take a patient with suspected swine flu. In Moscow, this is the 1st Infectious Diseases Hospital.

Prevention: Wash your hands before eating.

  • After touching common objects, do not put your fingers in your mouth and nose before washing them with hot water and soap.
  • Cancel trips to Mexico, to places where the focus of the most malicious strain persists. Travel to other countries as planned.
  • If you missed it in the fall, get vaccinated now with the current season's vaccine. I don't know how much it will help against the "swine" flu, but it will certainly reduce the chances of getting sick with an ordinary "human" and ending up in quarantine somewhere in a foreign land.
  • If you get the flu, for God's sake don't rush to the hospital and even more so to work!!! Instead, stay at home for 7 days. Don't put already weakened people at risk.

Dear friends! There is absolutely no reason to panic here. Another flu epidemic is developing on the planet. That's why the planet won't stop rotating :)

Portal "Eternal youth" www.vechnayamolodost.ru06.05.2009

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