02 September 2009

Swine flu: who is warned, is armed

Pig 's stepAlexey Yakovlev aka Russian doctor in the tropics

Dear friends,
for those of you who have not had time to get over the "swine" flu, I hasten to update the information. Since my April post, nothing fundamentally new has happened and all the assumptions made then have been justified.

So, at present, the H1N1-2009 influenza epidemic has been assigned a 6 (pandemic) threat level according to the WHO classification. The degree of threat does not characterize the danger of the disease to people's lives, but indicates its ability to spread. Thus, any flu transmitted from person to person can reach the sixth degree of threat.

Nevertheless, WHO concerns are related to the genetic novelty of the strain itself and its potential for further reassortment, as a result of which more aggressive variants of infection may occur. Then, by analogy with the most destructive pandemics of the last century, this virus will lead to serious human losses after a certain (usually six-month) period, accompanied by relatively moderate mortality.

Let me remind you how events developed in the last century:

Spaniard H1N1, 1918 (up to 50 million dead) – began in a mild form, and six months later resumed in a severe one that mowed down a lot of people.
Asian influenza H2N2, 1957 (2 million dead) – started in a mild form, and then resumed in a somewhat more severe form
Hong Kong H3N2 flu, 1968 (1 million deaths) – started in a relatively mild form, with the first wave preceded by individual cases of the disease; during the second wave, the pandemic remained mild in many, but not all countries.

The unpredictability of the behavior of any new strain, which is very different from others, causes concern. Most likely, it will pass, but the devil knows...

According to the latest WHO report on August 28, 2009:

• An analysis of the situation in various foci around the world has shown that the pandemic strain of the H1N1 virus has spread rapidly across the planet and is currently dominating the structure of the incidence of influenza.
Conclusion: Everyone dig in! As Academician Pokrovsky (head of the Research Institute of Epidemiology of the Russian Federation), WHO experts and even I have been saying from the very beginning, stupid quarantine measures such as travel restrictions, wearing masks, organizing screening cordons at airports are completely ineffective against influenza infections. Doubters here.

• The virus will spread in the following months until the entire susceptible population is fully covered.
Conclusion: We will all die. It is absolutely inevitable that everyone who is able to get sick will get sick. Fortunately, not everyone is capable. Some are generally immune to the flu, many people over 40 have already had similar strains in childhood and are partially immune to the new one, and the vast majority of susceptible individuals will suffer the flu in such a mild form that they will not notice.

• Current observations have shown that the new virus remains almost identical in all foci, so there are no signs of increased virulence or lethality of the virus yet. The symptoms in the vast majority of cases correspond to a mild form of influenza, the number of complications and deaths in predisposed individuals remains small;
Conclusion: So far, in terms of its consequences for our lives, this flu is no more dangerous than the usual seasonal flu that walks the planet every year. So it's better to get over it now, before winter destroys our immunity. Hurray! Everyone to Mexico for the infection :)!

• Since this virus differs significantly in antigenic properties from seasonal flus of recent decades, the disease proceeds with a large coverage of the young non-immune population in comparison with the usual seasonal flu outbreaks (the most severe cases were reported in people under 50 years old, whereas with seasonal flu, 90% of deaths occur in people over 65 years old).
Conclusion: A lot of children and able-bodied adults will be ill in winter. Employers need to prepare for such a plot, and children are expected to have a long vacation. Yes, give the old ladies raspberry jam and pepper patch already!

• Due to the fact that in the coming months there will be an increase in morbidity up to the coverage of the entire susceptible population in the world, the number of patients in need of drugs will grow, as will the total number of complications (pneumonia is a great danger).
Conclusion: Crowds are expected to be sick at the polyclinic, where you will be quickly infected, as you wanted. If people get sick more than usual, hospitals will be overcrowded, and medical staff (who also has the flu) will not be enough. I'm starting to eat tamiflu!

• Complicated forms of the disease occur, as a rule, in persons with predispositions: pregnant women, patients with chronic respiratory diseases (especially bronchial asthma), diabetes mellitus, cardiovascular diseases. AIDS patients on antiretroviral therapy develop complications no more often than healthy people.
Conclusion: Since almost exclusively people suffering from all kinds of crap die, it is necessary to treat them with special attention. As soon as the vaccine appears, it will have to be done. Chronicles should fully eat and carefully take treatment for their background diseases (hypertensive patients need to monitor blood pressure, diabetics for sugar, etc.). Sickly people, especially children, it would be good to be vaccinated against pneumonia and hemophilic bacillus.

• oseltamivir (Tamiflu) and zanamivir (Relenza) remain effective against the pandemic H1N1 strain, to which most variants of the strain are sensitive; WHO does not recommend any other antiviral drugs for the prevention and treatment of this flu.
Conclusion: In no case do we besiege pharmacies and do not buy any garbage to "increase immunity" and prevent flu, because there are simply no such means in nature. It is not necessary to support scammers, and there are enough of them both in their native fatherland and in Europe. Among all this fuflomycin, widely presented in the windows of any of our pharmacies, I would like to highlight the following baida:

• Homeopathic remedies (ocillococcinum, anaferon, aflubin, agri). I remind you that evidence-based medicine denies the effectiveness of homeopathic remedies (links here). Clinical trials of many of these drugs (e.g., ocillococcinum) have proven that their effect does not exceed placebo. In their recent appeal, WHO experts informed the world community about the dangers of using homeopathy in cases of life-threatening diseases.

• Domestic pseudo-medicines. I love my country and my people, and that is why I consider it my duty to inform you that all domestic drugs recommended for the treatment and prevention of influenza are a complete mess. I will list some by name: arbidol, cycloferon, amixin, kagocel, grippferon, karmolis. The list is endless, as is the endless thirst of scammers and officials to profit from the grief of people.

• Vitamin and herbal remedies. The virus doesn't give a damn about vitamins and botany. There is nothing wrong with these funds, but it is better to save money. Eat fully as usual, and use the money saved to buy fresh vegetables and good meat for children.

Note: This does not mean that everyone sneezing and coughing should urgently run to the pharmacy for Tamiflu! In general, it's bad that these drugs are available without a prescription. They should be taken only with a complicated course or those who are at risk. Your doctor will tell you more, and WHO experts have already told the doctors (here).

I will say separately about the vaccine.

So far, there is no vaccine against the new strain on sale, although it has already been developed and is already being bottled. It will not appear until winter. In the meantime, I advise everyone to make a regular seasonal vaccine. It also contains one of the strains of the H1N1 subtype and could theoretically help. This opinion is confirmed by the analysis of morbidity (among those who have the new flu, there are practically no people who were vaccinated with last year's vaccine).

However, those who will have time to get sick before the vaccine appears, do not worry! You did not suffer in vain! The vaccine provides immunity for only 1 year, whereas after the disease you have cellular immunity for life, both to this and to related strains :). No, right now I'm going to run for tickets to Mexico!

The best sites on the topic:
http://www.pandemicflu.gov / – website in the USA "for the people"
http://www.cdc.gov/h1n1flu / – CDC website
http://www.who.int/csr/disease/swineflu/en/index.html – WHO website (available in Russian)
http://h1n1.nejm.org / – New English Journal of Medicine website

From the comments:> Are there any ways to boost immunity at all?

– It does not need to be promoted. The phrase itself is stupid. I explain on my fingers: immunity is a combination of cellular and humoral (antibodies) forces that are in a certain balance, along with cells that fight against infections and cancers, there are those that fight the cells of the body itself (autoimmune diseases) and other immune cells. Therefore, it is useless to increase immunity: by increasing the action, you increase the reaction. Only antiviral agents (such as tamiflu) and antibodies (which are developed only after illness or during vaccination) are really effective against viruses. Everything else is from the evil one! (For more information, see the article "Don't raise immunity unnecessarily" – VM.)

> The question is somewhat off topic, but still.
"Clinical trials of many of these drugs (e.g., ocillococcinum) have proven that their effect is not superior to placebo."
I will not argue with this – we will take it for granted. However, it does not follow from this that it is useless to take these drugs! The effects of these drugs are compared with the placebo effect. That is, they themselves are placebo pacifiers. But the effect of pacifiers is still there – the same placebo effect. In other words, taking a placebo is better than taking nothing. Even if this placebo is called "fuflomycin" :)

– No, it follows from this that all this is useless.
I explain: The placebo effect in such cases is evaluated by a patient's survey (who says that he feels better). At the same time, the virus in the body and its destructive consequences do not become less. If such an effect did not go anywhere with back pain, but with AIDS, viral hepatitis or the same flu, such a "treatment" may end badly.
Yes, and evaluate this placebo effect: patients are allegedly relieved by symptoms only about 3-6 hours earlier than others. Laughter!

> I'm just a philistine and a mother of three children, I probably didn't understand everything – please let me ask ;)
The situations in polyclinics are so terrible (at least with us), it happens that you can't get through to the registry at all, and when you're sick yourself, you won't personally run to call a doctor... As a rule, with what is popularly called a "cold" (flu may also get here), we do not call a doctor. With a high fever, we rarely get sick (but even then it happens on the 2nd day only it is possible to call a doctor... What should I do now? Is it really necessary to bother a doctor with any ailment (we have a lot of them)? And here he will come, wrapped up with real patients, and we have acute respiratory infections, it was not worth bothering... You do not recommend taking it yourself, but how do we understand that we do not have acute respiratory infections and other St. Petersburg seasonal nonsense?

– A good question was asked. Unfortunately, there is only one answer to it – nothing special needs to be done.
Drink more fluids and that's it. If the fever rises above 38.4 (and only then!) you can drink terrafla or coldrex or something else based on panadol (aspirin is not allowed, especially for children!). If the temperature is lower, it is better not to knock it down, no matter how much you want to ease the condition (so the disease will be delayed). In 9 cases out of 10, SARS and flu will pass by themselves without any treatment in 7-10 days.
In case of suspicion of the flu (immediately fever under 39, almost no runny nose, red throat, splitting head, aching whole body) and if the body is weakened by the disease, you can still start drinking tamiflu or relenza, but only immediately. If you are healthy in principle, you don't have to drink them.
But, since the virus destroys a lot of tissues, bacteria can breed. Then purulent sputum will appear and the temperature may rise again for 10 days. Then you need to go to the doctor to advise an antibiotic.
Sooo rare, but still there are complications of the flu right in the acute period. If breathing becomes difficult, a person turns blue, convulsions occur – immediately call an ambulance. But this, I repeat, happens extremely rarely and with any flu.

> If we are offered a flu vaccine (including H1N1) sometime on September 22, will it be the usual seasonal and there will be no "necessary" pork? Does it make sense to undergo this procedure if I have never been vaccinated against the flu before? In recent years, I didn't seem to catch anything cold, but as a child (up to 20 years old), I went down with ARVI for a week every winter.

– Yes, you understood correctly. This will be last year's strain of H1N1 "seasonal" flu. But, I repeat, he is some kind of relative of the "pig". Therefore, it makes sense. Do it without hesitation! Any, except Russian.

> However, there are these mentioned tamiflu and relenza... :((((

– And thank God! At least they won't accept it without a real reason. Otherwise, make them at a bargain price, everyone will start drinking, and the virus will become resistant in a week!

...Antibiotics do not work on viruses. Nothing at all. They work exclusively against bacteria. Bacterial complications with the flu can occur no earlier than a week in principle. Therefore, it is pointless, harmful, and sometimes deadly to drink antibiotics right away.
...Children whistle and wheeze in the first days of infection, not because the bacteria have multiplied, but precisely because of the inflammatory reactions of the mucous membranes to the virus itself. Therefore, antibiotics are unnecessary here. But as soon as purulent sputum appears, then they can be prescribed. But it's only in a week.
Prior to this, it is good to remove the swelling of the mucous respiratory tract with the same (there are special substances, vasoconstrictors and antihistamines).

> I heard that if you are allergic to eggs, you can't get vaccinated against the flu. How true is this?

– Really. It is correct to say – an allergy to chicken protein. If you can't eat chicken, you can't get vaccinated. But neither I nor my colleagues have met such living people in all the many years of practice. That's one in 10 million!

> So, with light food, and even in remission, is it possible?

– If it's mild, it's possible (it's not an allergy) :) But if in doubt, it is better to consult a specialist (although the sensible ones have long been included in the Red Book).

Thank you, Doctor!

Portal "Eternal youth" http://vechnayamolodost.ru02.09.2009

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