Should we be worried about swine flu?

Flu pandemics occur once every 10-40 years so are fairly regular. Swine flu broke out in Mexico in early April and due to the interconnectedness of the world is now going global with confirmed cases (april 30th) in Mexico, USA, Canada, Costa Rica, Peru, UK, Spain, Switzerland, Germany, Austria, Israel and New Zealand. Should we be scared of this possible pandemic?

Should we be worried about swine flu?

Yes because... No because...

WHO threat level 5

On Wednesday 29th April the World Health Organisation (WHO) ‘decided to raise the current level of influenza pandemic alert from phase 4 to phase 5.’ Meaning that the threat now has to be taken very seriously indeed, we are one step away from having a flu pandemic. [[Swine Flu, Statement by WHO Director-General, Dr Margaret Chan, 29 April 2009, http://www.who.int/mediacentre/news/statements/2009/h1n1_20090429/en/index.html

We need to be 'concerned' about any virus outbreak but we must also be realistic and the possibility that mass medication may result in the virus mutating should be a factor when deciding future actions. Thereis also the psychological effect of media publicity on persons who do not realise that the change of threat level is to provide governments with information upon which they can act for the good of their country and not an individual prediction.

Raising the threat level is just a precautionary measure it means ‘All countries should immediately activate their pandemic preparedness plans. Countries should remain on high alert for unusual outbreaks of influenza-like illness and severe pneumonia.’ So the change in threat level is not a reason to be alarmed just a notice to health ministries around the world to be ready, make sure they have plans in place and are able to react to contain any outbreak in their countries. This change of threat level by the WHO is aimed at governments not at individuals.

Should we be worried about swine flu?

Yes because... No because...

Past cases

The best known past case of a flu pandemic is the 1918 Spanish Influenza. Estimates of the number killed This killed between 20 and 40 million people around the world. In two years more than a fifth, and up to a third of the world’s population was infected. It also had an exceptional mortality rate of 2.5% compared to less than 0.1% in previous influenza epidemics [[http://virus.stanford.edu/uda/]] Since 1918, almost all cases of influenza worldwide (except for human infections from avian viruses such as H5N1 and H7N7 – such as the last flu scare we had in 2005), have been caused by descendants of the 1918 virus, this includes H1N1 viruses and its mutations H2N2 and H3N2 viruses. We also still do not know what made this particular outbreak of flu have such a high mortality rate.[[ J.K. Taubenberger, D.M. Morens, 1918 influenza: the mother of all pandemics, Emerg Infect Dis, Jan 2006 http://www.cdc.gov/ncidod/EID/vol12no01/05-0979.htm

Dr Sanja Gupta from CNN has stated that although the H1N1 strain is the same, it is not the same virus [[Dr Sanja Gupta, Why should we be worried about this flu? CNN Health, April 30 2009, http://pagingdrgupta.blogs.cnn.com/category/swine-flu/, therefore it is perhaps difficult to make direct comparisons. Also in the intervening 91 years between this outbreak and he first appearance of H1N1, medical science has progressed beyond all recognition. The ability to investigate and find information on new diseases is more advanced, and the quality of medicines, vaccines and general treatment of patients have all improved drastically. Society is also infinitely more globalised now than in 1918, which means that once effective cures are discovered it is much easier to share this information with other countries quickly.

Should we be worried about swine flu?

Yes because... No because...

Containment is not possible

Due to the nature of the modern world it is impossible to contain such outbreaks once they have started, even before we travelled around the globe so much it was difficult to contain outbreaks, now it is impossible. Dr. Keiji Fukuda, deputy director general of the World Health Organization, believes “Containment is no longer a feasible option, The world should focus on mitigation. We recommend not closing borders or restricting travel.” Closing borders would have a negative effect because it would not stop the spread of the flu but would also cause a collapse of economic activity.[[Donald G. McNeil, Containing Flu is Not Feasible, Specialists Say, New York Times, April 29th 2009, http://www.nytimes.com/2009/04/30/health/30contain.html?_r=1&ref=world This would likely mean more people getting less food and medicine leading to more deaths when they get infected. Such measures would hamper relief efforts and make monitoring more difficult. It also means vital supplies of drugs, and ventilators are more difficult to move to where they are needed.

Containment has been successful in the past. Notably the policy from the WHO with regards to avian flu involved containing anyone who is infected, culling birds and disinfecting the area, so far this has been successful in preventing a pandemic from avian flu. Studies have shown that it is possible to contain outbreaks although it would require a lot of effort. Researchers in 2005 simulated a population of 500,000 with individuals mixed in a variety of settings such as households, preschool groups, and workplaces. researchers analyzed how flu, starting with a single case, would spread through the population in a variety of different scenarios. They found that targeted use of antiviral drugs could be effective for containment as long as the intervention occurred within 21 days and the virus' reproductive number (which represents the average number of people within a population someone with the disease is able to infect) was relatively moderate. So long as the antivirals reached 80-90% of the targeted population.[[Preventing a Pandemic: Study suggests strategies for containing a flu outbreak, http://www.bio-medicine.org/biology-news/Preventing-a-pandemic-3A-Study-suggests-strategies-for-containing-a-flu-outbreak-1644-2/

Should we be worried about swine flu?

Yes because... No because...

up to 750000 dead in the UK

In a worst case scenario within the UK the Department of health believes that 750,000 people could be killed and up to 1.2 million hospitalised, which could lead to the "complete or partial collapse of some or all hospital infrastructures" in the event of a flu pandemic that could be cought by up to 30million people within the UK. This is according to government guidelines that were drawn up in september. In the event of such a collapse hospitals would have to decide by lottery who would recieve intensive care.[[Graeme Wilson, Emma Morton, Nick Parker and John Kay, The Sun, 1st May 2009, http://www.thesun.co.uk/sol/homepage/news/article2406341.ece

In a best case scenario with in the UK estimates are that very few to no people could be killed.

Should we be worried about swine flu?

Yes because... No because...

Britain is well prepared for this outbreak

There are however areas of the world that are less prepared than the UK. Developing countries are quite likely to be harder hit due to more cramped living conditions, and less good sanitary conditions. Many countries are restricting the flow of goods (particularly food products) and people. For example kyrgistan has temporarily banned imports of meat from North America while Guatemala, Nicaragua, Panama and Dominican Republic are attempting to create a "sanitary cordon" in Central America.[[The World Response to Flu Crisis, BBC News, 29 April 2009, http://news.bbc.co.uk/1/hi/world/americas/8022516.stm This is something that the WHO has specifically said would not be helpful.

Britain is very well prepared for the outbreak of this disease. Sir Liam Donaldson the governments chief medical adviser has stated 'we have been planning for a situation like this for some years. The preparations we have in place and are continuing to make will help to ensure we respond well in the event of a pandemic' [[Audrey Gillian, flu threat level raised as virus spreads between humans, The Guardian, 30 April 2009, p.1]]. It has also been reported that Alan Johnson, the health secretary has requested extra anti viral drugs which will protect 50 million, which is more than 75% of the British population [[Audrey Gillian, flu threat level raised as virus spreads between humans, The Guardian, 30 April 2009, p.1]]. This means that the pandemic would have to be especially serious, or mutate into a much more virulent strain such as mutating with the avian flu H5N1 virus to pose a really serious outbreak in the United Kingdom.

Should we be worried about swine flu?

Yes because... No because...

More people die every day of normal flu than have been killed so far

We don't yet know how the pandemic will play out. Most others have taken months before they've really taken hold. And the WHO is not an organisation usually known for instilling panic.

According to Wikipedia [[http://en.wikipedia.org/wiki/Flu#History]]

"Typically, in a year's normal two flu seasons (one per hemisphere), there are between three and five million cases of severe illness and up to 500,000 deaths worldwide, which by some definitions is a yearly influenza epidemic"

Or in other words, on average 1,400 people die every day from normal flu - about 7 times the worst estimates for all the people to have died from Swine Fever in the past three weeks. And only one of those has occurred outside Mexico.

The media is exaggerating the problem because it helps shift papers and fill much of the 24 gaping hours they've got in their news cycle. If you want to be scared be scared of winter, or lightning for that matter. Both are far more likely to kill you.

Should we be worried about swine flu?

Yes because... No because...

Cases outside Mexico do not appear to be as serious

The WHO has suggested that the current outbreak of swine flu could lead to only a mild pandemic.[[Rebecca Smith, ‘Swine flu, why only deaths in Mexico?’, Telegraph, 28th April 2009, http://www.telegraph.co.uk/health/swine-flu/5237516/Swine-flu-why-only-deaths-in-Mexico.html ]]
However in the 1918 outbreak there was a relatively small peak in number of deaths at the start of the outbreak in June and July 1918 with under 5 deaths per 1000 people infected with a period from July to October with very few deaths. It was only in October to January that there was a spike in the death rate up to 25 deaths per 1000, there was then another period of calm followed by a third spike in mortality March 1919.[[ J.K. Taubenberger, D.M. Morens, 1918 influenza: the mother of all pandemics, Emerg Infect Dis, Jan 2006 http://www.cdc.gov/ncidod/EID/vol12no01/05-0979.htm, figure 1.]] This means that even if it is not serious outside Mexico at the moment it may well resurface.

Although the outbreak in Mexico has been devastating, there has so far only been one death outside that country. This occured in the United States, and that was a Mexican national visiting family friends. The five cases in the United Kingdom are all in people who have recently visited Mexico, with three cases coming from people traveling on the same plane from Cancun to Birmingham. Many medical experts have also attempted to play down the seriousness of the disease; professor John Oxford a virology expert at Barts & the London has commented:
'Not only are we coming up to the summer, which makes it less likely for these viruses to spread as well, but Britain has enough antiviral drugs for half of the population. So we should not panic in any way. This does not look as though it is going to be a virus that sweeps the world and causes huge mortality.' [[BBC News, Swine Flu: How serious a threat, 28 April 2009, http://news.bbc.co.uk/2/hi/health/8022102.stm ]]

Should we be worried about swine flu?

Yes because... No because...

no need to worry

this is not dangerous more people die of normal flu than swine flu

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