H1N1 flu victim collapsed on way to hospital [Latest H1N1 updates downthread]

Obama team mulls new quarantine regulations

http://www.recombinomics.com/News/08080901/H274Y_WW_Spread.html

Commentary

Global Spread of Tamiflu Resistant Pandemic H1N1
Recombinomics Commentary 20:35
August 8, 2009

The release of a full set of sequences from a patient in Hunan, China raises concerns that oseltamivir resistance is widespread and circulating at much higher frequencies than indicated by the eight detail isolates. The sequence from China, A/Hunan/SWL3/2009, was released yesterday, a day after the CDC released a sequence, A/Singapore/57/2009 at GISAID, which was a day after the sequence from Denmark, A/Denmark/528/2009, was released. All three isolates have H274Y appended onto a different pandemic H1N1 genetic background, and all three backgrounds were distinct from earlier sequences from Osaka, Yamaguchi, and Hong Kong. H274Y was also reported in isolates from patients in Quebec and Tokushima.

This pattern of H274Y on multiple H1N1 backgrounds was also seen in seasonal flu and recently released 2009 seasonal sequences from Central and South American countries also have H274Y, providing a large reservoir of H274Y, which can jump from N1 in seasonal H1N1 to N1 in pandemic H1N1.

Although details of the cases in Hunan and Singapore have not been released, most of the other cases involved patients who were on prophylactic Tamiflu. In Denmark and Tokushima, the patients developed symptoms on the 5th day of prophylactic treatment, raising doubts that the H274Y was due to a de novo mutation. The incubation period for wide type influenza is 2-4 days, so symptoms 5 days after the start of Tamiflu treatment are not likely to be due to de novo mutation, because the incubation period would be significantly longer than wild type, because the newly mutated virus would take longer than five days to grow to a level that would produce symptoms.

In addition, the repeated identification of the same polymorphism, H274Y, and the lack of detection of another resistant polymorphism, N294S, decreases the likelihood that random mutations are generating the resistance.

Instead, it is more likely that H274Y is circulating as a minor population, leading to a shorter incubation period than would be expected for de novo mutation, and a higher frequency of detection. The May 30 isolate date of the Singapore isolate coupled with the release date of August 6, raise concerns that the number of isolates with H274Y that either have not been sequenced or have not had sequences released, may be significant.

The concern was increased by recent reports on multiple resistant isolates along the Texas / Mexican border. Although the claims of confirmed cases were denied, the detail associated with the cases suggests that there is some indication of resistance in this area. Similarly, earlier reports of patients who remained H1N1 positive after extended treatment with Tamiflu raises additional concern of resistant H1N1 that has not been isolated or sequenced.

The rapid spread of H274Y in pandemic H1N1 would not be a surprise. H274Y spread in seasonal flu has been described in detail, and the level rapidly increased to 100%. The co-circulation of H1N1 seasonal flu with H274Y and widespread use of Tamiflu for treatment or prevention, increases the likelihood of rapid spread of H274Y in pandemic H1N1.

The recently released sequences, which contain H274Y on six different genetic backgrounds, including at least one patient who was not treated with Tamiflu, significantly increases concerns of additional worldwide spread in the near term.

End Comentary.

Now I am confused. I don’t know whether to buy some Tamiflu or not???

PING!

Dutch public health body says “swine flu” is same as ordinary flu

August 8, 2009 by Jane Burgermeister

Thank you to Matt Engelmann for translating this report from the Dutch newspaper:

NRC HANDELSBLAD

MEXICAN VIRUS IS ORDINARY FLU ====================

BILTHOVEN, 7 Aug. — From now on, the Mexican flu will be treated by the authorities as an ordinary flu. Patients will no longer receive the antiviral drug Tamiflu as standard treatment. These policies were announced this morning by the [Dutch] National Institute for Public Health and the Environment [R.I.V.M.].

Cases of Mexican flu no longer need to be officially confirmed or reported.

All Dutch residents will shortly receive a folder mailed to their homes with information about the flu, the standard treatment, and the diagnostic procedures. “We expect to send out the folder in the week of 17th August”, according to a spokesman from the Ministry of Health. The decision to stop the standard treatment of flu patients with Tamiflu was due to its side effects, according to Professor Jaap van Dissel of the Leiden University Medical Centre. Giving Tamiflu to 200 otherwise healthy flu patients will only protect 1 patient from complications, but meanwhile 20 to 30 people will experience serious side effects.

From the details so far available, the Mexican flu seems relatively mild, and the symptoms are very much like ordinary flu. 1% to 3% of patients experience complications – usually pneumonia. In approximately two thirds of these cases the patients belong to traditional risk groups. They already come under consideration for the annual winter flu shot. The World Health Organization announced yesterday that the first vaccines against the Mexican flu would be available in September.

According to Van Dissel, the risk groups also come under consideration for Tamiflu. This includes people with very serious flu cases. “For this kind of case Tamiflu treatment is useful, especially in the early stages after infection.” People between the ages of 15 to 50 have a higher risk of infection with Mexican flu. Also pregnant women in their third trimester have a greater risk.

All Dutch hospitals will meanwhile prepare for an eventual flu pandemic, said the Dutch Society of Hospitals [N.V.V.Z.].

Click

Eh. I failed to make the first cut for the vaccine trials here in Seattle area. They called this morning.

So now I have to wait for the vaccine just like everyone else. I was hoping to get a jumpstart on it.

Please PING your lists to this important article:

The Model State Emergency HealthPowers Act (MSEHPA) allows forced vaccination in a declared state of emergency

August 8, 2009 by Jane Burgermeister

Under the “Mandatory Medical Examinations” section (502) of the of the MSEHPA, persons refusing to submit to medical examinations and/or testing are liable for misdemeanors and forced isolation. If public health authorities suspect individuals may have been exposed to broadly defined infectious diseases, or otherwise pose a risk to public health, officials may issue detainment orders. In the case of an urban attack, or even one suspected,possibly thousands of people could be marshaled into isolation camps, according to the law. In this case, physicians, assisted by police, will be required to perform state medicale xaminations and tests.Under the law, “infectious diseases” are very broadly defined, states PandemicFluOnline.

Here is the full report:

“When explaining to people that the government will order a mass vaccination campaign as early as mid-September, 2009, many say, “They aren’t going to vaccinate me.” If you ask public health and law enforcement officials they will tell you that the law does not allow people to be vaccinated against their will. That may be true in times of peace while elected officials are performing their duties and civil governments are still empowered.

However, in a declared state of emergency, the civil authority is supplanted by martial,or military authority. Civilian officials and employees may be “deputized” to help administrate martial authority during an emergency, but civil law is effectively suspended for the duration of the emergency. The following article, originally written in Dec., 2001, has been edited and updated slightly to show that, if/when a medical emergency is declared, people will be forced to submit to a variety of inconveniences without their consent—including invasive medical interventions—or face severe consequences one generally associates with war zones.

It is also plainly stated that no one working for or with the government will be held liable for death or damages to persons or their properties should they result from good-faith performance of their “lawful” duties. Since October, 2001, the tenets of MSEHPA has been sewn into the pandemic preparednessplans of most, if not all, of the several states PandemicFluOnline.

Within weeks after the tragic events of Sept. 11, 2001, the Centers for Disease Control and Prevention (CDC) began promoting health policy legislation that dramatically suspends civil rights during declared state of biological emergency.

The text of the“Model State Emergency Health Powers Act (MSEHPA)” gives public health officials and governors of the several states the power to arrest, transport, quarantine, drug and vaccinate anyone suspected of carrying a potentially infectious disease.

The Boston Globe originally broke the October 31, 2001. The story was almost immediately forwarded to medical freedom activists throughout the country who responded en masse in outspoken opposition to the proposal. The article was quickly removed from The Globe’s website.

The 40-page MSEHPA was authored by Lawrence O. Gostin and James G. Hodge of the Center for Law and the Public’s Health at Georgetown and Johns Hopkins universities.

While stating that their proposal considered the “civil rights of the individual,” the appeals process described in the text describes the nearly absolute powers of public health authorities to detain people against their will and force them to submit to whatever medical intervention deemed appropriate by authorities.

The process gives little hope that the individual will prevail in an appeal and that he will continue to be detained throughout the process.

Unless intentional harm can be proven, the proposal states, “Neither the state, its political subdivisions, including the governor, public health authorities, the police, or other state officials, [will be held liable for] the death or injury to persons, or damage to property, as a result of complying with, or attempting to comply with this Act or any rules promulgated pursuant to this Act.”

Then Department of Human and Health Services Secretary Tommy Thompson a knowledged existence of the CDC model. He said, “We need not only a strong health infrastructure and a full stockpile of medical resources, but also the legal and emergency tools to help our citizens quickly.”

Under the proposed law, one case of smallpox or swine flu in a public school could trigger authorities to urge a governor to declare a state of emergency.

Once such is declared, the U.S. Constitution, Bill of Rights and most cherished civil liberties will be immediately suspended in addition to states being empowered to take immediate possession of private property under the doctrine of eminent domain.

Under Section 406 of the proposal under the heading, “Compensation,” it is explained that, “Compensation shall not be provided for facilities or materials that are closed,evacuated, decontaminated, or destroyed when there is reasonable cause to believe that they may endanger the public health…”

Under the “Mandatory Medical Examinations” section (502) of the law, persons refusing to submit to medical examinations and/or testing are liable for misdemeanors and forced isolation.

If public health authorities suspect individuals may have been exposed to broadly defined infectious diseases, or otherwise pose a risk to public health, officials may issue detainment orders.

In the case of an urban attack, or even one suspected, possibly thousands of people could be marshaled into isolation camps, according to the law. In this case, physicians, assisted by police, will be required to perform state medical examinations and tests. Under the law, “infectious diseases” are very broadly defined.

“An infectious disease may, or may not, be transmissible from person to person, animal to person, or insect to person,” the authors explain in the text.Section 504 of the Act details vaccination and treatment protocols.

Following these mandates, public health authorities may compel people to be inoculated and/or drugged with any medicaments selected by the state. Individuals refusing to be vaccinated or treated would be liable for a misdemeanor, subject to police arrest, isolation or quarantine.“Section 807” repeals existing state laws that are in conflict with the Act. Under this part,for instance, previous laws granting medical, religious, or philosophical exemptions to vaccination would be repealed. Former Secretary Thompson explained that, “the Centers for Disease Control and Prevention (CDC) led a process to develop a Model State Emergency Health Powers Act that will be an important tool for state and local officials to respond to bioterrorism and other public health emergencies.”

Thompson also sated that, the proposed model has been developed “Over the past six months.”According to the CDC production, “Preparing for the Next Influenza Pandemic” which was broadcast via satellite to health departments all over the world February 26, 1999, the federal government has been developing the infrastructure for total control of medical emergencies since 1973. The CDC stated that, after the swine flu debacle in which high percentages of the 45 million people who were inoculated against the disease developed a different disease called Guillean Barre, President Nixon ordered that the Federal Guidebook to Pandemic Preparedness be prepared.The CDC admitted that the guidebook was still in “draft form” as of 1999, but that President Clinton ordered the formation of the Working Group on Influenza Preparedness(known by the CDC as “the GRIP”) take up where the guidebook left off. As of this writing, Federal Guidebook to Pandemic Preparedness has not yet been made available to the public.

Official MSEHPA update

The link below contains the most recent tracking of MSEHPA and plainly states the intent of the model act’s provisions. To be certain as to how officials in your state will be administrating a declared state of medical emergency, you can obtain copies of state and local pandemic preparedness plans online or through your local health department. You will likely discover that your state and local plans mirror the key provisions of MSEHPA.

From the weblink at:

Click Here

The Model State Emergency Health Powers Act (MSEHPA) grants public health powers to state and local public health authorities to ensure a strong, effective, and timely planning, prevention, and response mechanisms to public health emergencies (including bioterrorism) while also respecting individual rights. Developed by the Centers in collaboration with a host of partners, MSEHPA has been used by state and local legislators and health officials nationwide as a guide for considering public health law reform in their states.

Legislative Status Update:

Since its completion on December 21, 2001, the Centers has been tracking state legislative activity related to MSEHPA.

As of July 15, 2006, the Act has been introduced in whole or part through 171 bills or resolutions in forty-four (44)states, the District of Columbia, and the Northern Mariannas Islands.

Thirty-eight (38)states [AL, AK, AZ, CA, CT, DE, FL, GA, HI, ID, IL, IN, IA, LA, ME, MD, MN, MO, MT, NV, NH, NJ, NM, NC, OK, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WI, and WY] and DC have passed a total of 66 bills or resolutions that include provisions from or closely related to the Act.

The extent to which the Act’s provisions are incorporated into each state’s laws varies.

Lawrence O. Gostin, et al. The Model State Emergency Health Powers Act: Planning for and Response to Bioterrorism and Naturally Occurring Infectious Diseases, 288 JAMA622 (2002)Click

Sun Aug 9, 5:23 am ET
WASHINGTON – President Barack Obama will fly to Mexico for a two-day summit with the leaders of Mexico and Canada.

The three men are expected to work on trade, immigration, drug trafficking and security issues, as well as clean energy.

They’re also expected to discuss the swine flu pandemic ...”

http://news.yahoo.com/s/ap/20090809/ap_on_go_pr_wh/us_obama_preview

-

Using New Laws for Swine Flu

http://www.zcommunications.org/znet/viewArticle/22264

Freeper Larousse2 asked for this to be pinged .

Overstretched paramedics’ response times shocker (UK)
http://www.sundaymercury.net/news/midlands-news/2009/08/09/overstretched-paramedics-response-times-shocker-66331-24352007/
Aug 9 2009 by Alison Dayani

WEST Midlands Ambulance Service is at crisis point, with over-stretched paramedics failing to get to almost HALF of life or death emergencies within the government target of eight minutes.

Official response times to high priority 999 calls have seen an alarming slump since May.

NHS West Midlands officials are closely monitoring the situation.

Ambulance chief executive Anthony Marsh has blamed swine flu and an “unprecedented” surge in calls, which are 20 per cent up on this time last year.

He is hoping an independent review being carried out will force local health trusts to give the service more cash and could lead to more ambulances on the streets.

He said chiefs were staggered by 71,571 people inundating the control room in July compared to 59,595 in the same month last year.

But the increase has led to callouts for urgent Category A calls deteriorating and breaching government targets to alarming levels since May 11.

Government rules say that paramedics must reach at least 75 per cent of the most serious calls within eight minutes.

But figures show that for the West Midlands service that fell to as low as 43.7 per cent in Birmingham and the Black Country at the beginning of July and has remained below 57 per cent since then.

The average number of emergencies reached quickly enough across the whole region dipped to 55 per cent five weeks ago and has since stuck around the 63 per cent mark.

An ambulance insider said: “The response times at West Mids are well below national targets and if you speak to any member of operational staff or control room staff, you will find out that morale has never been so low, with stress on staff building up day by day.

“The service cannot cope with the demands placed upon it and it is only a matter of time before things come crashing down.

“Highly paid executives in their ivory towers at Ambulance Headquarters and general staff have two very different perspectives on how the Trust is run.”

Mr Marsh said: “The numbers of calls to those patients who have breathing difficulties, have a headache or chest pains have seen particularly large rises. We believe this is linked to the West Midlands having one of the highest levels of swine flu cases in the country.

“The number of 999 emergency calls has risen considerably over the last four months when compared to the same period in 2008.

“The Trust is currently participating in an independent review with Primary Care Trusts which is exploring the funding received and the levels of emergency ambulances across the region.

“Our staff in our control rooms and on frontline vehicles are working extremely hard to ensure that we continue to treat those with serious and life-threatening conditions as quickly as possible.”

A Department of Health spokeswoman said: “Strategic Health Authorities are responsible for managing the performance of local organisations.”

Commentary

Reporting Delays of Tamiflu Resistant Pandemic H1N1

Recombinomics Commentary 10:55
August 9, 2009
http://www.recombinomics.com/News/08090902/H274Y_Delays.html

The quiet release of Tamiflu resistant pandemic H1N1 sequences from Singapore and China this week has raised concern. The releases were not associated with news story describing the circumstance surrounding the resistance, but the collection dates of May 30 and June 13, respectively, strongly suggests the resistance was identified through routine sequencing.

Most of the prior isolates were associated with patient contacts who had been placed on prophylactic Tamiflu, so when they developed symptoms, samples were collected and the H274Y was rapidly identified. The first two patients identified were described weeks ago even though the collection dates were also in mid-June. The delays linked to the sequences released this week were likely due to a backlog in sequencing samples collected weeks or months ago. Similarly the recent report of resistance in a recovered patient in Thailand is also likely linked to routine sequencing and this resistance may not be linked to Tamiflu treatment.

The sequence from Hong Kong was from a traveler from San Francisco who had a mild case and was not taking Tamiflu when diagnosed, and the patient declined antiviral treatment. Thus, the evolutionarily fit H1N1 was in a mild case that recovered without treatment. These characteristics raised concerns that such cases are wide spread but not detected because many countries, including the United States, are no longer testing mild cases. Moreover, cases detected because of prophylactic Tamiflu treatment might represent mixture of virus, with lower levels of the H274Y positive strains circulating below detection levels.

Many had expected H274Y in pandemic H1N1 because of the high levels in Brisbane H1N1 seasonal flu. The jump of H274Y from seasonal flu could happen via reassortment, which would be due to the acquisition of the human N1 gene, or ressortment, which would be due to the acquisition of the portion of the human N1 gene that encoded the H274Y. Both mechanisms require a dual infection involving seasonal and pandemic H1N1, and recently released seasonal flu sequences from June isolates from central America and South America have H274Y, but the jump via reassortment or recombination would be easily distinguished from a jump via recombination. None of the reported cases have acquired H274Y via reassortment involving a human N1 gene. Moreover, no pandemic H1N1 sequence has acquired any human flu genes. However, acquisition of human N1 by pandemic H1N1 would probably not pose a health risk, because swine isolates that acquire a human N1 almost always also acquire a human H1. Indeed, recent reports from Saskatchewan, Canada described 2 or 3 farm workers infected with a swine H1N1 that had acquired Brisbane H1 and N1 and although the reassortant had H274Y, the human immune response is largely directed against the H and N genes and most people have immunity to Brisbane H1N1 because of vaccination or prior H1N1 infections.

However, acquisition of H274Y would produce data that matched the reported sequence data. Each example of Tamiflu resistance would involve the same genetic change, H274Y, and the polymorphism would jump from one pandemic genetic background to another. This mechanism of recombination and genetic hitchhiking as been described for seasonal H1N1, and linked to the evolution and spread which resulted in levels if H274Y in the Brisbane/59 strain of H1N1 which became dominant in most regions of the world, and H274Y resistance levels in H1N1 approached 100%. The increase to 100% was also linked to one particular sub-clade with A193T in HA becoming dominant.

In pandemic H1N1, one sub-clade has not become dominant. There are currently multiple sub-clades, and several have been linked to the acquisition of H274Y. Each of the public sequences represent H274Y on a different pandemic H1N1 background, raising concerns that H274Y jumps are frequent and will lead to a association with an emerging sub-clade.

The widespread use of Tamiflu for the treatment and prevention of pandemic H1N1 increases the examples of emergence from minor populations, and the release of sequences from Denmark, Singapore, and China, coupled with a report of resistance in Thailand raise concerns that the frequent detection is due to Tamiflu treatment, as well as H274Y emergence on evolutionarily fit pandemic H1N1.

NYPD Officer, 27, Dies From Swine Flu

Published on 8/9/2009
http://www.theday.com/re.aspx?re=cee2ac2f-9715-4a50-b0d4-faa1ff4030aa

Hauppauge, N.Y. - Authorities say the swine flu’s latest New York victim is a 27-year-old police officer. The NYPD says Ryan Johnson died Friday after battling the respiratory illness for nearly two months. Johnson lived in Brookhaven, N.Y., on Long Island. He suffered from asthma, but had been healthy enough to work on the force for five years

Rich countries corner supplies of swine flu vaccine

28/07/2009
The World Health Organisation has unofficially estimated that the world’s labs may only be able to produce around 900 million doses for the A(H1N1) strain per year, for a planet that is home to 6.8 billion people...
http://www.expatica.com/fr/news/french-news/Rich-countries-corner-supplies-of-swine-flu-vaccine—_54916.html

Iran Stops Flights to S. Arabia in Fear of Swine Flu Pandemic
Sunday 09 Aug 2009
http://english.farsnews.com/newstext.php?nn=8805181123

Iran has decided to cease its flights to Saudi Arabia from August 11 due to a swine flu pandemic in the Arab country, an Iranian aviation official announced on Sunday.

“In order to prevent a pandemic of influenza type A (swine flu), there won’t be any flight from Iran to Saudi Arabia in the holy (fasting) month of Ramadan,” Spokesman of Iran’s Aviation Organization Reza Jafarzadeh told FNA.

Noting that the last flight to Saudi Arabia will be carried out on Monday, Jafarzadeh reiterated that all the Iranian pilgrims in the country will be flown back to Iran by Ramadan.

Each year, thousands of Iranians fly to Saudi Arabia to visit Kaaba - the House of God on Earth - in Mecca during Haj pilgrimage.

In the meantime, the Iranian Health Ministry announced on Friday that the number of infections with H1N1 virus in Iran rose to 144, rejecting that swine flu has taken toll in the country.

According to the ministry, 50% of the patients are, reportedly, Hajj pilgrims and the rest have returned form trips to other countries, including those in southeast Asia.

The ministry announced on Sunday that the speed of swine flu pandemic in Iran has slowed down this week.

WASS

H1N1 kills Pune teacher, Mumbai housewife (India)
http://timesofindia.indiatimes.com/news/city/pune/H1N1-kills-Pune-teacher-Mumbai-housewife/articleshow/4872656.cms
Malathy Iyer & Sharad Vyas, TNN 9 August 2009

PUNE/MUMBAI/NEW DELHI: The highly infectious H1N1 virus claimed two lives on Saturday,with a 33-year-old Mumbai woman and a 42-year-old Pune school teacher succumbing to it. This comes five days after the death of Pune schoolgirl Reeda Sheikh, the country’s first swine flu casualty.

Pune’s latest victim was Sanjay Tukaram Kokre who died at Sassoon Hospital around 12.30am. He had been put on a ventilator since he was admitted to the hospital’s critical care unit as a suspected H1N1 patient. He was moved to the confirmed H1N1 cases CCU on Saturday afternoon after the National Institute of Virology (NIV) confirmed that he was H1N1 positive.

Two more suspected H1N1 patients have also been admitted to Sassoon Hospital even as a doctor and a chemist continue to battle for life.

In Mumbai, flu claimed the life of Fehmida Panwalla, a housewife.

Civic officials, however, were at pains to point out that she was brought to Kasturba Hospital in a critical condition and had a history of diabetes and hypertension. It is an established medical fact that the H1N1 infection is severe in people who have an underlying condition such as diabetes or heart disease.

Asked whether the hospitals she was admitted to earlier had established if she had travelled abroad, her doctor said, ‘‘This was probably not thought about at that stage.’’

It is still not clear how Panwalla contracted H1N1. Overall, India is now seeing a spike in secondary cases of H1N1 infection — people who haven’t travelled to an infected country but may have got the virus from an infected individual.

Of the 3,624 people tested till now, 782 were found to be positive. Of these cases, 511 have been discharged. A central team has been sent to Pune to assess the situation and institute appropriate public healthcare measures.

Meanwhile on Saturday, India recorded 71 new cases of H1N1 - Pune (34), Mumbai (2), Chennai (7), Delhi (13), Amritsar (1), Faridabad (1) Bangalore (10), Manipal/Mangalore (3). Of these, almost 59 cases were of secondary infection.

Of the 13 cases in Delhi, two have a history of travelling abroad — an 11-year-old who came from Singapore and a 13-year-old who arrived from Manchester, UK.

Oh,.... yippee....

Just what we need.

Suffolk County man, an NYPD cop, dies after contracting swine flu
http://www.newsday.com/long-island/suffolk/suffolk-county-man-an-nypd-cop-dies-after-contracting-swine-flu-1.1356898

( My Comment : The reason I pinged the list is that important info is in this article that as of July 7th New York stopped counting deaths for the swine flu )

Yes. When we’re young, we don’t want to go, but when we’re more mature, we want to go suddenly. Scary words: lingering illness. Ugh.

as of July 7th New York stopped counting deaths for the swine flu

One way to make the problem go away...