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Experts concerned about potential flu pandemic

Susan Watts | 18:00 UK time, Saturday, 25 April 2009

Experts are clearly extremely concerned about the new swine flu virus which the World Health Organisation warned today has the potential to cause a pandemic.

The virus has killed at least 60 people in Mexico and appears to have infected more than 1,000. The same virus also appears to be behind infections in Texas and California, with suspected cases reportedly being tested in New York.

Dr Alan Hay, director of the World Influenza Centre in London, told me this afternoon that we must take this seriously: "It looks pretty ominous, one has to say. It's difficult to look on the bright side at the moment." He stressed, though, that it's still early days, there's a lot we don't know and he doesn't want to be alarmist.

What's most worrying is that this new virus is affecting young, healthy adults - the same group affected by the pandemic flu virus of 1918. Those usually vulnerable to flu, the elderly and the very young, were at less risk then and, it appears, now.

According to Dr Hay this is key in trying to assess the likelihood of this virus causing a pandemic: "That was the unusual feature about 1918, it was the healthy young adults that suffered most... and I think everybody understands the implications," he said.

He described the situation in Mexico as "totally different" from the intermittent cases of H5N1 bird flu among people, because it appears to be spreading so fast. Sporadic bird flu infections in people have alerted the world to the possibility of a pandemic, but Dr Hay said this H1 swine flu virus is "already worse than H5", in terms of "the number of cases, the number of deaths and the locality of the area affected...This isn't sporadic, this is human".

Dr Hay stressed that it may turn out that the situation is less alarming than it appears now, but this will be hard to assess until experts know clinical details of the cases in Mexico, such as the length of time from infection to death.

Dr Hay's laboratory in north London expects to receive samples from the new cases next week, via the US Centers for Disease Control. His team can then help to advise on the best possible vaccine. Already, his team and others around the world are working on a fast diagnostic test so that labs likely to see new cases can confirm whether or not people have the virus, as soon as possible. Speed will be of the essence in containing infections.

There are eight genes in the flu virus. According to Dr Hay, this new one has six genes from swine flu viruses already known to have been circulating in the US, and two from swine flu viruses from Europe and Asia. The US swine flu virus genes in this new virus are themselves mixtures of swine flu, bird flu and human flu viruses - what's described as a classic "re-assortment" - a combination feared most by those watching for a flu pandemic. Experts around the world have been warning for years that this is inevitable. The last pandemic was in 1968 and killed around a million people worldwide.

The next few days and weeks will be crucial. One possibly hopeful sign is that of the eight cases in the US there has been only one hospitalisation, and no deaths. So it may turn out that there is some other kind of infection at work in Mexico, as well as the new flu virus.

Comments

  • Comment number 1.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • Comment number 2.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • Comment number 3.

    Thank you Susan, keep it coming .

  • Comment number 4.

    Scary.

  • Comment number 5.

    Of course, it's not like the media to blow things out of proportion is it?

  • Comment number 6.

    Why is it that young adults are more affected than those who would be normally classed as most vulnerable?

  • Comment number 7.

    I have heard that the UK authorities will announce later today that the firs UK case of this Virus has been found. How does the UK compare in terms of preparedness to other European countries? Also how has this virus killed people in Mexico yet only hospitalised 1 out of 8 in the USA (thus far).

  • Comment number 8.

    This may sound geeky, 'conspiracy theory oriented' or just plain wild, but has anyone run a correlation between 'flu epidemics and solar activity?

    Just a thought.

    Seems that the 1918 and 1968 pandemics have a strong correlation with sunspot minima.

    Currently, we have similar conditions pertaining and a possible (potential) pandemic in the making.

    Comments?

  • Comment number 9.

    #6, in some variants of flu, the ferocious immune response itself is part of what causes the damage to the body. So if you have a strong immune response -- ie are a healthy adult -- then you're at extra risk from tipping over the edge.

    Hay is right, it is too early to panic about this yet. The infection is definitely spreading -- if it's in New York and New Zealand, it's almost certainly also in Beijing, London, Paris, Dubai and other major hubs -- but the lack of significant US deaths so far is an encouraging start.

    The next 48-72 hours will make it all clear.

  • Comment number 10.

    US data is not that reassuring. If the mortality rate is about 3-6% of clinical cases, as the Mexican figures suggest one would have expected no deaths yet from the US patients. On the positive side, this is a bad time of year for flu to spread at least in the Northern hemisphere.

  • Comment number 11.

    The fact that our airports are not being screened, the fact that Thomas Cook this morning flew another Airbus full of holiday makers to Mexico, the fact that the W.H.O. seem to be so slow acting all point to major problems for us in 7 days time.

    Expect panic by next weekend.

  • Comment number 12.

    The flu bug of 1918/1919 that killed 20,000,000 to 100 million was a summer flu.
    Labs have been working with the 1919 flu bug in level 4 labs-spacesuits. They had been trying to get permission to be able to use level 3 labs- surgical mask. Level 3 labs have let bugs out in the past. I hope they have not let out that bug.

  • Comment number 13.

    It is very early in the development of this form of the virus to make any predictions.

    The bits of information that I have seen so far suggest that people started getting ill in Mexico sometime in mid March. (This was when it started to be recognised).

    It also appears that it has been during the last two weeks that the deaths have occurred in Mexico.

    It is possible that that there has been an inital mutation of the H1N1 swine flu into a form that is not terribly virulent - but is easily communicable between humans - and then a second mutation into a more virulent form.

    The first (milder) form will have spread more widely in the initial area and could explain why the cases now turning up in USA and NZ are less virulent than the killer version now presenting in Mexico.

    The next 7-10 days will give everyone a much better idea of exactly what is going on.

    Unfortunately when the next pandemic does come along the initial phase will probably look much like the current situation - that is why WHO and CDC have to take this outbreak very seriously - whilst being aware that they cannot instantly stop the world from travelling every time a potential virus is identified.

  • Comment number 14.

    I have read that there a handful of people still alive that survived the Spanish flu influenza . Furthermore, because these people still have antibodies to that particular flu scientists are working on a vaccination to a possible pandemic using their antibodies. Do you know anything about this? How close are we to this being a viable possibility? If we are close to this being a real possibility- would it help with this particular outbreak?

  • Comment number 15.

    I read a book about the Spanish influenza (sorry cannot remember the name). The author said that the reason young people were affected moreso than the elderly and young was surprising. Young people have more antibodies. Generally, this a good thing & keeps them quite healthy. The author (someone help me here) - stated that the young people died for this very reason. The antibodies put up a huge fight against the virus and the virus put up even a greater fight. The result was like a war going on in their system and the result was death. Is this what is going on do they think? Also, if this IS what is going on- what is the difference between them & those who survived the Spanish flu pandemic, like the writer, Katherine Porter? What is essentially different concerning their antibodies? Do they know? Is there anything one can do ...or is it between genetics or the hope of a vaccination?

  • Comment number 16.

    Spanish flu was also an H1 flu virus, but it was the first one to really travel world wide. other flus died of in more isolated places and with slower transportation, died off on board ships between places.

    As for a vaccine, that would be no problem (the same is true of H5N1 avian flu when that eventually jumps species), the difficulty is it will take 4 months for the first doses to appear, such is the time it takes to produce vaccine whilst the number of factories in the world that produces vaccines is really no tthat high.

    In the UK we could expect production of half a million to one million doses a week. Do the maths. That's a long while to wait until you get jabs.

  • Comment number 17.

    @terblogger7: From reading some articles on Wikipedia (yes I know, but these ones have references to reliable sources) I think the term is "cytokine storms":

    http://en.wikipedia.org/wiki/Influenza_pandemic

    http://en.wikipedia.org/wiki/Cytokine_storm

  • Comment number 18.

    Nejsuk

    Not sure where u get your numbers from tbh. My father works for the ECDC, and his opinion is that the two best places to be in Europe, in terms of receiving a vaccination, are the UK and Sweden. UK has already bought and payed for virtual vaccines that simply need editing to be put into full scale production. Do u know how big a business drugs are? They can churn out lots more than 1mill a week. Its more of a distribution problem than anything else. However as yet there is no need for a vaccine, and the lack of info as to whether there is one definite strain of influenza.

  • Comment number 19.

    #15

    The reason I read why Spanish flu did not affect the middle aged and elderly was because a variant of that flu had been around in the late 19th century. Those living at the time had gained some immunity.

    Mortality rate was 1%-2% and, from beginning to end (there was the odd flare up after the main pandemic), was about two years. People could be hale and hearty one day and three or four days later, dead. The whole thing was exacerbated by the tail end of WWI where soldiers and PoWs were crammed into crude, unhygenic camps.

    What the effects of much more widespread travel on a much bigger population will have with this strain remains to be seen.

  • Comment number 20.

    If this has been going on for weeks, why is there so little real information? Comments from people in Mexico say there are more dying than reported including vaccinated hospital staff? What percentage of people contracting it die, and how long does the illness last either way? We can watch a war on live TV, but when it comes to something like this it's all a bit vague...? It's a recipe for complacency or panic, with not much room in the middle.

  • Comment number 21.

    re "re-assortment"

    Could you say something about how genes manage to jump species in this way. And wouldn't a simple way of mitigating its spread would be to have people wear facemasks when traveling on public transport, especially the Tube.

  • Comment number 22.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • Comment number 23.

    Thank you *9. I find this fascinating, especially how the body responding to this attack, itself can tip you over the edge. One important aspect, is how the media responds to this. Great care needs to be taken, especially in panic control. And the communication of good adivce.

    Number 11 is right. It seems that governments have not acted fast enough. We have already seen cases on every corner of the globe.

  • Comment number 24.

    I live in the USA. I am sure that 20-40 years ago I was in line and received a Swine Flu shot. We were told that it would guarantee us from the Swine Flu for a life time. At that time, it seems like I thought or was told that the Swine flu was in foreign countries.
    Now am wondering if I will be "safe" from it.

  • Comment number 25.

    Nos 20

    "Comments from people in Mexico say there are more dying than reported including vaccinated hospital staff"

    What is your reference for this please ?

  • Comment number 26.

    #25. It was reported on BBC News 24 earlier today, a news reader was reading emails received from Mexico.

  • Comment number 27.

    I am not sure that it's "another infection" that makes the 'flu more lethal in Mexico than New York, but pollution: the deaths are largely, if not wholly, in Mexico City, which has one of the least benign atmospheres on the planet.

    The New Zealanders who tested positive for this virus, "weren't really sick".

    With 'flu, it's the lung inflamation which kills, so pollution can't help but make it worse. (God help us if it gets loose in Slough!)

    In 1919, patients treated only with aspirin had a better survival rate than ones on more radical treatments.

  • Comment number 28.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • Comment number 29.

    From what's happened in the US, it seems that the fatality rate might be mercifully low, especially in Western countries with developed healthcare systems. Obviously we'll know more as more cases and deaths are reported. The concern would then turn to less developed countries where populations would be almost certain to suffer far more (and, probably, far more removed from the public eye)

    no 9 - suggesting a link on the basis of two occurrences is dubious; can't really see why how much light and radiation we get hit with from the sun would impact only on flu pandemics and not on other infections

  • Comment number 30.

    Diseases like this come and go and are a natural method of population control. Does our population need controlling? I think it does so even if this does kick off at full power then there is a positive element to it all and I say that as a fairly young person with a healthy immune system therefore susceptible to a cytokine storm. (fingers crossed and all that).

  • Comment number 31.

    Why is everyone waiting around to die ?

    If this thing turns out NOT to be a killer virus the disappointment will be huge - "you mean we are not all going to die today ?" Ah damn.

    Attention fear culture devotess : do you think following the What-Is-Called-News is enhancing your life ?

    What Bull-shlaka.

  • Comment number 32.

    grignard asked why are young people affected most?

    In non scientific terms, in 1918 the pandemic flu killed more young people because young people typically had a healthier immune system and that version of the influenza triggered a stronger response from the bodies defenses. It was this strong response of the immune system that led to a build up of fluid in the lungs so that the healthiest people seemed to die more of pneumonia.

    John M. Barry's "The Great Influenza" is the best description of what happened then.

    WHO does not yet know if this is happening this time but the similarity with 1918 is a worry.

    Any new strain that mutates from animal to human populations is potentially dangerous because the human population has less immunity. If it is a totally new mutation, the new influenza may be too efficient - killing too many people so that it dies out itself.

  • Comment number 33.

    @streetphotobeing:

    The comments from Mexico can be found here:

    http://news.bbc.co.uk/1/hi/talking_point/8018428.stm

    interesting reading.

  • Comment number 34.

    There's a timeline of previous pandemics ("outbreaks which spreads throughout the world, have a high infection rate and are caused by a new strain. ") with death rates and infection rates here:

    http://www.andypryke.com/pub/InfluenzaPandemic

    Andy

  • Comment number 35.

    Nos 33

    Thank you for that, I'm usually on to it faster. tut tut

  • Comment number 36.

    [quote]Why is it that young adults are more affected than those who would be normally classed as most vulnerable? [end quote]

    If this influenza is like earlier deadly forms it may induce a severe over-reaction from the individual's immune system that targets the body's own tissues where the virus is located, for example, the lungs. Hence those with a stronger immune system are more at risk from such an over reaction.

  • Comment number 37.

    We are due a pandemic of this sort, initial reports look like the real deal to me.

    Personaly I would take the reports that are not through any recognised media organisation seriously. People forget that the government and mass media do communicate and we have laws which allow 'gagging orders' to be put in place when national security or national interest is at risk.

    With a deep sense of pathos i must say that most will be ok here, with our poor diet and lack of sunshine all our immune systems are quite repressed anyway so if the logic explained earlier is true we may escape relatively unscathed.

    good luck everyone

    Jericoa

  • Comment number 38.

    #1 REPOSTED WITHOUT TITLE

    Is it not inevitable that the more removed from Nature our lives become (farming - industry - science - dense living - mass travel) that we will be serially 'tested', by opportunist bugs, until caught-out and brought down? Has anyone attempted to calculate the percentage kill required to bring on global social brakdown and massive secondary loss of life among humans?

    Would I be right in thinking a bug with a long incubation - passed on while the infected are symptom-free - would 'do the trick'?

  • Comment number 39.

    HAY WHILE THE SUN (still) SHINES

    "Dr Alan Hay, director of the World Influenza Centre in London, told me this afternoon that we must TAKE THIS SERIOUSLY: "It looks PRETTY OMINOUS, one has to say. It's DIFFICULT TO LOOK ON THE BRIGHT SIDE at the moment." He stressed, though, that it's still early days, THERE'S A LOT WE DON'T KNOW and he doesn't want to be alarmist."

    Alarmist? Perish the thought.

  • Comment number 40.

    I have just given a series of lectures on influenza virus at the college where I work, and my students will be fascinated by this unfolding news story. We have discussed in detail the scenario of the virus passing from animal to human, changing then being transmitted to others and being spread worldwide.

    The most sensible advice is to be extra careful with personal and hand hygiene, to wash hands frequently, to consider using hand disinfectants, antiseptic wipes to clean shared handles and object, not to share cups, bottles etc.

    Contracting the virus may inevitable for many of us if the worst case predictions are correct but we can minimise the infecting dose by using good hygiene. This will make it easier for the body to get rid of the virus.

    Yes, ironically a keen immune response can lead to more severe symptoms but these can be managed by good nursing and medication.

  • Comment number 41.

    'Could you say something about how genes manage to jump species in this way.'

    Here's a good illustrated explanation that isn't too technical:

    http://www.bcm.edu/molvir/eidbt/eidbt-mvm-flu.htm

    Susan has simplified things a little - although there are 8 segments of genetic material, there are more than 8 genes (some of the segments carry more than one gene). Reassortment can happen when two different viruses (in some cases viruses that normally 'prefer' to infect other species) happen to infect the same animal, allowing the segments to be swapped around as the viruses copy themselves, and packaged up into a new hybrid strain.

  • Comment number 42.

    Get the info. from the source, here is the link to the WHO, the wise old owl that is protecting us, hoo hoo... If you get the virus you will be lucky enough to have had the latest virus Update, so the next one will not even affect you. This is how the whole micro system works... we get the new latest virus update, then our antibodies are alerted ready for the next ones... Lets keep positive we are here, our ancestors lived by adapting.

    http://www.who.int/csr/disease/swineflu/en/index.html

    Swine flu illness in the United States and Mexico - update 2
    26 April 2009 -- As of 26 April 2009, the United States Government has reported 20 laboratory confirmed human cases of swine influenza A/H1N1 (8 in New York, 7 in California, 2 in Texas, 2 in Kansas and 1 in Ohio). All 20 cases have had mild Influenza-Like Illness with only one requiring brief hospitalization. No deaths have been reported. All 20 viruses have the same genetic pattern based on preliminary testing. The virus is being described as a new subtype of A/H1N1 not previously detected in swine or humans.

    Also as of 26 April, the Government of Mexico has reported 18 laboratory confirmed cases of swine influenza A/H1N1. Investigation is continuing to clarify the spread and severity of the disease in Mexico. Suspect clinical cases have been reported in 19 of the country's 32 states.

    WHO and the Global Alert and Response Network (GOARN) are sending experts to Mexico to work with health authorities. WHO and its partners are actively investigating reports of suspect cases in other Member States as they occur, and are supporting field epidemiology activities, laboratory diagnosis and clinical management.

    On Saturday, 25 April, upon the advice of the Emergency Committee called under the rules of the International Health Regulations, the Director-General declared this event a Public Health Emergency of International Concern.

    WHO is not recommending any travel or trade restrictions.

  • Comment number 43.

    What is concerning are the repeated reports from medics in Mexico of underreporting - see the comments page (http://news.bbc.co.uk/2/hi/talking_point/8018428.stm%29
    One junior doctor claims the underreporting is as bad as 10% of the true mortality rate.
    They also claim the problem has been going on for at least 3 weeks.

    This looks problematic - governments should be stopping nonessential travel to and from the US and Mexico, and other confirmed index countries now.

  • Comment number 44.

    Do you have an opinion about what alternative nutritional supplements might help those who have Swine Flu?

  • Comment number 45.

    The last pandemic was the "Hong Kong" flu in 1968 which killed 1 million people worldwide. Also, the H5N1 is still active in many countries’s especially Egypt...where it has killed 3 people this week alone. Egypt has the most cases after Asia. This swine flu virus has also an avian & now a human mutation, & I'm left wondering could it acquire a connection with H5N1? If so, then it could very nasty indeed.

    Another thing, since President Obama was in Mexico lately could there be a terrorist connection with this new swine "Flu"? Al-Qaeda I’m sure would be quite capable of carrying this out with bio martyrs , but wouldn’t dabble with the H5N1 as that could kill their own as well, this is just a thought, & maybe in the times we’re living in, a plausible one, as it would also play havoc with the already on its knees world economy.

  • Comment number 46.

    ?

  • Comment number 47.

    Another uncanny thing about the H1N1 virus is that it disappeared completely in 1957…only to return 20 years later in 1977 exactly in the same form as it was when it had vanished. Some say this was due to a lab escape, place not known or not revealed at least.

    Also, I’m afraid if this strain changes in its mutant form again over the time span that it spreads, will the Tamiflu & other treatments still be able to treat it successfully & will antibiotic’s be rendered useless if there are other infections that may alienate with same? & come next year will another strain of flu emerge to accompany this one on its journey worldwide? I hope I’m wrong on both counts!

  • Comment number 48.

    APOLOGY FOR PHILOSOPHY

    We must surely admit that the most successful self-replicating infection of this planet is us? Yet whist we have the knowledge and ability to attend to our rogue 'mutations' the cancerous ones are dominant.

    Were we able to apply ourselves to psychological/cultural failings in Homo Sapiens, as a priority, disease-control would be a minor matter. But being hedonistic/nihilistic by nature, we have a problem . . .

  • Comment number 49.

    maybe we are the lucky generation, free school milk, innoculations but we had to go through Scarlet fever, Mumps, Whooping cough, Measles and we played out in the street, got cuts and bruises scuffed knees and played football till ten at night.....what a blessed generation we were. The kids today are in back bedrooms on computers, playstations, all indoor activities with no outside pursuits except the car ride to school so they are ill equipped to deal with anything that is airborne or unfamiliar. Mums are paranoid about the MMR jab instead of getting their kids outside five nights a week playing rounders so if the big one hits I know which generation will handle it best....

  • Comment number 50.

    just read that BBC website on reports from Mexico...serious shit man

  • Comment number 51.

    This virus will mutate into a more serious virus or a less serious one, let's hope the latter is true. That may explain why people in Mexico are dying from same...& people elsewhere are just getting a mild version. Or maybe Mexico is worse off in the hygienic sense, after all they had floods & earthquakes in the latter years & that might have affected the sewerage system re; repairs etc especially in the poorer quarters of the city.

    And I have 2 questions or observations to make...1. Could the people now coming back to UK from Mexico be bringing in a silent virus, that hasn't affected them yet? 2. Why is it at least from what I see in all the reports up the latest one on TV from Mexico...that for every person wearing a mask, there's another who isn’t? Is this not half-baked lunacy? Let those of us that have a God pray…& those that haven’t just wish this “Enza” away!

    In 1918 Children would skip-rope to this rhyme.
    I had a little bird…its name was Enza…I opened the window…& in-flu-Enza!

 

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