What to look for in August....

[Jeremy]

Now that August is right around the corner I think we should remember what happened in 1918 around this time. While I am not saying that this is going to play out exactly like 1918, it is important to remember that we never had the sequences to know what the 1918 first wave strain looked like, ergo we don't know if it was more deadly when it first appeared in March of 1918.

"In late August 1918 (Roughly August 22nd), the second wave of the Spanish flu struck three port cities at nearly the same time. These cities (Boston, United States; Brest, France; and Freetown, Sierra Leone) all felt the lethalness of this new mutation immediately"

​

Without modern air travel the most logical conclusion, for the reason these three cities could got hit at the same time, is if the virus was already "seeded" or present in these locations.

With 2009 H1N1 already seeded, and the second wave almost upon us, I think we should all be on the lookout for the parallels to 1918. For August may very well be the Witching Hour...

 

[wotan]

Re: What to look for in August....

One thing I am noticing, qualitatively, not quantitatively, is that deaths worldwide seem to be on the increase. Now there's certainly many reasons why this might be, and a large part of it could simply be due to an increase in the number cases, more cases will necessarily be more deaths. But is that all there is to it? Has much of the rest of the world reached whatever "critical point" in number of infections is necessary to start seeing an increase in the number of deaths? Or is there something else going on?

Apparently the CDC still thinks there is no change in the virus versus the vaccine consensus, but as we have now seen, as long ago as a month an apparently poorly understood but potentially very important change was discovered in Brazil. If this change was fit then we have no way of knowing how far it spread since then, and apparently we are not seeing sequences released in a timely manner anywhere, hence we really don't know what we are looking at now.

The three ports Jeremy mentioned above are on the Atlantic coast of three continents. Shipping traffic can't have delivered the lethal strain to them all simultaneously, there is a fair chance that whatever ship(s) involved would have had a significant portion of their crew killed if they carried the lethal strain. But here is a different view.

Twentieth century pandemics (and possibly the Russian Flu of 1889) had a mild first wave that saw the virus get seeded around the world. In the case of 1918, the much more lethal second wave seems to have hit multiple places at roughly the same time. Perhaps this is what happened. As it spread around the world, the 1918 pandemic virus would have encountered other flu viruses and had chances to acquire various traits. As troops and war materiel moved around the world, these different strains would have spread back to other places, meeting up with different strains of the pandemic virus, or still other flu viruses, picking up additional traits. One of these, still not terribly lethal, but almost there, then got spread to these port cities. Three different ships from a single source could have done it, and perhaps it could have been South America, that being one location where the travel time would have been close to equal for all three destinations. With perhaps only one or two relatively small changes left, normal evolutionary pressures could have produced the more lethal strain simultaneously in different locations, and the new strain was much more fit, allowing it to spread.

So is Brazil pointing us that way? Perhaps they are the source of the new infections in Southern Mexico and Central America. Perhaps the "Sao Paulo strain" isn't the "final" more lethal version, but it could be one more step on the way thee. But with airline travel, the final version could easily crop up in multiple locations at the same time. We are looking for an immediate source, to areas where H5N1 is widespread. But whatever offspring H1N1 and H5N1 might produce will, perhaps, not be distinguishable from the current pandemic strain until a few more key changes crop up, and then it may already be worldwide.

The above was purely speculation, and I may be totally off-base.

 

[jeanne]

Re: What to look for in August....

Three different ships from a single source could have done it, and perhaps it could have been South America, that being one location where the travel time would have been close to equal for all three destinations. With perhaps only one or two relatively small changes left, normal evolutionary pressures could have produced the more lethal strain simultaneously in different locations, and the new strain was much more fit, allowing it to spread.

So is Brazil pointing us that way? Perhaps they are the source of the new infections in Southern Mexico and Central America. Perhaps the "Sao Paulo strain" isn't the "final" more lethal version, but it could be one more step on the way thee. But with airline travel, the final version could easily crop up in multiple locations at the same time.

i was interested that you pointed out the ripple effect of 1918 slow transport, carried about by individual travelers and small shipboard or trainbound groups. this mode of transmission is going on now, along with the much faster transmission by airplane. maybe they're compatible.

they're like multiple ripples of different wavelengths. the changes that occur with each mode of transportation are all happening inside their own ripples - the slow mode like in 1918, the faster mode of sheer numbers of people in motion today, and the superfast mode of jet planes and busy airports. i'd imagine three components mixed up in three different ways adds a different level of complexity to the ships-passing-in-the-night method of viral evolution.

 

[Tonka]

Re: What to look for in August....

I noticed "Swine Flu Symptoms" was number 9 on the top 10 Google search list today. Likely, not a good sign.

 

[peace]

Re: What to look for in August....

i was interested that you pointed out the ripple effect of 1918 slow transport, carried about by individual travelers and small shipboard or trainbound groups. this mode of transmission is going on now, along with the much faster transmission by airplane. maybe they're compatible.

they're like multiple ripples of different wavelengths. the changes that occur with each mode of transportation are all happening inside their own ripples - the slow mode like in 1918, the faster mode of sheer numbers of people in motion today, and the superfast mode of jet planes and busy airports. i'd imagine three components mixed up in three different ways adds a different level of complexity to the ships-passing-in-the-night method of viral evolution.[/QUOT sad to see you took your foot out your mouth lol it was profoundly true the subject does affect the object as in quantumn physics everything is interdependant as for august as you said so many differences to 1918 it could work for or against:yinyang:

 

[AlaskaDenise]

Re: What to look for in August....

I would expect that as temperatures decrease, cases will increase. Since some areas start cooling in late August, they should expect more pandemic flu then. Add to that an adapted version from the southern hemipshere, arriving via air travel and we could have quite a mixed can of worms. The public needs to understand that the severity level they're seeing now may not be indicative of what will occur this fall & winter. I'm not sure that message is getting through. Many people just think it's "crying wolf" again.

.

 

[wotan]

Re: What to look for in August....

I would expect that as temperatures decrease, cases will increase. Since some areas start cooling in late August, they should expect more pandemic flu then. Add to that an adapted version from the southern hemipshere, arriving via air travel and we could have quite a mixed can of worms. The public needs to understand that the severity level they're seeing now may not be indicative of what will occur this fall & winter. I'm not sure that message is getting through. Many people just think it's "crying wolf" again.

.

I subscribe to a mailing list for people with cystic fibrosis and their caregivers. This is a group with a bona fide risk from flu, period. As a group I would think the should be concerned. A couple of days ago, someone from the list posted that a group from their church had just returned from camp (200 kids) and that many/most/all of them came back with flu. She was freaking out, trying to figure out what to do for her daughter. I had not been checking my email the night it was posted so I didn't see if until sometime yesterday. No one on the list responded, at least publicly. Until I did. I fired off several emails, explaining various things that I have learned here and at other sites, explaining that this is more serious than most of them have been lead to believe, I even launch into an explanation of the general way that Tamiflu works and how resistance is such a concern. There has been almost no response to my posts. A few people emailed me privately, thanking me for keeping up with it, but there has been no further discussion on the subject. This is distressing. That list has been almost nothing but debating the pro's and con's of various health4 insurance reform ideas for most of the summer, and while I can understand the level of interest in that topic, the pandemic should be a much more immediate concern. I don't think most of them are aware of the pneumonia vaccine, and bacterial pneumonia is a serious complication for people with CF regardless of flu. Statistically, most people alive with cystic fibrosis are under the age of 39(I think that is still current). This is the prime risk group in terms of age for the pandemic. CF is not a disease that compromises the immune system, so a young adult with CF is probably still a likely target for cytokine storms, and even with bacterial pneumonia not apparently being a major complication in the pandemic so far, people with CF are highly susceptible to it with any respiratory infection, and after enough pneumonias, chronic P. aeruginosa infection, B. cepacia infection, etc, the lung of someone with CF will likely look very much like someone who had a cytokine storm, it just takes 20 years instead of "20 hours." So I am just flabbergasted I haven't generated more of a response.

OK, this turned into a rant....

 

[Treyfish]

Re: What to look for in August....

I have to give it 6-8 weeks. I think it will more widepread than we know before they tell us it has mutated or gathered strength. I also think it will still be an asian strain,"Vietnam area", that does the most killing...too much bf for it to not mix. Latin america doesn't seem to have a lot of BF laying around, so I don't feel mutation coming from that area. Remember Egypt and Africa are really just gettin started with it really, judging from reports so far anyway. The Hajj is comin up,"November" and that area is hot with bf too...not good Need I mention hurricane season is about to pick up..btw,did they have many in '17,'18, or 19? That and wartime prolly didnt help, and we are having Swine flu in area's our soldiers are in right now. They are travellers, too. The more travelling the faster any new mutation will be in our face. All just a hunch, or a humble opinon! I recommend all prepping be put on the front burner, on high. :tiphat:

 

[Jeremy]

Re: What to look for in August....

The more I think about it, the more I am thinking that it is highly likely that, if we are going to see a 1918 repeat, we will see an increase in reports of "lethal disease" outbreaks that don't seem to look like the current "mild" 2009 H1N1 influzena.

At first most reports will most likely not call it the flu, because it is killing to fast or causing hemorrhagic type symptoms. The tests might not come back positive for 2009 H1N1 because it may have mutated around the tests, which might cause delays reports.

The reason we know that the virus popped up all over the place at the same time in 1918 is because researchers scowered news articles and were able to put together the puzzle after the fact based on the symptoms and news reports.

I think for the next 6-8 weeks we should be even more suspect about "lethal disease" outbreaks than we have been.

Because the simple fact is, right now people have been hearing about this "mild" flu so the symptoms of a 1918 type repeat will not look anything like the "mild" flu so it most likely will be missed at first.

 

[Rwilmer]

Re: What to look for in August....

The more I think about it, the more I am thinking that it is highly likely that, if we are going to see a 1918 repeat, we will see an increase in reports of "lethal disease" outbreaks that don't seem to look like the current "mild" 2009 H1N1 influzena.

At first most reports will most likely not call it the flu, because it is killing to fast or causing hemorrhagic type symptoms. The tests might not come back positive for 2009 H1N1 because it may have mutated around the tests, which might cause delays reports.

The reason we know that the virus popped up all over the place at the same time in 1918 is because researchers scowered news articles and were able to put together the puzzle after the fact based on the symptoms and news reports.

I think for the next 6-8 weeks we should be even more suspect about "lethal disease" outbreaks than we have been.

Because the simple fact is, right now people have been hearing about this "mild" flu so the symptoms of a 1918 type repeat will not look anything like the "mild" flu so it most likely will be missed at first.

This is very interesting Jeremy, maybe we are seeing that in some places in the world now. The mystery disease in somalia and the one in malawi, that the cdc is involved in. Could those be a mutated h1n1?

 

[Jeremy]

Re: What to look for in August....

This is very interesting Jeremy, maybe we are seeing that in some places in the world now. The mystery disease in somalia and malawi, that the cdc is involved in. Could those be a mutated h1n1?

Right now, anything is possible....It could be that these outbreaks in Africa is H1N1 although we have to remember that Africa has so many diseases going around in a non-pandemic year that it makes it extremely difficult to know for sure without tests.

Most of the known diseases, typhoid, malaria, cholera, lepo, have fixed locations and traditional seasons.

I think the key to knowing if it is a more virulent strain of H1N1 in Africa will be twofold:
1) Frequencey - Are we seeing more reports of these mysterious outbreaks over Africa or other countries in greater frequence as August progresses.
2) Size (i.e. Doubling) - Are we seeing reports of larger numbers of people getting sick each week.

 

[tyto]

Re: What to look for in August....

Don't forget Adenovirus 14a or a variant spreading concurrently with AH1N1. That's a block party in your respiratory system you want to avoid.

FT post on emergent adenovirus 14.
http://www.flutrackers.com/forum/showthread.php?t=41234

 

[Mamabird]

Re: What to look for in August....

One thing I am noticing, qualitatively, not quantitatively, is that deaths worldwide seem to be on the increase. Now there's certainly many reasons why this might be, and a large part of it could simply be due to an increase in the number cases, more cases will necessarily be more deaths. But is that all there is to it? Has much of the rest of the world reached whatever "critical point" in number of infections is necessary to start seeing an increase in the number of deaths? Or is there something else going on?

Apparently the CDC still thinks there is no change in the virus versus the vaccine consensus, but as we have now seen, as long ago as a month an apparently poorly understood but potentially very important change was discovered in Brazil. If this change was fit then we have no way of knowing how far it spread since then, and apparently we are not seeing sequences released in a timely manner anywhere, hence we really don't know what we are looking at now.

From all of the available sequences, including those from Argentina and Sao Paulo, the Swine Flu virus has not changed in any meaningful, significant way. In addition, reports from the Southern Hemisphere indicate that while there are hospitalzations and deaths from the novel H1N1, thus far they are below the levels experienced with normal, seasonal flu.

Not quite time to panic just yet, although the virus could mutate into something more sinister.

 

[Hogweed]

Re: What to look for in August....

In addition, reports from the Southern Hemisphere indicate that while there are hospitalzations and deaths from the novel H1N1, thus far they are below the levels experienced with normal, seasonal flu.
.

I'm not sure a quick scan of Southern Hemisphere news items supports that statement does it?

http://www.thewest.com.au/default.aspx?MenuID=77&ContentID=160036
WA hospitals 'under seige': AMA
4th August 2009, 17:00 WST

A meltdown in West Australian hospitals during peak flu season could have given the federal government an excuse to take them over, says the state branch of the Australian Medical Association.

AMA WA president Gary Geelhoed said WA hospitals had been under siege for the past week, with patients suffering unnecessarily through long waiting times.

Most of the state’s elective surgery arrangements have been cancelled because of a bed shortage and ambulances have been forced to wait outside hospitals because there are no beds to take patients to, Prof Geelhoed said.

“For more than a week, our hospitals have been under siege and the situation is growing more serious by the day,” he said.

Some patients had waited six hours to be seen by a doctor in the emergency department on Monday night and some had to wait 24 hours for a hospital bed, Prof Geelhoed said.

He said the state had no capacity to deal with increased patient numbers during the flu season.

While the ideal situation was to have 85 per cent occupancy rates in hospitals, WA was working at close to 100 per cent capacity, he said.

“We just don’t have capacity in reserve,” Prof Geelhoed said.

“We just cannot do the work, we can’t deal with the sick, we can’t deal with the injured, we can’t deal with fluctuations due to swine flu. The hospitals go into meltdown.”

However, while Health Minister Kim Hames agreed hospitals were under “enormous pressure” he said the State Government was working hard to support them.

Dr Hames conceded while emergency departments were struggling, they were not beyond capacity.

“We have opened up every bed – we’ve got all our nurses working,” Dr Hames said.

“The advice I am getting from hospitals is they are under enormous pressure but are coping well.”

The fundamental problem was a lack of hospital beds across the nation, which has been reduced by 60 per cent in the past 25 years, Prof Geelhoed said.

Cost shifting and buck passing because of the different funding models - some State and some Commonwealth - were a problem, he said.

“The danger is that unless our hospitals can perform better, the Federal Government could have the excuse to take them over and that would be a disaster in our view,” Prof Geelhoed said.

Australian Nursing Federation WA secretary Mark Olson said the AMA should be wary of using the term ‘meltdown’ as it could erode the public’s confidence in WA hospitals.

But Prof Geelhoed said while the Federal Government had identified the problems in the health system, it had failed to fix the problems.

Funding administered by the State Government or smaller local authorities would avoid cost shifting between in and out-patient programs and create more efficiency in the system, Prof Geelhoed said.

====

More in thread http://www.flutrackers.com/forum/showthread.php?t=118806

 

[Jeremy]

Re: What to look for in August....

Mamabird,

I have to agree with Hogweed on this.

If the situation that is starting to develop in the southern hemisphere continues to trend the way that we are seeing then something is defintely occuring that is not the usual run of the mill seasonal flu.

First off, ventilators are already a extremely sparse commodity.
Secondly, they are reducing capacity in the hospitals because they are short of nurses.
Third, things go from bad to worse very quickly.

Fourth, if you are looking at only sequences you are going to be seriously lagging by a couple of weeks in terms of the ability to see changes. Whereas the news reports will tell the tale in relatively real-time.

 

[wotan]

Re: What to look for in August....

Three questions:

How many estimated flu deaths are there every year in any of these Southern Hemisphere countries?

How many confirmed flu deaths are there every year in these countires?

How many confirmed swine flu deaths are there so far in these countries?

 

[Mamabird]

Re: What to look for in August....

Folks, I guess I'm relying on the wrong sources for good, solid, objective, factual information. The MOH in Australia is currently reporting a total of 70 deaths due to Swine Flu, along with 419 hospitalizations. We are approaching the peak of their normal flu season.

So, while these deaths are regrettable, and our hearts go out to those families that have lost loved ones, the number would indicate a flu that is less virulent than seasonal flu. And while hospitals are clearly being inundated with the sick, I suspect that some of these patients might be just as well off at home. Only 419 due to Swine Flu does not stike me as serious at this late stage in the event.

Argentina is reporting that their Swine Flu cases and hosptializations have peaked. This leveling off is actually a bit surprising, but again it would indicate that Swine Flu, while highly contagious around close contacts such as families, schools and camps, is limited, and relatively moderate in terms of symptoms as confimed by CDC, WHO and ECDC.

If you look at the genetic sequences that have been made available by dozens of countries all over the world across four months of activity, this virus has been unusually stable, with only minor, insignificant changes. The Swine Flu virus has a very human HA segment allowing for ease of transmission, but PB2, NS, PB1 are missing significant characteristics that are known for virulence.

So, unless this virus materially changes, the Northern Hemisphere can expect a whole lot of sick kids when school kicks back in, and parents running to their clinics and hospitals with those kids in tow, but most of those without underlying health conditions will recover quite well with bed rest and liquids.

 

[Shiloh]

Re: What to look for in August....

I agree with Mamabird. However, I wonder how many lives have been saved due to early use of Tamiflu and Relenza. I do not know if it is standard practice to use these with seasonal flu. Also, given the use of rapid tests to screen suspect cases, there is likely to be an undercount of cases attributed to AH1N1. One indicator, although I dont know how good it will be, is to compare total deaths from respiratory ailments for 2009 against the same period in 2008.

 

[wotan]

Re: What to look for in August....

But you see, I think you are comparing apples to oranges here. I will speak to numbers I am a little more familiar with, US numbers.

The CDC estimates that there are ~36,000 deaths in the US from flu every year. But have you seen how many of those are lab confirmed? Looking through MMWR from past years, including the 2007 summary, so far all I have found is confirmation of <100 pediatric deaths. Now, to be sure, I haven't gone back through influenza surveillance reports yet, and I may very well see that there are more lab confirmed flu deaths in the US each year, but I think it has already been established that it is far fewer than 36,000.

With that in mind, how many deaths does Australia *estimate* in a normal flu season, and how many do they actually confirm.

 

[Jeremy]

Re: What to look for in August....

Folks, I guess I'm relying on the wrong sources for good, solid, objective, factual information. The MOH in Australia is currently reporting a total of 70 deaths due to Swine Flu, along with 419 hospitalizations. We are approaching the peak of their normal flu season.

So, while these deaths are regrettable, and our hearts go out to those families that have lost loved ones, the number would indicate a flu that is less virulent than seasonal flu. And while hospitals are clearly being inundated with the sick, I suspect that some of these patients might be just as well off at home. Only 419 due to Swine Flu does not stike me as serious at this late stage in the event.

Argentina is reporting that their Swine Flu cases and hosptializations have peaked. This leveling off is actually a bit surprising, but again it would indicate that Swine Flu, while highly contagious around close contacts such as families, schools and camps, is limited, and relatively moderate in terms of symptoms as confimed by CDC, WHO and ECDC.

If you look at the genetic sequences that have been made available by dozens of countries all over the world across four months of activity, this virus has been unusually stable, with only minor, insignificant changes. The Swine Flu virus has a very human HA segment allowing for ease of transmission, but PB2, NS, PB1 are missing significant characteristics that are known for virulence.

So, unless this virus materially changes, the Northern Hemisphere can expect a whole lot of sick kids when school kicks back in, and parents running to their clinics and hospitals with those kids in tow, but most of those without underlying health conditions will recover quite well with bed rest and liquids.

Mamabird,

I am not discounting the numbers we are seeing from Australia. This thread is about what to look for in August...if we are going to see a 1918 repeat.

The most difficult part of the problem is that we do not have the first wave 1918 strain. We have the second wave 1918 strain but not the first. So while we know where it ended up, we do not know where it started. Therefore it is impossible to know exactly what changes occured, if any from the first wave 1918 strain to the second wave 1918 strain that made it more lethal.

What we do know, is that sometime in August the cases all of the sudden turned more deadly. Now, maybe the virus was always capable of causing mass deaths and it just needed the right climate, or maybe it evolved along a pre-determined evolutionary path so that it was always going to cause the mass deaths but just needed to time to reach its evolution, or maybe something else.

The point is, we don't know what we don't know. You can't tell me with absolute certaintly that it is going to play out like you and I both hope.