Fears of a fresh outbreak of bird flu this year have been raised by the United Nations, after an increase in the number of deaths and, crucially, the emergence of a new, mutated strain of the disease.
Although in six countries – Bangladesh, China, Egypt, India, Indonesia and Vietnam – it is known to be endemic (present all the time albeit in smaller numbers), at least eight people have died of bird flu in Cambodia this year alone. Of note – the emergence of a new, mutated strain of the disease for which the existing vaccines do not work.
Just as a reminder, the H5N1 bird flu virus spread across Asia in the last few years, killing millions of fowl and several hundred people but never gained genes to spread easily among humans. This is unlike the swine flu virus (H1N1) which readily affects humans and spread rapidly in 2008 from Mexico to the US and beyond, killing thousands.
While it is expected that the the new Avian mutant virus may not be so transmissible to humans, it is difficult how dangerous it potentially is. Nevertheless, it is of sufficient concern for the United Nations’ Food and Agriculture Organisation (FAO) to issue a warning urging stiffer surveillance measures to prevent the disease spreading to new areas, particularly when bird migration can take the virus to countries which have never got the illness.
The threat of catching the disease aside, the economic impact of another outbreak can be quite tremendous, considering that in 2008, some 400 million domestic poultry were slaughtered and the disease was said to have cost the world’s economies US $20bn.
As the paranoia spreads with the increasing number of reported deaths worldwide, I couldn’t help noticing the plethora of mask types that are being worn. Is the right mask being worn? More important, are people wearing them for the correct reasons?
First a few facts:
- The H1N1 virus, like any flu virus, spreads in the air as droplets, mainly through the coughs and sneezes of people who are sick with the virus, but it may also be spread by touching infected objects (including hands) and then touching your nose or mouth.
- The flu virus is 0.08-0.12 microns in size (micron= one millionth of a metre). Small enough to pass through most masks!
So, using an ordinary facemask, whether single-ply, 2 ply or 3 ply, is really to protect other people from you. Its designed to keep the germs in and should be worn by those having a influenza-like illness(ILI).(fever 37.8°C or greater) and a cough and/or a sore throat).
Otherwise, if you want to keep the germs out & protect yourself from getting the flu, then you need to use the N95 mask (also called respirator). It must be tight-fitting and is rather uncomfortable to wear over long periods as extra effort is sometimes needed to inhale.
Whichever mask you use, you need to practise social distancing (2 metres away), social etiquette (blocking off a sneeze and cough) and frequent handwashing.
Should the general public wear facemasks?
There is no evidence to suggest that this is a useful preventative measure. Unless of course, you have a flu-like illness (to prevent others from catching it) or you are in close contact with a probable, suspected or confirmed person. Confused with all these terms? The US Centre for Disease Control has made it somewhat easier by defining it:
A confirmed case of A (H1N1) virus infection is defined as a person with an influenza-like illness with laboratory confirmed novel influenza A (H1N1) virus infection by one or more of the following tests:
- real-time RT-PCR
- viral culture
A probable case of A (H1N1) virus infection is defined as a person with an influenza-like-illness who is
- positive for influenza A, but negative for human H1 and H3 by influenza RT_PCR
A suspected case of A (H1N1) virus infection is defined as a person who does not meet the confirmed or probable case definition, and is not novel H1N1 test negative, and is/has:
- a previously healthy person < 65 years hospitalized for ILI
- ILI and resides in a state without confirmed cases, but has traveled to a state or country where there are one or more confirmed or probable cases
- ILI and has an epidemiologic link in the past 7 days to a confirmed case or probable case.
If you would like to know more about facemasks and who exactly should be wearing one, this CDC website is recommended.
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Today’s print media highlighted the possible shortage of swine flu vaccine (when it eventually becomes available). The Director-General of WHO, Dr Margaret Chan was even reported to have accused Western nations of hoarding the vaccine and appealed to the big pharmas to divert just 10% of the supplies to developing countries so as not to deprive the less fortunate.
There is also a sense of panic developing as the number of deaths throughout the world rise to 700 (see here). Currently, the only form of possible cure, apart from the vaccine, is by taking Tamiflu or Relenza capsules by mouth. But they don’t come cheap at USD 60 per course. Besides, supplies are scarce and they need to be taken within 48 hours of the onset of the symptoms to be effective.
So where does that leave most of us, especially those who don’t like popping pills?
A comforting fact is that 95% of those who contracted swine-flu recover from it without any complications – this is a reassuring fact that is not emphasized by media hype. Apart from this consolation, an important principle is that the virus attacks those with diminished immunity. That explains why many of those that succumbed are either elderly, the very young, pregnant women, sufferers of chronic disease or thse taking steroids.
How can one increase one’s immunity?
- Leading a healthy lifestyle. Hate to repeat it, but regular exercise, no smoking, enough sleep and reducing stress are indispensable pillars.
- Hygienic measures. Perhaps the most important preventive measure is washing the hands. You need to cough and sneeze safely too, because the tiny droplets expelled can contain the virus.
- Hydration. Drinking water often and adequately (about 2 litres daily) is an important measure too.
- Supplements to enhance the immune system. Zinc, selenium and ginseng have these properties.
- Antioxidants. No need to buy expensive over-the-counter stuff. Taking them naturally is even better – berries,green tea, dark chocolate, coffee and red wine all have antioxidants.
- Staying away from crowded places. This comes in last in my book as many of us just can’t avoid this, especially public commuters!
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The Chinese character for ‘crisis’ is a hybrid for ‘danger’ and ‘opportunity’. This applies as well for the current H1N1 influenza near-pandemic, formerly known as Swine Flu.
Already, websites and emails are sprouting extolling the virtues of products that claim to diagnose, prevent, mitigate, treat or cure the 2009 H1N1 influenza virus. These fraudulent sites have escalated in intensity recently, enough for the US Food and Drug Administration FDA to issue a warning on fraudulent influenza products here.
Here’s a quick rundown on on some myths about the current H1N1 flu infection:
1. There are currently no flu vaccinations that can prevent an attack by the H1N1 virus. The current stockpile was derived from the flu epidemic a few years ago caused by the H3N1 and related viruses, so they will not be effective here.
2. The two antiviral drugs approved by the FDA for treatment and prophylaxis of the 2009 H1N1 influenza virus are Tamiflu (oseltamivir phosphate) and Relenza (zanamivir). However, health experts caution against using them routinely for several reasons: the emergence of resistant strains when used in mild flu infections, its ineffectiveness when given more than 48 hours after the onset of flu, the presence of side-effects (in particular,psychiatric disturbances, heart and lung disorders and deaths in children).
3. Should masks be used? Certainly not the ordinary ones as they do not filter small particles that carry the culprit viruses. You need to get the N95 respirators which block off 95% (hence the name) of small particles which carry the viruses. These are expensive and are for single-use only.
Said the Federal Trade Commissioner, Jon Liebowitz, “The last thing any consumer needs right now is to be conned by someone selling fraudulent flu remedies”.
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Economists will give a wry smile on seeing the above title, as its a well-known mantra that the shape of the US economy determines that of the whole world! Yet, the swine flu outbreak in Mexico seems to affect the world’s business scene just as well..
One of the first things that accompany news of dangerous flu viruses is an economic evaluation of the effects of a pandemic. In a recent article, Reuters pointed out in 2008 that the IMF said a flu pandemic could cost $3 trillion and cause a 5% drop in global GDP. In other words, it would almost certainly turn the current deep recession into a worldwide depression, says Newsweek.
In Hong Kong, where the government machinery is well-versed in handling potential epidemics (after the SARS outbreak in 2003), there are 1,400 empty beds ready to take in isolation cases as and when necessary. Despite this, the Hang Seng Index fell 2.7% yesterday – worse hit being airline shares (Cathay Pacific dropped 8%, China Airlines 13%).
However, behind every dark cloud, there is a silver lining – rubber glove-makers are rubbing their gloved hands in glee. The makers of the only two antiviral drugs approved for the treatment of influenza viruses in general -Tamiflu (Roche) and Relenza (GlaxoSmithKline)-have seen their stocks climb on share markets.
For those who think that they cannot get Swine Flu as long as they do not come into close contact with pigs, recent research has shown that this is not true for at least two reasons: the virus responsible ( Influenza A H1N1) has been shown to adapt and change readily with the common flu viruses, so that transmission is possible from human to human. This was not the case with the Avian Flu outbreak in 2003 which started in China as the virus responsible (H5N1) was not able to change as readily, so the outbreak among humans fizzled out. See the Bloomberg report here.
With the rapidness of air-travel and the fact that passengers are cooped up in an enclosed space for hours, its not surprising that the World Health Organisation (WHO) called the outbreak a “public health emergency of international concern” , with 81 Mexicans succumbing so far. Eleven cases in California, Kansas and Texas, all of them mild, have been connected as well, and at least eight students in New York are being tested for whether they match the Mexico strain, health officials said.
Here are some FAQs about Swine Flu (more details from the CDC website):
As there is no specific treatment for this potential epidemic, many countries have resorted to screening passengers who have just been to Mexico; but if this illness rapidly spreads across borders, we may very well see health screening procedures at major airports around the world (remember the SARS epidemic in 2003?).