May 2, 2009 – Saturday

MEXICO CITY – Mexico reported no new deaths from swine flu overnight — more reason to be optimistic that the worst is over at the epicenter of the outbreak. But the virus keeps spreading around the world, with new cases confirmed in Latin America, Europe and Asia, and governments banning flights and preparing quarantines.

The World Health Organization said it has sent 2.4 million treatments of anti-flu drug Tamiflu to 72 developing countries, taking the drugs from a stockpile donated by Roche Holding AG.

“At this point it’s important that all countries have access to antivirals,” said Dr. Mike Ryan, WHO’s global alert and response director.

The WHO has decided not to raise its alert to a full pandemic, since the virus has yet to cause sustained transmission outside North America. But Ryan warned against complacency.

“These viruses mutate, these viruses changes, these viruses can further reassort with other genetic material, with other viruses. So it would be imprudent at this point to take too much reassurance” from signs the virus is weaker than feared.

The U.S. Centers for Disease Control and Prevention also said it’s too early to declare victory.

“We have seen times where things appear to be getting better and then get worse again,” said Dr. Anne Schuchat, the U.S. agency’s interim science and public health deputy director. “I think in Mexico we may be holding our breath for sometime.”

Costa Rica reported its first confirmed swine flu case — and the first flu case in Latin America outside Mexico.

GOP leaders launch listening tour

(AP)-With the party at its lowest standing in several decades, Republicans on Saturday launched a listening tour in the heart of the Democratic suburbs, where several of the party’s leading voices steered clear of hot-button issues and instead emphasized the need to advance new policy ideas to revive the party’s prospects.

House Minority Whip Eric Cantor and former Republican governors Jeb Bush and Mitt Romney – both frequently mentioned as potential 2012 GOP presidential candidates – spoke to about 100 attendees at a pizzeria in the Washington suburb of Arlington, Va.. The event was the first held by the newly launched National Council for a New America.

They chose Pie-tanza, a small independently owned pizzeria in a suburban strip mall, that Cantor deemed “emblematic of thousands of small businesses across America,” a symbol Republicans hope to harness as they re-couch their free-market principles in response to President Obama.

The common thread at the forum was that Republicans party’s struggles are rooted in its nostalgia for a more successful past, and inability to offer a policy agenda suited for the 21st century. To make a political comeback, the GOP leaders argued, the party needs to modernize its ideas and agenda.

“Our party has taken its licks over the last couple of cycles,” Cantor acknowledged. “But that’s why we’re here.”

At the forum, there was little talk about the president’s recently passed budget and stimulus proposals, which were vigorously opposed by Republicans. Instead, the GOP trio talked about bread-and-butter issues that directly impact voters – the rising cost of health care, merit pay for teachers, and the price of college tuition.

“From the conservatives, it’s time for us to listen first, to learn a little bit, to upgrade our message a little bit and to not be nostalgic about the past,” Bush said. “You can’t beat something with nothing, and the other side has something. I don’t like it but they have it and we have to be respectful and mindful of that.”

Bush added: “We have principles and values that are shared by the majority of Americans, but we have to now take those principles and apply them to these challenges are country faces today.” 

The former Florida governor offered a panoply of proposals on education reform, citing a study showing the United States lags well behind other developed countries in math and science.

Romney touted his work in Massachusetts to implement a universal health care system that he said incorporated the private sector, not the government, in the process. And he warned that rising spending under the Democrats threatens to stagnate long-term economic growth.

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NATO thwarts hijack off Somalia, seizes dynamite

NAIROBI, Kenya – Special forces on a Portuguese warship seized explosives from suspected Somali pirates after thwarting an attack on an oil tanker, but later freed the 19 men. Hours later and hundreds of miles away, another band of pirates hijacked a cargo ship, a NATO spokesman said Saturday.

Pirates are now holding 17 ships and around 300 crew, including the Greek-owned cargo ship Ariana, hijacked overnight with its Ukrainian crew.

The attack on the Ariana, about 1,000 miles (1600 kilometers) from the sea corridor NATO guards and the seizure of explosives from the group that attacked the crude oil tanker MV Kition may indicate the pirates are adapting their tactics as crews become better trained in counter-piracy measures.

Sailors are aware that pirates generally attack during the day and that some guidelines suggest designating a safe room with a bulletproof door where crews can lock themselves in case of an attack. Such a room would still be vulnerable to being blown open with explosives.

It was the first time NATO forces found pirates armed with raw explosives, Lt. Cmdr. Fernandes said from the Portuguese frigate the Corte-Real, which responded to the attack. The Corte-Real had sent a helicopter to investigate a distress call from the Greek-owned and Bahamian-flagged Kition late Friday about 100 miles (161 kilometers) north from the Somali coast in the Gulf of Aden.

The suspects fled to a larger pirate vessel without damaging the Kition, but were intercepted by the warship an hour later.

“The skiff had returned to the mothership,” Fernandes said, referring to the vessels pirates commonly use to tow their small, fast speed boats hundreds of miles (kilometers) out to sea. “Portuguese special forces performed the boarding with no exchange of fire.”

They found four sticks of P4A dynamite — which can be used in demolition, blasting through walls or potentially breaching a the hull of a ship — which were destroyed along with four automatic rifles and nine rocket-propelled grenades. It was unclear how the pirates planned to use the dynamite, Fernandes said, because there were no translators to conduct interrogations.

Andrew Mwangura of the East Africa Seafarers’ Assistance Program said explosives were also commonly used in illegal fishing.

The 19 pirate suspects were released after consultation with Portuguese authorities because they had not attacked Portuguese property or citizens.

Decisions on detaining piracy suspects fall under national law; Fernandes said Portugal was working on updating its laws to allow for pirate suspects to be detained in such situations.

Nearly 100 ships have been attacked this year by pirates operating from the lawless Somali coastline despite deployment of warships from over a dozen countries to protect the vital Gulf of Aden shipping route.

The latest seizure was another Greek-owned ship, the Maltese-flagged Ariana. Lt. Cmdr. Fernandes, who originally said the ship’s British agents were its owners, said it was seized overnight.

‘Walking well’ flood hospitals with — or without — flu symptoms

(CNN)-A runny nose. A cough. A sore throat. And even pork eaten a week ago.

Hospitals like Sutter Delta Medical Center in Antioch, California, set up triage tents to handle overcrowding

After a week of headlines about the H1N1 virus, or swine flu, many emergency rooms and hospitals are crammed with people, many of whom don’t need to be there.

The visits by the “worried well” have triggered concerns of overburdening the nation’s hospitals and emergency departments, several health care professionals told CNN.

This week, some hospitals saw record numbers of patients. A few emergency departments shut down to paramedics because of overcrowding.

“We have had a lot of nervous patients with minimal respiratory tract symptoms,” said Dr. Mark Bell, principal of Emergent Medical Associates, which operates 18 emergency departments in Southern California. “It has caused signficiant amount of delays in emergency care. They’re all walking well.”

“I haven’t seen such a panic among communities perhaps ever,” Bell said. “We are spending significant time in the emergency department, calming people down. Right now, people think if they have a cough or a cold, they’re going to die. That’s a scary, frightening place to be in. I wish that this hysteria had not occurred and that we had tempered a little bit of our opinions and thoughts and fears in the media. It just went haywire.”

In California, triage tents were set outside. Clinics doubled their traffic in major cities like Dallas, Texas, and Chicago, Illinois. In the Los Angeles area, some Emergent Medical Associates locations shut down their paramedic traffic.

“We’re closing to the real emergencies that may be befalling our community,” said Bell. “There is a little sense of hysteria among the community about the H1N1 virus.”

Emergency rooms are usually crowded and “if you increase that volume, you’re throwing them right over the edge,” said Bill Briggs, president of the Emergency Nurses’ Association.

“This has the potential to clog the system and emergency departments already facing serious crowding issues throughout the U.S.,” said Briggs, a registered nurse at Tufts Medical Center, in Boston, Massachusetts.

Some came to the hospital because they reported eating pork and having a cough, and thought this meant they had H1N1 virus. Though commonly known as swine flu, this virus is not contracted through eating pork products.

Even in cities that have yet to have a confirmed case of H1N1, health care workers have noticed an uptick in the number of patients. The Minute Clinic, a walk-in health care chain that has 500 offices around the country, saw a 50 percent increase in flu-related visits Thursday.

Chicago Children’s Memorial Hospital’s emergency department had more than double their average number of patients this week.

“It was a lot of ‘worried well’ people,” said Cathleen Shanahan, the nursing director for the emergency department at the hospital. “A lot of parents who were worried they about the flu.”

The anxiety is understandable, but Shanahan cautioned, “At some point, they need to realize it’s still flu season and it could be a normal flu season, and have nothing to do with [H1N1] flu.” CNN.com: Regular flu has killed thousands since January

“The situation is that people get the flu all the time,” said Dr. Nick Jouriles, president of the American College of Emergency Physicians. “H1N1 flu is just a bad strain of that. If you have flu symptoms and you ordinarily see the doctor for that, go ahead. If you would not ordinarily go to the doctor, don’t.”

If a person has no symptoms, then he does not need to seek emergency care, said Jouriles, an emergency room doctor at Akron General Medical Center in Akron, Ohio. And if the person does not have a fever or cough, it is extremely unlikely it’s the H1N1 virus.

“Very often when this happens, people naturally become afraid and overinterpret every symptom as a harbinger of the flu or what the epidemic is,” said Dr. Jeffrey Steinbauer, professor of family medicine and the medical director of the Baylor Clinic in Houston, Texas. “That’s part of providing care to patients and it’s kind of expected.”

Rather than panicking when you have a cough or runny nose, Steinbauer advised finding more objective measures.

“A temperature is very objective,” Steinbauer said. “If the temperature is normal, the allergens in the world and other viruses in the world can give you cough and runny nose. But if you don’t have a fever, chances of it being a flu is very low.”

While, the symptoms of the current swine flu and seasonal flu are very similar, reports suggest that this flu virus may result in nausea, vomiting and diarrhea more often than the typical flu. Symptoms include excrutiating body pains, difficulty breathing, significant nasal congestion and high fever. Doctors in Mexico have reported seeing sudden dizziness as well.

Health care workers find themselves trying to balance caution while allaying fears and panic about the virus.

“We recognize this as an infectious disease, this is moving,” Dr. Robert Salata, the chief of Infectious Diseases at the University Hospitals Case Medical Center in Cleveland, Ohio. “For the general population, we’re trying to calm the fears of people and the worried well, by stressing other elements like cough and sneezing etiquettes, and that you shouldn’t go to work if you’re feeling sick. If there is a concern, working through this with your physicians would be very important.”

But dashing into the emergency department because of a runny nose is not helpful.

“We have a tendency in the U.S. to abuse our emergency departments,” Salata said. “If this escalates, you want to use them for people that are not having mild or moderate symptoms.”

George Ure’s Take on the Mexican Flu

Drifting Flu Mortality Rates

The latest out this morning from the World Health Organization causes me a bit more concern over hybrid flu:

2 May 2009 — The situation continues to evolve. As of 06:00 GMT, 2 May 2009, 15 countries have officially reported 615 cases of influenza A(H1N1) infection.

Mexico has reported 397 confirmed human cases of infection, including 16 deaths. The 241 rise in cases from Mexico compared to 23:30GMT of 1 May reflects ongoing testing of previously collected specimens. The United States Government has reported 141 laboratory confirmed human cases, including one death.

The following countries have reported laboratory confirmed cases with no deaths – Austria (1), Canada (34), China, Hong Kong Special Administrative Region (1), Denmark (1), France (1), Germany (4), Israel (2), Netherlands (1), New Zealand (4), Republic of Korea (1), Spain (13), Switzerland (1) and the United Kingdom (13).

Following the same methodology I used earlier this week — namely Total flu cases, less flu cases with no deaths divided into total deaths to get a mortality rate — today’s calculation shows:

Totals deaths:     16

________divided by____

Total Cases:       615

Less 0 dead:    –   77

subtotal:             538____

Mortality Rate:  2.974%

Much better than yesterday’s 3.77% calculated the same way.  The problem, of course, is that there are a whole slew of variables to be considered in trying to make an intelligent estimate of how serious the flu is and could become.  Among these:

• Transmissibility:  How contagious is the flu in the pre-symptom mode and then how contagious is it when symptoms begin to appear?

• Incubation period:  Once a person has been exposed (transmissibility) what is the incubation period?

• Average course: Once the flu has incubated, how long are you going to be sick.  And then…

• Transmissibility Window:  Have far into the course of the disease (and from what point ont he front end) are people contagious?  And last, but not least:

• Relapse, Long Term Impacts:  Just because someone gets this version of the flu, does it come roaring back at some future juncture?  If so, what is the relapse mechanism?  Or, if there is no relapse case, how different a new strain need there be?  Or, worst case for a weaponized flu, does this flu open up patients to other illnesses as a consequence of this immune response? 

Troubling stuff, to be sure.  So far (as of Saturday morning) New York had 50 cases while Texas had 28, but still only one death, and that was a child brought to the US from Mexico for treatment.

Speaking of which – there go the Cinco De Mayo celebration plans for Queens (which is in NYC in case you live under a rock).

Oh, and with 400 schools closed, don’tcha think this argues in favor of home schooling online?