Swine flu 2009 – the flu that has not been detected before in either pigs or humans—makes headlines around the world.
It’s big news for sure. Virtually every paper and news channel is saturated with news of the spread of this supposedly ‘deadly’ strain of the influenza A (H1N1) virus that the World Health Organization (WHO) confirms has never been detected before in either pigs or humans.
Given that viruses can remain stable for some time and then suddenly mutate, the fact that the organism from which it originated cannot be detected is not altogether surprising, but it does beg the possibility of other explanations. A substantial amount of recent research has been carried out on the strain of the H1N1 virus responsible for the so-called Spanish flu pandemic of 1918-20 which was responsible for the death of between 20-50 million people around the world. Could we be looking at an 'escapee' subtype from some of this work? It would be difficult to rule out this possibility. But people may be happier to blame intensive animal farming for the time being despite there being thus far no evidence of the virus in their midst.
Putting it into perspective
Let’s start by looking at the deadliness of the strain of the virus responsible for the current concern. To generate the sort of fear the epidemic—or near-pandemic— is presently generating, surely the virus must be deadly and capable of causing mass deaths around the world?
When you look at death rates from the strain of seasonal influenza A (H1N1) endemic in humans, which is responsible for the well-known seasonal deaths of influenza and pneumonia, and compare this with that associated so far with this new strain, we see an interesting picture emerge. Let’s remember that regular influenza, which itself jumped to humans from birds or pigs back in the early 20th century, is actually derived from the very same virus that caused the 1918-20 pandemic.
Data from the USA is usually fairly complete, so looking at data from the Centres for Disease Control (CDC), the death rate from influenza and pneumonia is around 32 per 100,000 of the US population. This, according to the CDC, makes it the sixth leading cause of death in the United States following heart disease, cancer, stroke, unintentional injuries, and chronic obstructive pulmonary disease. If you then convert this death rate to a daily death rate, you’ll find that on average, taking into account even the non-influenza seasons when death rates are substantially lower, on average around 270 people die from this cause in the USA every day, 365 days a year.
In contrast, so far in the USA (1 May 2009), the US Government has reported 109 confirmed cases of swine flu, with just a single death. Over the same period, Mexico has reported just nine deaths, and 156 confirmed cases. Sixty six further cases have been reported in a further nine countries—with no deaths. None.
On this basis, surely thre's no basis to claim that 'swine flu' represents a massive threat, when it is clearly responsible for considerably less death than the common and garden seasonal influenza A….?
Fortunately, if you listen to those who are a little more in the know than the rabid media channels, you'll find experts like Professor Wendy Barclay, chair of influenza virology at Imperial College London, quietly referring to this recent bout as a "mild strain" and "of no particular concern".
We get some further perspective when we look at other diseases. Malaria for example kills over 1.14 million people a year. This means that—every day—365 days a year, over 3,000 people die from the mosquito-vectored plasmodium, particularly in Sub-Saharan Africa. But the media is conspicuously silent about this, perhaps because the pharma and pesticide companies have failed over such a long time to get anyone excited over their mostly unsuccessful attempts to deal with the disease. More cynically, there's also less money available in malaria-infected countries than there is in western countries susceptible to the swine flu hype.
What is swine influenza?
Genetically, this virus appears to contain a combination of swine, avian, and human influenza virus genes. Technically, this why it is being referred to as a novel human flu virus. So while intensive farming of pigs, poultry and other animals have the potential to be fertile production grounds for new strains of pathogenic disease organisms, you can’t help feeling that, given the media hype about ‘swine flu’, pigs are in this case being unfairly maligned.
Historically, human transmission of swine flu from birds or pigs may often have gone undetected due to them yielding mild or even no symptoms at all, or assumed to be normal seasonal flu. Subsequent human to human transmission has happened before too, although this has been limited to close contacts or closed groups of people. As with seasonal flu, deaths would occur, particularly among those with poor immunity, and among the vulnerable such as the very old, the very young or the already sick. The World Health Organisation (WHO) website provides some answers to frequently asked questions about swine influenza, as well as giving the official figures for infections and deaths in the current outbreak of what they now refer to as influenza A (H1N1).
The particular strain or subtype of the H1N1 virus associated with the current concern could of course also cross to pigs, something the pig industry is justifiably concerned about. But for the time being it has found a way of transmitting readily between humans, mainly cause it binds to tissues in the nose and throat where it can easily be passed on by coughing or sneezing. In contrast, the much more virulent H5N1 bird flu virus, although it has not yet found ways of sustainable ways of human to human transmission—and may never mutate to do this—binds to tissues in the lung. There it causes much more serious disease, notably viral pneumonia, and creates a massive imbalance in the immune system referred to as a 'cytokine storm'.
When looking at ways of reacting to the current situation we should particularly draw from the lessons of the past. The swine flu epidemic of 1976 is of particular relevance and is a good example of hype leading to catastrophe. In this epidemic more people were harmed by the efforts to deal with the virus—notably vaccination—than they were by the virus itself, which remained fairly non-virulent.
One particualar problem was the increase in Guillain-Barré syndrome (GBS) among the more than 40 million Americans who received swine flu immunizations. The syndrome causes paralysis from the legs upward as a result of a response in the immune system which attacks the nerve sheaths. The condition may be fatal while some may be left permanently paralysed. Click here to read the CDC’s reflections on the events of 1976. It is estimated that some 500 vaccinated people developed GBS, and of these, 25 died. This means that vaccinated persons were between 4 and 8 times more likely to get GBS. Are you prepared to trust vaccine companies and governments this time around?
If we’re not careful, another 'debacle' or 'fiasco'—the terms frequently used after the 1976 event—could be in the making today.
Is there cause for alarm?
It is of course early days, and vigilance and reasonable precautions are prudent due to the unpredictable and fast evolving nature of influenza viruses. We have a new strain of a virus that has acquired the ability to transmit from human to human rather easily. But the big question is: what will be its effect in the infected? All signs thus far is that the virus produces mild symptoms and the lack of a sky-rocketing death rate in Mexico might mean that its effects will become even less marked in time. But we can’t be sure—a single mutation could increase its virulence—and that means surveillance is a worthwhile venture. What about anti-viral drugs and vaccines? The current pattern of the disease would suggest that any use of drugs or vaccines would be utter madness, given that both carry significant risks to health and may have very little if any beneficial effect.
The apparent trend of lowering virulence of this viral epidemic of course makes the increasing alarm around 'swine flu' even more absurd. The facts: we have a flu virus that already causes relatively mild symptoms, milder than the seasonal flu virus to which it’s related, and even the World Health Organization is telling us that it doesn’t warrant anti-viral drug treatment or vaccines to be developed. And it’s effects will likely become even milder……
Who benefits from the hype?
This swine flu pandemic scare is very timely indeed for the pharmaceutical industry, which has not been enjoying, in the recent years, the easy ride it had in previous decades. The hype has already seen share prices in the pharma companies Roche and GSK, makers of the anti-viral drugs Tamiflu and Relenza, soar. Even if a pandemic does eventuate, the companies will have some difficulty making a killing (excuse the pun…[ed]) from immediate sales because of the significant lead time required to prepare for large-scale manufacture. But the pharma companies are already gaining from sales to countries to replace or even increase country-held stockpiles of anti-virals that will be approaching the end of their shelf life. You’ll remember how countries built up their stocks following the bird flu scare of 2006? Well, now it’s three years on and, yes—you’ve guess it— the shelf life of Tamiflu is 36 months, and around the same for Relenza.
Hogwash or hog hoax? The maligned swines?
You can see how GSK is gearing people up by checking out its Pandemic Planning webpage, which is nothing short of a commercial.
There’s also a lot of money to be made from countries that decide they want stockpiles held by the drug companies ready for use. The drug companies themselves manage these stockpiles on behalf of individual countries, being paid a fat retainer for the privilege, allowing them to rotate stocks keeping them in date. But certainly in the case of Roche and its anti-viral drug Tamiflu, when a country wants the stock because of an imminent pandemic, it will be shipped within 48 hours and the drug company receives in exchange a fat cheque from selling the drug at wholesale price. Not a bad business arrangement if you can ensure a pandemic from time to time so you get your cash prize on top of your retainer!
So, saying that the current epidemic is convenient for the pharma companies is a bit of an understatement. The vaccine companies will also be major beneficiaries of 'swine flu 2009'; they are already increasing their sales of seasonal flu vaccines to countries, knowing full well that that they will have little effect on a mutated form of H1N1. In due course, they will also be able to 'upgrade' their future seasonal flu vaccines by incorporating swine flu, and governments will no doubt try to persuade or force ever more people to be vaccinated. For example, Maryland-based Novavax Inc. and Illinois-based Baxter are are gearing up to fast-track a human vaccine for this particular strain, while increased use of vaccines in the pig industry is also likely.
Looking back at the bird flu scare
The pharma companies certainly benefitted enormously from the avian flu pandemic scare: The Independent, a leading UK paper, reported on the 12th March 2006 that Donald Rumsfeld, the US Defence Secretary, made more than $5m (£2.9m) in capital gains from selling shares in the pharma company that discovered and developed Tamiflu, the drug that was stockpiled by Governments in more than 40 countries to treat a possible human pandemic arising out of avian flu.
The most common side effects of Tamiflu are, nausea, vomiting and stomach ache. These side effects mostly occur only after the first dose of the medicine and will usually stop as treatment continues. The frequency of these effects is reduced if the medication is taken with food.
Less common side effects of Tamiflu
Skin reactions and liver function disorders have been very rarely reported.
Children (aged 1 to 12 years)
Other less common side effects, which may also be caused by influenza, are diarrhoea, ear inflammation, inflammation of the lungs, sinusitis, bronchitis, aggravation of pre-existing asthma, nose bleeding, ear disorders, inflammation of the skin, swelling of the lymph nodes and conjunctivitis.
Adults and adolescents (children aged 13 years and older)
Other less common side effects, which may also be caused by influenza, are nausea, diarrhoea, bronchitis, dizziness, tiredness, headache and sleeping difficulties".
This in-pack leaflet ignores the potentially fatal neuropsychiatric effects of Tamiflu. Drugs.com is more revealing, saying: "Influenza can be associated with a variety of neurologic and behavioral symptoms which can include events such as hallucinations, delirium, and abnormal behavior, in some cases resulting in fatal outcomes."
The Australian division of Roche gives a more accurate warning : "People with influenza, including those taking TAMIFLU may be at an increased risk of seizures,confusion, hallucinations, and/or abnormal behaviour during their illness. These events may occur shortly after beginning TAMIFLU or may occur when influenza is not treated. These events are uncommon but may result in accidental injury to the patient."
But even here, Roche appears to have cleverly worded its statement to suggest such lethal side effects could be caused by influenza and not by Tamiflu!
The ANH looked at the problem with both anti-viral drugs and vaccination strategies in some detail when, back in 2006, we were requested by the WHO to prepare guidelines for how natural products might be used to support the body's immune system in the event of an H5N1 pandemic.
Don’t panic, get some perspective
When you look at the bigger picture and see the facts and figures in context, the present situation does look to be massively overblown by the media, by governments and by the drug companies.
Here’s what we advise for the time being:
Keep a watchful eye on reliable media sources informing you of the spread of the new strain of 'swine flu'
In particular, watch out for evidence of its virulence. If the virus is decreasing rather than increasing in virulence, there is really nothing to worry about