The meeting was only short, but it was enough to give Barry Greatorex a dose
of swine flu. Ten days ago the 43-year-old project manager for a freight
company travelled to Castle Donington in Leicestershire to see a colleague
who had returned from a holiday in Mexico.
“I was just in her office and was probably only there for half an hour or so
having a conversation with her,” Greatorex said yesterday from his home in
Chipping Sodbury, Gloucesterhire. “In that period of time I seemed to have
contracted it. She had a cough and that’s seemingly where I got it.”
Last Monday the symptoms began. “The first two or three days were pretty
horrible,” he said. “Each day was worse, starting with chest pains and then
the fever.”
Eventually he was put on antiviral drugs and the pain eased. “I have a runny
nose now and a bit of a cough, but I’m feeling a lot better,” he said.
Greatorex’s experience was being repeated across Britain as the virus spread
with alarming speed. Children at a primary school in Paignton, Devon, were
in tears after it was confirmed that a 12-year-old girl had contracted swine
flu.
Yesterday morning Graham Young, an oil-rig worker, was flown to Aberdeen from
the North Sea after concerns that he had been exposed to the virus. Last
weekend he was drinking with his friend, Graeme Pacitti, 24, the first
victim of human-to-human transmission of swine flu within the UK. Pacitti is
thought to have contracted the virus from Iain Askham, the Falkirk man who,
with his bride, Dawn, became the first confirmed UK case after honeymooning
in Mexico.
By the end of the week 15 cases of swine flu had been confirmed in Britain, as
far apart as Merseyside, Tyneside, London and Bristol. This weekend more
than 600 samples were being tested for the virus.
As the week progressed, experts issued a procession of dire warnings. Some
compared the virus with Spanish flu, which killed an estimated 50m people
worldwide in 1918-19. Both viruses are of the same strain and are mainly
affecting people aged between 25 and 45.
Professor Neil Ferguson, an epidemiologist at Imperial College, London, warned
that up to 40% of the population could become ill in this outbreak.
Robert Madelin, the European commission’s most senior health official, said:
“The question now is not whether people will die, but whether it will be
thousands, tens of thousands or hundreds of thousands.”
The warnings reached fever pitch on Wednesday when Margaret Chan,
director-general of the World Health Organisation (WHO), raised the global
alert from phase four to phase five, one below the maximum. This meant that
a pandemic, in which a disease spreads rapidly from continent to continent,
was imminent. “It really is all of humanity that is under threat,” she said.
This week the Department of Health will post leaflets to every household
urging people to find “flu friends” who can bring them groceries and
supplies if they fall ill. It will also dispatch bundles of antiviral drugs
to hospitals and clinics.
Yet despite the preparations and warnings, the number of deaths remains small.
To date, 17 countries have confirmed more than 700 cases of H1N1, although
the figures are rising constantly, with just 17 deaths having been directly
attributed to it. All bar one were in Mexico, where the virus is believed to
have originated. The exception was a two-year-old Mexican boy who died on a
visit to Texas.
In the UK, swine flu is producing mild symptoms, almost identical to those
associated with seasonal flu. The virus is also responding well to treatment
from the antiviral drug Tamiflu.
At Newcastle University, where a new case was discovered on Thursday, Ellis
Hanson, a 20-year-old fine arts student, said she and her friends were not
concerned because they remembered previous scares about bird flu and Sars.
“We have exams coming up and people are worrying more about them,” she said.
Is her sang-froid justified? Just how severe will a potential flu pandemic be?
Why is it killing only people in or from Mexico? And why are scientists and
the WHO so concerned?
AT THE Azcapotzalco farmers’ market in Mexico City, Esmeralda Salazar was
hunting for protection from swine flu. She brushed past the stalls laden
with fresh fruit and vegetables and stopped at a small stand advertising
“medicinal plants . . . spiritual waters . . . natural lotions . . .
amulets”.
Behind a table piled high with strange-looking herbs, tangled weeds and strips
of bark, an elderly man who said his name was Christian produced a small
plastic bag stuffed with what seemed to be tea leaves and twigs.
The concoction smelled vaguely of peppermint and, according to Christian,
would “build up your defences against the virus”. The woman handed over 10
pesos (about 45p).
Thousands of Mexicans took a conventional approach to the swine flu threat,
and queued for hours last week to see doctors at hospitals and clinics. Yet
Salazar’s preference for alternative medicines reflected a popular Mexican
tradition that officials believe almost certainly contributed to a dangerous
delay in the initial diagnosis of swine flu.
“When Mexicans fall ill, they first try to cure themselves,” said Edmundo
Bermudez as he queued at a nearby chemist. “It’s easy to get drugs here
without a prescription, so you just go to the chemist and say, ‘I’m not
feeling well, give me some penicillin’.
“Everyone here thinks penicillin cures everything. But go to a doctor? That’s
expensive, and then he sends you to hospital and you have to wait all day.
For many of us that means missing work and losing pay.”
A lingering enthusiasm for traditional herbal medicines remains potent even in
sophisticated cities. In rural areas they are often the norm.
“People wait too long to go to doctors,” agreed Marcelo Noguera,
undersecretary of health for the state of Oaxaca, where the first fatality
in the outbreak was recorded.
The high fatality rate among Mexican victims – compared with the much less
severe effects of the virus in other countries – was being blamed largely on
initial delays in seeking treatment and on possible complications from
misdiagnosis and inappropriate medicine.
Some of these factors appear to have been present in the death of Adela Maria
Gutierrez, who fell ill at the beginning of April. She treated herself with
aspirin and waited three days to see a doctor who then gave her antibiotics
for a sore throat.
She was reluctant to leave work to go to hospital – where, it later turned
out, there were Easter-related staff shortages and no available respirator.
By the time specialists realised she might have a rare form of flu, it was
too late to save her.
One senior Mexican epidemiologist last week blamed “the idiosyncrasies of
Mexicans” for a shared suspicion of hospitals or anything run by the
government; less easy to explain was why Gutierrez died while many people
who came into contact with her – including her husband Luis – have displayed
no symptoms of the virus.
Even in the country worst hit by the flu, opinion polls last week indicated
high levels of public scepticism about the government’s handling of the
crisis – notably its confused and contradictory announcements about the
numbers of people infected.
On Friday health officials said that of 908 samples from apparent victims
tested in the latest batch sent to America for assessment, only 397 came
back positive, suggesting that the overall numbers may be below the 2,500
suspected. Yesterday the Mexican government revised the number of suspected
swine flu deaths in the country from 176 to 101.
The capital’s hospitals and clinics were also strangely quiet for the supposed
centre of a global flu pandemic. On Friday at the city’s biggest hospital,
only a handful of relatives waited anxiously for family members who were
feeling unwell. “It’s very quiet,” said a nurse at the gate. “We are seeing
no more people than usual.”
Left-wing critics of President Felipe Calderon’s government were quick to
suggest that the authorities had deliberately inflated the threat of a
pandemic to take credit for resolving a much milder crisis. Part of his
prescription was an enforced five-day public holiday that started on Friday.
“They have been sowing a climate of fear and psychosis,” claimed a trade union
leader who addressed fewer than 100 communist faithful in a brief May Day
rally at the capital’s main square, the Zocalo.
Ricardo Monreal, a leftist senator, said of the government’s virus data:
“These are overly conservative numbers and they seem to be hiding
something.” MODERN diagnostic techniques and the internet, however,
guaranteed that the secrets of the virus could not be hidden. The first
reports of a novel flu emanating from Mexico sparked a worldwide race to
unpick the virus.
Last weekend the Centers for Disease Control (CDC) in Atlanta published the
DNA sequences of several virus samples in an online public library. Since
then more than 30 swine flu samples have been made available by scientists.
These virtual viruses are being pored over by hundreds of scientists as they
search for clues about swine flu’s origins, its infectiousness, virulence
and susceptibility to antiviral drugs. Despite the WHO’s gloomy prognosis,
initial analysis suggests the virus may not be as lethal as first thought.
In the US scientists have found that the virus differs significantly from the
strain that brought such carnage in 1918, lacking an amino acid that
increases the number of virus particles in the lungs and makes the disease
more deadly.
“There are certain characteristics, molecular signatures, which this virus
lacks,” said Peter Palese, a microbiologist and influenza expert at Mount
Sinai medical centre in New York.
In many cases, previous exposure to other viruses may also be giving people a
level of natural immunity.
Ralph Tripp, an influenza expert at the University of Georgia, has compared
the virus with the 1957 flu pandemic strain, which killed up to 2m people
worldwide. His early analysis of the protein-making structure suggests they
are similar. As a result, exposure to the earlier pandemic may be giving the
elderly a higher level of immunity, as seems to be the case in Mexico where
the disease has mostly killed young adults.
According to Wendy Barclay, chairwoman of influenza virology at Imperial
College, London, the swine flu looks like a mild strain. It is an H1N1
virus, the same type as seasonal flu which circulates around the world every
year and kills about 0.1% of those infected.
The virus tends to attach to receptors on cells in the upper respiratory
tract, the nose and the throat, causing mild illness but spreading easily
through coughs and sneezes. By contrast bird flu, H5N1, attaches deep in the
lungs and causes severe illness.
Professor Alan Hay, director of the WHO’s World Influenza Centre in Mill Hill,
north London, is encouraged by the similarities. His team is analysing a
live sample of the virus and assessing whether people may already have a
level of natural immunity.
If so, swine flu may ultimately prove no more deadly than seasonal flu, which
nevertheless kills up to 12,000 people a year in the UK and up to 1m
worldwide.
Hay said: “The viruses are related. That means there is a chance that we have
natural immunity. The difficulty is that people have been primed with the
bird flu horror stories about pandemics, which was a pretty horrendous
scenario.
“This might not be any more virulent than normal seasonal flu infections. We
feel reassured that if this develops into a pandemic it might not be a
particularly severe one.”
Some scientists are consequently becoming increasingly concerned by the levels
of hype and fear surrounding the virus.
Tripp warned that the WHO is failing to keep the risk in perspective,
especially after Chan’s comment that “all humanity is under threat”.
“They should just tell the facts and not extrapolate anything,” he said. “[The
statement] is clearly her opinion – it’s completely comment, not impartial
fact.”
Frank Furedi, professor of sociology at the University of Kent, said: “They
[the WHO and other researchers] have adopted this language where they
continually assume the worst case scenario. It means we lose the ability to
make balanced assessments of risk.
“It is like the boy who cried wolf – if we react with this level of hysteria
now, what will we do when a really bad pandemic comes along?” SO are the
warnings and preparations by governments out of kilter?
Even though the virus is relatively mild, it is highly contagious, meaning it
has the potential to infect so many people that a large number could die.
Nikki Shindo, a medical officer at the WHO, said: “Even though the fatality
rate is relatively low we will see a lot of people dying because of the
large number of people being infected. As more and more cases are reported
in the US, we are starting to see some hospitalisations and more severe
cases. We may see the same pattern in the UK.”
The lingering fear is that the virus will mutate into a more lethal form.
Barclay said: “We need to watch out for whether this virus will change.
Often viruses that have jumped species and found new hosts are under
considerable pressure to adapt.”
The WHO is also concerned that the virus will develop a resistance to Tamiflu,
the world’s drug of choice in the fight against a pandemic flu outbreak.
There are already ominous signs.
According to the CDC, in the flu season of 2007-8 only 12% of circulating H1
flu viruses were resistant to Tamiflu. This season 98% of them are, for
reasons not yet understood.
The prospect of swine flu developing a spontaneous resistance to Tamiflu, or
swapping genes with an existing resistant H1N1 strain, is alarming officials
at the WHO. “It is a big concern,” said Shindo.
There is another treatment option, however. The UK has stockpiled 12m doses of
Relenza, an antiviral that has also proved effective at treating swine flu.
H1 viruses have no resistance to it.
The government has stockpiled twice as much Tamiflu, however, and last week it
ordered 15m more doses, making the ratio of Tamiflu to Relenza almost four
to one.
Hugh Pennington, emeritus professor of bacteriology at Aberdeen University,
said stocks of Relenza in Britain should be increased.
“We have to get as much as possible because we don’t know how effective
Tamiflu will be,” he said. “There is an issue of Tamiflu resistance. All
things being equal, it would be nice to get as much Relenza as we can get
our hands on. No one really knows if Tamiflu will significantly reduce
transmission; the expectation is it will, but we don’t know for sure.”
The only long-term solution to a pandemic would be to develop a vaccine.
At present four laboratories worldwide, including the National Institute for
Biological Standards and Control in north London, are working with the live
virus to find one.
The scientists will take the genes that make swine flu’s outer coating and
attach them to a harmless human virus called PR8. This reconstructed virus
is safe for humans, but triggers an immune response that specifically
protects against the swine flu strain.
The process, however, is slow. Scientists estimate that it will take three
weeks to make a seed vaccine, then a further four to six months to grow
enough for mass distribution.
It is also not without controversy. To accommodate the mass production of a
pandemic flu vaccine drug, manufacturers will have to scale back production
of the annual winter flu jab for the elderly and other vulnerable groups.
Ministers admitted last week that there would be a significant “public health
difficulty” if the WHO ordered companies to switch production.
Eric Althoff, a spokesman for Novartis, the Swiss pharmaceutical company that
is one of the world’s biggest vaccine manufacturers, said: “The WHO will be
trying to balance the benefits of producing a pandemic flu vaccine against
the risks of halting production of seasonal flu vaccine. It is a difficult
choice.” THIS weekend the WHO was preparing to declare a full-blown
pandemic. According to its experts the swine flu alert is likely to be
raised from phase five to six in a matter of days, despite its being a
relatively mild strain. The move will leave the government continuing to
tread a fine line between raising public awareness and avoiding scare
tactics.
Sir Liam Donaldson, the chief medical officer, has to date been notably
restrained, refraining from discussing the number of people who could be
killed and from the alarmist language of the WHO.
Many in the forefront of treating the virus fear the line has already been
crossed, with the public mistrusting what they have heard from official
sources.
One doctor who treated a swine flu sufferer last week said: “The patient was
terrified when he got it. It’s really been talked up. This time last week we
were all incredibly worried because the reports coming out were that
hospitals were full and people were dying all over the place.
“We have this awareness of the 1918 epidemic which had a very, very high
mortality rate. But actually we are getting much more relieved that it
doesn’t seem to be severe. In terms of severity the symptoms are unpleasant
– fevers, shivering, aches – but not severe. Our patient made a full
recovery.
“The way they [the WHO] are talking you would think our culture is collapsing.”
Additional reporting: Ronald Buchanan
Dealing with the dread factor
As a species, we are poor at assessing risk, writes Hugh Aldersey-Williams.
Evolution has equipped us well to deal with immediate danger – our senses
alert us when we prepare to cross the road or taste unfamiliar food – but we
have no way of measuring dangers further off: that is to say, risks.
We find it easy to imagine risks but impossible to assess them. As I write, I
have no practical idea what’s the greatest risk I face. A virus might fly in
through the window, a plane might crash on the roof.
More likely, perhaps, a rat might chew through the wiring and start a fire.
But I can’t make the assessment.
Statistics don’t really help. They appear to us as cold, abstract numbers.
There’s no way to relate them to the visceral horrors we create in our
mind’s eye.
Even if I could get hold of a figure for the likelihood of a rat-induced fire,
I couldn’t be sure it was valid for my circumstances and I still wouldn’t
have a basis for comparing it against all the other hazards I face.
As a result, we underestimate the risk where the context seems benign, such as
that from x-rays, and overestimate it where there is a high dread factor –
in the cases of, say, nuclear power, terrorism or knife crime.
Sigmund Freud gave three core reasons for human anxiety. The first two are our
failing bodies and nature’s might, which cover our fear of disease and
disaster. The third agent of worry is social aggravation: we can talk
ourselves into a state of fear.
Our response to risk is negotiated over the dinner table and by the water
cooler. Worried about the economy, migrant workers taking your job, or your
children’s school? Well, then, talk about it. It’s how we decide what to
worry about.
That is why there has been little panic about the spread of swine flu. The
national conversation recalls the bird flu scare of 2005-6. Alarming
government figures were published suggesting that a quarter of Britain’s
population would be infected and that 1 in 100 might die. The outbreak never
came.
A rational response then was to observe that while probably nobody would die
of bird flu in Britain, the usual 12,000 people a year were pretty sure to
die of ordinary flu, a disease too chronically boring to write headlines
about. This time the virus is a type of ordinary flu. That is why planning,
and not panicking, seems to be the order of the day.
Hugh Aldersey-Williams is the co-author with Simon Briscoe of Panicology
(Penguin)
Is this the bird flu scare revisited?
Why all the fuss? Influenza is a virus that constantly changes, some versions
being mild, others lethal. The current outbreak of swine flu is causing
concern because many of the 101 people believed to have been killed by it in
Mexico have been young and middle-aged, rather than the elderly and infirm,
the usual victims of flu.
But hasn’t only one person outside Mexico died? Yes, and that victim was a
child in the US who had come from Mexico. The disease may indeed be a mild
form of flu, but it’s too early to tell for sure. What is clear is that it
has spread worldwide and that it can transfer not just from pigs to humans,
but from human to human.
Why is this called a “pandemic” when ordinary flu is not? Flu viruses
circulate all the time, usually causing epidemics in winter in temperate
countries. A pandemic occurs, according to the World Health Organisation
(WHO), when a new flu virus appears against which humans have no immunity,
resulting in outbreaks worldwide. The swine flu virus, even though it has
yet to kill large numbers – and may never do – meets this criterion.
Why does everyone mention 1918? The “Spanish flu” of 1918-19 was the worst
pandemic in modern history. A new flu strain emerged that, unusually, was
most deadly for those aged between 20 and 40. Many are thought to have
suffered “cytokine storms” – massive overreactions of the immune systems. An
estimated 50m people worldwide died. Remember, however, that mortality rates
may have been high because living conditions and medical treatments in 1918
were nowhere near as advanced as they are in many countries today.
If we’re not at that point, why is the WHO saying “all humanity” is at risk?
There hasn’t been a significant pandemic for decades; younger generations
may have low immunity; modern travel spreads disease faster than ever. All
these factors mean a virulent new virus could circle the globe very rapidly.
How does the virus spread? Mainly through tiny airborne droplets from the
coughs and sneezes of infected people. Carriers can become infectious a day
before they show symptoms of flu. The virus can also survive for several
hours on an inanimate surface, such as a door handle. If you pick up the
virus on your hands and then touch your mouth, nose or eyes, it can still
infect you.
So what can I do to protect myself? Avoid people who have the flu and are
coughing and sneezing, and wash your hands frequently.
What about a face mask? They are better than nothing if you cannot avoid
infected people – but they are not designed to stop flu infection and you
may still inhale the virus even if you are wearing one.
What should I do if I get symptoms? Consult the NHS website, which has a
“symptom checker”, for advice or ring the government’s advice line on 0800 1
513 513. If your symptoms are confirmed, ring your GP or NHS Direct. Do not
go to your doctor in person.
Can medicine save me? Swine flu H1N1 is at present treatable with a drug
called Tamiflu, which the government has stockpiled. However, as flu viruses
mutate they can develop resistance to drugs. Scientists may also develop a
vaccine against swine flu, though this will take months. Remember: even in
the 1918 pandemic only a tiny fraction of those infected died. Most people
recover naturally.
Is this a rerun of the bird flu and Sars panics that came to nothing?
Possibly, though it’s too early to say. But with flu pandemics, officials
err on the side of caution.
