Swine flu Q & A: Is it going to get much worse?
Should I try taking
Vitamin C?
Wednesday, 29 April 2009
Q. How infectious is swine flu?
A. In the days since the disease was first reported in Mexico and the US
it has spread across the world, triggering the World Health
Organisation' s decision to raise the pandemic threat from level 3 to
level 4 (out of six). Flu is one of the most infectious illnesses known
and the WHO has already recognised that the outbreak cannot be
contained.
Q. Will we see it spread like ordinary winter seasonal flu?
A. That is not yet clear. Outside Mexico, swine flu has not so far been
shown to spread widely in the community. Outbreaks appear to have been
caused by travellers returning from Mexico spreading the virus in
schools or to their families and close contacts. The first confirmed
cases in Britain, Iain and Dawn Askham of Falkirk, Scotland, who had
been on honeymoon in Cancun, Mexico, had contact with 22 people in the
week since they returned, of whom nine have developed symptoms that
could be swine flu.
Q. How bad is it going to get?
A. So far, cases outside Mexico have been mild. No one knows how it is
going to develop but the WHO has warned that it would be a mistake to be
lulled into a false sense of security. The 1918 Spanish flu pandemic
started mildly – and went on to kill 20 to 40 million people round the
world. "I think we have to be mindful and respectful of the fact that
influenza moves in ways we cannot predict," Keiji Fukuda, WHO acting
assistant director-general, said.
Q. Could it die away over the summer?
A. Yes – but only temporarily. Swine flu has struck at the end of the
winter flu season in the northern hemisphere. Flu normally dies away in
summer, only to return the following winter. The reasons are thought to
be linked with the increase in ultraviolet light from longer days, which
destroys the virus, and the fact that people spend less time huddled
together indoors where it is easier to transmit the infection. The worry
is that if it subsides over the summer it could return with a vengeance
next winter, in a more virulent form. Professor Neil Ferguson, of
Imperial College, London, said yesterday that up to 40 per cent of the
population in Britain could be infected.
Q. Can I call the national flu line for advice?
A. Not before next autumn. Lord Darzi, health minister, said the
dedicated telephone and web based advice service, which would be a key
feature of the countries defence against a pandemic helping patients
diagnose their symptoms and obtain anti-viral drugs, would not be up and
running for six months. The service is supposed to be capable of taking
six million calls a week and come on line when the WHO raises the threat
level to Phase 5 (it is now Phase 4).
Q. Is it worth taking Vitamin C?
A. Alternative health practitioners of homeopathy, herbal remedies and
nutritional medicine are recommending measures to protect against the
flu. They are about as useful as a water pistol against a forest fire.
Q Do masks provide protection against swine flu?
A Yes, but probably not to the person wearing them. They help stop the
virus being expelled from the mouth and nose when coughing or sneezing,
but are much less effective at protecting the wearer from a virus picked
up on the hands or circulating in the air. Wearing a mask thus becomes a
public-spirited act.
Q Now swine flu has arrived in Britain how likely is it to spread?
A Highly likely – if it hasn't already. There were 14 suspected cases
under investigation in Britain yesterday. It is a new virus, with a
combination of genes from pigs, birds and humans, and has proved that it
is easily transmitted from human to human. As it is a novel virus,
immunity to it is likely to be low and almost anyone could be
vulnerable.
Q Should Britain screen travellers at its borders?
A Flu is one of the most infectious illnesses known – one cough by an
infected person can transmit the virus to a roomful of people. The
disease takes up to seven days to produce symptoms so most travellers
would not know they were infected until after they reached their
destinations. Screening at airports and land borders may pick up some
travellers but the effect would be limited. Politicians like to impose
border controls because it shows they are doing something.
Q Will this outbreak develop into a pandemic?
A It has all the hallmarks of one and has already been identified on
both sides of the Atlantic. Just how rapidly it is spreading will be
confirmed in the coming days. What we don't know is how virulent the
virus is. While some victims have died, others have recovered after only
a mild bout of illness.
Q What defence do we have against swine flu?
A Better than we did against the last pandemics in 1957 and 1968. We
have a stockpile of anti-viral drugs – Tamiflu and Relenza – which we
did not have then. We also have a pandemic plan, drawn up by the
Government since avian flu became a threat in 2003, which sets out what
is to be done – from distributing the drugs and setting up helplines to
closing schools and banning public events.
Q Has the pandemic plan ever been tested?
A Yes, in one of the biggest emergency planning exercises since the end
of the Cold War that took place in 2007. It involved hundreds of health
officials across the country.
Q Are there enough anti-viral drugs?
A Not according to the Tories. The Government says it has over 30
million courses of the drugs, enough for half the population. The Tories
say this is not enough if family members of an infected person are to be
treated prophylactically. In that case, enough drugs to cover three-
quarters of the population will be necessary, they say.
Q How do anti-viral drugs work?
A Two anti-viral drugs have been licensed in Britain in the last decade:
Tamiflu and Relenza. The problem with the flu virus is that it is
constantly mutating, so a new vaccine has to be produced each year. The
anti-viral drugs get round this by targeting not the virus itself but an
enzyme that enables the virus to spread from cell to cell. Provided they
are taken within 48 hours of the onset of symptoms they can shorten the
illness and reduce its severity.
Q What is the difference between Tamiflu and Relenza?
A The big difference is that Tamiflu is taken as a pill while Relenza is
inhaled directly into the lungs.
Q Why has the Government got both drugs in its stockpile?
A Because resistance has emerged in flu strains in some countries,
rendering the drugs ineffective.
Q What about a vaccine?
A Pandemics tend to happen in waves separated by several months, so a
vaccine could potentially be developed against the second or third wave,
if they occur. A vaccine first has to be matched to the exact strain of
the virus and then incubated in hen's eggs, which may take up to six
months. Hundreds of millions of doses would be required which would put
huge pressure on the world's laboratories.
Q Shouldn't a vaccine be the first priority?
A Previous vaccines against swine flu have turned out to be worse than
the disease. An outbreak in the US in 1976 infected 200 people, of whom
12 were hospitalised and one died. But before it was over 40 million
people had been vaccinated, 25 of whom died and 500 of whom developed
Guillain-Barre syndrome, which can be fatal.
---
Q: What is swine flu?
A: Much the same as human flu – but in pigs. The worry is that pigs are
excellent hosts for the virus. And because they are genetically close to
humans, they can pass the virus to us more easily than birds can. The
great fear over the past decade has been that the avian flu virus, H5N1,
would infect pigs which would act as a reservoir for its transmission to
humans. Luckily for the world, apart from a few isolated outbreaks, this
did not happen.
Q: How worried should we be?
A: At this stage, no one knows. The virus that has caused the outbreak
is a strain of the H1N1 type that contains bird, pig and human genes in
a combination never seen before. Immunity to it will thus be limited.
Scientists are working to establish the precise nature of the virus, the
symptoms it causes and its capacity to cause disease and death.
Q Has swine flu infected humans before?
A: Yes. There have been rare cases since the 1950s, mostly in people
such as farmers who work directly with pigs. In Europe, 17 cases have
been reported since 1958. In the US, an outbreak at a military camp in
New Jersey in 1976, infected over 200 soldiers, of which 12 were
hospitalised and one died.
Q What are the symptoms of swine flu?
A: Similar to ordinary human flu – cough, sudden fever, headache, muscle
pains. In severe cases, it may lead to pneumonia, multi-organ failure,
and death. The incubation period for ordinary human flu is two to five
days.
Q: Can it be treated?
A: Yes – up to a point. Early indications are that patients in Mexico
and the US have been successfully treated with the antiviral drugs
Tamiflu and Relenza. These drugs cannot prevent flu but they can limit
its severity, and thus save lives, if taken as soon as symptoms develop.
However, the swine flu has proved resistant to older anti-virals such as
amantadine.
Q: Is Britain prepared for a pandemic?
A: Better than it was five years ago. A pandemic plan has been prepared
detailing action by everyone from pharmacists, who will hand out anti-
viral drugs, to hospitals handling the seriously ill, to mortuaries
which may have to be temporarily expanded. Over 14 million courses of
Tamiflu have been stockpiled and the Government announced last year it
was doubling the amount to provide enough for half the population.
Q: How bad might a pandemic be?
A: At its worst, it could have a devastating global impact, greater than
a terrorist attack, nuclear accident or environmental disaster. The
World Health Organisation estimates that a mild pandemic could cause up
to 7.5 million deaths. In the UK, Sir Liam Donaldson, the Government's
Chief Medical Officer, has said that in the worst case scenario the
country could face up to 750,000 deaths. However, in the flu pandemics
of 1957 and 1968 most victims recovered. There was no panic, cities did
not empty, travel did not come to a halt and economies weren't
devastated. Each of those pandemics killed 50,000 people in the UK and
around one million worldwide. In a normal year, flu kills 12,000 to
20,000 mainly elderly people in Britain and 250,000 around the world.
Q: Who is at greatest risk?
A: In Mexico, the virus appears to be targeting those aged 20 to 40.
This is not unusual – the same occurred during the worst pandemic of the
last century, in 1918, when 20 to 40 million people died. Young healthy
people with strong immune systems react most powerfully to the virus but
the very strength of their reaction produces inflammation and secretions
in the lungs which can be overwhelming. In the US, the virus appears to
be targeting children who are suffering only mild illness. The
difference in the two countries is so far unexplained. One hypothesis is
that a second virus may be circulating in Mexico which is interacting
with the swine flu virus to produce more severe symptoms.
Q: How can I protect my family?
A: By acquiring a stock of anti-viral drugs such as Tamiflu or Relenza,
available only on prescription at an NHS cost of around £20 for a course
of 10 doses (enough for one person). Otherwise, the best defence is
strict personal hygiene. It is hard to better the advice printed by the
'News Of the World' on 3 November 1918: "Wash inside nose with soap and
water night and morning; force yourself to sneeze night and morning,
then breathe deeply. Do not wear a muffler, take sharp walks regularly
and walk home from work; eat plenty of porridge." Porridge is, of
course, a known cure-all – but the rest of the advice holds as true
today as it did then.
Q: Is there a vaccine against it?
A: Not in humans (there is in pigs). Ordinary seasonal flu vaccine for
humans might offer some protection because there are similarities
between the H1N1 human flu viruses and the new H1N1 pig flu virus.
Investigations are under way to see if the seasonal vaccine would have a
protective effect but those will "take some time".
Q: Why has this outbreak started in Mexico and the US?
A: No one knows, but it is certainly a surprise. The next threat was
expected to come from the Far East. Avian flu has spread through poultry
populations, and 400 humans have been infected, 250 of whom have died.
Health experts warned that a small mutation to the virus could turn a
rare but lethal disease into one which could threaten the entire planet.
Now, the threat has emerged – but on the other side of the world.
Q: Is it safe to eat pork?
A: Yes. Cooking destroys the virus.
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