Couldn't agree more... anyone who proposes radical soultions to overpopulation that have anything to do with sterilization, birth limits, or "other" measures should be part of a special trial run to test the validity of the idea.

Calvert Co Maryland
 

Worth keeping an eye on. It's since been confirmed they had Type A influenza but the variant/clade is still being determined. There are conflicting reports that a funeral home worker who handled the bodies subsequently died from the flu as well. Who knows...this could be nothing.

Edited to add: the chair-against-the-wall event in these things is illness/death in the health care workers who tended the victims and there is no indication of that here.

ORIGINAL PRESS RELEASE ISSUED March 5, 2012
Calvert County Health Department (CCHD) is aware of a cluster of severe respiratory illnesses in five (Lusby area), including four members of a Calvert County family, residing approximately a mile south of the power plant. All five were hospitalized over the last two weeks. Four of the five have died of their illnesses.

The cause of these illnesses has not been completely confirmed at this time, although much testing is underway. At this time, there is no information that indicates special preventive measures, like antibiotics, are needed for family or other close contacts of the patients; however CCHD will continue to work with the healthcare providers and others on this situation and will update Calvert County residents if new information important to their health becomes available.

In the meantime, we continue to recommend that people ill with influenza-like illnesses (fever and cough or sore throat) check in with their healthcare provider to be evaluated and see if they would benefit from antiviral or other medications.

FROM: CALVERT COUNTY HEALTH DEPARTMENT
DAVID L. ROGERS, MD MPH
HEALTH OFFICER

Called a guy who should know. He said it's Type A subtype H3 but they have doubts it's the same H3N2 clade that has been going around this season. It's not unusual for the circulating flu virus to do an end-around the current flu vaccine. he's not particularly worried.

I saw press reports that another sister in the family is now hospitalized in fair condition (elderly mom got sick, 50ish kids all took care of her).

The deaths were apparently associated with hemorrhagic symptoms (cytokine storm?) and concurrent staph infection. The simple explanation is this family had some genetic vulnerability or co-morbidity that led to this.

Thanks, mugwump.

Always appreciate an inside perspective.

TR

:D

It's empowering.

H7N9
 

Just a heads up. Google h7n9, you can use google translate to read the Chinese media reports directly. I'm not involved with this field anymore, so no inside gouge, but this appears to be heating up. Most recent reports indicate human-to-human transmission--ignore the "thankfully there's no sign of h2h transmission" reports, they're dated. Closing all of Shanghai's poultry markets indicates a high level of concern among the inscrutables. Airline stocks are taking a hit on speculation of potential quarantines. On the upside, social media are preventing media blackouts and the Chinese press seem to be doing a good job of reporting the facts. It may be time to review your "social distancing" plans.

The sudden appearance over a wide geographic area is the reason for concern. You'll need to zoom out to see the cases in the southwest. https://maps.google.com/maps/ms?msa=...6&source=embed

A Sobering Anecdote
 

So I had an interesting case in the ED the other day pertaining to this topic.

A healthy "normal" mid-20s female presented with fever, altered mental status, confusion, and hypotension.
Family had not seen her for a few days and she wasn't answering her phone so police and then medics broke down her door and brought her in.

Febrile to 40 C, tachy 130-150s, initial BP 70s systolic. Only history was upper respiratory/ cold like symptoms per family who hadn't seen but talked with her. She would look directly at you but not answer appropriately. First thoughts were Tox- anticholinerics, SSRIs, various common illicit drugs, dextromethorphan. Medics reportedly found a bottle of NyQuil near her so thought likely anticholinergic but couldn't rule out infectious so she got the whole 9 yards- chest xray, urine, blood cultures, considered toxic shock, performed lumbar puncture, tox screen, salycilate and acetaminophen levels. A CT scan showed a very small intraparenchymal temporal lobe hemorrhage. We were concerned for herpes encephalitis but CSF was normal (and final assay tests as well).

However, 5 L of normal saline later and everything completely negative she was still hypotensive into the 70s and required a central line, pressors and the ICU. In the ED we rarely discuss cases with infectious disease but since we had no explanation I consulted them and they were at a loss as well feeling our differential, workup, and exam was fairly comprehensive. A few hours later the Influenza Assay came back positive for Influenza A. She recovered after an ICU stay on pressors and the only thing positive was flu which ID agreed was the likely diagnosis.

While I am not an ID specialist I shared my thoughts with one of our experts and he agreed. Given the extremely high fever, pronounced tachycardia, altered mental status, and hypotension my only explanation is that she had what is described as "cytokine storm". Essentially the virus caused her immune system to become hyperactive causing more harm than good. This is what is believed to have made the Spanish Flu of 1918 so lethal. This is described in some cases of H1N1, and is why younger folks with great immune systems may actually be worse off (aside from the partial immunity of past strains). To those of you that study flu this is not news. I had read about it but seeing it first hand was quite different and really demonstrated how quickly we would become overwhelmed knowing how many resources it took to stabilize this one healthy 27 year old.

Such a strain only needs to present itself as we have shown that vaccines are only partially effective at best.

Yeah thankfully this doesn't look to be producing the number of cases you'd see in a real breakout. Touch wood this trend will continue.

I just read an article that said that public health was “The art and science of deciding who dies, when, and with what degree of misery.” The decision they have to make now is do they continue making the 2013-2014 seasonal flu vaccine or shift over to a crash program for h7n9. People will die whichever way they go. The h7n9 is already sequenced, cultured, and they know it reproduces effectively at normal human body temperature. Compared to how they reacted to h5n1 and h1n1 they're moving at the speed of light.

Compared to the h1n1 vaccine, it is light speed. I recall that the major pharm companies were considering getting out of the vaccine business around that time. Plus the CDC denials of the potential seriousness of h1n1. At least on the surface. They formulated worst case scenario plans for municipalities to deal with large numbers of casulties ala' 1918. To include body storage in refridge semi trailers. I was on our local disaster planning committee at the time.

I don't know if it's been mentioned in the previous 50-odd pages of posts here, but John M. Barry's book, "The Great Influenza" is an excellent source for those of us who do not have a medical background to get an understanding of how a flu epidemic works using the 1918 h1n1 outbreak as an example.

We are lucky to have you guys on this forum. All of your insight and information is greatly appreciated. Thanks!

Deadly new bird flu vindicates controversial research
 

Deadly new bird flu vindicates controversial research

http://news.yahoo.com/deadly-bird-fl...142717817.html

"LONDON (Reuters) - Scientists in the Dutch city of Rotterdam know precisely what it takes for a bird flu to mutate into a potential human pandemic strain - because they've created just such mutant viruses in the laboratory.

So as they watch with some trepidation the emergence in China of a strain of bird flu previously unknown in humans, they also argue it vindicates their controversial decision to conduct these risky experiments despite fierce opposition............................."

More info.......

http://www.forbes.com/sites/melanieh...urgent-report/

Good summary of the current situation and new research on the virus. Scary.

H7N9 has crossed borders...first case reported in Taiwan. The last WHO case fatality rate estimate was 60% (106 lab confirmed with 21 deaths in 35 cases with outcomes). There is no evidence of sustained human to human transmission. The Shanghai auto show is ongoing, Apr 20-29, and there will be thousands of Americans returning from Shanghai over the next week. Interesting times.

Thanks for monitoring this and for all your input. Influenza is in reality the greatest potential threat to this country and mankind. As John Barry said, "it's not if, but when?"