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H1N1 Flu Virus Far From Over

A few weeks ago, Junior Pundit primo, aka William, age 7, was washing his hands, drying them and then washing and drying them again. When we inquired as to what he was doing he explained, “Daddy, there is a terrible flu going around and you can die from it. I don’t want to die. I am too young to die! So you have to wash your hands really well.”

By this past weekend, his advice had changed: “Dad, the flu turned out not to be so bad. If you get it, you have to stay home from school for a few days and you feel like any other cold or flu. So it is OK now to go to Disney.”

As they say, from the mouth of babes you get the truth, and William’s perspective generally mirrors what he was taught in school. The crisis we feared — with millions not merely sick but dead — doesn’t seem imminent:

Elizabeth Weise of USA Today wrote a piece, Swine Flu Outbreak Getting Longer-term Look by the CDC:

With about 2,600 cases of swine flu reported in all but seven U.S. states, the Centers for Disease Control and Prevention is changing its focus from identifying cases of H1N1 to a comprehensive, longer-term perspective.

Though not ignoring people still falling ill, researchers say they have enough understanding of the outbreak to begin looking ahead at what the new strain of influenza will do during the Southern Hemisphere’s winter flu season, which is just beginning, and how H1N1 may have evolved when it comes back to the Northern Hemisphere next fall for the regular flu season, says the CDC’s Anne Schuchat.

The World Health Organization reports 4,694 cases of H1N1 flu in 30 countries and 53 deaths as of Monday. The outbreak is still classified as Phase 5 — just below a pandemic — because it doesn’t appear to have established itself outside North America, WHO’s Keiji Fukuda says.

The CDC has linked three deaths in the USA to the new flu. The number of confirmed cases is almost certainly only “the tip of the iceberg,” Schuchat says.

In the USA, more young people than old are getting sick; the median age for reported cases is 15, Schuchat says. “We would love to nail down” why, she says.

One theory is that it’s simply because the first people who got sick were young, and it has remained in that population. Another possibility is that previous outbreaks of influenza shared at least some genetic attributes with this one, which gives older people partial protection.

The CDC and the World Health Organization are working on plans to develop a vaccine against the strain, though a decision on whether to move forward with production has not been made.

About 40% of people being tested for influenza in the USA are positive for the H1N1 virus, and the remaining 60% are positive for regular seasonal flu viruses, the CDC says.

Doctors can’t let their guard down, Schuchat says. “We need to guard against complacency as we move into a new normal.”

We asked Pundit Investigator and Special Projects Editor Mira Slott to update us on the situation by speaking to a medical/public health authority and an industry participant:

Marc Schenker, MD, MPH
Professor of Public Health Sciences
UC Davis School of Medicine

Q: What is your assessment of how the H1N1 virus outbreak is being handled?

A: My background is as a professor of medicine and public health pulmonary physician. There is no casual dissemination of this virus at this point from going to work or at work. It is not that type of dissemination. It is typically in schools with people in close quarters and known cases that have spread.

What do you do as an employer? Recommendations are pretty clear:

First, any employees that have symptoms should stay home. Don’t take the risk of disseminating the virus until it is clear what illness it is. That’s the major recommendation.

The second general precaution and what has been said by the President on down, washing hands, covering coughs and preventing aerosols (sneezes, coughs, etc.) from disseminating.

For anyone in food handling, hand washing is part of the 10 commandments; it’s in the bible.

Q: In New York City, Mayor Bloomberg spoke poignantly at a press briefing that he continues to ride the subway every day to work, trying to allay fears to avoid cramped public places. At the same time, local organizations were just cancelling public Cinco de Mayo celebrations in anticipation of large crowds.

A: Should you avoid going to work, movie houses, crowds? No. This is not necessary. There is no need to panic. People should continue riding the subway. It is not necessary to stop. I agree with Mayor Bloomberg.

Q: Some scientists are extrapolating numbers from earlier pandemics to highlight the potential risks. Is this an over-reaction?

A: It is important to realize that people haven’t gotten the virus by walking down the street or taking public transportation. In addition, it is important to realize this is not 1918 Spanish Flu or SARS, where there was a high fatality rate. The H1N1 virus seems to be mild illnesses. Obviously, we need to prevent an epidemic, or pandemic. You have to walk a fine line. People need to realize these are serious recommendations, but this is not a killer virus and we’re all doomed.

Q: What other advice can you impart to alleviate the potential spread of the virus, while assuaging panic?

A: There are other recommendations. If I do have symptoms and am concerned, call into a health care provider. Do not go into an emergency room or doctor’s waiting room with other people and put them at risk. Finally, medication for flu virus can be given early in the course of illness. But the medication is not for prevention; that is not the way it is being stocked.

Q: Is there enough to go around if the situation gets worse? There have been reports that we will have major shortages in vaccines and other equipment such as masks if the virus escalates.

A: In California, we have enough for a quarter of the population. There’s a lot. And the same applies to other states. Distribution obviously is an issue if people panic. I hope that’s not the case. Hoarding is a terrible thing.

Q: The produce industry is a strong trading partner with Mexico, and there is concern that business will suffer as a result of this outbreak. What information can you share with the industry to insure the relationship continues to prosper?

A: Mexico is, of course, going through enormous trauma with this. We should be helping and supporting the country. It is not at all clear the virus started in Mexico and came here.

Go back to AIDS. It was believed Haiti was the source and it came to the U.S., but when it was looked at more closely, it was learned that it started here and went to Haiti. No one knows where H1N1 originated. No one understands why there were more severe cases there. I speculate that poor communities could be more vulnerable, and illness is more of a problem.

We should not be victimizing or stigmatizing people or products from Mexico. They are being as aggressive, collaborative and appropriate as they can, while dealing with a horrendous situation. We must realize this is a global phenomenon, with no winners and losers or good guys and bad guys. This includes farm workers, millions crossing borders.

There is no evidence of danger from farm workers in produce fields. This virus is spread through aerosol transmission… if someone coughs or sneezes on you it’s a risk. It’s not something on an avocado, which wouldn’t survive. You don’t get this virus from eating pork, or from eating fruits and vegetables. The second commandment is wash fruits and vegetables, and that should always be followed for food safety reasons.

I work on immigration and health. People reacting to this outbreak by disparaging Mexican immigrants is just another example of the need for having a policy on immigration that will help address these issues. Disease doesn’t respect national boundaries or legal status. It’s a medical issue. Lack of immigration policy only exacerbates the problem.

Allison Moore
Communications Director
Fresh Produce Association of the Americas
Nogales, Arizona

Q: What has been happening on your end since the swine flu outbreak? Has there been significant fallout?

A: The big thing from the start was people had questions, concerns and misinformation about what was going on. We acted to stem the tide of rumors, trying to calm association members calling in, who were anxious to learn, what do we need to know, and what should we tell our customers and buyers? We put together concise, accurate information and references back to the government agencies.

Q: What were the main concerns and misconceptions?

A: Hopefully, we can fill a vacuum so often consumed with false anecdotes and rumor, to send something out to let people know the borders are opened. It has been said many times and in different venues. The Department of Homeland Security said publically and in Congress that closing the borders is not the solution. Containment is not possible. We must focus resources on mitigating and alleviating the situation. We are reiterating the scientific information and medical advice that the spread of the virus comes from person-to-person contact, sneezing and coughing, and the importance of practicing proper hand-washing and covering your mouth when you cough.

It is helpful this information from CDC that the virus is spread by the ill person, not through food. The border remains open, and every indication shows it will remain open. There is no plan to close borders.

The big questions from our members and our customers is: Will we have consistent supplies, and how is this spread so I can take appropriate measures? Is it safe to buy food products and sell to consumers, and will we have enough supply?

At the importer and distributor level, we’ve done all we can to arm our members.

We are working with other associations to put out accurate information. The swine flu doesn’t affect the produce industry directly. It is important to put out a consistent message and to show we are all on the same page.

Q: You say the outbreak doesn’t affect the industry directly, yet companies do a large amount of trading with Mexico, migrant workers are in the fields, trucks are going back and forth across the border, so there is at least the perception that the industry is impacted directly, and heightened concern that it could seriously harm business. Has anyone stopped buying Mexican produce?

A: Right now we haven’t heard that anyone’s going to stop importing produce; some growing regions are phasing out right now naturally and shifting to other parts of Mexico and Canada, and even the U.S., so any change in importing is due to the natural evolution of growing regions. Remember we are moving into summer when many US-producing regions come online.

We are working with growers and produce businesses to take the right steps to mitigate any spread of swine flu, following the recommendations of health officials. There are always rumors floating around that someone is going to stop buying, but we have no proof of that right now. We have received questions from the buying community, and hopefully we’ve been able to give them the government information they need to pass on to their own executives and to customers.

It’s really about putting out calm, rational information. These are the facts, and we need to base our decisions everyday on the facts. I’m heartened to see that most people have really behaved that way. Rumors are counter-productive. We need to focus on the fact that swine flu is not spread by food.

I want to reiterate that the border remains open, and there are no plans to close it. Government agencies both here and in Mexico are proactive in pre-planning and implementing common sense measures.

Q: Do you believe the U.S. has taken the proper level of precaution? Some folks see an over-reaction, others question whether the world will be prepared if a pandemic occurs?

A: I feel the U.S. reacted fairly well. President Obama was quick to point out the unfounded irrational thinking to suggest Mexican people should not come to the U.S. He used good reasoning in looking at travel restrictions. President Obama is maintaining a common sense approach. In cluster areas, close schools and offer additional outreach, limit travel to certain places for essential purposes.

A lot of public health officials have it right. Instead of acting on irrational fears, focus on good hygiene, don’t share utensils and cups, and follow the basic health message going out. They are advising consumers to take personal responsibility, don’t go to school if sick. This is nothing new for the swine flu, but the recommendation for any flu season.

We’ve tried to get out in front of the rumors and address the facts; these are the points to remember: it isn’t related to food, borders remain open, and there are common sense things to do in order to stop the spread of the virus. In times like this, people need to avoid knee jerk reactions.

None of this seems earth-shattering, and though young William is surely getting all the latest information from his school, it is not clear that he getting the final word. And even if he is, risks may be building for the next time.

Rob Stein over at The Washington Post wrote a piece titled, Viral Threat Emerged in a Ready World, which posits that a dangerous pathogen intersected with extensive preparation to cause an initial feeling of great urgency. The piece quotes, among others, Michael T. Osterholm, who we interviewed here:

“We’ve been getting ready for something like this for years,” said Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “And then this comes along, and all of a sudden the alarm goes off that says: ‘Oh, my God, it’s here.’ “

That alarm activated a network of disaster plans put in place after seemingly disparate crises and threats, including Sept. 11, the anthrax letters, SARS, Hurricane Katrina and the ominous avian flu virus, which has been skulking around Asia and other parts of the world for several years.

“What we’ve seen is a combination of lessons that we’ve learned from these events and the alarming news we were getting out of Mexico,” said Thomas V. Inglesby, deputy director of the Center for Biosecurity at the University of Pittsburgh. “All these things put together really set things off.”

An influenza virus can mutate easily, and there is a real danger that because the danger is not imminent, we could fall victim to the “boy-who-cried-wolf” syndrome:

Experts stressed that it remains far from clear that the danger from the H1N1 virus, as it is formally known, has passed, and they are concerned that the sharp shifts could leave the public jaded and complacent.

“I’m afraid that a kind of epidemic fatigue or the-boy-who-cried-wolf syndrome could set in,” said Stephen Morse, founding director of the Center for Public Health Preparedness at Columbia University’s Mailman School of Public Health. “But what’s the alternative? Not to talk about it? Not to respond? It’s a real Catch-22.”

Mike Osterholm gets the final word in the article:

With the virus in the Southern Hemisphere, experts will be watching what happens as winter sets in.

The virus could mutate at any moment to become more lethal.

“We’re dancing with this virus right now, and no one knows what will be the next step that the virus will take,” Osterholm said. “All of us have to understand that we are not done with this dance yet — not by a long shot.”

Complacency may be the enemy as much as the virus. Many thanks to Marc Shenker and Allison Moore for helping to keep the industry informed.

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