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The day the Swine Flew !

>> Friday, November 13, 2009



It was said that a black man could become the President if a swine  flew.Both happened.Obama became POTUS( President Of The US ) and the swine flew!Literally flew all over the world !!
The other day,a patient of mine asked me, doctor  how come we got the flu from  Pigs? Is it because we have similiar nature? Though it appeared a simple question, she had a genuine reason to ask. North of kerala they call good people  " Panneeente Mone" and she had heard it often.

Having said this,the pigs could have their reasons too.Probably,Pork is the most consumed  meat in Europe.And the Pigs must have been waiting for their turn.
Now,let us be serious.
The data on swine flu is very confusing.The WHO appears to be very  conservative,and reported about 1800 deaths and about 200,000 cases till September.They reported a death rate of about 0.9% across the world.But India is the leader in mortality rate,with a registered mortality rate of 2.4%.This probably indicates our management problems in critically ill patients.In  a study recently reported in JAMA, one in five of the patients admitted to hospital for swine flu ended up in the ICUand 24% of those died.The report from Winnipeg,Canada ,also showed that many of the Canadians who died where young adult females. This is a matter of concern.Many of our initial understanding of the disease have been proven to be wrong.This disease seem to take away the lives of younger adults than the elderly.I had witnessed two deaths  in our ICU since the onset of the pandemic.The first was a young boy of 23 years who was brought in from another hospital seriously ill,was ventillated immediately,but died with in 48 hours. The other patient had many other illnesses,and the death could have been due to his basic liver disease than H1N1.

The key to the management would be early treatment of people suffering from severe illness. Approximately 98% of the swine flu viruses are sensitive to Tamiflu.Personal hygeine like frequent hand washing,covering the mouth and nose with a clean cloth or mask( respiratory etiquette),staying at home while being sick,can all help prevent transmission.
There is another  intriguing question. Was all the fuss about this disease warranted? Has it really benefited? If so,whom?The media and the governments did a good job in instilling fear in the the world.Traditionally ,fear is used as a control mechanism by dictatorships.But now,democratic governments are also turningto fear( Like they use the threat of terror strikes,missiles from Iraq,atomic tests and bird flu !!) to control their populations.And then the media who loves a bit of drama in everything.( They will wait for the whole day under scortching heat to get a shot of the prostitute,who was "molested") In general one would expect the governments to calm their people,but the opposite is happening!
Who has benefited out of all this fuss?The Swiss pharmaceutical Giant Roche is selling more Tamiflu than they expected.Sales of Tamiflu is expected to reach about 3 billion francs this year,a huge boost to company coffers.The pharmaceutical sector has not been doing very well this year,so the pandemic has been a good windfall !




Small biotech companies are getting  fresh attention from investors looking for less expensive ways of making H1N1 vaccine.Diagnostic companies have been reaping the harvest as well,as doctors order more flu tests.The truth is,at the hospital where I  work,we have stopped ordering for flu tests,unless it is needed for documentation in the  seriously ill patients.The easier thing to do is to treat those who are having  the illness.
Everyone ,who has got  something to do with Inflienza, has gained form the pandemic. The Swiss drug maker,Novartis expects to sell flu vaccine worth  700 million dollars in the 4th quarter of this year.Glaxo and Aventis  are expected to sell higher.The expected sale of flu vaccine next year is somewhere between 10 to
 18 billion dollars !!
Many countries have started the vaccination programme.This being the Haj season, the flu vaccine is becoming a mandatory requirement. Over in the land of the free, free swine flu vaccine is not tempting folks and their kids,according to the New York Times.While most considered the vaccine safe,majority had no plans to get vaccinated. As a professional,there are no clear cut data  against the vaccine till now .But no vaccine is 100% safe.
The last time we had seen a similiar virus was in 1976.Cases of swineflu were reported in soldiers in the US, and 40 million Americans were vaccinated  during a national campaigne.But many who received the vaccine at that time filed injury claims saying they suffered a paralysing condition called Guillean - Barre syndrome.Reportedly, it can affect one in a million cases of vaccinations,but the claims were many more.The vaccine was withdrawn after just 10weeks,when the link to GBS was known.More people died of the vaccine than the swine flu itself!The US Govt was forced to pay out millions of dollars to those afflicted with the problem.
So,the vaccine makers have gained legal immunity this time from law makers in America.The document sigened last month grants immunity to those making swineflu vaccines.The federal court will take the responsibility of handling the cases. This was done to facilitate the manufacture of the vaccine.But it appears that the Health protection Agency,the official body that oversees public health,has issued an alert to neurologists, to be observant for any vaccine related problems.
The disease probably is getting controlled.Everyone has had their share of the windfall,and probably it is time for a dog flu or cow flu next year !!

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