Couldn't get past the pig

Couldn't get past the pig

I shall be kind and attribute it to a rush job both at the Health Ministry and at the Straits Times on a Saturday night. But it was the kind of information that could prove misleading.

On the front page of the Sunday Times, 26 April 2009, was the headline "New flu virus kills 68 in Mexico". For want of a short name, the article mostly referred to the infecting agent as "swine flu", though a simple glance at the headline and a closer reading of the story would indicate that it was a new strain.

On page 2, the newspaper had a box providing "Flu Facts". It said:

The Health Ministry (MOH) yesterday released information on swine flu.

What is swine flu?
It is a respiratory disease affecting pigs that is caused by type A influenza virus. Most outbreaks occur during the late fall and winter months, similar to influenza outbreaks in humans.

Does it affect humans?
Swine flu viruses very rarely affect humans. However, sporadic human infections with swine flu have occurred. These cases commonly occur in people with direct exposure to pigs.

How does it spread to humans?
It spreads to humans mainly through contact with infected pigs.

Can people catch swine flu from eating pork?
There is currently no evidence to suggest that swine flu can be transmitted to humans from eating pork or pork products that have been thoroughly cooked.

And so on....

Did you spot the problem?

Both the newspaper and the Health Ministry were misled by the convenient use of the name "swine flu" when referring to a new type of flu. Relying on that name, the ministry regurgitated irrelevant stuff about a pig disease -- and the reporter obviously didn't spot the problem -- when the news story was about "a new version of the A/H1N1 flu virus, which is a combination of bird, pig and human viruses" –- words from the front page article itself.

By telling people that swine flu is contracted mainly through contact with infected pigs, Singaporeans are led to complacency. It is correct, but irrelevant. The news was not about good ol' swine flu.

A quick tour of news reports from other countries' newspapers provided the following key pieces of information:

• There have been 1,300 cases in Mexico in recent weeks, mostly in the capital. This at a time when the usual winter flu season should be over. 81 have died as of Sunday night (26 April) Singapore time. Of these, 20 cases have been definitely linked to the new flu virus, with 61 cases still under investigation. These 61 died from symptoms very similar to the 20 confirmed ones.
  
• Most patients died of severe pneumonia.
  
• The worrying thing is that most deaths have been of healthy young adults aged 25 – 45, unlike the usual flu that hits us from time to time, which tends to affect young children and the elderly, i.e. those with immature or compromised immune systems. In this respect, it resembles the 1918 – 1920 pandemic of "Spanish flu" -– more below.
  
• Indications are that it is being spread by coughs and sneezes from human to human since Mexico City, a conurbation of 20 million, doesn't have many pigs running around.
  
• Fortunately, early reports are that Tamiflu and other anti-viral drugs appear to work to reduce symptoms.

The Mexican government has declared a state of medical emergency. Schools have been closed and events that would bring together crowds have been cancelled. Masks are being distributed as widely as possible.

A few cases have been found in the US states of Kansas, Texas and California. No fatalities have been reported yet. Nonetheless, the virus has already spread so far in Mexico and the US that a containment strategy is out of the question, said Anne Schuchat, interim deputy director for science and public health programs at the Centres of Disease Control.

The World Health Organisation is poised to declare the outbreak "a public health emergency of international concern". If that happens, travel advisories, trade restrictions and border closures may follow. The world economy, already down in the pits, will suffer another blow, with airlines the first to reel from the impact.

* * * * *

Experts have been warning for over a decade that the world is due for another flu pandemic. It has been 90 years since the great pandemic (the "Spanish flu") of 1918 – 1920.

A pandemic sweeps the world when a new strain appears for which humans have no immunity -– since no one has ever encountered the virus before. But other factors, like how easily it can be transmitted from human to human also determine its extent and effect.

In this respect the H5N1 bird flu, although of concern, has thankfully not (so far) evolved into a form that can pass easily from human to human. Without this mutation, outbreaks tend to be isolated. This new flu, however, looks like it has made the leap to human-human transmission, thus the sudden spike to over 1,000 cases in a non-farming environment.

The 1918 pandemic -- also an H1N1 virus like the current Mexican one -- was estimated to have infected about one billion people during the two years that it ran its course, about half the global population at the time. It reached every continent and some of the remotest Pacific islands as well, in an age without air travel and mass tourism.

Estimates of fatalities ranged from 20 – 100 million, representing a mortality rate of 2 – 10 percent. (The 81 deaths so far out of 1,300 infected in Mexico in the current outbreak would represent a mortality rate of 6 percent.) According to a Wikipedia article about the earlier pandemic, an estimated 7 million died in India, nearly 3 percent of India's population at the time. In the Indian Army, almost 22% of troops who caught the disease died of it.

Why did soldiers die so easily? Because the 1918 virus was believed to provoke a "cytokine storm" in patients. A cytokine storm is an overreaction of the body's immune system, which explains its severe and sudden symptoms -- in some cases, too weak to walk within hours and dead within a day. Young healthy adults with robust immune systems were ironically most at risk.

* * * * *

I should not sound alarmist. It is not yet known how infectious the new strain is. We have anti-virals today that the 1918 generation did not have. We have better public health systems that in theory should be able to monitor the disease's spread better than pervious generations ever imagined possible, and which can swing into action at a moment's notice.

With luck, we can nip this new disease in the bud.

But it won't help if our Health Ministry and leading newspaper confuses the new strain with the usual swine flu, contact with pigs, and the importance of well-cooked pork. Don't throw away your chashao bao yet.

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