Paranoia reaches pandemic proportions

“The only thing we have to fear is fear itself.” These were the immortal words delivered by U.S. President Franklin Roosevelt during his 1933 inaugural address. They helped inspire his nation through an economic depression and world war — but probably could do little to ease the pandemonium that now surround a microscopic organism with an identity crisis.
The warnings have been unrelenting — and they have come from all corners in the debate over the H1N1 virus. For months, health officials have warned that the virus formerly known as Swine Flu has reached pandemic proportions. And as the public’s fears continued to mount, they were advised of the imminent need to receive the H1N1 vaccination. Oh, and did we mention by the way that supplies of the vaccine are low so you’re probably going to have to wait a few weeks to ward off your impending death.
While that might not have been the exact message delivered by Canadian health authorities, it’s the one that came through for the average Canadian whose anxiety rose with each new reported H1N1 death. As of this week, 198 Canadians have died of H1N1.
The Canadian public is riveted to any news on the spread of the H1N1 virus. And who could blame them. The sight of young, otherwise healthy individuals being struck down by a microscopic organism is pretty hard to ignore. With those sights often accompanied by respected doctors calling the virus the “most frightening” thing they’ve ever seen. And with each new case, the public’s anxiety continues to grow. And as many Canadians are turned away from the vaccination clinics that fear turns to outrage. It’s enough to even turn Canadians against their hockey heroes.
But the H1N1 virus isn’t the only thing that’s spreading fear across the country. The vaccination itself has become a lightning rod for irrational fear.
“If you Google H1N1, most of what comes up is conspiracy theory paranoia that this is a government plot to kill you,” said provincial health officer Dr. Perry Kendall.
Those theories range from H1N1 being a plot cooked up by the major pharmaceutical companies to help immunize them from potential lagging profits; to the new strain being the result of a top-secret military bio-weapon hatched by former U.S. defence secretary Donald Rumsfeld and the original Dr. Evil, Dick Cheney, during their quest for world domination. (This strand of paranoia is helped along by the fact that Rumsfeld does hold millions worth of stock in the company that owns the rights to Tamiflu, the drug used to remedy symptoms of H1N1. That’s kind of like Cheney having a relationship with a company that stood to profit from the invasion of oil-rich countries. But now I’m starting to sound like an MSNBC newscast.)
Whatever the cause, fear of the virus and/or vaccination is spreading faster than Lindsay Lohan on her way to the bar at last call.
And as the resulting paranoia reaches a fevered pitch, Canadians are increasingly becoming divided into two camps: those scanning the internet for the latest conspiracy while frantically sealing their windows with tinfoil to block out the harmful gamma rays sent out by the government to indoctrinate the public into embracing the vaccine; and those who would sooner judge a talent show comprised solely of Kardashians than venture into any public spaces, and faithfully avoid all forms of human contact, save the goodnight kiss they give their children — after said child’s face has been properly sanitized, of course. 
But no matter what side of the debate you’re on, Canadians would be well advised to keep this all in perspective. We made it through bird flu, West Nile, SARS and who could forget flesh-eating disease. That one had panic written all over it. I mean, come on, even the official medical terminology — Necrotizing fasciitis — sounds like the title of a George Romero movie. 
So if we can manage to maintain the reserved Canadian composure that has made Canada synonymous with politely dull the world over, I’m convinced we can weather this storm. Keep in mind: it’s been my experience that incompetence and ineptitude make any form of government conspiracy about as likely as the Olympics coming in under budget. And you’re probably more likely to be trampled outside a flu clinic by crowds rushing to the scalpers offering up their spot in line to the criteria-challenged, than die from the flu itself.

H1N1 second wave may have peaked on Vancouver Island’s

Vancouver Island’s second wave of H1N1 swine flu may have peaked this week, a health authority report indicates.
The Vancouver Island Health Authority reported numbers of visits to Island doctors for flu-symptoms remain above historical levels. But the rate of increase appears to be slowing. “Based on a 12-week wave, we estimate that we are now at the pandemic peak and some acute-care data suggests that we may be entering the post-peak phase,” says the report, dated Nov. 10.
The second pandemic wave is believed to have hit Vancouver Island in mid-September, ahead of the rest of B.C. and Canada.
Since April, when the first wave arose, 55 H1N1 cases have required hospitalization on the Island. Of those, 10 patients in the south Island and five in the central Island have needed intensive care.
B.C. chief medical officer Dr. Perry Kendall said he is cautiously optimistic about indicators showing the pandemic is levelling off. Those indicators include the percentage of doctors’ visits by patients reporting flu-like symptoms, the number of tests performed for H1N1, the amount of anti-viral Tamiflu prescribed and the number of hospitalizations over the last two weeks.
“It doesn’t mean to say that [the indicator signs] might not take off again. But we are hopeful that they won’t,” said Kendall, who has advised people to continue to be vaccinated to prevent a third wave this spring.
Meanwhile, based on clinical studies in Europe and accepted by federal officials, B.C. will limit healthy children aged three to under 10 to a single, half dose of H1N1 vaccine.
Previously, children between six months and 10 years were said to need two half doses, spaced at least 21 days apart.
“That’s good news. It means we have a little more to spread around,” said Kendall.
Two half doses will still be required for children aged six months to under three, and those 10 and under with chronic health conditions.
B.C. was expecting delivery yesterday of about 135,000 doses of adjuvanted vaccine, along with about 118,000 doses of the unadjuvanted variety. 
The adjuvant is a compound of water, fish oil and vitamin E that boosts a body’s immune response. The unadjuvanted vaccine was originally reserved for women in the early stages of pregnancy, but will now likely be pooled with the rest of the supply.
Vaccination clinics at Hillside Centre and Esquimalt High School reported few people coming yesterday, indicating Vancouver Island may be close to vaccinating most of its initial target groups. They include people under 65 with chronic health conditions, pregnant women, people living in remote communities, some front-line health-care workers and young children.
No announcement has been made yet about expanding vaccinations to the general population.
Clinics continue today, with some offering the unadjuvanted vaccine for pregnant women. Obstetricians and midwives are also being supplied with the unadjuvanted vaccine.

Rethink usage of Tamiflu, expert warns

Doctors should be cautious about giving Tamiflu to people to prevent them from becoming ill after they’ve been exposed to H1N1, an antiviral expert said Wednesday as he reported details of North America’s first reported case of Tamiflu-resistant H1N1 viruses.
Dr. Guy Boivin said people who’ve been exposed to the virus may already be in the process of becoming ill, a circumstance that can foster the emergence of Tamiflu-resistant viruses.
As of late last week the World Health Organization was reporting that 42 cases of Tamiflu-resistant pandemic H1N1 viruses had been seen globally since the pandemic began. The case Boivin reported on in the New England Journal of Medicine was the third, from late June.
"I have to admit I would have expected more cases, considering . . . the large volume of Tamiflu that has been used in the last few months, certainly more than in the last five years, probably," said Boivin, who is based at Laval University in Quebec City.
"But I’m still concerned that the same situation that has occurred with the seasonal H1N1 could be . . . repeated with the pandemic H1N1."
Seasonal H1N1 viruses developed resistance to Tamiflu a couple of years ago for reasons that remain unclear.
Though it had previously been thought that the mutation needed to confer resistance to the drug would cripple any resistant viruses that emerged, that proved not to be the case. The resistant viruses spread like wildfire, virtually crowding out susceptible seasonal H1N1 viruses and rendering Tamiflu useless against them.
Public health authorities worry that if that happened with seasonal H1N1 viruses, it could happen with the pandemic virus, especially at a time when much more of the drug is being used than ever before.
The case Boivin reported in the medical literature was played out in the popular press last summer.
A man from Quebec who had chronic lung disease was put on Tamiflu as prophylaxis after his teenage son, who had asthma, contracted H1N1 and was treated with the drug.
A prophylactic dose is one pill a day. A treatment dose is two pills a day.
The father started experiencing flu-like symptoms within about 24 hours of starting the drug, a likely signal that he was already sick. A prophylactic dose can stave off infection, but it isn’t powerful enough to kill off all the viruses in an infected person’s body. Those that survive are likely to be resistant to the drug.
In fact, about one-third of the cases of Tamiflu resistance that have been spotted so far have been in people who had been given the drug for prophylaxis.
"Because of that we need to limit as much as possible the use of Tamiflu prophylaxis and instead focus on early treatment," Boivin said.
He suggested if doctors do give patients Tamiflu to prevent H1N1 infection they should monitor them and switch them to a full treatment dose if they start experiencing symptoms.

Tamiflu-Resistant Swine Flu Found in Canadian Father

Researchers report that a father in a Canadian family developed a strain of the H1N1 swine flu that was resistant to the antiviral Tamiflu, after being given the drug to prevent the disease.
To date, the World Health Organization has reported some 45 cases of H1N1 swine flu that were resistant to Tamiflu, which is why the U.S. Centers for Disease Control and Prevention and others caution against using Tamiflu to prevent the disease in people who are symptomless.
"We have a person who was taking post-exposure prophylaxis with Tamiflu, probably at the time he was already incubating the virus, but before symptoms developed," said lead researcher Dr. Guy Boivin, of the Centre Hospitalier Universitaire de Quebec, in Quebec.
According to the report, when the father's 13-year-old asthmatic son was hospitalized with H1N1 swine flu, other family members were given a reduced dose of Tamiflu to prevent them from getting the disease. These included the 59-year-old father, who suffered from chronic obstructive pulmonary disease (COPD), his 50-year-old wife and two teenage daughters.
Within a day the father developed flu symptoms, but he did not see a doctor for eight days. A test of his virus showed that it was resistant to Tamiflu. None of the other family members developed flu. The father recovered from the flu, according to the report in the Nov. 11 online edition of the New England Journal of Medicine.
The mutated strain of H1N1 swine flu remained susceptible to another antiviral, Relenza, Boivin added.
The family's experience was a good setting for resistance to emerge, Boivin said. When someone has the H1N1 swine flu, Tamiflu is given twice a day for five days. But when the drug is used to prevent the disease, it is given only once a day for 10 days, he explained. 
Since the father was most likely already infected with swine flu, the dose of Tamiflu he received was ineffective at stopping the virus and low enough to allow the virus to develop resistance to the drug, Boivin said.
"In that context, Tamiflu is a risk factor for the emergence of resistance," he explained.
Boivin said that one-third of the known cases of H1N1 virus resistant to Tamiflu have been among people already exposed to the pandemic flu. "Another third emerged in imuno-compromised [weakened immune system] patients who received prolonged therapy with Tamiflu," he said.
The mutation of the H1N1 virus that caused its resistance to Tamiflu was the same one that was found in seasonal flu resistant to the drug. Last year, one strain of the seasonal flu was resistant to Tamiflu, Boivin said.
"You should be careful when you use post-exposure prophylaxis," Boivin said. In most cases, Tamiflu should be reserved for early treatment of flu when symptoms develop, he said.
Dr. Marc Siegel, an internist and associate professor of medicine at New York University Langone Medical Center in New York City, said that "Tamiflu prophylaxis given to the wrong people can increase your risk of a resistant strain developing -- and that's the last thing we need."
Siegel thinks, however, that Tamiflu used correctly can help prevent people from getting the flu, especially when the vaccine is in short supply.
"In the absence of available vaccine, one of the ways you can cut down on the spread of H1N1, to people you feel are at risk, is with the proper use of Tamiflu prophylaxis," he said.
Another expert, Dr. Pascal James Imperato, dean and Distinguished Service Professor of the School of Public Health at SUNY Downstate Medical Center in Brooklyn, N.Y., said that "based on our current knowledge, it appears that resistance of influenza viruses to the anti-influenza drug Tamiflu occurs in a setting of drug overuse."
This reported case from Canada underscores the need to limit the use of Tamiflu in people who aren't displaying flu symptoms, Imperato said.
"It also points out the need for increasing the dose of the drug to therapeutic levels in anyone who develops symptoms of influenza while on lower post-exposure prophylactic doses," he said.