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Medicine

Swine flu: how real is the threat?
The international press has convinced us that we have been teetering on the brink of a deadly pandemic. How serious is the threat for us in Russia?
Text by Anastasia Kachevskaya

Doug Stevens, chief medical officer,
Moscow SOS International

A
s of May 17, 2009, 39 countries have officially reported 8,480 cases of influenza A (H1N1) infection: Mexico has reported 2,895 cases of infection and 66 deaths. 4,714 cases have been confi rmed in the United States, and four deaths. Canada has reported 496 cases and one death. Costa Rica has reported nine cases and one death. Russia has (at the time of going to press) so far, reported no laboratory- confirmed cases. You can put away your gas-masks and plans to evacuate to Antarctica, for the time being.

In hindsight, it seems that we may have over-reacted to the ‘pandemic’. The spread, not the lethality, of this outbreak was so rapid that WHO raised its pandemic alert level on April 29 from 3 to 5 on a scale that goes to 6. The Avian flu in Asia never made it past 3, though the H5N1 was defi nitely more virulent. Yet it was not able to hop from person to person effectively. With A/H1N5, no animal contact is required. It is easily transmitted from person to person and presents a toxic cocktail of genes specially designed to smash up your immune system. So far the antiviral Tamiflu has proved to work, although that does not explain in full why deaths outside Mexico have been proportionally few.

Swine flu, unlike ordinary flu, which mostly carries off the old, affects mostly the young and healthy and is a sign of a highly pathogenic virus strain. A highly pathogenic virus is rare, and historically- speaking, usually brings high death tolls. There is no natural immunity and the virus is prone to evolve gaining new genetic features with each successive wave. We have only seen the first version of this virus. Chances are high that a mass use of the currently eff ective antivirals (Tamiflu and Relenza) will prompt the virus to develop resistibility and become extremely aggressive.

Given all this and the accompanying media frenzy, it was hardly surprising that the Russian Government tried to protect the state from an uncertain, yet potentially fatal disease. Well, at least it appears to have, considering official statements and news feeds emerging in newspapers, TV bulletins and on web-sites of the most dependable information agencies.

Chances are high that a mass use of the currently effective antivirals (Tamiflu and Relenza) will prompt the virus to develop resistibility and become extremely aggressive.

Moscow authorities are said to have been, and to continue to be, particularly vigilant. Security has been tightened at Moscow airports and across the borders. Passport has received reports that some arriving passengers (particularly from swine flu smitten countries such as Mexico and the USA) are being subject to close examination with infrared imagers and disposable thermometers. Any passengers with a higher than normal temperature have been temporarily isolated in newly-equipped care centers at the airports. Checking has, as far as we can ascertain, been sporadic. There has been a ban imposed on pork imports from the Americas, Spain, Britain and some Canadian provinces for fear that the virus may be transmitted through pork – a most controversial measure bearing in mind that it has not been proven that swine flu spreads from eating cooked meat. Ludmila Shvetzova, first deputy mayor of Moscow, said in a statement that the air in the Moscow metro and other public places is being treated with ultraviolet for disinfection. It is not clear exactly what this means, and further clarification has not been forthcoming. Nikolai Vlasov, head of the Federal Veterinary and Phytosanitary Monitoring Service, said at a conference that authorities are strengthening disease-surveillance systems, allocating financial resources to fight the flu and improving communication channels between health ministries, their regional outlets and international bodies. He preferred, however, not to elaborate on exactly what measures are being taken.

National stockpiling of drugs has been stepped up, with antiviral factories being put on overtime, a welcome surge in manufacturing capacities, which will be “enough to provide for the whole country,” according to Vlasov. Vlasov also said that pig-breeding farms are seeing a lot of swine vaccination activities these days, and laboratories have started to clear the decks after the Avian flu to receive their first samples of the new strain from the CDC (the USD-based Center for Disease Control and Prevention) early in May and work on a human vaccine. This vaccine will become available to “ordinary” Russians in November this year, according to RIA Novosti, although how CDC can be so sure that they have developed an effective vaccine is not clear, bearing in mind that the rest of the world is trying, so far unsuccessfully, to produce such a drug. The new drug will apparently be distributed through state health care units or licensed private clinics such as the Moscow outlet of SOS International. Though the regular seasonal flu vaccine is unlikely to provide any effective protection against the current strain, Russian public healthcare officials recommend those who have not been vaccinated at all to consider doing so in the near future. There is evidence that even a seasonal flu vaccine may help make a swine flu case milder and reduce death risk, according to Vlasov.

What Russians Think

Two predominant attitudes seem to prevail. One is alarmism with a tinge of mob hysteria. In April and May, Yandex, the most popular Russian search engine, registered over 130,000 enquiries about flu on the Internet. Thousands of people all over Russia are following the latest swine-flu-news over the radio and television with a sinking heart and heated debates in local communities. Both state and private companies are working out pandemic action plans and unfolding public awareness campaigns. Chemists in regional centers ran out of existing antiviral drugs and gauze bandages in a matter of hours when news of deaths in Mexico first broke. Macabre doomsday scenarios occupied front pages of newspapers and people’s minds for weeks. According to Nikolai Philatov, head of the Moscow outlet of the Russian Consumer Inspectorate, up to 7 million people could be infected in Moscow in the near future, 3 million people may be taken down with severe infection, 2.7 million people may require out-patient treatment and 480,000 people may be hospitalized. However it is difficult to know whether to take such figures seriously or not.

The alarmist attitude didn’t last long, and most Russians now regard the swine flu issue with a large degree of pophigism, basically a Russian screw-itall- attitude, highlighting lack of interest in anything but private matters and an unshakable belief in the omnipotence of the state to protect you against any outer menace. While the threat of a world pandemic is looming large, Muscovites, perhaps correctly, have been enjoying a blissful spell of nonchalance and caressing rays of the spring sun, leaving it to the government to deal with anything more substantial. From a Passport survey carried out by asking 100 bystanders on Tverskaya on May 15, many do have a vague idea of what is going on, however as yet the problem is too far away to be of any real signifi cance.

Many analytical comments are not devoid of skepticism, though. Some think the flu is just a ploy of pharmaceutical companies, concocted to make money in fi nancially troubled times. The price of Tamiflu in Moscow, has almost doubled, according to one video blog connected with RIA Novosti. Even the least effective remedies (for instance, Remantadin) have seen a surge in price here in Russia. Shares of one pharmaceutical company based in Moscow skyrocketed by an average of 19% the other day.

Others view the swine crisis as a helpful tool for the Russian Government to divert public attention from more inconvenient problems such as economic recession, inflation and soaring unemployment rates. After all, protagonists of this attitude claim; the flu appears to be barely more contagious than any normal seasonal flu so far. In Russia, 10% of all the population are affected every year, and that is over 14-15 million people. With the current contagion rate, and the form that the flu has taken, one stands a greater chance of being murdered here than coming down with swine flu, – a 1% chance per 12,000 people roughly, according to offi cial statistics. As a Russian blogger put it, “the swine flu panic appears to be nothing but another TV-driven scare to produce mass hysteria. First, there was SARS, then Avian flu, and now this swine thing, to be followed, perhaps, by an outbreak of a cockroach infl uenza virus. Of all those infected, only 50 have died, yet enough to scare tens of millions out of their wits to cry ‘Wolf’ at every sneeze and spread panic.”

This ostrich-type attitude will remain in vogue as long as the virus doesn’t come to Russia. Undoubtedly, sooner or later the virus will come to Russia. According to Doug Stevens, chief medical officer with Moscow SOS International, most probably it will come from Europe – or will be brought in from Mexico. According to estimates of the Russian Association of Travel Agents, there are over 2,500 Russian tourists in Mexico now. Soon they are to come back home bringing swine flu problems home to roost. According to Doug Stevens, there are 3 factors to aggravate a swine flu outbreak in Moscow. First, a very high percentage of public transport use. Second, unhealthy lifestyles extremely widespread among Russians (heavy smoking, drinking, which saps the strength of the stressed organism and suppresses the immune system). And finally, but not least, social behavior such as spitting in the street and discarding garbage and personal hygiene tissues in public places. However, such grave sentiment came under fire from Gennady Onitschenko, head of the Russian Consumer Inspectorate, who when presented with this view, called such claims “absurd and groundless”.

The good news is that that this is the end of the flu season in Russia. Russia is a long way from Mexico and has a different climate, much more severe than that in Mexico or Europe, and a different national diet with a heavy reliance on onions and garlic, two natural antiviral remedies. Due to regular seasonal onslaughts, with mass vaccination campaigns, Russians have developed a heightened collective immunity, suggesting a milder course of the disease and fewer death cases. Finally, it is not the flu itself that brings about death, rather the complications which it causes in advanced cases when a patient faces lack of proper treatment.

So Russia seems to be quite hardened to weather the swine viral storm, and much better than other involved countries. The swine flu strain may be no more dangerous than any ordinary seasonal flu, yet it is absolutely unpredictable. Even if there is a lull to come for weeks or months, it is too early to feel complacent. There is a danger that the swine flu virus with its ability to hop from human to human may penetrate Indonesia and Central Africa, where another virus, the highly pathogenic H5N1, also known as Avian flu, has become endemic, and mutate there. If these two viruses produce an offspring, which will inherit the worst qualities of its ancestors, then Russia will find itself in a very serious situation indeed. Currently things seem to be under control. It remains to be seen, though, whether the fortifications are strong enough to withstand any new mutation may take. A year ago the whole issue of a flu pandemic was not taken very seriously. However, with swine flu, things have changed. The danger is that ‘Wolf’ has been called out too many times. The fact is that now swine flu has broken out, there is considerably more chance that the virus will continue to mutate and create an extremely dangerous form.

To Those Who do not Want to Catch Swine Flu – From Moscow SOS International

As swine flu is a respiratory disease, it spreads from person to person in the same way other flu viruses do – through infectious respiratory droplets. Released when a person coughs, sneezes or talks at a distance of up to a meter or so. Sometimes people may get the infection by touching something with the flu virus on it (doorknobs, keyboards, counters) and then touching their mouth or nose.

So, the best way you can protect yourself is to observe good hygiene. Avoid surface contact as well as people who are obviously or might be sick, wash your hands frequently with soap and water or cleanse them with an alcohol-based hand rub, avoid touching your face, and if you do, be sure your hands are clean. Reduce the time spent in crowded places, improve airflow in your living space by opening windows and practice good health habits including sleep, eating nutritious food, and keeping physically active. To boost your resistibility, take vitamins, eat plenty of vegetables and a minimum of 4 pieces of fruit a day, drink less alcohol, smoke less, restrict travel, monitor your friends and colleagues and get regular check-ups with your doctor. Better strike pork off your diet for a while. Remember, home cleanness and hand washing are essential. At work, check with your HR department what is being planned to be done as part of your company’s Pandemic Action Plan.

What about a mask? If you are not sick you do not have to wear a mask. Yet if you are caring for a sick person, you should wear a mask when you are in close contact with them and dispose of it immediately after contact, and cleanse your hands thoroughly afterwards. If you are sick and must travel or be around others, cover your mouth and nose.

According to CDC, infected people are potentially contagious during the incubation period – one day before the symptoms start, and seven days after the symptoms start or as long as they are still showing symptoms. Children, especially young children, might be contagious for longer periods. It is highly advisable to monitor your health for 7 days after possible exposure and stay away from work, school and other public places. Should you develop any symptoms of an infl uenza-like illness, get in touch with your doctor without fail. Report your symptoms and explain why you think you have infl uenza A (H1N1) (e.g. if you have recently traveled to a country where there is an outbreak in people). Follow the advice given to you. Before the doctor arrives, rest and take plenty of fl uids, use a mask and avoid contact with people. To bring your temperature down, use paracetamol or ibuprofen, but not aspirin which can bring complications! If the illness is serious, call an ambulance (03 or 112 from your cell phone). In any case, if you have any doubts about your health, you should check with your health care provider.







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