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Swine Flu Outbreak at Washington State University

I imagine pretty much every university has been developing a plan for addressing a massive flu outbreak. My law school, Washington College of Law, has been extremely diligent, setting up web systems for holding classes using remote cams and distance learning, for example. It has offered free regular flu vaccinations to students and staff, and has installed hand sanitizers everywhere. Still, especially before Labor Day flu preparations of any kind seem a little remote and hypothetical to those of us who aren't health care providers ... then I saw this article, about a massive outbreak involving several thousand students, at a campus in Washington state.

Washington state's Whitman County, where the school is located said that tests at a state laboratory late last week "confirmed that the influenza outbreak at Washington State University (WSU)... is indeed caused by the novel 2009 H1N1 Influenza A."

The west-coast school last week instituted a blog to help provide information to students about the sudden and dramatic spread of the A(H1N1) virus on campus just days into the new school term.

"We estimate that we have been in contact with about 2,000 students with influenza-like illness in the first 10 days of our fall semester," the latest online posting said.

"At this time of year, we would typically only see a handful of patients with influenza-like illness. Health care providers in the local community have also seen WSU students with influenza-like illness, but we have no way of knowing how many.

"We also have no way of estimating how many students are self-caring at home without contacting us," school officials said.

Okay, this has all just hit me at a whole new level of reality check. I'm going to make sure my webcam is working. Between my school, with a vast number of students and faculty from all over the world constantly traveling during the semester, my wife's school, and my daughter's school, plus my own travel ... I am at the intersection of way too many disease vectors.

Update: Sorry - I wasn't clear - I'm not especially worried about getting sick. It's rather things like sizable numbers of students getting sick, classes canceled for days and weeks at a time, big mess, like what's going on at WSU. Not plague and death, but big disruption to students in the semester, when it is not a great time to have things like classes postponed and all, makeups that postpone exams and grades. The economic situation is bad enough not to compound it with any extra badness.

Serendipity:
It's everywhere:
9.6.2009 11:18pm
http://volokh.com/?exclude=davidb :
Calm down. I'm not an epidemiologist, nor do I play one on TV, but I doubt you face a materially greater risk than most other people.
9.6.2009 11:19pm
Mark Buehner:
You know the difference between this flu and the ones that kill tens of thousands of Americans every year? They gave this one a name.

Relax, its the flu.
9.6.2009 11:27pm
Kenneth Anderson:
Sorry - I wasn't clear - I'm not especially worried about getting sick. It's rather things like sizable numbers of students getting sick, classes canceled for days and weeks at a time, big mess, like what's going on at WSU. Not plague and death, but big disruption to students in the semester, when it is not a great time to have things like classes postponed and all, makeups that postpone exams and grades. The economic situation is bad enough not to compound it with any extra badness.
9.6.2009 11:29pm
http://volokh.com/?exclude=davidb :

I am at the intersection of way too many disease vectors.
Update: Sorry - I wasn't clear - I'm not especially worried about getting sick.

Sure you're not.
9.7.2009 12:03am
Laura(southernxyl) (mail) (www):
Don't know why a person shouldn't be at least somewhat concerned about getting sick. Getting the flu sucks, at best; at worst, it's a killer. Who wants to spend a week wanting to crawl in a hole and die (to quote my daughter who used to get it every year)? I sure don't.
9.7.2009 12:18am
SenatorX (mail):
"...none of the cases of swine flu so far has required hospitalization.

"The overwhelming majority of our patients have had mild symptoms and are usually better in three to five days," the university said."

Yawn.
9.7.2009 12:24am
DG:
"...none of the cases of swine flu so far has required hospitalization.

"The overwhelming majority of our patients have had mild symptoms and are usually better in three to five days," the university said."

...which is strange. I thought the whole schtick behind H1N1 was that young people got really sick and died, unlike most flu variants.

On the public health side, I think a huge mistake had been made here. If nothing happens, there will be (yet another) "boy who cried wolf" situation and people will start discounting warnings concerning pandemics.
9.7.2009 12:29am
Laura(southernxyl) (mail) (www):
"According to the Polk County Health Department, there have been 66 laboratory confirmed swine flu deaths in Florida and 522 swine flu deaths in the U.S." article

This is as of August, which is not typically flu season.

Tangential gripe: The article says that the most recent deaths, of a 50-year-old and a 34-year-old, were of people who had underlying health conditions. It's my sad experience of journalism, that maybe they did and maybe they didn't. You can try to track this kind of thing down, and you may find out that the reporter was on autopilot and reprinting what they always see; or that, for instance, somebody told the reporter that these people probably had underlying health conditions because with flu deaths that's usually the case, and they ran with it. I say this b/c of articles about things I do know about.

There were a bunch of deaths reported from H1N1 in Mexico that turned out to be from pneumonia, IIRC. (Many of the people who died from the pandemic of 1918/19 died of flu-related pneumonia.) I think the "schtick" now is that it's more easily spread than the usual flu, so more people are getting sick. Is that because of some way the virus enters the body, or because it's a newly mutated strain that those of us who've had the flu recently don't have immunity to? Don't know.
9.7.2009 12:45am
Patriot Axiom (mail) (www):
I've been warning about it for years. The coming pig zombie invasion will kill us all.
9.7.2009 1:23am
cheap jordan shoes (mail) (www):
This is a great piece. Very thought provoking. I like the sort of ending that leaves it opn to personal input. Makes it work for just about everyone I think. Nicely done! I'll subscribe.
9.7.2009 2:15am
Kirk:
The article (and many others like it) are just engaging in alarmism. I was at a gathering tonight here in WA that included some Cougar fans who had just returned from Pullman, along with my friend the pediatric pulmonologist. The latter expressed great scepticism that any number approaching 2,000 could have actually received a specific diagnosis of H1N1.

Turning to the article, sure enough: they get to that number by counting people "with influenza-like illness". Now it may turn out to be all H1N1, but then again it may not.
9.7.2009 2:23am
John Moore (www):

You know the difference between this flu and the ones that kill tens of thousands of Americans every year? They gave this one a name.

That is simply not true, as should be obvious from two things:

1) The flu is continuing in months when seasonal influenza is normally absent. At the moment, 99% of typed cases reported to CDC are swine flu ("Pandemic 2009 H1N1").

2) Health authorities are seriously alarmed - worldwide. It is not just a media phenomenon.

I follow this (anyone can) on the Pro-MED mailing list, an interesting disease outbreak list I've been reading for years. There is a whole lot of concern expressed there, and a lot of information.

This flu is different because:

1) Although the case fatality rate is quite low, it is expected to kill roughly twice as many Americans as in a normal flu season. That's a lot of folks.

2) The fatalities have a significantly different pattern, with young folks more at risk.

3) This influenza infects deeper into the lungs than seasonal influenza, making it more dangeorus.

4) Only those of us who were around in 1957 have any natural immunity to it (or cross-immunity).

So it's not the end of the world, but it's worth paying attention to.

Besides, as others have pointed out, it sucks badly to get the flu.
9.7.2009 2:41am
Mike McDougal:

4) Only those of us who were around in 1957 have any natural immunity to it (or cross-immunity).

Just part of another Baby Boomer plot to screw over Generation Y.
9.7.2009 5:13am
texasfox82:
pandemics, natures way of telling us birth control ain't so bad; or her way of telling us there is too many of us.
9.7.2009 8:34am
merevaudevillian:
Isn't this an annual problem? Don't schools have flu outbreaks all the time? Why should H1N1 (particularly given its low mortality rate, about 0.1%, comparable to the ordinary flu) be treated so seriously in the media or by school officials? Or are you just suggesting that schools generally treat illnesses incorrectly, and this is part of a broader point not necessarily specific to H1N1?
9.7.2009 8:49am
SenatorX (mail):
Turning to the article, sure enough: they get to that number by counting people "with influenza-like illness". Now it may turn out to be all H1N1, but then again it may not.

That's exactly what has happened so far and I suspect will happen. Any sickness or death associated with "flu like symptoms" will be counted as a stat for H1N1. What will end up happening too is the government will pull a baliout backslap with "it would have been so much worse if we didn't save the day".
9.7.2009 9:25am
Cornellian (mail):
I say we nuke the place from orbit. It's the only way to be sure.
9.7.2009 10:03am
erp:
The media, instead of hyping a new crisis for their dear leader to use to scare us into buying his brand of socialism, would better serve the public by giving simple suggestions on how people, including students, can possibly avoid getting this new and improved flu.

Simple sensible stuff like get and stay healthy with good nutrition, exercise, getting enough sleep and basic hygiene. Washing hands and face frequently, not eating out of each others mouths, covering your mouth when coughing or sneezing, etc.
9.7.2009 10:56am
Laura(southernxyl) (mail) (www):
erp, I don't know where you live, but I see that stuff in the media all the time. ALL the time.

My daughter went to a petri dish of a high school in Memphis. The kids were totally packed together in the hallways between classes, and it was not unusual for her to have to sit on the floor to eat lunch on rainy days because all of the chairs in the cafeteria were taken. During flu season the principal helpfully told the kids to "avoid crowds".
9.7.2009 11:28am
DeezRightWingNutz:

not eating out of each others mouths


I'm always being forced to remind people not to do this.

My workplace has been very pro-active, placing numerous placards reminding people to wash their hands.

The FAQ section (not making this up) replies to "What should I wash my hands with?" thusly:

Use soap and warm (not boiling) water.

Ohhhhh, DON'T use boiling water. I thought you said DO use boiling water.
9.7.2009 12:52pm
ChrisatOffice (mail):
hyping a new crisis for their dear leader to use to scare us into buying his brand of socialism,

Oh please.
9.7.2009 12:54pm
Sammy Finkelman (mail):
There was a study which was summartized some weeks ago in the Wall Street Journal - I think every two weeks they report some newe medicasl studies and always throw in some caveat no matter what - if schools were to be closed (at the time of outbreak) it would probably cut the total number of cases by about 15%, and the peak number (number of cases at one time) by about 40%.

THe people it seems to hit harder are people with some kind of neurological problem. Could thjis be because something in that strain of FLU, stimulates antobodies that also can in some people attack other things? Don't forget Guillain-Barre syndrome, which was associated with the "swine flu" vaccine in 1976.

The worst thing about all of this is the idea that flu mutations follow some kind of predictavble pattern. I felt that was ridiculous in 1976, and it's ridiculous now. IT makes about as much sense as trying to find sa pattern in lottery numbers that come up.

In the case of the 1976 flu, it was pretty deadly, but it was also caught very early and probably became extinct before they manufactured any vaccine. This one seems to have pretty deadly in Mexico, but that was probably a secondary mutation that has now become extinct. What we are left with is a flu that spreads faster (maybe because very few people have immunity?) but tends to actually give milder cases to most people - but people with neurological problems may find they get worse. That's maybe a better guess than most of what you are hearing.

There was a pretty big epidemic in Israel around the first week of August.
9.7.2009 12:57pm
ChrisatOffice (mail):
Perhaps we should try to use available facts and good sense.

A more widely and rapidly spread flu, even at a low mortality rate, is likely to kill more people than the flu viruses with which we are recently familiar.

A more widely and rapidly spread flu is likely to make more people ill, and thus make life harder for more people. (I think this was KA's point).

No, it is not the Black Death, and, yes, we are better prepared in this country to provide medical help for the associated problems of pneumonia and dehydration.

So: panic? No. Take it seriously? Yes.
9.7.2009 12:59pm
Bob in SeaTac (mail):
This is insane! I'm sure none of you ever got sick when you went away to college or summer camp and encountered a group of people you'd never met before, or had been away from for a long time.

The situations I mention above ALWAYS cause a flurry of illnesses.

I caught a REAL flu in 1951 or 1952, and have NEVER had another case of it. When I was at Cal in 1957, there was a big flurry of that flu in my dorm, but I didn't catch it then. It sure seems like catching the disease provides lasting immunity.
9.7.2009 1:39pm
ibeth (mail):
The information about this flu is insanely inadequate. I have read that less than 2-billion has been spent worldwide so far on a vaccine, which is pathetic (the Wall Street nonsense cost maybe 2 trillion). I have been told that Belgian had flu vaccines bought from the US at high prices available in August. There is obviously, if the thing attacks big time, going to be a huge panic for shots and some awful system of allocation. Will it hit big time? I have no idea. Two-thousand in Washington? A ridiculous number and all wrong or real? A pandemic in South American (cf. NYTimes) or in fact almost no one dying (relatively) in their flu season just finishing. Here's one: can a flu virus live outside the body for four hours, four days (at normal room temperatures) or one month in thirty-degree weather? One of the above from column A? Like always, Google this stuff and you find odd factoids and then, too, nothing often concrete, and no doubt pure absurdity. I have no idea. I also have COPD and am reasonably frightened, but then I was around in 1957 so I have some immunity? right? wrong? Whatever.
9.7.2009 1:56pm
Laura(southernxyl) (mail) (www):
Bob - what is insane, exactly?

That anyone else might be concerned about the flu, since you personally don't believe you have reason to be?
9.7.2009 2:52pm
erp:
Well. For the first, and most probably last, time in my adult life, I'm proud of my current president for telling kids to wash their hands, but I wish he had included the teachers and other adults in the school too.

Chrisatoffice, I sure hope your sarcasm proves right and dear leader isn't going to use the scare of a non-existent flu pandemic to pass his time bomb of a health care insurance plan.
9.7.2009 3:33pm
ChrisatOffice (mail):
Bob:

It sure seems like catching the disease provides lasting immunity.

But not to all variants. (In other words, there is not one 'disease.')
9.7.2009 4:39pm
Orson Buggeigh:
One little quibble about the news report you quoted - I don't think of WSU as a 'west coast' university. It's quite a ways inland. Practically to Idaho, in fact.
9.7.2009 6:22pm
Randy R. (mail):
I read an obit this summer of a man of 27 who died from swine flu. At least, that's what the obit said.....
9.7.2009 7:56pm
Eli Rabett (www):
Problem is that the advice the unis are giving is not very useful. Sort of you're a professor, think of something. We do have some tools, blackboard, camista, mailing lists, etc.
9.7.2009 10:08pm
John Moore (www):
Isn't this an annual problem? Don't schools have flu outbreaks all the time? Why should H1N1 (particularly given its low mortality rate, about 0.1%, comparable to the ordinary flu) be treated so seriously in the media or by school officials?

This is different for reasons which were given above and are widely available. No, this is not a normal flu outbreak. It is more serious, especially for young people. It isn't the black death, but it is going to make about half the population quite sick, and kill twice as many as a normal flu.

That's exactly what has happened so far and I suspect will happen. Any sickness or death associated with "flu like symptoms" will be counted as a stat for H1N1. What will end up happening too is the government will pull a baliout backslap with "it would have been so much worse if we didn't save the day".

Nonsense. Take a look at the CDC site or the Pro-Med mailing list or the many other authoritative sites. Right now, if you get the flu in the US, there is an extremely high probability that it will be the pandemic strain, based on CDC sampling.



I caught a REAL flu in 1951 or 1952, and have NEVER had another case of it. When I was at Cal in 1957, there was a big flurry of that flu in my dorm, but I didn't catch it then. It sure seems like catching the disease provides lasting immunity.

Nope. There are many varieties of flu. Infection with some may provide cross-immunity to others, but not across the board. You proabably just have a natural immunity to it. That *might* make you at higher risk if you do catch this flu.

The information about this flu is insanely inadequate. I have read that less than 2-billion has been spent worldwide so far on a vaccine, which is pathetic

The information is easy to find in the day of the internet (as is posting about it's absence without even checking). As for the money spent, have you ever heard the saying "you can't push a rope?"

What would you do with a trillion dollars to spend on this? There is not enough time to build more production capacity - in fact there wasn't enough time to even make a vaccine before the southern hemishphere got clobbered, and the northern hemisphere is likely to have a lot of trouble before the vaccine becomes widely available here. That isn't due to money, it's due to biology and the fact that you can't create new production capability overnight.
9.7.2009 11:46pm
Ricardo (mail):
pandemics, natures way of telling us birth control ain't so bad; or her way of telling us there is too many of us.

Not really. Possibly the worst pandemic in history killed off over 90% of the natives of the Americas in the early 16th century. The problem wasn't that there were too many of them on the continent (well, if you were European and wanted to grab some land you might have thought that but population density was far below what it is today).

---
The media, instead of hyping a new crisis for their dear leader to use to scare us into buying his brand of socialism...

I know I shouldn't even respond to this but between me and my friends, we have been to Japan, Hong Kong, Singapore, Philippines, Thailand and mainland China in the past few months. All have introduced thermal scanning and quarantine checkpoints for all arriving international passengers to prevent passengers with fever-like symptoms from entering the country. I suppose these other countries are all doing this to please Obama?
9.8.2009 4:22am
Mark Buehner:

1) The flu is continuing in months when seasonal influenza is normally absent. At the moment, 99% of typed cases reported to CDC are swine flu ("Pandemic 2009 H1N1").

When is the flu ever totally absent? Source?


2) Health authorities are seriously alarmed - worldwide. It is not just a media phenomenon.

Health authorities are paid to be seriously alarmed. Or, to be kinder, to a carpenter every problem looks like a nail.

Isn't it possible that so many cases are reported because so many people are going to the hospital or doctor in fear of the swine flu? In other words, most folks would just ride out the flu, but if it might be swine flu better get to the doctor asap?

And as far as cause of death, we have the same thing. If last year somebody died of pneumonia that had a common flu as well, he is listed as dieing of pneumonia. This year any hint of H1N1 and thats the cause of death, period (see point #2).
9.8.2009 9:48am
Prof. S. (mail):

2) Health authorities are seriously alarmed - worldwide. It is not just a media phenomenon.

They were likewise "seriously alarmed" a few years ago when we had a shortage of flu vaccines. I remember being in the airport sitting next to a health official and overhearing his phone conversation. You would have thought that it was time to stock up on food and head for the bunker.

And nothing happened afterward. People got the flu like every other year, but nothing serious happened. So the fact that they are seriously alarmed doesn't necessarily mean that there is anything particularly alarming.
9.8.2009 9:49am
Pauldom:
My daughter went to a petri dish of a high school in Memphis. The kids were totally packed together in the hallways between classes, and it was not unusual for her to have to sit on the floor to eat lunch on rainy days because all of the chairs in the cafeteria were taken. During flu season the principal helpfully told the kids to "avoid crowds".

Laura--lol! The advice given at my university is about this helpful. We've been told to be less strict with attendance requirements. In some situations (e.g., speech classes, big exam sections) that's easier said than done, but it doesn't hurt to think through alternatives.

Do anyone think the tradition of shaking hands at graduation will ever come back? Some of our administrators who shake thousands of hands per graduation are sure hoping it won't.

I've already had the swine flu. Or rather, I was diagnosed with flu type A, which had a 98% chance of being swine flu at that time of year. No one, at least in my area, is spending time on further tests--they just assume nonseasonal flu A is h1n1.
9.8.2009 10:31am
ray_g:
This particular child has cried wolf far, far too many times. Going back at least to the 1976 swine flu, and IIRC the earlier "Hong Kong" flu (1972?) about every 4 years there is another round of scares. If the MSM is always replaying the 60s and Vietnam, the public health community is always replaying 1918.
9.8.2009 11:40am
ChrisTS (mail):
Eli Rabett:
Problem is that the advice the unis are giving is not very useful. Sort of you're a professor, think of something. We do have some tools, blackboard, camista, mailing lists, etc.

True. And none of the tools will help with the problem of having lots of students too ill to think or use Blackboard or having the professor to ill to do so. Rather, they would be most useful if everyone stayed home and we all went to 'distance-learning.'

ray-g:

There is a difference between the story of the proverbial child crying 'wolf' and the public health community fearing a pandemic: one simply lied, repeatedly, and the other has past experience of real cases.

And, don't forget, even in the fable, the wolf eventually arrives.
9.8.2009 2:19pm
Laura(southernxyl) (mail) (www):

An eighth-grader at White Station Middle School died today of the swine flu, becoming the first confirmed death from the H1N1 virus in Shelby County.

Michael Howse was diagnosed with the virus last week and died in a hospital Monday.

Health Department officials would not release the boy's name or age, but teachers at the school confirmed that it was him.

"He was an awesome, awesome child," said social studies teacher Gina Murphy, who taught Michael last year. "Everybody absolutely loved him. His mom, I told her last year, 'You need to write a book on how to raise kids. You've done an outstanding job with this child.'"

Medical professionals are trying to determine whether any underlying medical conditions may have contributed to his death, Health Department officials said.


article

This was my daughter's middle school. Throughout all of her 13 years of K-12 schooling, and 4 years of college, I don't remember any students in any grades dying of the flu.
9.8.2009 4:45pm
ray_g:
"There is a difference between the story of the proverbial child crying 'wolf' and the public health community fearing a pandemic: one simply lied, repeatedly, and the other has past experience of real cases. "

Being sincere yet constantly wrong has the same effect as if they were lying.
9.8.2009 5:09pm
John A (mail):
Late again...
Er, "novel?" Unseasonable?

via common-sense-about-swine-flu

We find an alert from the British Journal of Medicine about a US report -
response to swine flu may be seen as alarmist, overly restrictive, or even unjustified


Pandemic A/H1N1 virus is not a new subtype but the same subtype as seasonal H1N1 that has been circulating since 1977. Furthermore, a substantial portion of the population may have immunity.
9.8.2009 6:39pm
John Moore (www):
Late again...
Er, "novel?" Unseasonable?

Yes, novel - H1N1 has been circulating since 1977, but this subtype has not.

Unseasonable - yes - there is dramatically more flu than is normal for the time of year, and 99% of it is 2009 Pandemic H1/N1.

We find an alert from the British Journal of Medicine about a US report -
response to swine flu may be seen as alarmist, overly restrictive, or even unjustified

From one PhD STUDENT, cherry picked for this debate.

Here's some common sense:

1) For an individual, there is little need to panic, as the odds of you dying from this are low. The odds of you being painfully sick are high (40%). Taking infectious disease precautions are reasonable, but they ALWAYS ARE doing the flu season, even if few people do.

2) For a hospital, this is a very serious issue. It probaly will increase the number of people needing ICU services significantly, and there is little spare capacity. That means that as the numbers increase, the case fatality rate may rise, as resources are not enough for those critically ill patients. Hence anything that will slow down the pandemic and reduce the number of people sick at one time in one area is good.

Get it? It is a probable public health emergency, and not likely a personal health emergency, unless you just happen to be unlucky. Since we can't predict who is going to be lucky or unlucky (although you are worse off if you are young), you may in fact be at increased, albeit not large, risk.
9.8.2009 11:37pm
tamiflu against flu (mail) (www):
Reading so many articles about it... To be afraid, or not?
9.10.2009 8:06am
Eli Rabett (www):
Ebso (who distributes journals to university libraries) has a useful site on the swine flu for clinicians, nurses and chumps
9.10.2009 7:39pm

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