Sliver bullet ?

Novartis says produces first batch of H1N1 vaccine

wiss pharmaceuticals company Novartis AG said Friday it has successfully produced a first batch of swine flu vaccine weeks ahead of expectations.

The vaccine was made in cells, rather than grown in eggs as is usually the case with vaccines, the company said.

The announcement comes a day after the World Health Organization declared swine flu, also known as A(H1N1), a pandemic. The move indicates that a global outbreak is under way. WHO says drugmakers will likely have vaccines approved and ready for sale after September.

Novartis said it would use the first batch of vaccine for pre-clinical evaluation and testing. It is also being considered for clinical trials, the company said.

The vaccine was produced at a Novartis plant in Marburg, Germany. Novartis said the facility could potentially produce millions of doses of vaccine a week.

A second plant is being built in Holly Springs, North Carolina, the company said.

Now Panic!

WHO: Swine flu pandemic has begun, 1st in 41 years

Swine flu is now formally a pandemic, a declaration by U.N. health officials that will speed vaccine production and spur government spending to combat the first global flu epidemic in 41 years. Thursday's announcement by the World Health Organization doesn't mean the virus is any more lethal — only that its spread is considered unstoppable.

Since it was first detected in late April in Mexico and the United States, swine flu has reached 74 countries, infecting nearly 29,000 people. Most who catch the bug have only mild symptoms and don't need medical treatment.

WHO chief Dr. Margaret Chan made the long-awaited declaration after the U.N. agency held an emergency meeting with flu experts and said she was moving to phase 6 — the agency's highest alert level — which means a pandemic is under way.

"The world is moving into the early days of its first influenza pandemic in the 21st century," Chan said in Geneva.

Don't Panic

WHO on verge of declaring H1N1 flu pandemic

The World Health Organization (WHO) is on the verge of declaring the first influenza pandemic in more than 40 years, but wants to ensure countries are well prepared to prevent a panic, its top flu expert said on Tuesday.

Keiji Fukuda, acting WHO assistant director-general, voiced concern at the sustained spread of the new H1N1 strain -- including more than 1,000 cases in Australia -- following major outbreaks in North America, where it emerged in April.

Confirmed community spread in a second region beyond North America would trigger moving to phase 6 -- signifying a full-blown pandemic -- from the current phase 5 on the WHO's 6-level pandemic alert scale.

"The situation has really evolved a lot over the past several days. We are getting really very close to knowing that we are in a pandemic situation, or I think, declaring that we are in a pandemic situation," Fukuda told a teleconference.

Is she talking about the fall return?

WHO chief says world should prepare for severe flu

Countries should be ready for more serious H1N1 infections, and more deaths from the newly-discovered virus, World Health Organisation chief Dr. Margaret Chan said on Friday.

"In cases where the H1N1 virus is widespread and circulating within the general community, countries must expect to see more cases of severe and fatal infections," she said. "We do not at present expect this to be a sudden and dramatic jump in severe illness and deaths."

Kentucky now has 24 confirmed swine flu cases

Four more flu cases confirmed in state

Kentucky health officials confirmed four new swine flue cases in the state Thursday, including a Fayette County man who became ill on a trip to Nevada.

The Lexington patient remains in Nevada and is being treated there with anti-viral medicine, according to the Lexington-Fayette County Health Department. Officials think he picked up the flu virus in Nevada, not Kentucky.

The other three other new cases confirmed Thursday are in Lincoln, Mercer and Jefferson counties, state health officials said.

That brings the state total to 24 confirmed cases.

Meanwhile, Jefferson County health and education officials held a joint press conference Thursday to reassure the public after a middle school there recorded two confirmed and two probable cases of flu.

Swine flu confirmed in Daviess County Kentucky

Second swine flu case confirmed in Ky.

One of Kentucky's five probable swine flu cases has been confirmed as actual swine flu, state health officials said Tuesday.

Officials initially reported the Daviess County man's case as probable swine flu last weekend. Further testing by the federal Centers for Disease Control and Prevention confirmed the diagnosis.

The young man is receiving anti-viral drugs and is doing well, state health officials said.

He is the state's second confirmed case of H1N1 swine flu, the other being a woman from the Bowling Green area who was hospitalized in Georgia after becoming ill on a trip.

No new flu cases were reported in Kentucky Tuesday.

Kentucky health officials are still awaiting confirmation on four other probable cases: a Fayette County man; an infant in Western Kentucky, a toddler in Hardin County, and a child in Montgomery County.

Probable swine flu case reported in Daviess County, Ky.

Probable swine flu case reported in Daviess County, Ky.

A Tri-State resident has come down with what officials believe to be swine flu, the Kentucky Department for Public Health said today.

The case marks the fourth probable instance of H1N1, known commonly as swine flu, in Kentucky. The Centers for Disease Control and Prevention will conduct further testing on the specimen.

"In Kentucky and nationally, we are still in the early stages of identifying cases of H1N1 swine flu, and determining how widespread it might become," Department of Public Health Commissioner William Hacker said in a news release. "While we have not identified many probable or confirmed cases, we continue to encourage individuals to stay informed as this situation evolves and to continue practicing basic health habits to prevent illness."

The new case involves a young Daviess County man who has since received antiviral treatment and has recovered, health officials said. The Green River District Health Department will check close contacts for the illness and offer preventive treatment.

Kentucky officials are coordinating investigation of the case with Massachusetts health officials because the man attends college there, said Gwenda Bond, a spokeswoman for the Kentucky Cabinet for Health and Family Services.

Bond said the man, whose name and age are not being released, came down with symptoms in the middle of last week shortly after he came home from Massachusetts.

"But it is possible to spread the virus before the symptoms appear," Bond said.

My fear as well

Scientists dig for lessons from past pandemics

If there's a blessing in the current swine flu epidemic, it's how benign the illness seems to be outside the central disease cluster in Mexico. But history offers a dark warning to anyone ready to write off the 2009 H1N1 virus.

In each of the four major pandemics since 1889, a spring wave of relatively mild illness was followed by a second wave, a few months later, of a much more virulent disease. This was true in 1889, 1957, 1968 and in the catastrophic flu outbreak of 1918, which sickened an estimated third of the world's population and killed, conservatively, 50 million people.

Swine flu comes to Kentucky

One Confirmed, One Probable Case Of Swine Flu In KY

Gov. Steve Beshear announced that the Kentucky Department for Public Health (DPH) will report one confirmed case and one probable case of swine flu to the Centers for Disease Control and Prevention (CDC) Thursday.

"Like the rest of the nation, we are concerned about the spread of this new strain of swine flu," said Beshear. "I want to assure Kentuckians that health officials here are responding aggressively to detect possible cases of swine flu and respond with the appropriate preventive measures. Individuals should continue to monitor this situation as it develops and practice basic measures to stay healthy, such as hand washing and staying home when sick."

The confirmed case involves a woman from Warren County who had recently traveled to Mexico. The patient is currently hospitalized in Georgia, and samples were submitted to CDC for confirmation by Georgia health officials. Officials from the Barren River Health District are actively investigating the circumstances of this case to determine whether any contacts of the patient may be ill or need preventive treatment.

The probable case that is being reported involves an infant from another area within the Barren River Health District who had been in close contact with an individual who recently traveled to Mexico. It is unrelated to the confirmed case. The child's family and other close contacts are being evaluated for illness and possible preventive treatment. The child has not been hospitalized. A sample from the patient has been sent to the CDC for further testing to determine whether swine flu is the cause of illness. The name of the county in which the patient resides will be released if the case is confirmed.

Whats in a name?

WHO to stop using term 'swine flu' to protect pigs

GENEVA – The World Health Organization announced Thursday it will would stop using the term "swine flu" to avoid confusion over the danger posed by pigs. The policy shift came a day after Egypt began slaughtering thousands of pigs in a misguided effort to prevent swine flu.

WHO spokesman Dick Thompson said the agriculture industry and the U.N. food agency had expressed concerns that the term "swine flu" was misleading consumers and needlessly causing countries to ban pork products and order the slaughter of pigs.

"Rather than calling this swine flu ... we're going to stick with the technical scientific name H1N1 influenza A," Thompson said.

Why not just call Egypt on its stupidity. Certainly there would be many broken relationships if it were sheep flu instead.

Advance team member for Obama Mexico trip sick

White House aide's family likely has swine flu

WASHINGTON (AP) - A member of the U.S. delegation that helped prepare Energy Secretary Steven Chu's trip to Mexico City has demonstrated flu-like symptoms and his family members have tested probable for swine flu.

White House spokesman Robert Gibbs said Thursday that three members of an aide's family are being tested to see if they have the same strain of swine flu that is threatening to become a pandemic. The aide worked in presidential advance, which is responsible for planning and preparing trips.

Gibbs said that Secretary Chu has not experienced any symptoms. The spokesman also said that President Barack Obama also has had no symptoms of the virus and doctors see no need to conduct any tests on his health.

Bad PR for Disney

South Carolina students report flu-like symptoms after Disney trip

Officials in South Carolina shut down a school today and are disinfecting the building after 16 to 18 students in their marching band reported flu-like symptoms after visiting Walt Disney World.

Reports from the South Carolina Department of Health and Environmental Control show lab results released today indicate that 10 students from a different school probably have the swine flu virus after a recent school trip to Mexico.

Those lab results have been sent to the Centers for Disease Control and Prevention for final confirmation, which can take up to 48 hours.

Meanwhile, Orange County Health Department officials said test results on a tourist who had visited Disney earlier this week and also displayed flu-like symptoms are expected sometime today.

WHO Pandemic Phase 5 (of 6)

WHO raises flu threat level, warning pandemic imminent

Its on now Skippy.

Marijuana for Swine Flu?

One interesting thing about the avian flu H5N1 was that the Cytokine Storm as seen in severe sepsis was responsible for many of the deaths. It may have also played a large role in the 1918 Pandemic and in the SARS deaths. Research has shown those on statin therapy for cholesterol can reduce mortality from the avian flu and presumable the swine flu as well.

So in researching that last night on line I ran across another intersting study on reducing the effects of the cytokine storm and cytokine production.

Marijuana and Cocaine Impair Alveolar Macrophage Function and Cytokine Production

So we all just need to get some Tamiflu, take some Zocor and smoke some pot while we watch it spread across the google map?

WHO goes to Pandemic level 4

WHO said the new phase 4 alert means sustained human-to-human transmission is causing outbreaks in at least one country, signaling a significant increase in the risk of a global epidemic, according to Mexico health department spokesman Carlos Olmos. Phase 4 doesn't mean a pandemic is inevitable, but many experts think it may be impossible to contain a flu virus already spreading in several countries.

WHO raises pandemic alert; Mexico deaths climb

Pandemic Google Map

View H1N1 Swine Flu in a larger map

WHO stuck at Pandemic Phase 3 reality at Phase 5

Politics are obviously hampering the efforts of the WHO and the CDC. I'm just a lowly RN but seems to me by the WHO's on criteria we are way past level 3 but they will not meet again until Tuesday.

In nature, influenza viruses circulate continuously among animals, especially birds. Even though such viruses might theoretically develop into pandemic viruses, in Phase 1 no viruses circulating among animals have been reported to cause infections in humans.

In Phase 2 an animal influenza virus circulating among domesticated or wild animals is known to have caused infection in humans, and is therefore considered a potential pandemic threat.

In Phase 3, an animal or human-animal influenza reassortant virus has caused sporadic cases or small clusters of disease in people, but has not resulted in human-to-human transmission sufficient to sustain community-level outbreaks. Limited human-to-human transmission may occur under some circumstances, for example, when there is close contact between an infected person and an unprotected caregiver. However, limited transmission under such restricted circumstances does not indicate that the virus has gained the level of transmissibility among humans necessary to cause a pandemic.

Phase 4 is characterized by verified human-to-human transmission of an animal or human-animal influenza reassortant virus able to cause “community-level outbreaks.” The ability to cause sustained disease outbreaks in a community marks a significant upwards shift in the risk for a pandemic. Any country that suspects or has verified such an event should urgently consult with WHO so that the situation can be jointly assessed and a decision made by the affected country if implementation of a rapid pandemic containment operation is warranted. Phase 4 indicates a significant increase in risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion.

Phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region (Figure 4). While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short.

Phase 6, the pandemic phase, is characterized by community level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in Phase 5. Designation of this phase will indicate that a global pandemic is under way.

During the post-peak period, pandemic disease levels in most countries with adequate surveillance will have dropped below peak observed levels. The post-peak period signifies that pandemic activity appears to be decreasing; however, it is uncertain if additional waves will occur and countries will need to be prepared for a second wave.

Previous pandemics have been characterized by waves of activity spread over months. Once the level of disease activity drops, a critical communications task will be to balance this information with the possibility of another wave. Pandemic waves can be separated by months and an immediate “at-ease” signal may be premature.

In the post-pandemic period, influenza disease activity will have returned to levels normally seen for seasonal influenza. It is expected that the pandemic virus will behave as a seasonal influenza A virus. At this stage, it is important to maintain surveillance and update pandemic preparedness and response plans accordingly. An intensive phase of recovery and evaluation may be required.

Where our tax dollars go

9 patients made nearly 2,700 ER visits in Texas

No surprised at all. I bet I could think of a few here that match those numbers.

Short coats

Exchange between a family practice MD and critical care RN as a medical student tries to navigate the maze of the ICU at 5am:

RN: Here comes a short coat is that one of yours?

MD: Where? No not one of mine.

RN: She looks kind of lost....and about 12.

MD: Hey wait did you call me short coat when I was a student too?

RN: Heh.

For the uninformed in a teaching hospital (training wheel hospital) a short white lab coat is worn by medical students and they are not allowed to wear long white coats until after graduation as an MD. Residents wear the long coats but have not completed their training yet (Most impressive but you are not a Jedi yet!) in their specialty field. So the pecking order is MD>Resident>Med student.

Sometimes the the medical students are courteous and the nurses can be nice and helpful. I don't mind giving some of them a little info so they look smart when they present their case. Some seem to think we work for them and I am glad to give them just enough info to make them look like blithering idiots. Other times the little bastards take off with your chart to a quiet room without telling you when you have real live saving shit to do, sit in your chair and generally get in your way showing up at the busiest possible times to play 20 questions.

Eventually most of the grow up to be real doctors and some are eaten. Its the circle of life at its best.

Jerry Springer Live

Sometimes you are in your patients room while they are watching Springer and you think "where do they find these familys?". Then visiting time rolls around and you think the ones from Springer might be an improvement.