Friday, May 01, 2009

My Experience with Swine Influenza

I sat down with four other infectious disease physicians in a small room this afternoon to discuss a problem: we don't have any drugs left to treat influenza.

It was worse, we were running out of kits that do the rapid test to check for influenza. We have to run test that take a long time to come up with a result

We had 10 patients who almost certainly had the swine influenza virus, which makes me think we have hundreds of cases only in town. In the US, it's almost certain there are thousands of patient with the infection who are yet to be diagnosed, and probably will never get diagnosed.

The CDC (Center for Disease Control) encouraged anyone with symptoms resembling influenza to go to the ER. Meanwhile, they told physicians to not check those with mild or moderate symptoms for the virus. So we have more people coming to the ER with large numbers, but we won't be testing them.

Our ER is full, so we are emptying one of our wards and transferring all patients coming in with such symptoms to that ward. Most will not be tested, and only the very sick will be admitted to the hospital and treated. I'm still not sure were will the drugs come from , but they will come from somewhere. Even in America, you'll need someone influential to push some buttons and get some drugs sent to those who need them.

Homeland security (headed by the former Arizona governer) will be shipping doses of Tamiflu (influenza drug) that will be enough to treat 30 patients in our hospital. It's harsh to say that, but I'm glad the first case of swine influenza was reported in Arizona yesterday, which allowed them to send us some Tamiflu. It didn't occur to them that Arizona borders Mexico, and that we have hundreds of people coming to Arizona from Mexico everyday.

And here comes the challenge: we had to make a policy of treating only a certain group of patients who we believe will be the sickest and who may actually die from this influenza. It's not an easy decision to tell someone with the infection that they will not be treated because there isn't enough drug on board.

What makes things less dramatic is the fact that those drugs work only within 2 days of the onset of symptoms, so even without the extreme shortage that we're experiencing we wouldn't have treated a lot of those infected to start with.

Last year I took part of an enormous workshop lead by former Surgeon General Richard Carmona to teach students from the colleges of medicine, pharmacy and law about the dangers and implications of an influenza epidemic. It was a little overwhelming for most participants, but the point we all agreed upon: We can never be 100% ready to face an epidemic. The ethical and economic challenges of any epdiemic can be more dangerous than the epidemic itself.

Take this for example: In 1972 in Yugoslavia, one citizen came back from Saudi Arabia carrying a small pox, and infection that had been eradicated long before that. This one person infected many relatives, and those relatives spread the infection all over the country. The military had to act and lock those infected or even anyone with symptoms in buildings. They forced everyone in the country to be vaccinated, and held checkpoints to make sure everyone was vaccinated, and would force everyone to get the vaccine. They succeeded in eradicating the infection, and thanks to science smallpox has been eradicated from the face of the earth since 1979.

If you think the military would only violate the privacy and freedom of citizens in communist Yugoslavia, think again. If the US was faced with a similar epidemic , it won't be surprising to see soldiers down the streets forcing sick people to stay home, forcing laws that decide on the patients who need to be treated, and shutting down schools and arresting whoever aims at spreading mass hysteria and panic among people.

Fortunately, this current swine influenza epidemic is similar to "the regular human influenza" that have affected everyone of us several times in our lives. Even though the number of those infected will continue to rise, and very few people may succumb to the diseases, it's nothing out of the ordinary and most infected people will recover beautifully. This outbreak showed that we are much better prepared for epidemics than we were a century ago, a lot of work still needs to be done, and influenza will keep mutating and hitting and the next hit may not be as soft as this one.

And Egypt slaughtered all pigs- for this moment I am ashamed of being an Arab, seriously.


Unknown said...

Don't be ashamed there are idiots all over the world! Here's a poem my sister wrote hope it makes you laugh,-I take off my clothes and get in the tub-
I lather my soap and then start to scrub-

I discover a rash on the small of my back-
Going all the way down deep in my butt crack-

I go to the doctor and then start to scream-
He gives me advice and a new special cream-

I lather my skin from my toes to my chin-
And after some time I'm all better again- she's so retarded sometimes! I figured with you being a doctor you would appreciate this!

KJ said...

Wow. It's really a tough job to choose patients. People tend to think that doctors are ethical and would treat everyone - but with the shortage of medicines I guess there need to be priorities.

I can't even imagine being in the shoes of one of the rejected patients. You must be really stressed out dealing with so many such cases on a daily basis now! God help you.

mab3oos said...

can't you just get a شوال of حبة البركة? there will be enough to treat all those coming into the ER.

Tallouza said...

Serious question....I am planning to go to Spain in mid May...What do you think? Is the problem serious enough to reconsider travel plans in your opinion?

The Observer said...

That is really sad to have all those patients without enough medication! I can't imagine how difficult such situation can be. It is almost impossible for me.

But what can one do?! People should trust that you doctors take the right decisions.

Sam said...

wow i heard someone mention that they are running of the Twhatever u call it drug..i guess it is pretty scary if it gets any worse...this morning i was sneezing and had a runny nose and thought o no..but then i remembered that it was just my allergies that i have every morning this time of year...dah...
my poor son got scared of pepperoni now..he wouldnt sit near the kids eating pepperoni pizza yesterday....

za3tar said...

I still don't know how to feel about this swine flu. On one hand, it seems that the government is telling everybody that this flu is not as deadly as that in Mexico and it isn't likely that many people will die because of it. Yet, everybody is freaking out. What is worse is that the described symptoms of this event are identical to that of normal flu so should we freak out or stay calm ? Of course stay calm .. but i don't know why i feel confused about this pandemic ... blekh .. i don't know

Hareega said...

San Antonio C.. LOL!! That was funny, and sometimes real

KJ.. fortunatley I'm not treating most patients, it's the ER doctors who seem them first, we just make the policy and treat the sickest of them!

mab3oos, it also treats Alzheimer's cancers and AIDS. Good stuff.

Tallouza, you can travel to any country but Mexico whenever you want. It's probably safe to travel to Mexico as well but I won;t argue with the WHO, if they say don't go there just folow their advice!

Observer, it's not that bad, fortunatley this infection is very benign so most people don;t need to be treated, which makes things easier.

Sam, you won't get it from eating pork or bacon or any pork products. Also the virus itself is very benign and it might even be milder than getting the human flu. The numbers of infected people will rise dramatically next week probably to thousands but I doubt many people if any will die from it.

za3tar, the virus is very benign and nobody in the US died from it. There is one child in Texas who's been sick fro weeks and eventually got the flu and died and it's unclear if the death is attributed to infleunza. It's now becoming questionnable if really 149 people died in Mexico, it might have been 9! Anyway, don't panic.

Unknown said...

......I was just wondering if the comment below is true or not......

million) and that the main problem is pigs. These disgusting creatures can carry both human flu and bird flu and so these viruses can interchange the genetic material inside pigs, and the avian flu (which is a deadly one) can gain the genes that makes it able to invade human’s respiratory system.

To make you disgusted a little bit more, I will tell you about a method called integrative farming. Because pigs eat anything, they usually feed them the domestic birds’ manure (I can not say the other word). So what these guys do, is feeding the chickens, and pigs will eat whatever it can get. Sometimes a third species is integrated into this kind of farming, which is usually fish! Yes fish, they feed them pigs manure (oh my, at the end you discover that your meal is nothing more than you know what).