On swine flu; Speaking Personally I strongly advise vaccination

Many people I have a lot of respect for tend to rework a loss of respect for financial elites and the excesses of medicine into anti vaccination diatribes. Clean water and a place to shit that doesn't spread disease and the discovery of vitamins and vaccination against illness are the fundamental bedrock of 90% of the great improvements in human life in the last century. Doctors might have lost the plot with the over medication of the middle aged but for the record this blogger does not recommend throwing out the babies with the bathwater.
I'm a big proponent of the sciences, sense and the power of information and therefore think the elites of the library, the sciences and the academy deserve more respect, not less. The masters of con-commerce and dollar-finance and the bullies of business who seek political advantage over a better mousetrap I have no time for. Don't confuse the two, imo.


Nearly 5000 people worldwide are known to have died of swine flu so far. But on average 36,000 are said to die of flu each winter in the US alone. On the basis of such numbers, many have concluded - wrongly - that swine flu is less dangerous than normal flu.

These numbers should not be compared directly. The 36,000 figure comes from epidemiological studies. Because the timing of flu outbreaks varies from year to year, the normal number of deaths in any month can be compared with the number of deaths in the same month when there was a flu outbreak, says Lone Simonsen of George Washington University in Washington DC. Such studies reveal a bulge in deaths during and just after the flu season every year, mainly among the elderly. Many are clearly due to flu and other lung infections that can follow it, but more than half are not obviously connected, because flu often kills in indirect ways, by triggering heart attacks or strokes, for instance.

By contrast, the deaths attributed to swine flu are those directly caused by respiratory infection with the pandemic virus. Indirect deaths - the majority of the 36,000 figure for regular flu - are not being counted. The full death toll for 2009 H1N1 flu will not be known for a while, if ever. Perhaps there will be fewer deaths than normal because older people, more at risk from secondary events such as heart attacks, have some immunity to the virus. However, the total seems likely to be higher simply because the virus will infect far more people than normal, and it kills directly more often.

The impact of a pandemic is not simply about the number of deaths, though. This pandemic, like previous ones, is killing mainly young people, not the very elderly as flu normally does (see diagram). By early October, 76 children and adolescents in the US had already died of swine flu (see diagram). That is more than the usual winter toll, and the winter has just begun.

(Update 30 October: 114 children in the US have now died of H1N1 flu.)

Think of it this way. 2009 H1N1 flu is effectively two diseases: ordinary flu for most, a lung disease that can kill quickly in a few. Most of the severe cases are in babies, and adults aged between 20 and 50. The impact of the deaths of young adults, on dependent families and the economy, will be much greater than that of the deaths among the elderly.

The real worry, though, is the severe form of the disease - a direct viral attack on the deep lungs. That is more likely in people with underlying conditions that damage lungs (such as asthma and smoking), suppress immunity (pregnancy) or involve long-term inflammation (including obesity, diabetes and cardiovascular disease). Of those few getting the severe form, however, between a third and two-thirds of adults and 80 per cent of young children have no underlying condition.

Tests in ferrets show that the 2009 virus binds deeper down in the lungs than normal flu viruses, explaining why it can cause serious lung disease. But why do only a few people succumb?

Keeping healthy may make a mild case of flu even milder. And stopping smoking, losing excess weight and avoiding binge drinking will reduce your chances of getting the severe form of pandemic flu. But beyond this, little of the advice proliferating on the internet is backed by any evidence.

Being obese definitely increases your risk of severe disease but there is no evidence that eating organic food, or any other kind, helps at all. Vitamin D has been touted as a preventive, but the latest study found no such effect. People with flu are told to drink plenty of fluids, but a recent review found no evidence for or against this, and some signs that too much fluid can be harmful in pneumonia.

Many people believe a mask will protect them, but Canadian nurses wearing an N95 mask, which keeps out most viral particles, got flu just as often as they did wearing a cloth mask, which doesn't - suggesting neither works very well. Surprisingly, there is little evidence that hand-washing works either, except among young children.