Monday, December 28, 2009

Who intimidate who? Police or the citizens?

Intimidation must be accompanied with the ability to commit violence.
How can the citizens commit violence against the police?

Unless police is intimidated when its actions are questioned by the
citizens, especially elected representatives.
Actions such as violence against witnesses and suspects resulting in
deaths, which are widely reported and yet no successful prosecution.

But demanding actions demanded by the law of justice, is not
intimidating, it is called fighting for justice. It is those who stop
the fighters of justice who are doing the intimidating.

Actions speak louder than words.
How many citizens died under police custody? Many. Just because the
police had never been found guilty is not surprising when those doing
the investigations are the police themselves.

How many policemen died as a result of direct actions of opposition
elected representatives. None.

You can also apply this to the Israeli Jews versus Palestinian Arabs.
Who do you think intimidate who?

You have to be consistent with your judgement if you really believe in
justice.


It's police intimidation, says Liew

GEORGE TOWN (Dec 28, 2009) : The Selangor police's decision to
investigate Selangor state exco Ean Yong Hian Wah after he had asked
them to cease their probe on Penang Chief Minister Lim Guan Eng for
making allegedly seditious comments is a form of intimidation, says
Bukit Bendera MP Liew Chin Tong.


Ean Yong Hian Wah

Liew Chin Tong
Liew, in a statement, said: "Since when have the police gained such
clout that its actions are beyond public scrutiny and criticism?

"It is the most regrettable that the police has decided on such a
harsh and draconian course to quell views expressed in public sphere."

By doing so, the police is clearly "intimidating" its critics, he
said.

On Sunday, Selangor police chief Datuk Khalid Abu Bakar said Ean
Yong's statement directing the police to cease their investigation of
Lim seemed like an attempt to intimidate the police and as such, the
Seri Kembangan state assemblyman would be hauled up for questioning.

Khalid had earlier said Lim would be questioned this week for
allegedly making seditious comments after the DAP secretary-general
told a Pakatan Rakyat convention on Dec 19 that Teoh Beng Hock had
been "murdered".

Teoh, 30, the political secretary to Ean Yong, was found dead on July
16 at the fifth floor corridor of Plaza Masalam in Shah Alam, which
also houses the Malaysian Anti-Corruption Commission (MACC) office. He
was a witness into an MACC probe on alleged abuse of state funds.

An inquest into his death is currently ongoing.

Updated: 06:26PM Mon, 28 Dec 2009

Risk of death ten times higher in children with H1N1

This is the most accurate description of the Swine Flu danger but be
careful with the data.
Is it with Tamilflu or not? Most probably some.
Is it with artificial lung treatment or not? Most probably not all.
If children were treated early with Tamilflu and given access to
artificial respirators and lung machines, fatality rate can be zero.

This is shown by developed nations such as Germany.


http://sitemason.vanderbilt.edu/news/campusnews/2009/12/28/risk-of-death-ten-times-higher-in-children-with-h1n1.102992

Risk of death ten times higher in children with H1N1
RSS feed Print email to a friend
12/28/2009
2:26 pm

A Vanderbilt researcher, while working in his native country of
Argentina, has found that children with H1N1 influenza die at a rate
10 times higher than those who suffer from seasonal flu.

Dr. Fernando Polack, the Cesar Milstein associate professor of
Pediatrics in the Department of Pediatrics at Vanderbilt, describes
the serious impact of the H1N1 influenza virus on children in an
article titled Pediatric Hospitalizations Associated with H1N1
Influenza in Argentina, published in the Dec. 23, 2009, issue of the
New England Journal of Medicine. The overall death rate with H1N1 was
1.1 per 100,000 children, compared to .1 per 100,000 for seasonal flu
in 2007.

Polack also details which children were at highest risk. Due to
Argentina's location in the southern hemisphere, Polack was able to
collect detailed surveillance data during the peak of the H1N1 virus
outbreak in Buenos Aires in June. His cohort included six hospitals
that combine to serve 1.2 million children.

"One thing that was striking was the tremendous impact on hospital
logistics. Routine surgeries were cancelled; mass infection control
practices were put in place; wards doubled-- particularly in ICU's,
with everyone working over capacity. It was pretty rough," Polack
said.

Dr. Kathryn Edwards, Sarah H. Sell Chair in Pediatrics and director of
the Vanderbilt Vaccine Research Program, is a coauthor on the article.
Edwards says the H1N1 outbreak showcases opportunities which can
result from observing opposing seasonal illness peaks from the
northern to the southern hemispheres. The hope is that scientists can
learn to respond more quickly to a developing pandemic.

"Flu is a global disease and we need to work together to understand
and deal with each flu virus," Edwards said.

The first author of the article is Argentinean pediatrician Dr. Romina
Libster, who is currently in Nashville working as a research
specialist with the VVRP. Libster said Polack realized what was
happening when reports began to arise in Mexico that a new flu virus
was causing serious illness.

Contact: Laurie Holloway (615) 322-474
laurie.holloway@vanderbilt.edu

Sunday, December 27, 2009

Everyone should get innocuated with swine flu vaccine

In CAnada, 60% still had not been vaccinated. Let us see how they
survive.
My gut instinct is that we all must get it in order to prolong our
lives.

I certainly will invest money into the well being of my family. those
of us of can afford it should also be vaccinated so that it will slow
down the spread of this dangerous flu.

http://thestar.com.my/health/story.asp?file=/2009/12/27/health/5362081&sec=health

Sunday December 27, 2009
A(H1N1) vaccine by March/April 2010
By LEE TSE LING

Here's that update on flu vaccines in Malaysia you've been waiting
for.

HOW long more do we have to wait for a publicly-available A(H1N1)
influenza vaccine? Anytime from March to April, says Sanofi-Aventis
medical manager (Malaysia/Singapore/Brunei) Dr Shree Jacob.
Unlike the pandemic A(H1N1) vaccine due to arrive in January, the new
seasonal flu vaccine due to arrive in March/April will be available to
the general public, as long as they can pay for it. – AP/ Amy Sancetta

If this is news to you, it's probably, and understandably, because you
were caught up in Christmas festivities and didn't manage to catch our
news report about it on Friday.

Seasonal, not pandemic

The formulation due to arrive in March/April is the routinely produced
southern hemisphere trivalent seasonal influenza vaccine, which
arrives every year around the same time.

This year, it will contain a component that is protectective against
the A(H1N1) strain currently circulating. The new formulation is
different from the expedited pandemic A(H1N1) monovalent vaccine that
is due to arrive in January.

"Monovalent" here means the pandemic flu vaccine contains just one
viral strain ie the A(H1N1) strain everybody has been so worried
about. "Trivalent" means the seasonal flu vaccine contains three viral
strains.

One of the three strains is the A/California/7/2009-like strain, which
the World Health Organisation (WHO) recommended for inclusion in the
seasonal vaccine back in Sept.

This strain closely resembles the A(H1N1) strain currently circulating
and will protect recipients against it, confirms technical officer
with the WHO Representative Office for Brunei Darussalam, Malaysia,
and Singapore, Dr Harpal Singh.

Available, at a price

Unlike the pandemic A(H1N1) vaccine due to arrive in Jan, which will
only be available from public hospitals and clinics to frontliners and
high-risk groups, the new seasonal vaccine will be available as usual
to the general public (as long as they can pay for it) through private
hospitals and clinics that stock it.

Normally, the seasonal flu vaccine costs below RM100. (Between RM40
and RM60, consultant cardiologist Datuk Dr Khoo Kah Lin told us a
while back.)

Their arrival is good news, says recently appointed Health Ministry
disease control director Dr Lokman Hakim Sulaiman.

"We very much welcome these new seasonal vaccines, which should also
protect against A(H1N1). The public will now have access to the
vaccine," he told Fit4Life.

In other news

Malaysia will not be one of the 95 nations receiving pandemic A(H1N1)
WHO vaccine from its stockpile of donations sourced from various
governments, foundations, and manufacturers.

Not surprising, as Malaysia did not request vaccine aid. (Nations that
did were then selected based on their vulnerability to the pandemic
and their readiness and ability to use the vaccine for priority
populations.)

If we had requested aid, we would not have qualified, says Dr Harpal.
After all, "Malaysia has already procured their own vaccines, compared
to countries like Somalia and Sierra Leone, which can't even afford to
initiate discussions," he explains.

Who should/shouldn't get it?

High-risk groups for complications should, advises Dr Lokman.

Generally, these groups include the elderly, the pregnant, those with
chronic conditions or suppressed immune systems, and those in nursing
homes or long-term care facilities.

However, the ministry's policy on vaccination for high-risk groups,
like any other vaccination, still very much depends on the indication
of use from the vaccine manufacturer, which they are awaiting.

Generally, people who should not get the vaccine include those
allergic to eggs or previous flu vaccines. For other
contraindications, consult your doctor.

What about other instances that aren't so clear-cut? Healthy
travellers, for example. Or those who aren't at risk, but can afford
to purchase it.

On one hand, widespread vaccination prevents the target virus from
hanging around in a community for long.

That doesn't just reduce infections. It prevents the virus from
meeting, mingling, and mutating with other flu viruses in human
bodies.

On the other hand, we can't deny vaccines can cause adverse effects,
however rare or small.

So what should you do? Decide. With your doctor, weigh the risk
factors you and your loved ones face. Consider which is higher - the
risk associated with getting vaccinated (eg adverse effects) or the
risk associated with not getting vaccinated (eg flu complications)?

If you're young, fit, and in robust health, the balance obviously tips
in favour of not needing vaccination. But if you have, say, chronic
heart disease, then the balance tips the other way.

Ultimately, what we should all keep in mind is that vaccination is not
the end-all when it comes to flu mitigation. Public health measures
like practising good hygiene, cough/sneeze etiquette, and social
distancing when ill, Dr Lokman stresses, remain a cornerstone of
prevention for all.

Friday, December 25, 2009

Re: Brain Drain from Malaysia

On Dec 24, 12:10 pm, Tanki <5191...@gmail.com> wrote:
> The Brain Drain Plan
> Posted by: Yogeswaran Gopala Krishnan
> We have talked and debated about the brain drain situation in
> Malaysia. It is happening in front of our very own eyes and more often
> then not, we are left wondering why not enough is done to plug this
> hole
>
> Now, if we carefully think about it, maybe the country can benefit
> from brain drains.
>
> We have a growing number of unemployed graduates who can't speak
> English.  If the clever ones who are able to articulate in English can
> leave the country, we would have enough jobs for these low performers.
>
> Malaysia is not a design hub but more of a Manufacturing/Agricultural
> country. Let's face it, we don't have to be rocket scientists to
> control operators and make sure factory operations runs. It does not

Actually we still have these brilliant scientists, and many of them
are chinese in Malaysia, but their views are not taken seriously
because the leaders and those in power don't understand anything at
all.

As usual, just because they don't understand new ideas, it means that
these ideas are all wrong.

Low salaries is not the main reason why a nation is so backward. Look
at China and Russia. Their salaries are low but most citizens are
still loyal to their nations and will not take up offers of better pay
overseas.

In Malaysia there is a general belief that leaders and decision makers
need not know what they do. This is clearly shown by the Malaysian
federal government policy that anyone can be leaders in agencies
despite them not qualified to work in these fields. For example,
geologists head account departments, and vice versa.

So clearly brain drain is not the reason but idiocy is.

Why Malaysians tolerate idiocy and blame it on brain-drain?

Because Malaysians don't really care. They only care for getting
better paid jobs instead of improving the lives of Malaysians in
general.

The reason is actually very simple. Malaysians think that they are
alright but statistics don't lie.
The income gap is the same as sahara nations, i.e. the worst in the
world.
The human trafficking and slavery is among the worst in Malaysia.
Water and electricity supply is also among the worst in the world
judging from the electric lines shown in the towns in Darfur, Sudan
well known to be the worst in the world.

Malaysians are proud of their development. It certainly looks better
than Mecca of Saudi Arabia, but Bangladeshis are laughing at the state
of development in Kota Kinabalu.

Imagine nobody complain when Johor has no water at all in their water
reserve tanks and yet nobody complained while Singapore cried and
wailed when their water reserve tanks are still half-full.

Despite all these miserable statistics of Malaysia, and the obvious
excesses of the police and enforcement agencies reinforced by
illogical court judgements that don't seem to understand simple
English phrases, the same government is returned to power with
overwhelming majority.

The bottom line is that, Malaysians have never really suffered
compared to Russia and China.
The only cure is for Malaysia to fall into chaos and disasters before
Malaysians react logically to preserve their livelihood. It is going
to be painful and will take decades of pain, just like what History
had told us.

Look at Zimbabwe.


> even have to run efficiently as Malaysia does have a certain low
> production cost advantage to all these multinational companies, who
> will likely to continue to invest.
>
> Yes, going backwards is the way forward……it will benefit the country
> and politicians.
>
> Low performers do not need to be highly paid. Where are they going to
> go? They are not competitive and cannot survive anywhere else except
> in Malaysia. They are not smart, English illiterates, contented
> without any ambition and hence easily controlled and manipulated.
>
> With all the highly paid intelligent people gone (they are now
> Singapore's problem), the country can is able to function at a lower
> cost.
>
> Sure, income from the taxes will be reduced but we have PETRONAS, to
> take care of the Politician's….ahem….the People's needs as there will
> be more oil money to go around – remember, there will less intelligent
> people to question how the money is being spent.
>
> The unintelligent people will not argue and will grab whatever crumbs
> (i.e. Development Projects) that are thrown at them.
>
> The Plan is Fail Proof!

Wednesday, December 16, 2009

Is Swine Flu really mild?

Despite the not coming of my prediction of severe deaths in November,
the 2nd wave actually hit.

The number of deaths had been minimised but still very tragic, but why
the 2nd wave? People dropped their guard allowing the 2nd wave. Once
they realise how bad it was, people and doctors start taking
precautions.

The good news is that in Malaysia, from the worst death incidences,
due mostly to non-usage of Tamilflu, despite their availability, it is
now zero. Doctors in Malaysia are now well trained. For instance, my 2-
year old nephew got mild flu, but chest sound and later X-ray
confirmed the start of a pneumonia at a specialist hospital. He was
quickly prescribed Tamilflu and antibiotics. He was quickly cured.
Just imagine what will happen if he were treated mildly as had
happened in the early days in Malaysia. Despite having high fever and
chest pains, doctors still do not consider it as swine flu. Let alone
have an X-ray. My nephew didn't see a specialist first, he was seen by
a general practitioner at SMC but probably they are more experienced
and caring than new government doctors.

The 2nd wave was stopped because vaccinations were started and people
in US start taking precautions. Prior to the 2nd wave in November, 20%
doctors didn't prescribe Tamilflu immediately, and yet it had strained
the US health care.

By December only 1 in 7 US citizens got the Swine flu and yet, some
healthcare already strained. Vaccination is ongoing but slow moving.
The usual peak flu season is January to March when school resumes.
December is vacation time.

Let us hope that more citizens opt for the vaccination because even if
only 2 out of 7 remained unvaccinated, it will likely overburden their
health care.

Why should Malaysia care? We never have any peak flu season but many
of us visit US and they may return to Malaysia bringing this flu
pandemic.


http://scienceblogs.com/effectmeasure/2009/12/mild_pandemic_bite_your_tongue.php
Mild pandemic? Bite your tongue.

Category: Pandemic preparedness • Swine flu
Posted on: December 16, 2009 6:44 AM, by revere

A spot-on column in CIDRAP Business Source [subscription] by Center
for Infectious Disease Research and Policy's (CIDRAP) Director, Mike
Osterholm, reminded me to say something I've wanted to say for a long
time. We should banish the word "mild" from the influenza lexicon.
There's no such thing as a mild case of influenza, any more than there
are "mild" auto accidents. There are cases that for reasons we don't
understand don't make you very sick (or sick at all), and there are
cases that can lay you lower than you ever want to be, including six
feet under. What Osterholm does with great cogency is put paid to the
idea this is a mild pandemic. His reasons will be familiar to readers
here, but he says them extremely well.

Both Osterholm and we find CDC's most recent estimates (November 14)
of about 10,000 deaths, 47 million infections and over 200,000
hospitalizations "credible and thoughtful." To compare the oft quoted
number of 36,000 excess deaths from seasonal flu to this 10,000 number
is an "apples and oranges" affair. The 36,000 number is an excess
mortality figure derived by different and non-comparable methods (see
our post here for more details). Here is some of Osterholm's version:

In that CDC study, only 9,000 of those estimated annual seasonal
deaths are due directly to influenza or secondary bacterial pneumonia.
The other deaths are among persons who have influenza and who die of
events like heart attacks or strokes. If you want a comparison, think
of the guy who has a heart attack while snow blowing his driveway
after a large snowstorm and whose death is labeled "storm-related."

More important, though, is what we pointed out early on. It's not just
the number of deaths but the pattern of illness in the population,
flu's descriptive epidemiology:

More than 90% of the estimated seasonal influenza deaths occur in
the elderly, who in many instances have existing serious health
conditions that mean their deaths may not be far off, regardless of
their influenza illness. We all realize that death is inevitable, and,
as a public health practitioner, I find that this mad race to
eliminate the top 10 causes of death is not always well thought
through. If we were to accomplish such a goal, there would be 10 new
leading causes of death, and I'm not so sure some of those would be
better than the current ones. But I think we can all agree that "early
deaths"—or those that occur well before our elderly years —just
shouldn't happen. The way we count influenza mortality, an influenza-
related death in an 87-year-old person with advanced Alzheimer disease
is the same as the death of a 22-year-old otherwise perfectly healthy
pregnant woman. Both deaths are equally tragic, but any reasonable
person would agree they are not equivalent public health outcomes.

[snip]

Of the estimated 9,820 deaths:

* 1,090 (11%) have occurred in children 0-17 years of age
* 7,450 (76%) in people 18-64 years of age
* 1,280 (13%) in people over 65 years of age

This age distribution differs considerably from what we see with
seasonal influenza. (Dr. Michael Osterholm, Featured article CIDRAP
BUsiness Source; subscription required)

Which brings me back to the issue of "mild" flu and mild pandemics.
While this pandemic is not 1918 (for which we can be grateful,
although no one knows what prevents this or any other pandemic from
repeating that catastrophe), it is still pretty bad, already producing
more estimated hospitalizations than seasonal flu and we aren't even
into the heart of flu season yet:

It's challenging our healthcare system unlike any previous
seasonal influenza season over the past 30 years. That makes it hard
for me to call this a "mild" pandemic. I just don't believe the term
works.

Yes, there are mild, moderate, or severe influenza illnesses on an
individual basis. But how do we describe a pandemic that hits a
limited group of people really hard and causes only "routine
influenza" for most others?

Whatever you describe it, I'm with Osterholm. Don't call anything
connected with flu, mild. Most flu infections don't have dire
consequences, but a significant number do. And we never know who is
going to win the lottery. The convergence in our views extends to the
same analogy: automobile accidents. As we've noted several times, it
doesn't make much sense to call any encounter with several tons of
moving steel "mild." It may be an encounter that produces little or no
damage, but that's luck. Anyone who's gotten the repair bill for what
can happen when hit by another car going only 5 miles per hour won't
consider the encounter "mild." More importantly, any such encounter
has the potential to be a catastrophe and the really bad ones are
often just plain dumb luck. Mostly we don't have such terrible luck.
Yet even a fender bender can be expensive or result in minor injuries
and be emotionally traumatic as well as result in lost work. Whatever
you might be tempted to call an auto accident (minor or a scratch or a
fender bender), very few people would be prone to call it "mild." And
whle the number of people killed each year in motor vehicle accidents
is roughly the same as seasonal flu, we don't usually think of our
nation's annual highway death toll of 40,000 as "mild" either. Its age
distribution isn't too different than pandemic flu's either, the
source of much anxiety to any parent whose child has just gotten their
driver's license.

It's not just that "mild" is an inapt word. It is an inapt and
dangerous idea. It is based on comparing total deaths in flu seasons
with each another, not with the public health toll they exact. It is
worse than a word not conveying the proper seriousness. It sends a
message that itself has consequences, promoting a lack of urgency
about taking rational public health measures like vaccination.

That's especially pertinent this year when we don't yet know what the
usual flu season (January to March) will bring, either with seasonal
flu or a recrudescence ("wave 3") of swine flu. As Osterholm points
out, even with available vaccine now certain in the next few months,
we are likely to find ourselves in January with a very large
proportion of the population still without immune protection.

After all, what's the hurry? It's a mild pandemic.

Sunday, November 22, 2009

Children death data confirms Swine Flu is much worse

http://www.guardian.co.uk/world/2009/nov/22/panic-flu-deaths-ukraine-politicians

40 - 150 children die annually from normal flu.

CDC had admitted that it had VASTLY underestimated the swine flu
deaths.

In just 6.5 months 300 - 800 children died with 13 - 14 million
infected with swine flu. Which means that it will get much worse.
Given a population of 300 million, i.e. about 30 times, the death
could reach 9000 - 24000 children, alone.

It makes swine flu 200 times worse than all common flu variants
combined altogether.

It makes it vital for Tamilflu to be used quickly as currently
recommended by WHO and CDC.

Despite so much evidence from Mexico and Canada, WHO and CDC didn't
make such clear recommendations making them responsible for all the
unnecessary deaths due to late or even non-administration of Tamilflu,
which is still effective at the moment.

Cases of Tamilflu resistance is increasing and is as predicted by any
intelligent person. Even manufacturers predict it will happen as in
the case of all antiviral and antibiotics.


Published Sunday November 22, 2009
Scientists struggle to explain some cases

THE WASHINGTON POST
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JETERSVILLE, Va. — On Wednesday, Oct. 7, 6-year-old Heaven Skyler
Wilson dragged herself off the school bus that dropped her in front of
her home on a rural road in Jetersville, just south of Richmond. The
little girl, who had never had so much as an ear infection in her
life, was pale and feverish and complained of an upset stomach.

The next day, Heaven's grandmother, Pat Sparrow, took her to a nearby
clinic. Heaven, usually a bright, bubbly girl with blond pigtails,
dimples and effusive energy, had a sore throat and a 103-degree
temperature. The doctor swabbed her for the flu, and the test was
positive.

It was just something going around, Sparrow said she was told. The
doctor told Sparrow to take Heaven home, give her Tylenol and chicken
broth, and let her rest.

By the next morning, Heaven couldn't breathe. Sparrow called 911.
Advertising

"How does she sound?" Sparrow said the dispatcher calmly asked.

Sparrow's panicked husband held the phone to the child's heaving
lungs. "This is how she's breathing! Will you get here now?"

He scooped the child in his arms and rushed across the lawn to meet
the ambulance. By the time they arrived at Chippenham Hospital in
Richmond about 30 minutes later, Heaven's face was blue. Emergency
room doctors intubated her and put her on a respirator.

Two weeks later, on Oct. 21, ravaged with double pneumonia and a staph
infection that deprived her brain of oxygen, Heaven was disconnected
from the respirator. She lived for four minutes.

At 11:18 p.m., Heaven died in the arms of her mother, Sara Wilson.
"You never heard such an awful scream from someone who loved her child
so much," Sparrow said, her voice shaking.

This year's swine flu is, by official standards, a "mild to moderate"
pandemic. As in every year, with every seasonal flu, people get sick.
Some are hospitalized. And some die. But it is the seemingly random
deaths of healthy, young people such as Heaven that are driving much
of the fear around swine flu.

With seasonal flu, 90 percent of the people who die are older than 65;
most of those victims are older than 85. The worst outbreaks of
seasonal flu are usually reported in nursing homes. But with this
year's H1N1 strain, the demographics are reversed. Now, most of those
dying are younger than 65, the worst outbreaks are in schools and the
highest hospitalization rate is among children younger than 4.

Forty to 150 children die from the seasonal flu every year. The
Centers for Disease Control and Prevention recently said that it had
vastly underestimated the number of children who have died from swine
flu. The number of pediatric deaths had previously been reported to be
129. Now, the government estimates that 300 to 800 children died
between April 1 and Oct. 17. During that period, 14 million to 34
million Americans came down with swine flu, the CDC said.

Nationwide, about one-third of the children who have died were, like
Heaven, otherwise healthy, CDC officials and other reports said.

Heaven was the first and only confirmed H1N1 victim in Virginia to die
despite having no underlying complications or health condition. Of the
27 Virginia swine flu victims who have died since April, three have
been children.

The mystery over a relative handful of cases is fueling anxiety about
the scarcity of vaccine, jamming switchboards at pediatricians'
offices and sending concerned parents to overflowing health clinics.
(That eagerness to get the vaccine is, however, a minority phenomenon:
In a Washington Post-ABC News poll last month, more than six in 10 of
those surveyed said they will not get vaccinated, and only 52 percent
of parents planned to have their children vaccinated.)

Scientists are at a loss to explain why perfectly healthy young people
might die from the flu.

"Why would younger individuals, otherwise healthy, succumb to this
virus?" asked Anthony Fauci, director of the National Institute of
Allergy and Infectious Diseases. "That, in the experience we have
generally with other viruses, rarely, rarely happens. We don't know
the answer to that. But that is the thing that scares parents,
understandably."

In any flu, death most often comes because the virus has so weakened
the lungs and body that infection sets in.

Beth Bell, an associate director of the CDC's National Center for
Immunization and Respiratory Diseases, said many of the children who
have died had no underlying medical condition but succumbed to a
secondary bacterial infection.

"That's one of the reasons why we say that if a child appears to be
getting better, then gets worse again, that's a danger sign," Bell
said. A child might be recovering from the viral infection when common
bacteria that naturally colonize in the nose, mouth or throat begin to
reproduce wildly and take hold of the weakened body. "We don't know
why that might be," Bell said. "But it's not a time to wait."

Saturday, November 21, 2009

CDC confirms importance of early Tamilflu

http://www.latimes.com/features/health/la-me-flu-guidelines21-2009nov21,0,2717012.story?track=rss

Many doctors in US had been warned by CDC not to delay administering
Tamilflu, because it is found that 25% of those with confirmed Swine
Flu were not administered with Tamilflu.

The author also recommends Tamilflu even after 48 hours because there
were cases that Tamilflu was effective.

When to take a sick child to the ER
Children and youths are especially hard-hit by swine flu. It is
important to watch for danger signs, as the onset of respiratory
failure can be swift.
By Rong-Gong Lin II

November 21, 2009


For parents worried about a child sick with the flu, deciding when to
head to the emergency room can be difficult.

Unlike the typical seasonal flu, which is generally most dangerous to
infants and the elderly, the H1N1 strain has hit children, teenagers
and young adults unusually hard and with little warning.

The U.S. Centers for Disease Control and Prevention estimated earlier
this month that more children have died from the H1N1 flu than people
over 65, about 540 children as of mid-October compared to 440 seniors.
And the agency recently reported that flu-related pediatric deaths
were continuing to rise. An estimated 2,900 adults between 18 and 64
have died. Most years, 90% of people who die of the flu are 65 or
older, officials said.

Life-threatening cases, however, remain unusual. As concern grows
about the danger of H1N1, doctors also are seeing an uptick in what
they call the "worried well," parents who seek emergency care for
perfectly healthy children.

So when should you take your child to the emergency room? Doctors say
parents and guardians should assess how sick a child is in part based
on experience.

"Is there something really different about your child that's different
from the seven or eight viral infections your kid gets every year?
Those are the changes to look out for," said Dr. Mark Morocco,
associate residency director for emergency medicine at UCLA.

Warning signs include significant difficulty breathing; inability to
drink fluids or urinate for more than six hours; change in the color
of the mouth or lips; or unusual behavioral changes, such as a crying
child who cannot be consoled, or a child who doesn't wake up or walk
or talk normally.

If any of those symptoms show up in children, parents should take them
to the emergency room, Morocco said, noting that "respiratory
infections are often things that are the most life-threatening in
children."

Lung inflammation is particularly dangerous to infants and young
children because their airways are smaller. According to the
California Department of Public Health, the flu virus replicates in
the airways and lungs, causing them to swell. The inflammation makes
it difficult for the lungs to work, reducing the body's ability to
take oxygen into the bloodstream.

In California, the most common causes of deaths associated with H1N1
flu have been viral pneumonia and acute respiratory distress syndrome,
state health officials wrote in a recent report in the Journal of the
American Medical Assn. Experts are telling clinicians to treat the
H1N1 strain differently than the seasonal flu.

In a Journal of the American Medical Assn. editorial published earlier
this month, former CDC director Julie Louise Gerberding wrote that
patients who have a five- or six-day history of flu-like illness and
whose ability to breathe is worsening "appear to be at risk for rapid
deterioration" and should be treated with antiviral drugs and admitted
to the hospital.

"Clinicians should not be falsely reassured by previous good health,
young age and absence of major comorbidities because these
characteristics do not exclude the potential for respiratory failure
and death," Gerberding wrote.

The CDC has also warned that some physicians are not prescribing
antiviral drugs to H1N1 patients, pointing to studies that show that
about 25% of hospitalized patients with lab-confirmed H1N1 did not
receive Tamiflu or similar drugs.

Even among those who did get antiviral drugs, medication was often
delayed for one or two days after they were admitted to a hospital,
the CDC said. California health officials have also said that
antiviral medication can reduce mortality even when given late, which
is defined as more than 48 hours after symptoms begin.

Although most people who are hospitalized or have died from H1N1 have
underlying medical conditions, a significant proportion of H1N1
victims are otherwise healthy.

"What's surprising about this flu is . . . we're seeing patients
between the ages of 10 and 47 with no underlying medical problems that
are getting into trouble. And that's scary for us, because it's hard
to know who is going to get in trouble," said Dr. Gail Carruthers,
director of the pediatric emergency department at Long Beach Memorial
Medical Center and Miller Children's Hospital.

Sometimes, patients will report flu-like symptoms for as little as
three hours or as long as two weeks, then quickly become significantly
worse. Their lungs begin to fail and fill up with fluid, requiring
intensive care.

Carruthers recalled two recent patients, a teenager and a middle-aged
person, whose lungs began failing even though they had no underlying
medical conditions.

"It's almost like watching them drown," Carruthers said. "They feel
like they can't get any air." But, Carruthers added, "if you don't
feel short of breath, and you have a dry cough, you're probably fine
staying at home."

ron.lin@latimes.com