confirmed that Swine flu is 100 times deadlier than Common Flu when it
comes to ARDF.
WHO only admits to Swine Flu being not the same as Common Flu,
probably out of fear or respect for the stupid opinions in many health
authorities that Swine Flu is milder than Common Flu.
Swine Flu may be milder than Common Flu but it affects Younger people
much more and therefore spread rapidly and affects more people.
Despite the availability of Tamilfu which can cure Swine Flu with
certainty provided given within 48 hours, many had been hospitalised
and subsequently require ICU treatment. The death rate is 10 per
month, and had been true to the last 3 months, i.e. 1000.
In the 4th month(August), it is more than 2,500 but it is more due to
the slowing down of testing than to actual deaths. Malaysia is a very
clear case. They can't even speed up the testing of patients who are
in the risky groups.
At the end of September, it will be 100,000 so it will tax most health
care systems all over the world. By October, it will be 1 million.
The second wave has nothing to do with mutation. Even in 1918, it is
more due to the natural exponential rate that swamp the health care
system in those places. At the end of the day, the death rate remain
low at 0.67% the most, i.e. in Wales, UK.
If ever, Swine Flu were to mutate into virulent forms, you can see the
large death rates immediately, and will prompt world health
authorities to close borders, effectively stopping its spread.
The danger with Swine Flu is that authorities are lax in enforcing
quarantines resulting in the slow but exponential rate that will
eventually overflow the health care systems.
Global Alert and Response (GAR)
Country activities | Outbreak news | Resources | Media centre
WHO > Programmes and projects > Global Alert and Response (GAR) >
Diseases covered by GAR > Pandemic (H1N1) 2009 > Briefing notes
Preparing for the second wave: lessons from current outbreaks
Pandemic (H1N1) 2009 briefing note 9
28 AUGUST 2009 | GENEVA -- Monitoring of outbreaks from different
parts of the world provides sufficient information to make some
tentative conclusions about how the influenza pandemic might evolve in
the coming months.
WHO is advising countries in the northern hemisphere to prepare for a
second wave of pandemic spread. Countries with tropical climates,
where the pandemic virus arrived later than elsewhere, also need to
prepare for an increasing number of cases.
Countries in temperate parts of the southern hemisphere should remain
vigilant. As experience has shown, localized "hot spots" of increasing
transmission can continue to occur even when the pandemic has peaked
at the national level.
H1N1 now the dominant virus strain
Evidence from multiple outbreak sites demonstrates that the H1N1
pandemic virus has rapidly established itself and is now the dominant
influenza strain in most parts of the world. The pandemic will persist
in the coming months as the virus continues to move through
Close monitoring of viruses by a WHO network of laboratories shows
that viruses from all outbreaks remain virtually identical. Studies
have detected no signs that the virus has mutated to a more virulent
or lethal form.
Likewise, the clinical picture of pandemic influenza is largely
consistent across all countries. The overwhelming majority of patients
continue to experience mild illness. Although the virus can cause very
severe and fatal illness, also in young and healthy people, the number
of such cases remains small.
Large populations susceptible to infection
While these trends are encouraging, large numbers of people in all
countries remain susceptible to infection. Even if the current pattern
of usually mild illness continues, the impact of the pandemic during
the second wave could worsen as larger numbers of people become
Larger numbers of severely ill patients requiring intensive care are
likely to be the most urgent burden on health services, creating
pressures that could overwhelm intensive care units and possibly
disrupt the provision of care for other diseases.
Monitoring for drug resistance
At present, only a handful of pandemic viruses resistant to
oseltamivir have been detected worldwide, despite the administration
of many millions of treatment courses of antiviral drugs. All of these
cases have been extensively investigated, and no instances of onward
transmission of drug-resistant virus have been documented to date.
Intense monitoring continues, also through the WHO network of
Not the same as seasonal influenza
Current evidence points to some important differences between patterns
of illness reported during the pandemic and those seen during seasonal
epidemics of influenza.
The age groups affected by the pandemic are generally younger. This is
true for those most frequently infected, and especially so for those
experiencing severe or fatal illness.
To date, most severe cases and deaths have occurred in adults under
the age of 50 years, with deaths in the elderly comparatively rare.
This age distribution is in stark contrast with seasonal influenza,
where around 90% of severe and fatal cases occur in people 65 years of
age or older.
Severe respiratory failure
Perhaps most significantly, clinicians from around the world are
reporting a very severe form of disease, also in young and otherwise
healthy people, which is rarely seen during seasonal influenza
infections. In these patients, the virus directly infects the lung,
causing severe respiratory failure. Saving these lives depends on
highly specialized and demanding care in intensive care units, usually
with long and costly stays.
During the winter season in the southern hemisphere, several countries
have viewed the need for intensive care as the greatest burden on
health services. Some cities in these countries report that nearly 15
percent of hospitalized cases have required intensive care.
Preparedness measures need to anticipate this increased demand on
intensive care units, which could be overwhelmed by a sudden surge in
the number of severe cases.
An increased risk during pregnancy is now consistently well-documented
across countries. This risk takes on added significance for a virus,
like this one, that preferentially infects younger people.
Data continue to show that certain medical conditions increase the
risk of severe and fatal illness. These include respiratory disease,
notably asthma, cardiovascular disease, diabetes and
When anticipating the impact of the pandemic as more people become
infected, health officials need to be aware that many of these
predisposing conditions have become much more widespread in recent
decades, thus increasing the pool of vulnerable people.
Obesity, which is frequently present in severe and fatal cases, is now
a global epidemic. WHO estimates that, worldwide, more than 230
million people suffer from asthma, and more than 220 million people
Moreover, conditions such as asthma and diabetes are not usually
considered killer diseases, especially in children and young adults.
Young deaths from such conditions, precipitated by infection with the
H1N1 virus, can be another dimension of the pandemic's impact.
Higher risk of hospitalization and death
Several early studies show a higher risk of hospitalization and death
among certain subgroups, including minority groups and indigenous
populations. In some studies, the risk in these groups is four to five
times higher than in the general population.
Although the reasons are not fully understood, possible explanations
include lower standards of living and poor overall health status,
including a high prevalence of conditions such as asthma, diabetes and
Implications for the developing world
Such findings are likely to have growing relevance as the pandemic
gains ground in the developing world, where many millions of people
live under deprived conditions and have multiple health problems, with
little access to basic health care.
As much current data about the pandemic come from wealthy and middle-
income countries, the situation in developing countries will need to
be very closely watched. The same virus that causes manageable
disruption in affluent countries could have a devastating impact in
many parts of the developing world.
Co-infection with HIV
The 2009 influenza pandemic is the first to occur since the emergence
of HIV/AIDS. Early data from two countries suggest that people co-
infected with H1N1 and HIV are not at increased risk of severe or
fatal illness, provided these patients are receiving antiretroviral
therapy. In most of these patients, illness caused by H1N1 has been
mild, with full recovery.
If these preliminary findings are confirmed, this will be reassuring
news for countries where infection with HIV is prevalent and treatment
coverage with antiretroviral drugs is good.
On current estimates, around 33 million people are living with HIV/
AIDS worldwide. Of these, WHO estimates that around 4 million were
receiving antiretroviral therapy at the end of 2008.