Japan.
Only those who treat Swine Flu lightly suffer unnecessary deaths.
Without any treatment and ICU, Swine Flu is as deadly as Spanish Flu
of 1918. It is only the wide availability of Tamilflu that had reduced
fatalities. But those nations that enforce quarantine had fared much
better because their ICU facilities are not stretched.
China had done well at the early stages with its aggressive quarantine
but slacked with its quarantine as Swine Flu spreads to its regions.
Among developed nations, Australia suffer the most because its Health
Authorities treat Swine Flu as milder than Common Flu.
"A World Health Organization report shows Japan's mortality rate is 2
deaths for every 100,000 people. The rate is higher by 11 times in the
U.K., 16 times in the U.S. and 43 times in Australia
http://www.bloomberg.com/apps/news?pid=20601124&sid=auxGTNXRwuAI
Japan Mask Wearing, Tamiflu Rush Beat Back Swine Flu Threat
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By Kanoko Matsuyama and Jason Gale
Dec. 11 (Bloomberg) -- Eight hours after Tokyo office worker Shungo
Yamamoto started feeling feverish and faint, he got a diagnosis of
swine flu, received antiviral drugs and embarked on three days of self-
imposed isolation last month.
"I knew it was influenza immediately" because of the fever and joint
pain, Yamamoto, 25, said. His doctor confirmed the diagnosis with a
nose swab test and prescribed five days of Roche Holding AG's
antiviral drug Tamiflu. When he left the doctor's office, Yamamoto put
on a mask, bought a three-day supply of food, rented DVDs and headed
home, where he stayed for the duration of his illness.
Japan's aggressiveness against H1N1 influenza, the result of hygiene
standards, social etiquette and a willingness to test and medicate
immediately, means the country has fared better than the U.S. or the
U.K. in battling the first pandemic in 41 years. A World Health
Organization report shows Japan's mortality rate is 2 deaths for every
100,000 people. The rate is higher by 11 times in the U.K., 16 times
in the U.S. and 43 times in Australia.
"No doctor in Japan would tell a flu patient just to go home and sleep
it off," said Norio Sugaya, a pediatric specialist at Keiyu Hospital
in Yokohama, a port city south of Tokyo. Sugaya sits on a committee
that advises WHO, a Geneva- based arm of the United Nations, on
managing swine flu patients.
In the U.K., a study this month found patients typically waited three
days to start taking Tamiflu, one of two medicines available to fight
the new virus as well as seasonal influenza.
Complication Risk
The U.S. Centers for Disease Control and Prevention, based in Atlanta,
recommends that antiflu drugs be given to hospitalized patients,
pregnant women and others with increased risk of complications. In
Japan, doctors are advised to administer the medicines to anyone
suspected of having flu, even if a rapid diagnostic test is negative,
according to the Japanese Association for Infectious Diseases, a Tokyo-
based organization of specialist doctors that provides treatment
recommendations.
Japan accounted for three-quarters of the Tamiflu dispensed globally
in the drug's first five years of sale, Roche, based in Basel,
Switzerland, said in a November 2005 filing to the U.S. Food and Drug
Administration.
Three years later, Japan's government announced plans to stockpile
enough antiflu medicines for 45 percent of its 128 million people.
That may be triple the amount required to treat every swine flu
patient. The proportion of people sickened by the pandemic virus
ranges from 7 percent to 15 percent, depending on the country,
according to WHO.
Japanese Practices
Japan's status as one of the biggest users of antiviral medicines and
its approach to treating seasonal and pandemic flu should be compared
with practices elsewhere and the data should be published in English,
said Lance Jennings, a clinical virologist with Canterbury Health
Laboratories in Christchurch, New Zealand, who has studied flu for
more than 30 years.
"If you have better capacity to diagnose cases earlier and are
treating appropriately and early, you're more likely to reduce the
number of patients who will go on to develop more- severe influenza,"
Jennings said in an interview.
While the majority of pandemic flu sufferers got over their illness
within days without treatment, 1 percent to 10 percent needed
hospitalization and as many as a quarter of those patients required
intensive care, WHO said on Dec. 4.
Early Treatment
Tamiflu and Relenza, an inhaled medicine made by London- based
GlaxoSmithKline Plc, appear beneficial in fighting the H1N1 virus,
especially if treatment begins within 48 hours of the onset of
symptoms, researchers said in a study in the New England Journal of
Medicine in November. A paper in the same journal in December reported
reduced complications, including deaths, among hospitalized patients
treated with the medications.
A survey of Japanese patients in 2005 found 85 percent sought medical
treatment for flu and 90 percent of consultations took place within 48
hours after the first symptoms appeared, according to David Reddy, who
heads Roche's influenza task force in Basel.
"These people do not wait until it's too late," Reddy said in a
telephone interview. "Japan has to be the gold standard of management
of influenza. It's almost a societal response in terms of the way
people modify their behavior."
Japanese have become accustomed during the past decade to wearing
masks in public to ward off allergic reactions to pollen from cedar
trees throughout the country, said Masataka Yoshikawa, a researcher
who tracks consumer behavior at Hakuhodo Institute of Life and Living,
the research arm of a Tokyo-based advertising company. Japanese expect
someone with a cold or flu to wear a mask to limit the spread of the
virus, he said.
Wash and Gargle
"Hand-washing, gargling and wearing masks are three hygiene measures
that are very well accepted in the community in Japan," said Nikki
Shindo, the Japanese doctor who is leading WHO's investigation of
swine flu patients. "People don't really hesitate to wear masks in
public places. Even the 24/7 convenience stores sell high-particulate
respirators at a reasonable price."
Some researchers say they are skeptical that Tamiflu is effective and
concerned that the virus will develop resistance to the drug because
of misuse. An analysis of 20 studies published in the British Medical
Journal on Dec. 8 showed Tamiflu offered mild benefits for healthy
adults and found no proof it prevented lower respiratory tract
infections or complications of flu. There is little evidence to show
that otherwise healthy people should be given Tamiflu routinely, the
researchers said.
'No Doubt'
"Based on our analysis and other subsequent work, there is no doubt
that the drug can reduce complications," said Frederick Hayden, a
professor of clinical virology at the University of Virginia School of
Medicine in Charlottesville, who was one of the first doctors to study
Tamiflu in patients.
Missing doses or failing to complete a course of medicine increases
the risk that a drug-evading strain will emerge, said William Aldis,
an assistant professor of global health at Thammasat University in
Bangkok and a former WHO representative to Thailand. In societies such
as Japan, where treatment compliance is high, patients are less likely
to contribute to drug resistance, he said.
"So this is one more reason to think carefully before applying Japan's
approach elsewhere," Aldis said.
Japan, whose flu season typically peaks between January and March, may
face more deaths from H1N1 if the infection trend follows that of
seasonal flu, said Hitoshi Oshitani, a virology professor at Tohoku
University in Sendai, in northern Japan.
"Japan will enter its regular peak flu season from now, and we have to
observe whether the pattern continues or not," he said. Oshitani, who
advises WHO on pandemic strategies for developing nations, also
credits the country's school-closure program for helping battle swine
flu.
To contact the reporters on this story: Kanoko Matsuyama in Tokyo at
kmatsuyama2@bloomberg.net; Jason Gale at j.gale@bloomberg.net.
Last Updated: December 10, 2009 10:05 EST
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