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Understanding Swine Flu
Henry I. Miller, Wall Street Journal
The extent and impact of the swine flu epidemic, which appears to have originated in Mexico and spread rapidly to a dozen countries and parts of the U.S., is still unknown. The epidemiology of such disease outbreaks is rather like a jigsaw puzzle, and we are now at the stage where the picture is intriguing even if we're not sure what we're seeing.

We do know the number of cases in Mexico exceeds 1,995, there have been at least 149 deaths, and there have been 20 cases in five U.S. states (with no fatalities as yet). And that the outbreak causes us to confront complex issues that encompass medicine, epidemiology, virology and even politics and ethics.

These events demonstrate that good surveillance is needed in order to detect early on that a new infectious agent, transmissible between humans, has emerged. Unfortunately, conditions in many countries are conducive to the emergence of such new infectious agents, especially flu viruses, which mutate rapidly and inventively. Intensive animal husbandry procedures that place poultry and swine in close proximity to humans, combined with unsanitary conditions, poverty and grossly inadequate public-health infrastructure of all kinds -- all of which exist in Mexico, as well as much of Asia and Africa -- make it unlikely that a pandemic can be prevented or contained at the source.

Dr. Miller, a physician and molecular biologist, is a fellow at Stanford University's Hoover Institution. He is a former flu researcher and was an official at the National Institutes of Health and the Food and Drug Administration from 1977 to 1994.
(28 April 2009)

Symptom: swine flu. Diagnosis: industrial agriculture?
Tom Philpott, Grist
Several days after news broke of a possible link between Mexico-based hog CAFOs and the rapid spread of a novel swine-flu strain, what have we learned?

• Clarifying details about respiratory ailments in the Perote area of Vera Cruz State—where U.S. pork behemoth Smithfield Foods raises nearly a million hogs a year in large confinement buildings, under a subsidiary called Granjas Carroll—have emerged. In my original post on this topic, I didn’t fully understand that the outbreak of a virulent respiratory condition in the town of La Gloria—located near Smithfield’s farming operations—wasn’t initially identified as swine flu. The disease emerged as early as February and infected 60 percent of the town’s 1,800 inhabitants, according to the widely cited blog Biosurveillance, run by the U.S. disease-tracking consultancy Veratract (which claims the CDC, the World Health Organization, and the Pan-American Health Organization as clients). Three children died during the outbreak, Veratract reports. Residents blamed the Granjas Carroll confinements for the outbreak; and local authorities evidently agreed. “Health workers soon intervened, sealing off the town and spraying chemicals to kill the flies [which grew in swarms on Granjas Caroll’s manure lagoons] that were reportedly swarming through people’s homes,” according to a Monday account in the [UK Times].

There was evidently much confusion about the cause of the disease. “According to residents, the [Granjas Carroll] denied responsibility for the outbreak and attributed the cases to ‘flu,’” Veratract reports. And “State health officials also implemented a vaccination campaign against influenza.” However, “physicians ruled out influenza as the cause of the outbreak.” Yet the symptoms experienced in La Gloria closely resemble those that would later be diagnosed as swine flu, according to several accounts. The [UK Times] quotes a La Gloria resident:

The symptoms were exactly like the ones they talk about now [with swine flu] .... High fevers, pain in the muscles and the joints, terrible headaches, some vomiting and diarrhoea. The illness came on very quickly and whole families were laid up.

(29 April 2009)

Swine Flu: We're All In This Together
Sarah Kuck, WorldChanging
In our globally connected world, we can fly to distant lands in a matter of hours, ship cargo in only few days and meet instantly online. This connectivity is changing the rules of proximity, allowing everything to move quickly, from news and culture, to people and viruses.

Today, global citizens woke up to more news of international Swine Flu reports. Since last weekend, we’ve been watching this story unfold, and wondering with the rest of the world how this came about and what we should do to protect ourselves.

Although the verdict is still out on exactly how the Swine Flu outbreak began, many epidemiologists are suggesting that the origins of the outbreak may have to do with human proximity to livestock.

... For us, news of the Swine Flu ultimately triggered thoughts about the really hard, challenging things we must do to create a bright green future: be prepared, globally, enable a future forward diet, stabilize the bottom billion and create a globally transparent society. Each of which could empower people with the tools and models they need to either stave off a pandemic or more effectively contain an outbreak.

The Swine Flu is just one of many events highlighting our interconnectedness and responsibility to each other, reminding us that our global resilience is only as effective as the resilience at the base of the pyramid.
(28 April 2009)

The swine flu crisis lays bare the meat industry's monstrous power
Mike Davis, Guardian
The Mexico swine flu outbreak should alert us to a highly globalised industry with global political clout
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The Mexican swine flu, a genetic chimera probably conceived in the faecal mire of an industrial pigsty, suddenly threatens to give the whole world a fever. The initial outbreaks across North America reveal an infection already travelling at higher velocity than did the last official pandemic strain, the 1968 Hong Kong flu.

... one of its first victims has been the consoling faith, long preached by the World Health Organisation, that pandemics can be contained by the rapid responses of medical bureaucracies, independent of the quality of local public health. Since the initial H5N1 deaths in Hong Kong in 1997, the WHO, with the support of most national health services, has promoted a strategy focused on the identification and isolation of a pandemic strain within its local radius of outbreak, followed by a thorough dousing of the population with antivirals and (if available) vaccine.

An army of sceptics has contested this viral counter-insurgency approach, pointing out that microbes can now fly around the world (quite literally in the case of avian flu) faster than WHO or local officials can react to the original outbreak. They also pointed to the primitive, often non-existent surveillance of the interface between human and animal diseases.

... Perhaps it is not surprising that Mexico lacks both capacity and political will to monitor livestock diseases, but the situation is hardly better north of the border, where surveillance is a failed patchwork of state jurisdictions, and corporate livestock producers treat health regulations with the same contempt with which they deal with workers and animals. Similarly, a decade of urgent warnings by scientists has failed to ensure the transfer of sophisticated viral assay technology to the countries in the direct path of likely pandemics. Mexico has world-famous disease experts, but it had to send swabs to a Winnipeg lab in order to ID the strain's genome. Almost a week was lost as a consequence.

... Last year a commission convened by the Pew Research Center issued a report on "industrial farm animal production" that underscored the acute danger that "the continual cycling of viruses … in large herds or flocks [will] increase opportunities for the generation of novel virus through mutation or recombinant events that could result in more efficient human to human transmission."

... Any amelioration of this new pathogen ecology would have to confront the monstrous power of livestock conglomerates such as Smithfield Farms (pork and beef) and Tyson (chickens). The commission reported systemic obstruction of their investigation by corporations, including blatant threats to withhold funding from cooperative researchers .

... it is likely that the forensic epidemiology of the swine flu outbreak will pound its head against the corporate stonewall of the pork industry.
(27 April 2009)
Next article has more on the book by Mike Davis on epidemics.

The Monster at Our Door
Scott McLemee, Inside Higher Ed
... you really couldn’t pick a worse time to get sick than right now. On the other hand, this is a pretty fitting moment for healthy readers to track down The Monster at Our Door: The Global Threat of Avian Flu, by Mike Davis, a professor of history at the University of California at Irvine. It was published four years ago by The New Press, in the wake of Severe Acute Respiratory Syndrome (SARS), which spread to dozens of countries from China in late ‘02 and early ‘03.

The disease now threatening to become a pandemic is different. For one thing, it is less virulent -- so far, anyway. And its proximate source was pigs rather than birds.

But Davis’s account of “antigenic drift” -- the mechanism by which flu viruses constantly reshuffle their composition -- applies just as well to the latest developments. A leap across the species barrier results from an incessant and aleatory process of absorbing genetic material from host organisms and reconfiguring it to avoid the host’s defense systems.

... There is more to that plot, however, than perverse viral creativity. Davis shows how extreme poverty and the need for protein in the Third World combine to form an ideal incubator for a global pandemic. In underdeveloped countries, there is a growing market for chicken and pork. The size of flocks and herds grows to meet the demand -- while malnutrition and slum conditions leave people more susceptible to infection.

Writing halfway through the Bush administration, Davis stressed that the public-health infrastructure had been collapsing even as money poured into preparations to deal with the bioterrorism capabilities of Iraq’s nonexistent weapons of mass destruction. The ability to cope with a pandemic was compromised:
(29 April 2009)