nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
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Thursday, April 30, 2009


Newsletter recipients:  I’m going to keep up a running dialogue on this outbreak for a while.  If you want to op-out, let me know.  I’ll get back to the regular-type issue later.  There’s some interesting medical research that’s been piling up in my notes.


Back to the flu:

The interesting thing about the data today (below) is that California has not really changed, Texas increased by 10, but New York didn’t accelerate from their initial quick increase—in fact, Calif dropped by one case, from 51 to 50…as did Michigan.  Possibly due to some false positives.


Containment is very difficult for a disease that has high infectivity and rapid transmission.  Influenza is one of those diseases.  Nature note:  The all time champ for quick and sure spread is chickenpox.  Some of you may remember being sent to a neighbor’s house to play with their kid who had the disease, so that you would get it…and get it over with.   It only took a couple of hours in the same room.   Chickenpox was seen as a fairly harmless disease.  Only later in medical school did I learn there were things like chickenpox pneumonia, and chickenpox encephalitis—thankfully both are rare in developed countries.  Whew….


There’s still not enough data to say whether the point outbreaks will accelerate, begin a new round of cases, or remain fairly stable.  If an index case has exposed a new group of people, you will see a new locus of disease pop up over the next couple of days.  The case pattern in Texas, while not large in numbers, is broadening:  yesterday we had Seguin, and Richardson.  Reports of cases in a couple of new places need confirmation.  I’m cautious about this because there have already been maliciously false rumors of spread.  One rumor of a case in an adjacent county was debunked by the news media.


Clinical severity is turning out to be moderate in most cases (so far).  One death (and that one a small child) out of a hundred is not unusual for many strains.  The 1918 pandemic was very different:  people were well one day and then dead in as little as 48 hours, with a fatality rate considerably higher.  Since that time the human “herd” has seen H1N1 several times and this has the effect of mitigating virulence.  This is a common occurrence in extended host-parasite relationships:  over time each species begins to accommodate to the other to some extent.  You may ask why the disease appears much more severe in Mexico:  this is pretty standard.  Indigenous populations in developing areas always do much worse. 


For those of you who may worry that you wasted your time getting the flu shot last year…don’t.  There’s some evidence to suggest that having annual vaccination, even with a different strain, imparts a “touch” of immunity that is broad-based.  Not enough to keep you from getting the disease, but maybe to make it a little less severe.  So get that flu shot every year.


The president’s call for more spending on influenza research is mostly pointless, but well-intended, providing reassurance that the government is responding.  There is a vaccine in early trials right now that might solve the problem of needing an annual shot to account for changing patterns of the virus.  A lot of money is already spent every year on influenza research.


Doc D




U.S. Human Cases of H1N1 Flu Infection
(As of April 30, 2009, 10:30 AM ET)


# of laboratory confirmed cases























New York






South Carolina







109 cases

1 death





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