[Marxism] Bad news for the privileged on the Swine Flu front

Joaquin Bustelo jbustelo at gmail.com
Wed Apr 29 16:39:01 MDT 2009

	Those who have been following the A(H1N1) virus story, especially on
TV, have undoubtedly heard about the "baffling" circumstance that many of
those with the severest cases in Mexico, including among the deaths, have
been otherwise healthy, even downright robust people between 20 and 40 or 50
years of age -- the group that usually does best in influenza outbreaks.
Normally, it is children and the elderly, often already suffering from other
maladies, who succumb to the common flu.

	Today in my "day" job I got to talk to an up-and-coming flu
doctor/scientist. I'd been surprised by one of his on-air answers to our
anchor about many healthy people being among the most afflicted in Mexico.
He said that in certain types of flu this happens, which is why no one can
be complacent about ... followed by the usual litany: don't travel to
Mexico; wash hands all the time; keep your distance; wave hands, don't
shake; don't greet with kisses on the cheek and so on.

	I was surprised because he seemed to know how it could be that this
virus might have a "preferential option" for the healthy. So off camera, and
when I was off the clock, I bought him coffee, and this is what I learned. 

	The killer in these cases of "healthy" folks is respiratory distress
leading to shock. That is caused not by the virus directly, but by the
immune system. Certain variants of viruses cause a "XXX" storm in the body
-- I did not get the word, but it is some sort of molecule that signals the
immune system to counterattack. SOME people react too well, or overreact
--and IF you are one of those, the healthier you are, the stronger your
immune system, the worst it is. 

	The counter-attack winds up compromising/killing lung cells
themselves but more importantly so many troops are mustered (which then
somehow die or disintegrate) that the lungs fill up with fluid. (I did not
get all the details of the exact mechanism for the immune response to lead
to fluid filling up the little sacks for air in the lungs). 

	Now, if you're a fat lazy hack/TV news producer in your late 50s who
just stopped smoking after 40 years, your lung functioning and immune
response is likely to be good enough to keep the flu from killing you the
regular way, but not good enough to get you killed this other way. But if
you're a clean-living,  well-fed, well-exercised, slim and trim all-American
yuppie born in the 70's or the 80's, look out!

	The million-dollar (or Nobel prize) question is WHY some people's
immune systems over-react and most people's don't. At any rate, he said
scientists believe that was the major mechanism in causing deaths in the
1918 pandemic (the way he said it makes me think there isn't universal
agreement, but he is absolutely convinced), and the anecdotal evidence
(there is not yet good epidemiological data) suggests this bug is doing
something similar. 

	It is, he suggested, too complicated an answer for general audience
television (maybe OK on the science or NASA channel, which is why he did not
offer details on air, he said, just keep stressing to people that just
because they're healthy and well-fed and all that, they're not out of risk.
He also said that the anecdotal evidence from clinicians (doctors in the
trenches) suggest that anti-virals are HIGHLY effective against this bug if
given within a couple of days, perhaps three or four in a slow-progressing
case, of the onset of the first symptoms. But once a person has been sick
for most of a week, even very high doses seem ineffective. He said this is
pretty normal for Tamiflu with "seasonal" bugs also. 

	This --take Tamiflu-- he said is the meaning of the WHO's message
that "mitigation" should be the focus, as well as the reason why the US
government seems to be talking out of both sides of its mouth, declaring a
national health emergency but at the same time putting out "don't worry, be
happy" messages. 

	The formal declaration of a health emergency is the magic wand that
with a wave allows the feds to ignore/short circuit all sorts of safeguards,
formalities, accounting and other restrictions in doing what they believe is
needed (have enough Tamiflu on hand all over the country to give everyone
who THINKS they might have a sniffle a dose or two). That not only limits
the severity but it is believed undercut contagiousness, perhaps not 100%,
but hugely. 

	He said (contrary to what I suggested) that the WHO decisions were
sound -- but poorly presented. When the WHO says quarantine a country or
area, they're thinking in terms of something like Ebola fever, with
immediate life-threatening consequences for much/most of the population
where caring or even comforting the affected patients is subordinated to
isolating the outbreak *absolutely.* For this virus that is ALREADY too
late, but more to the point, quite unnecessary. Most cases are not severe;
most severe cases are not life threatening; and all cases seem to respond
almost immediately to anti-virals provided they are at the onset of
symptoms. It's not statistical "hard data," he said, just "clinical
observation" but even what seems like an especially severe onset of symptoms
responds right away to antivirals. 

	He explained that WHO wants 80% or 90% of the traveling to or
through or from Mexico stopped. The cost of stopping the last few percent of
trips to Mexico in social, political and economic terms isn't worth it. He
said this was the WHO's miscommunication -- they should have said all
unnecessary or casual travel to Mexico should stop but a complete "sealing"
of the border/airports is not justified. That because with a very limited
number of business, professional and official travelers, and proper
controls/education in place at airports, this additional risk was small
because of the effectiveness of antivirals and the kind of passengers that
would be involved (i.e., relatively privileged officials and professionals
with a high level of education and privileged access to medical care).

	So that's the gist of what was a very enlightening, and actually
fairly long session. There are a lot of things I missed because it wasn't a
"reporter talking to a source" sort of conversation with me taking notes,
but more of "an editor having his understanding broadened by an expert"
session, which happen all the time but are never written about. I decided to
do so in this email context in this case as I think it provides significant
help in understanding how the political/social issues interpenetrate with
the technical/scientific ones, because it corrects or nuances some of the
things I'd been writing, and because this is a relatively narrow, almost
"private" space. 


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