How does pandemic H1N1 kill?

This is a simple question, yet, surprisingly, we still don’t really know.

The primary organs damaged in H1N1 infections are the lungs. Damage may either be directly due to the virus or as a result of a secondary bacterial infection (viral and bacterial pneumonia, respectively). The role of direct action of the new H1N1 virus versus bacterial superinfections in severe cases is still unsettled. Early studies indicated few or no bacterial infections in patients with lab-confirmed infections. However, a more recent study (Louie et al. 2009) demonstrated bacterial infections of the lungs in 29% of the patients who had died of pandemic flu. Bacteria included Streptococcus pneumoniae, Staphylococcus aureus, Streptococcus pyogenes, Streptococcus mitis and Haemophilus influenzae, in decreasing order of frequency.

So, bacteria appear to be present in some, but not all, fatal cases. One possibility is that people die for more than one reason. Some may die directly from viral infections while others die from bacterial superinfections. What are the implications of this possibility for treatment? Anecdotal reports suggest that Tamiflu decreases the severity of symptoms for most people diagnosed with pandemic H1N1. Antivirals may be regarded as an “upstream” treatment which decreases the damage done to the lungs by the virus. This might prevent both viral pneumonia, directly, and bacterial pneumonia, indirectly, by protecting the lungs from damage. If antivirals are not used, the lungs may fail as a result of direct viral damage. Some individuals may survive this initial assault but then suffer a second invasion by bacteria. If antibiotics are given in time, this may stop bacteria from doing irreparable damage to the lungs. If not, some patients may survive the virus only to die from bacterial infections. The final treatments for people with severely damaged lungs, mechanical ventilators and ECMO, offer some hope, but have relatively high failure rates.

The CDC is looking for patients with hemorrhagic pneumonia (see Coughing up blood for information). They suspect that it may be more common in patients infected with pandemic H1N1 than seasonal flu. Such patients may experience acute respiratory distress syndrome, which has a poor prognosis. As the CDC acknowledges, determining whether a person infected with H1N1 will go on to exhibit severe symptoms is difficult. Although some have underlying conditions, many do not. Some patients have gone from mild symptoms to death within 48 hours.  If we apply the precautionary principle to H1N1 infections, the logical treatment is both antivirals and antibiotics.

We have the means to reduce death from pandemic flu – Tamiflu and antibiotics. Let’s use them.

Reference

Louie et al. (2009) Bacterial Coinfections in Lung Tissue Specimens from Fatal Cases of 2009 Pandemic Influenza A (H1N1) — United States, May–August 2009. MMWR Weekly. October 2, 2009. 58: 1071-1074.

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2 thoughts on “How does pandemic H1N1 kill?

  1. Extensive time and money was spent in the US since Pandemic Alert in 2005, since antivirals were chosen not to be stockpiled for 75% of America,
    and, govt has chosen the past decade to remain dependent on foreign imports for vaccines and about 80% of our other, “critical” medical supplies, despite this being a National Security risk)
    on, planned-on-paper,
    “Early Targeted Layered Interventions”
    http://www.flu.gov/professional/community/commitigation.html#XIII to Mitigate impacts of Pandemic flu,

    but officials never wanted to warn the public,
    so, we’re now at the left-hand edge of
    graphs like this: http://www.flu.gov/professional/community/commitigation.html#XV

  2. Doctors have been refusing antivirals at onset (some do not even return calls made the first 48 hours!).

    The CDC recently sent physicians (another) memo, but, doctors seem too busy to keep up.

    Why no PSAs? The govt can say we’re in an, “unprecedented” National Emergency;
    Pandemic killing the young and healthy
    just as in 1918-1920,
    and take free media time to get word out to all; educate the public, as was supposed to have been done, because 7 months of, “guidance” from the CDC hasn’t trickled down to clinicians, even yet.

    People are dying every week that could easily have been saved; we are not even into the worst of the, “degraded conditions” we will be forced to experience later in this Pandemic. (Anyone who didn’t click the links, the graph is really worth a look.)

    Because there is no way to know at onset which cases cannot recover on their own, the public without Antivirals is being forced to play, ‘russian roulette’, and, the children being told they, “must” attend daily, “Swine Flu Parties”:
    schools were supposed to be on, “extended” dismissals, (4 to 12 weeks) and, “Distance Learning” by now; that was the, “plan” until everyone had been vaccinated.

    (The early WHO Report as of May 22 showed about 5% to 6% of cases, back when cases were sought and all counted, required hospitalization (and antivirals) to survive – and remember, Indonesia, which has been having endemic human-to-human H5N1 since early 2006, right before China took over the WHO,
    Indonesia said, Don’t panic;
    swine flu is only 5% fatal,
    nothing to worry about compared to our, “bird flu”!
    The WHO Report also said,
    “severe” 2009 H1N1 cases lungs and outcomes
    looked just like “H5N1 cases”;
    doctors were supposed to use H5N1 guidance on, “severe” panflu cases going into pneumonia. Antivirals were Not optional, if available at all.)

    Well, either doctors need to start getting antivirals and antibiotics to patients in a timely manner,
    and workplaces need to own up to they ignored warnings that started 4 years ago to prepare for this and let workers stay home when they or family members are ill, without penalty, and, schools dismiss students to shelter-at-home,

    or, as govt ‘modelling’ pre-Pandemic,
    and ‘common’ sense predicted, case numbers are going to overwhelm our medical systems, and numbers of dead are going to overwhelm our mortuary systems, just as in, “Spanish” flu in 1918.

    Twitter is full of people reporting they are, “coughing up blood” -someone should tell the CDC…

    (Twitter users are also reporting many cases of doctors telling them they, “don’t have” Pandemic H1N1 -“just have regular flu” which is a lie;
    99.6% of all flu in the US right now is Panflu.
    “Respiratory infections”, “pneumonia” – but they won’t tell people they have probably have Panflu – and they are Not telling them to be careful enough in their infection control nor recuperation, either.

    The public is stunned, “just a bad cold”, or “just a flu” is killing even healthy children, working-age adults, and pregnant women- but, officials knew all that was possible as a fact since Outbreak.

    The public could have known Pandemic flu
    would be like nothing they knew, and dangerous,
    since Oct. 2005.

    “Public Health” officials and politicians (and banksters)
    did not want the public to know
    in time to use Mitigation
    and (temporarily) “hurt the Economy
    (but save decades of productive life;
    “60% of the deaths have been Under age 49”)
    but people, taxpayers, voters are finding out the hardest way;
    PanFlu can kill any age,
    “pre-existing conditions” or Healthy,
    and “robust” immune response can lead to very rapid death; by, “cytokine storm”.

    Panflu can also kill via bad leadership, via refusal to stockpile, via Propaganda, and Censorship, and via Ignorance; this virus is gettting help.

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