This morning I watched the Formula 1 race broadcast from Barcelona Spain. Although it’s difficult to discern, the stands do not appear to be anywhere near sold-out, but still, it’s a considerable crowd gathered at the track for today’s race.

Spain is a country that has an officially declared H1N1 case count of 93 as of WHO’s latest update, fourth to Mexico, United States, and Canada. North America accounts for 4,160 of the 4,379 lab confirmed cases. Considering there are only 219 confirmed cases [as of the latest WHO update] outside N. America, Spain’s 93 cases is notable.

Influenza infections during seasonal epidemics (what we face year in and year out) tend to double every three days (on average). If you have ten cases on a given day, three days later you will (on average) have 20, three days after that you will have 40, three days after that you will have 80, and so on until your community attains “herd immunity”. Herd immunity is when a community, whether our towns and cities, or the small closed communities of nursing homes, have enough recovered or vaccinated cases to no longer support forward transmission of an infectious disease.

We have our first publicly accessible estimation of what the R0 [Reproduction number] for 2009 H1N1. The R0 is important in disease outbreaks because it tells us how many new infections to expect from any other one infected person [on average].

From the New Scientist:

Warm weather may not halt swine flu

08 May 2009 by Debora MacKenzie

[Excerpts]

New data from Mexico and case numbers so far suggest that if the spread of H1N1 “swine flu” continues elsewhere as it has in the Americas, the virus could infect more than a billion people by July.

The data also suggests that the virus may not be slowed by summer temperatures in temperate countries. However, it spreads slowly enough to respond to the “social distancing” measures used in Mexico.

[snip]

“We will be moving to much more of a system like we use with seasonal flu,” which tracks levels of “flu activity”, says Besser – the number of regions in a state confirming outbreaks of flu, rather than case numbers. States such as Georgia and New York already test only serious cases.

Health experts tell New Scientist that based on the apparently exponential rate of rise soon after the WHO started counting cases, H1N1 could infect more than a billion people by July. Mexico’s numbers show just such a rise in cases of flu this spring. The Mexican health ministry thinks that would have continued without the closure of schools, businesses and mass gatherings imposed by the government.

They may be right. Based on observation of individual cases, they calculate that the R₀ of the virus in Mexico – the number of people infected by each case, a measure of how readily it spreads – is 1.4. A genetic analysis had put this at 1.16, but an underestimate was expected for technical reasons.

Mathematical modelling shows flu with low R numbers, such as 1.4, is easier to stop with “social distancing” measures.

We should view this estimate with qualified caution since many of those infected in Mexico are assumed to have self-treated.

Flu exposes flaws in Mexico’s health care system

By JOHN RICE

[Excerpted]

MEXICO CITY (AP) — Mexicans will do almost anything to avoid a public hospital emergency room, where ailing patients may languish for hours slumped on cracked linoleum floors that smell of sweat, sickness and pine-scented disinfectant.

Many don’t see doctors at all, heading instead to the clerk at the corner pharmacy for advice on coping with a cold or a flu.

So it’s no surprise that when a dangerous new swine flu virus began to sweep across Mexico, many waited too long to seek medical help — more than a week on average, according to federal Health Secretary Jose Angel Cordova.

[snip]

Mexico’s big cities have fancy private hospitals stocked with modern equipment and staffed with U.S. board-certified specialists. Americans increasingly come to Mexico for good care at low prices. The best of the public system is world-class too, with top doctors at elite centers for specialized diseases.

But Mexico’s everyday public hospital system is in crisis.

Some patients suspected of having swine flu told The Associated Press that public hospitals turned them away or forced them to wait for hours for treatment even after the government declared a national emergency.

Those who sought help before the alert — often arriving with headaches, high fevers and difficulty breathing — encountered baffled doctors who had not been warned to watch for a new virus.

[snip]

While access to health care is a right enshrined in the Mexican constitution, millions of Mexicans have no health insurance at all.

Mexico spends only 6.6 percent of its gross domestic product on health care — less than half the U.S. figure. No country in the 30-nation Organization for Economic Cooperation and Development puts a smaller share of public money into its health care system.

That means the hospitals serving most of Mexico’s 44 million poor are often crowded, ill-equipped and staffed with harried, underpaid staff working for a dizzying array of bureaucracies.

It’s so crowded, confusing and bureaucratic that the poor are more likely to head for a pharmacy, hoping to find a cheap remedy for “gripe” (pronounced GREE-pay) — a word that can cover anything from a mild cold to a deadly flu.

Most pharmacies dole out antibiotics and a host of other powerful drugs without a prescription. That encourages Mexicans to self-medicate, relying on a counter clerk’s suggestion, dosing themselves with whatever worked the last time they had a fever and waiting a day or two to see what happens.

Given the realities of Mexico’s healthcare system(s), the initial estimation of R0 is hardly definitive. That said, it is comforting that this preliminary and narrow data does not show an R0 close to or greater than 2. Once R0 approaches or passes 2 control becomes very, very difficult.

Getting back to this morning’s F-1 race in Barcelona:

As I watched, I thought about all those gathered in person, all those opportunities for a communicable disease to spread. Large gatherings are one of the things that contribute to an infectious disease’s R0, and one of the reasons influenza burns through our schools with such efficiency.

Even in our clean and modern communities, human habitation and behaviors can be very pathogen friendly.

From the Times Online [UK], an article about hand sanitizers and antimicrobial products:

Are hand sanitisers winning the war on sickness?

With all the hype about swine flue it’s no wonder germ phobai is on the rise, but are kill-or-cure handwashes really necessary?

It’s a germ-filled world out there: swine flu and bird flu, Sars, MRSA, not to mention a host of other superbugs that threaten our health. So it’s little wonder that we are increasingly obsessed with products that promise to fight germs with sterility. Top of the list on our antimicrobial crusade are hand washes and sanitisers, sales of which have soared by up to 80% in the past two years and, according to the Cosmetic Toiletry & Perfumery Association, are part of a market worth £119m in 2008. If you carry your handbag-sized bottle of chemicals designed to kill any germs that cling to the skin, then, the theory goes, you can stroll carefree through the microbial battlefield of daily life. But experts in the field argue that they could provide a false sense of security.

Available as products used with water, or as gels rubbed directly onto the hands, most of these cleansers contain alcohol and other powerful antibacterial chemicals such as triclosan or benzalkonium chloride, substances that will destroy bugs. They work by stripping away the outer layer of oil on the skin. For many, they have become indispensible. They have also helped to fuel a paranoia about personal cleanliness that has been dubbed HSOCD (hand sanitizer obsessive compulsive disorder). The symptoms are clear: a fear of contact with anything — from door knobs to hand rails on the Tube — that may have been touched by someone else, and the prompt use of a hand sanitiser to eradicate germs.

I use two different brands of gel based alcohol sanitizer and neither product contains any trace of triclosan. Triclosan is a product that I do not allow into my home, much less onto my skin, and haven’t since 2005. I did, however, chuckle when I read the underlined bit above.

[snip]

But are sanitisers really the answer in the fight against germs and disease? Most experts think not. Dr Anthony Hilton, a microbiologist at Aston University, says: “The antimicrobial component of these products has become a psychological safety net for people who have become alarmed by high-profile viruses.” He says there is no evidence that they offer “significant additional protection” . Studies have shown that while antibacterial products may initially remove more harmful organisms than soap and water, within 90 minutes there is no difference in the number of bacteria on your hands. “In everyday life, people do not need antibacterial sanitisers,” says Dr Derren Ready, a microbiologist at University College London. “Old-fashioned soap and water is fine.”

Their opinions are backed by evidence from a 2007 study that found antibacterial cleansers to be no more effective than soap and water at removing bacteria from the hands. Professor Allison Aiello, an epidemiologist at the University of Michigan School of Public Health, also showed that people who used sanitising hand products on a daily basis suffered just as many bouts of cold, flu and stomach problems as those who used soap and water. Professor Stuart Levy, a microbiologist at Tufts University in Boston, agrees. “Illnesses such as the common cold are not caused by bacteria, but by viruses,” he says. “Antibacterial products won’t destroy a virus.”

I do not disagree with the statements so much as counter with a question: How many people tote around a sink, warm water, and soap as they navigate their day and environments inhabited by other people – and all their germs?

Hand sanitisers might even do more harm than good. Aiello found that triclosan caused some bacteria to become resistant to commonly used antibiotics. Scientists are also worried about the indiscriminate killing of germs by hand sanitisers. Antimicrobial washes kill both harmful and helpful bacteria, adding weight to the argument that we can be too clean. Many experts believe that the overuse of cleaning products dulls the immune system to the point that it no longer knows how to fight bacteria, and that increasingly sterile environments have led to a rise in allergies such as asthma, eczema and hayfever.

Which is precisely the reason I do not use any product with triclosan as an ingredient or embedded. Yes, they now embed triclosan type products into all sorts of products to make them more “appealing” to the germ conscious consumer.

However, while the popularity of antibacterial hand cleansers remains controversial, all bug experts agree on one thing: washing your hands well is a vital step towards fighting disease. “Viruses can survive on human hands for several hours and may be spread by direct contact,” says Professor John Oxford of the Royal London Hospital. Given that we can touch up to 300 surfaces in half an hour, a person may easily pick up infections on their fingers by touching an infected object. “People would be better off paying attention to how they wash their hands, not what they wash them with,” says Ready. “It is important to wash the whole of the hand — not just the thumbs as many people do — and vital to dry them thoroughly as bacteria need moisture and warmth to thrive, but soap and water will do.”

Again, it’s not that I disagree, in fact I very much agree, but I do not have immediate access to soap and running water as I “touch up to 300 surfaces in a half an hour” throughout my day. I do wash my hands nearly as compulsively as I use my alcohol gel, when I have access to the necessary accouterments to do so. Additionally, if I know I am going “out and about” I carry a small baggy of Clorox wipes that I can use to touch things such as door knobs; it’s actually a bit more convenient and time efficient than deploying my purse-sized hand sanitizer.

Hey, it is a “germy” world out there!

From China View:

Horse flu kills 43 horses in India

NEW DELHI may 9 (Xinhua) — Though India has remained free so far from influenza A/H1N1, another animal disease, Equine Influenza, or horse flu, has killed 43 horses in the west Indian states of Rajasthan and Gujarat, local Hindi daily Danik Bhaskar reported Saturday.

    A laboratory based in Hissar of Haryana, in north India, has confirmed that the deaths were caused by the Equine Influenza commonly called “horse flu.”

    The first death occurred in January in Gandhinagar in Gujarat, where 15 horses died of the disease last month, said the report.

    To prevent the disease from spreading, the Gujarat government has instituted ban on buying and selling horses in the state.

    In Rajasthan, 25 horses have died at a horse fair in the Jodhpur area, according to the report.

    Equine Flu is caused by strains of Influenza A that are endemic in horses.

    The virus can cross the species-barrier and affect humans as well.

    Equine influenza is characterized by a very high rate of transmission among horses, and has a relatively short incubation time of one to five days.

    Horses with horse flu can develop symptoms of fever, dry hacking cough and runny nose.

Important information on expired, or soon to expire, stocks of Tamiflu from the Financial Times [UK]:

Tamiflu can be used past ’sell by’

By Andrew Jack

Published: May 9 2009 03:00 | Last updated: May 9 2009 03:00

European regulators yesterday took the rare step of extending the shelf life of a medicine for two years when they ruled that Tamiflu, the leading antiviral drug to treat flu, could be used for up to two years beyond its current expiry date.

The European Medicines Agency said for the first time ever that a medicine could remain safe to use for seven years, in response to concerns of a global shortage of a drug that could help prevent and treat a pandemic flu virus. “The recommendation is don’t throw it away,” a spokeswoman said.

The move may reduce short-term pressure for additional stockpile orders by governments from Roche of Switzerland, which produces the drug. Andrew Jack, London