Thursday, May 7, 2009

Swine flu fears subside, but second wave looms

The rest of the world may be exhaling at the apparent easing of a potential swine flu pandemic, but some global experts are tempering their optimism with concerns about what one calls "the fall question."

That's the uncertainty over whether the current outbreak is only a preview of what's to come, an echo of previous epidemics — including the 1918 flu — that saw mild first cases of infection in the spring followed by more severe second and third bouts in the fall and winter that brought widespread infection, illness and death.

"Right now, you have to wait and watch," said Ann Marie Kimball, professor of epidemiology and an expert in emerging infectious disease at the University of Washington in Seattle.
But Kimball and others, including Dr. Margaret Chan, the World Health Organization’s director-general, warn that it's possible the swine flu could re-emerge in a stronger form next fall.

"We hope the virus fizzles out, because if it doesn't we are heading for a big outbreak," Chan told Britain's Financial Times on Monday. "I'm not predicting the pandemic will blow up, but if I miss it and we don't prepare, I fail. I'd rather over-prepare than not prepare."

More than 20 countries have reported cases of swine flu, with most of the more than 1,600 confirmed cases in Mexico, the United States and Canada. Health officials in the U.S. and abroad say that the death toll, which now stands at 30, is not as bad as they originally feared.

Flu season is ending in the northern hemisphere, where most of the current infections of the H1N1 swine flu virus have been reported. The coming summer with warm temperatures and higher humidity means that the flu will be less transmissible there, although it raises worries for the spread of virus during the approaching winter in the southernhemisphere. So far, countries there have escaped the outbreak.

But the big fear is that the current swine flu virus could die down now in the north, but mutate during the ensuing months to become more transmissible and more virulent, fueling a serious outbreak when flu season resumes in that hemisphere, Kimball said.

“You have to remember that you are dealing with a flu virus,” she said. “They do reassort, shift and drift.”

1918: Second wave most deadly
The echoes of the 1918 flu are unavoidable. Historical accounts long have suggested that the first pandemic wave appeared in the U.S. in the spring of 1918, causing illness, but no appreciable deaths above normal.

Dr. Jeffery K. Taubenberger, an influenza investigator in the Laboratory of Infectious Diseases at the National Institutes of Health, said cases may well have turned up in the spring, but evidence suggests they certainly did by the summer of that year, causing out-of-season infections and deaths among young, healthy people.

Those early cases were followed by far more fatal second and third waves in the fall and winter of 1918 and 1919 in the United States.

"When it got cool enough to spread well, the virus exploded," Taubenberger said.
The thought was that the virus initially was strong enough to cause serious illness in some places, but not fit enough to launch a pandemic. Quickly, however, it progressed from causing uncomplicated influenza infections to fatal pneumonia, eventually leading to an estimated 650,000 deaths in the U.S. and between 25 million and 100 million around the world.

That model has led some scientists and ordinary people to question whether coming down with a mild case of swine flu now might actually protect against more serious illness in the future.

So far, government health officials say they still can’t tell whether infection now would confer immunity, said Dr. Anne Schuchat, a deputy director with the federal Centers for Disease Control and Protection. And Taubenberger said flu viruses mutate so quickly, there's no guarantee that this virus will be the same in six months.

Other flu experts said they would recommend avoiding exposure because the virus is still capable of causing severe disease, as seen in the cases in Mexico. And few would be willing to take chances with their own families, said Dr. Anne Moscona, a professor of pediatrics, microbiology and immunology at Weill Cornell Medical Center/New York Presbyterian Hospital.
“I think that it’s just too unpredictable to know how this virus is going to be in any one individual,” said Moscona, whose own children are 8 and 14. “I would by far prefer to avoid it.”

Avoiding the swine flu outbreak, even as it wanes in this country, depends on the habits that health officials have been emphasizing: good hand hygiene, avoiding close contact with sick people, staying home at the first sign of illness.

It does not depend on stockpiling antiviral medications, such as Tamiflu and Relenza. In Miami, CVS pharmacist Lauren B. Strzelecki saw a several months’ supply of Tamiflu disappear overnight from her as patients with valid prescriptions but no symptoms of illness loaded up on the drugs.

“They said, ‘I just walked in and said I was really nervous about swine flu,’” Strzelecki said.

Drug-resistant antivirals a worry
Increased use of antiviral medications raises concerns about growing drug resistance, said Moscana and Dr. David M. Weinstock, a flu expert and an assistant professor at the Department of Medicine at Harvard Medical School.

Before this new strain of swine flu emerged, the dominant strain of H1N1 influenza was almost entirely resistant to oseltamivir, or Tamiflu. So far, the new strain is susceptible to Tamiflu and to zanamivir, or Relenza.

“What we’ve learned about influenza is every time we feel confident with the way it evolves, it throws us a curveball,” Weinstock said.

Although the new flu is not likely to become resistant overnight, ill-advised use could speed up the process, allowing flu viruses to develop immunity to the only drugs that remain.
“The worst case scenario is that if people decided they want to take their Tamiflu, they’d take one pill a week for the next four months, then get the flu,” he said.

That could accelerate the person’s own resistance to the drug, as well as the wider resistance in the larger community.

Worries about a second wave of flu, early immunity and growing drug resistance all could be eased by the development of a safe, effective, widely available vaccine to protect against the new H1N1 swine virus.

Federal officials have started growing enough “seed stock” of the novel virus to provide material to vaccine manufacturers, according to press briefings. So far, it appears that the process is going as it should.

“I’m very hopeful that we’ll have a vaccine by the fall,” Weinstock said.

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Swine flu outbreak costs Mexico $2.2 billion

MEXICO CITY - Mexico's finance secretary says the swine flu outbreak has cost the Mexican economy at least $2.2 billion.

Agustin Carstens said Tuesday the government will implement a $1.3 billion stimulus package, aimed primarily at small businesses and the tourism industry, the sectors hardest hit by the epidemic.

The government will temporarily cut health insurance payments for small businesses and reduce taxes for airlines and cruise ships.

Tourism, the country's third largest source of foreign income, has taken a serious blow with hotel occupancy at half its normal rate.

Many airlines have canceled flights because of the outbreak.

Carstens spoke to reporters on Tuesday.

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In Europe, social safety net softens the slump

EPPELHEIM, Germany — With its tidy villages, orderly cities and atmospheric scenery, there are few outward signs that the German state of Baden-Wuerttemberg, home to historic Heidelberg and the famed Black Forest, is a victim of the current economic crisis.

But with the auto industry here hit especially hard — this is the home of Mercedes-Benz — things are tougher than they have been in decades. Unemployment is up 70 percent in the past year (albeit to a relatively low 5 percent total) and many employees have been forced to cut down their hours.

Misery below the surface, perhaps? Not at the bustling Fuerstenberger home just outside Heidelberg, where little has changed for the family's four children despite neither parent currently working.
“If we were in Detroit, we could worry every minute,” said Sarah Fuerstenberger, 37. “But here, we’re safe because of the system."

While economic forecasts are just as dire on this continent as in the United States, Germany’s citizens — and, indeed, most across western Europe — can count on a broad government safety net that includes generous unemployment checks, universal healthcare and inexpensive university education to tide them over.

“The German government is really good about taking care of people; we know we won’t be starving one way or another," she added.

With "Jobs Bloodbaths" in the headlines, tax money being used to bail out private banks and iconic car companies such as Britain’s Mini, France’s Renault and Italy’s Fiat laying off thousands, news here is similar to that across the Atlantic. Unemployment is also the same — around 8.5 percent across Western Europe and the United States.

However, Europe fiercely resisted President Obama's calls for it to increase its stimulus programs last month at the Group of 20 industrial and developing nations summit in London. That’s because leaders here argue that their existing social welfare initiatives are already keeping people afloat as well as stimulating demand.

Of course, these ongoing European programs come with a cost — higher taxes, which critics say can sap economic vitality.

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GE plans $6 billion health care initiative

WASHINGTON - General Electric Co. said Thursday that it will invest $6 billion over the next six years in an attempt to lower the cost of health care and improve the quality of medical care in underserved regions of the United States and abroad.

The broad program sets goals of reducing health care costs by 15 percent through $3 billion of spending on new, lower cost medical technology. The initiative also plans to broaden the use of tools such as electronic medical records and other medical information technology, with the hope of providing more advanced care to 100 million additional people each year.

That will include $2 billion of financing for rural health care systems in the United States to adopt medical IT systems. It will also expand clinics in Cambodia and provide additional funding for maternal health care programs in Bangladesh.

“Health care needs new solutions,” said GE CEO Jeffrey Immelt. “We must combine technology with innovations and smarter processes that help doctors and hospitals deliver better health care to more people at a lower cost.”

The company, which has struggled over the past year due to the recession and problems at its GE Capital financing arm, has said that health care and energy are two likely growth areas over the next several years.

GE plans to use its NBC television networks as a way to increase consumer knowledge about health, and will launch a daily program devoted to health in June on MSNBC.

The Fairfield, Conn.-based GE is one of the world’s largest industrial companies, making products like jet engines, household appliances and light bulbs. It also has a large health care division, which produces diagnostic equipment for hospitals and medical information technology systems.

GE has dubbed the program “healthymagination,” saying it is on par with its “ecomagination” initiative that focuses on cleaner energy projects like wind turbines and more efficient electric grids.

As part of “healthymagination,” GE plans to appoint a health care advisory board that includes former Sens. Tom Daschle and Bill Frist.

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Stocks slip as investors take profits

NEW YORK - Investors heard some more good news about the economy Thursday but locked in profits anyway following huge gains earlier in the week.

Upbeat reports on the job market and retail sales initially sent stocks higher but the gains eroded by mid-morning as traders asked “What’s next?” and trimmed their holdings following the 4.8 percent gain so far this week in the Standard & Poor’s 500 index.

“This is a market that is starting to bake in a lot of positive surprises,” said Craig Peckham, a market strategist at Jefferies & Co.

The selling comes ahead of the formal release of results from the government’s “stress tests” of bank balance sheets after the closing bell. News reports have already given investors a decent idea of what to expect so analysts aren’t predicting big surprises.

A massive two-month rally has left the S&P 500 index in the black for the year and up more than 30 percent from 12-year lows reached in early March. Analysts said it wasn’t surprising that the market would take a break after such big gains.

Technology shares posted the biggest losses Thursday after security software maker Symantec Corp. posted weaker-than-expected results. Retailers were mixed even after many of them, including Wal-Mart Stores Inc., reported better-than-expected April sales.

“The fact that we’re seeing the retailers sell off on these positive surprises suggests the bar has been raised on what companies need to do to take stocks higher,” Peckham said.

In early afternoon trading, the Dow Jones industrial average fell 82.20, or 1 percent, to 8,430.08 a day after the blue chips jumped 102 points to close above the 8,500 level for the first time in four months. The index is down only 3 percent for the year.

The Standard & Poor’s 500 index fell 8.37, or 0.9 percent, to 911.16, and the Nasdaq composite index fell 34.55, or 2 percent, to 1,724.55.

Federal Reserve Chairman Ben Bernanke, addressing a Fed conference, said a broader approach is needed for strengthening oversight of the banking system and said information gleaned from big bank “stress tests” should pave the way for improvements on that front.

In economic news, new applications for unemployment benefits fell last week to the lowest level in 14 weeks. The Labor Department’s tally of new jobless claims fell to 601,000 from 631,000 the previous week, well below the 635,000 economists had been expecting. A four-week moving average of initial jobless claims that smooths out fluctuations fell from a high in early April.

The employment reading follows a better-than-expected private snapshot of the labor market on Wednesday and comes a day ahead of the government’s April employment report. It is often regarded as the most important economic news each month because a drop in unemployment could bolster everything from banks to retailers if consumers can continue to make mortgage payments and go shopping.

There were also reports showing that productivity rebounded slightly in the first quarter while wage pressures eased.

Wal-Mart said sales of Easter merchandise and more shoppers in its stores helped its sales jump 5 percent, much more than the 2.9 percent rise analysts had forecast. Wal-Mart rose 89 cents to $50.40.

The well-being of retailers is key to the economy because consumer spending accounts for more than two-thirds of economic activity.

Symantec reported a loss for its fiscal 2009 fourth quarter, hurt by a hefty goodwill impairment charge and lower-than-expected revenue. The stock fell $2.59, or 14.7 percent, to $15.

Financial stocks were mixed ahead of the government report cards on banks. The tests, designed to determine which banks would need a stronger capital base if the economy weakens, are at the crux of the Obama administration’s plan to fortify the financial system. The market rallied this week ahead of the results, despite some initial concerns that the tests would show more pain in the industry.

Citigroup Inc. rose 8 cents, or 2.1 percent, to $3.94, while Bank of America Corp. rose $1.19, or 9.4 percent, to $13.88. Both banks are among those told by regulators they will need to raise more money. Regions Financial Corp. will also need to raise more money, according to people briefed on the results, as will Wells Fargo & Co. Regions Financial rose 3 cents to $5.86, while Wells Fargo fell $1.64, or 6.1 percent, to $25.20.

Bond prices dropped as demand for government debt waned. The yield on the benchmark 10-year Treasury note jumped to 3.28 percent from 3.16 percent late Wednesday.

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Influenza Outbreak Changes the Friendly Skies

If you’ve been second guessing your vacation plans because of the H1N1 influenza outbreak, you’re not alone. According to a recent poll of 2,857 users of the site, one-fourth of respondents said they were changing their plans because of the virus. Experts say it’s too early to access the fallout from the outbreak, which has spread to 12 countries, but one area is already feeling the crunch—the airline industry.

Instead of gearing up for the summer travel season, many airlines are being forced to reduce their flights to Mexico, the epicenter of the outbreak, and nearly every U.S. airline with routes to Mexico have extended the period that customers can change their travel plans without a penalty. “It (the outbreak) couldn’t come at a worse time for the travel industry,” said Matthew Jacob, an analyst with Majestic Research LLC. “It had seemed like things were starting to recover. This will probably set that back a little.”

Continental, with the most Mexico flights at 450 a week, announced that beginning May 4, it will be reducing the number of flights and switching to smaller planes on some routes. Weekly flights to Cancun will drop from 98 to 46, then to 40 the following week, according to spokeswoman Julie King. Weekly flights to Mexico City will be cut from 116 to 78, and to 60 the subsequent week. “We were already experiencing soft market conditions due to the economy,” said Continental chief executive Larry Kellner, “and now our Mexico routes in particular have extra weakness.” The airline is allowing passengers to postpone trips to Mexico without penalty for all flights departing the U.S. through May 15.

United Airlines says they will continue to serve all four of its destinations but will reduce its weekly round-trip flights between the U.S. and Mexico from 61 to 24 in May and from 90 to 52 in June. Its nonstop flights from Denver to Mexico are being canceled in May, but will resume to two per week for Cancun, Puerto Vallarta and Los Cabos in June. John Tague, United’s chief operating officer, said the airline is “adjusting our schedule to match customer interest.” The carrier says they will monitor demand and make further adjustments as needed. United is issuing waivers for tickets purchased by April 26th for travel to, from, or through Mexico through May 31.

Delta, the world’s biggest airline, plans to cut some of its 350 weekly flights to Mexico, spokeswoman Betsy Talton said in a statement, but that the company still plans to provide service to all of its 11 Mexico destinations. For flights leaving through May 16, Delta will allow you to exchange your tickets to Mexico for another destination altogether without a change fee.

US Airways says it will reduce flights by 38 percent in two phases between May 10 and July 1 and then re-evaluate to see if further cuts are needed in July and August. US is providing a one-time option to re-schedule or re-route for those who are ticketed and traveling to, from or through Mexico City and will waive the standard change fee, advance reservation and ticketing requirements. AirTran Holdings said it has reduced its total flights to Mexico from 16 to 14. They will waive change fees for passengers who want to alter their travel scheduled to or from Cancun through May 31.

On the other hand, American Airlines, the second-largest U.S. carrier flying to Mexico, hasn’t trimmed Mexico flights. Tim Smith, a spokesman for the airlines, said the airline is “monitoring and evaluating demand” on a regular basis. American “does not plan to make any changes unless given a directive from the CDC,” the Association of Professional Flight Attendants told its members in a message. “At this time, all flights are scheduled to depart regardless of flight loads.” But the airline is taking precautions, such as issuing medical kits consisting of masks, gloves and medical equipment to cabin crews and allowing flight attendants to wear both gloves and a mask while working flights in and out of Mexico. For those who still feel skittish about travel to Mexico, American has activated its “storm policy,” which allows passengers to change routes or dates without charge and is also offering refunds for all tickets to Mexico for flights through May 31.

Some global airlines have also reduced links to Mexico. Canada’s largest carriers, Air Canada and WestJet Airlines have suspended all flights to Mexico, as did Cuba, Ecuador and Argentina. Germany’s Deutsche Lufthansa announced plans to cut flights and drop routes and says the planes that do fly to Mexico will have a doctor on board. “The doctor is there to answer passenger questions and to identify suspicions of flu during flight and to act to handle the situation before landing,” said Thomas Jachnow, a Lufthansa spokesman in Frankfurt.

Alaska Airways said it will remove blankets and pillows from all its planes and British Airways is handing out face masks to passengers so they can comply with a request by Mexican authorities that passengers cover their faces as they go through Mexican airports.

Brian Hoyt, a spokesperson for Orbitz, a travel booking and comparison site, said overall “people are still flying.” He said their site is suggesting alternative destinations with similar climates, such as Las Vegas or the Caribbean. “Travelers should take precautions, but they should let science, meaning the Centers for Disease Control and the World Health Organization, dictate their decisions,” said Hoyt. “Right now the only place they’re saying to be careful is in Mexico.”

However, that recommendation could change at any time, so if you are planning to travel, be sure to check with your airline for their current policies or access Orbitz’s list of airlines and their status.

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Drug Use for Mental Illness on the Rise

Although mental illness has not always been treated as a medical condition, increasing knowledge and greater conceptual sophistication have brought with them significant change. Both the acknowledgment of mental illness by medical science and its quest for successful treatment of these disorders have marked milestones in the journey toward improving these aspects of the human condition. However, there remains a great deal of research to be done regarding the causes and treatment of mental illness.

Mental health disorders affect an estimated 22 percent of American adults each year due to very complex causes that often involve a combination of genetics, biology, and uncontrolled life experiences. Studies have shown that mental disorders are linked to physical changes in the brain and that some mental illnesses run in families, indicating a genetic association. Millions of Americans suffer from various forms of mental health issues ranging from social anxiety and obsessive-compulsive disorder to drug and alcohol addiction to personality disorders. However, successful treatment options including medications and psychotherapy as well as other treatments are available.

Since 1996, the number of Americans who use prescription drugs for the treatment of mental illness has been on the rise. In fact, among seniors 65 and older, the use of psychotropic drugs such as antidepressants, antipsychotics and Alzheimer's medicines doubled between 1996 and 2006. In addition, the 10-year period revealed an increase of 73 percent among adults and 50 percent among children in drug use for the treatment of mental illness. This accounts for one in 10 adults and one in 20 children having reported prescription mental health drug use in 2006.

According to health policy researchers Sherry Glied of Columbia University and Richard Frank of Harvard Medical School, the drug usage increase may be due in part to the expansion of insurance coverage for these drugs as well as a broader familiarity with them among primary care physicians. Their report appears in the journal Health Affairs and is titled "Better But Not Best: Recent Trends In The Well-Being Of The Mentally Ill." Glied said, “What we generally find is there has been an increase in access to care for all populations.” She went on to explain, “Mental health has become much more a part of mainstream medical care.”

The researchers gathered their data from several large U.S. public health surveys that included the National Center for Health Statistics, the Agency for Healthcare Research and Quality, the Substance Abuse and Mental Health Services Administration and the Social Security Administration.

Glied voiced concern regarding the little progress that has been made in the access to care for people suffering from more serious mental illnesses. The study found that treatment for older adults having mental limitations and requiring assistance with dressing, eating, or bathing dropped over the 10-year period between 1996 and 2006. Frank agreed by saying, “seniors are most concerning to us.” These patients have been the most under-treated and although many are now getting psychiatric medication, access to specialists is declining among the seriously impaired. In addition, with approximately 7 percent of Americans suffering from serious mental illness ending up in jail or prison each year, the researchers noted, “New policies are desperately needed to reduce the flow of people whose primary problem is a mental disorder into the criminal justice system.”

With the 2008 federal parity law came the requirement employers to provide equivalent insurance coverage for both physical and mental illness in an effort to improve access to care. However, concerns remain that the ongoing recession will leave a growing number of Americans uninsured and this could leading to less mental health coverage for many in the near future.

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