Posted to the Eugene Permaculture Guild listserv, September 4, 2009. The following bulletin synthesizes the latest local and global intelligence about Pandemic (H1N1) 2009 as of September 4, 2009. What is influenza? Influenza is an acute viral infection of the respiratory system, largely restricted to the surface membranes of the upper respiratory tree, with tissue damage normally concentrated in the throat and trachea (windpipe). A much more serious disease than the common cold, it is characterized by the dramatic and sudden onset of whole body symptoms which include, in their full form: fever, chills, dry cough, headache, nasal congestion, sore throat, muscle pains, fatigue and general discomfort. Some or all of the symptoms may not be present. Symptoms occurring in children, but rarely in adults, may also include vomiting, diarrhea and ear infections. Acute symptoms typically resolve in 6-10 days, although a cough, weakness and fatigue may linger for weeks and sometimes months. ‘Influenza deaths’ are often associated with complications arising from pneumonia, a viral and/or bacterial infection affecting the lower respiratory tree – the lungs – prompting a respiratory collapse often involving sepsis and the dysfunction of other key organs such as the heart, liver and kidneys. Other complications which may contribute to mortality include dehydration through vomiting and diarrhea, electrolyte imbalance and metabolic exhaustion. The H1N1 pandemic virus is typically, so far, a mild strain of the flu, “of moderate severity”. Worldwide, the majority of patients infected with the pandemic virus continue to experience mild symptoms and recover fully within a week, even in the absence of any medical treatment. Monitoring of viruses from multiple outbreaks has detected no evidence of change in the ability of the virus to spread or to cause severe illness. Pandemic (H1N1) 2009 not the same as seasonal influenza Within this largely reassuring picture, there is need for caution. Pandemic (H1N1) differs from seasonal epidemics of influenza in two key respects. First, and strikingly in common with the 1918-20 ‘Spanish flu’ which killed between 20-100 million people worldwide, the age groups affected by the pandemic are generally younger. This is true for those most frequently infected, and especially so for those experiencing severe or fatal illness. To date, most severe cases and deaths have occurred in adults under the age of 50 years, with deaths in the elderly comparatively rare. This age distribution is in stark contrast with seasonal influenza, where around 90% of severe and fatal cases occur in people 65 years of age or older. Severe respiratory failure Second, and perhaps most significantly, clinicians from around the world are reporting ‘a very severe form of disease, also in young and otherwise healthy people’, which is rarely seen during seasonal influenza infections. We have already seen such cases in Lane County. In these patients, the virus directly infects the lung, rather than the upper respiratory tree, causing severe respiratory failure. In this form, the disease appears to emulate the pathophysiology of Highly Pathogenic Avian Influenza (H5N1) or ‘Bird Flu’ and represents a highly disturbing development in the H1N1 subtype. Saving the lives of these patients is involving highly specialized and demanding care in intensive care units, usually with long and costly stays. There is a growing concern worldwide that intensive care units will be overwhelmed by a sudden surge in the number of severe cases. Vulnerable groups An increased risk during pregnancy is now consistently well-documented across countries. This risk takes on added significance for a virus, like this one, that preferentially infects younger people. Data continue to show that certain medical conditions increase the risk of severe and fatal illness. These include respiratory disease, notably asthma, cardiovascular disease, diabetes and immunosuppression. Many of these predisposing conditions have become much more widespread in recent decades, increasing the pool of vulnerable people. The World Health Organization estimates that, worldwide, more than 230 million people suffer from asthma, and more than 220 million people have diabetes. Obesity, which is frequently present in severe and fatal cases, is now a national and global epidemic. Higher risk of hospitalization and death Several early studies show a higher risk of hospitalization and death among certain subgroups, including minority groups and indigenous populations. In some studies, the risk in these groups is four to five times higher than in the general population. Although the reasons are not fully understood, possible explanations include lower standards of living and poor overall health status, including a high prevalence of conditions such as asthma, diabetes and hypertension. There is growing concern that the pandemic could have a devastating impact in many parts of the developing world where many millions of people live under deprived conditions and have multiple health problems, with little access to basic health care. Preparing for the second wave Pandemic (H1N1) 2009 is now the dominant influenza strain in most parts of the world. Historically, pandemic influenzas arrive in three or four waves, with deaths peaking at the onset of each wave. Here in Lane County, we can expect the arrival of a second wave, soon: our local seasonal influenza season is typically October through March, peaking December through February. It is possible the severity of this pandemic may evolve: the ‘Spanish flu’ had a mild first appearance returning with greatly increased lethality in its continuing waves. Prevention and Treatment Given the sudden and dramatic onset of both ‘mild’ and ‘severe’ forms of this disease and the fast-approach of the influenza season, we are recommending you familiarize yourself with a prevention and treatment protocol to support your own health and those of others – many people are likely to become infected by this highly contagious, novel strain of H1N1. Even when dealing with a “moderately severe” form of influenza, the manner in which the infection is immediately managed will strongly influence the experience of the acute phase of the illness, and may have a significant impact on a patient’s long-term health in the aftermath. There is evidence to suggest some chronic health conditions derive from poorly managed influenza infections. A wealth of evidence clearly demonstrates that simple steps to support general health are a highly effective way of very significantly reducing the likelihood of influenza infection and of markedly lessening the severity of symptoms should infection occur. A local response We hope to release details of a “Prevention Protocol” within ten days, and a “Treatment Protocol” with a focus on localized therapeutics, shortly thereafter. We are also working with others to urgently determine a prevention and treatment protocol for mothers-to-be and babies, both high-risk groups. We hope to provide details of a first aid kit for treating influenza, soon. Around food, our recommendations stress the healthful integrity of a year-round, locally-sourced diet. Around medicines, our protocols reflect a synthesis of the wise-woman and neo-eclectic herbal traditions: we are hands-on medicine-makers deeply rooted in a localized materia medica. Healthcare practitioners with backgrounds in Traditional Chinese Medicine, Ayurvedic Medicine, Homeopathy and Naturopathy, also have valuable insights in the face of Pandemic (H1N1) 2009. Currently, we are making efforts to encourage a local dialog between these differing but complementary schools of experience and understanding. Stay healthy. Sonja Ljungdahl and Nick Routledge Eugene-Springfield, OR September 4, 2009 Our influenza page
	September 4, 2009