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Hello, you're watching SDSU LIVE, a live streamed video production of San Diego State University.
I'm your host, Lorena Nava Ruggero and today we're talking about H1N1, formerly known as Swine Flu.
The faculty experts I will speaking with today are The College of Sciences Dean Stanley Maloy;
Dr. Gregg Lichtenstein, Medical Director of Student Health Services;
and then Public Health Professor Tom Novotny.
Thank you for joining me today. It's been a busy couple of weeks here on campus.
As far as getting started, lets talk a little bit about the university response. I know Dr. Lichtenstein, you were involved from the very start
when this first student came to light, and working with the county public health. What was that like in terms of how we responded?
We were following the course of this illness down in Mexico, and it seems like eons ago, but I guess it was only 9 days ago,
where we saw a student with symptoms that were influenza-like. They did some testing at Health Services
and took a couple days to get preliminary results back. The preliminary results indicated that it was probably H1N1.
Then another few days to hear back from Center for Disease Control, confirming the diagnosis.
However, basicially on the first day that we saw the student, we started to meet in emergency sessions several times a day
here on campus to plan a response because obviously we didn't expect to just see one student with this illness
and reports that we were getting from Mexico were pretty disturbing about deaths, particularly in young adults
with no prior history of health problems. So, the campus responded extremely rapidly,
letting the campus community know that there was a possible case on campus, informing people what they could do to protect themselves
and if they did become symptomatic, what they should do next.
Like you said, it seems like eons ago, but from the start we were aware it was happening.
And had been working with the appropriate agencies since then.
That's correct and we have been in touch with the county Department of Health and Human Services
agency from the very beginning on this and they've been providing us with a lot of recommendations
as far as what they thought was relevant to our campus. We've also been following what the CDC has been saying which
unfortunately as far as universities go, hasn't been very much. The focus from CDC has been on K through 12 kids
and childcare to some extent. It's interesting that you mentioned childcare, because the children's center
here on campus was closed for the past week based on a lot of children showing flu-like symptoms.
Now, we know it's going to open next week. None of the children, at least the preliminary tests have come back negative.
What was the impetus? Was that because of the recommendations you were receiving?
Basically what happened at the childcare center was we were receiving court reports late last week that
there was a spike in the number of children who were ill.
They were either being kept at home, and we were getting calls at the childcare center that they were ill,
or they were actually developing illness in the childcare center and being sent home
with fevers. And frankly, similar things happen periodically at childcare centers, where there will be some bug going around
and kids all tend to get it so up to this point it wouldn't have been particularly disturbing to see that spike,
but given that there was the H1N1 epidemic going on, we decided to act with an abundance of caution
in deciding to close the childcare center and reduce the potential spread of whatever it was that was going around at that point.
Abundance of caution is not necessarialy a bad thing. We do want to let any of our viewers know that
your questions in real time feed on Twitter, just send a message to @SDSU_newsteam. That's @SDSU_newsteam on Twitter.
And you can also e-mail your questions to SDSULive@gmail.com
Again, that's SDSULive@gmail.com. Now, to move away from the campus response for all-intensive purposes,
we're kind of dying down on that, the media is leaving this story behind as well, which is good in some ways.
Maybe that's a good place to start in terms of the media. Some people think that it was over blown, others think that this
is an abundance of caution, that you do need to inform people as much as possible. Thomas Novotny, from a public health standpoint,
do you think the media response was good, bad, other, neutral?
Well I think it was expected. This was a novel virus. That term alone was enough to create tremendous interest accross the world
and it got that interest at the highest level, the WHO, the World Health Organization who has worked hard, along with the member countries,
to develop a response that can manage this interest, to manage the information transfer. That's a very important thing.
Because, on one hand, you want to make sure that everybody is completely informed about what the disease is,
what the pattern is, what the spread is. But on the other hand, you don't want it to become an out of control over-reaction.
And so that kind of response is necessary. And I think from the WHO on down to the CDC down to the county health department,
there's been a very concerted effort to address it directly and answer the questions and get people out that can answer those questions
and develop web-based resources and others that can manage these concerns.
I think it's been effective. It hasn't always been that way. SARS, back in 2003 was a lesson to the countries
who have a new infectious disease issue that they need to report it quickly and get the kind of advice they need
from outside or to make sure that the information is appropriately distributed.
And so WHO through the International Health Regulations, which is an aggreement that all the WHO countries sign on to,
has a process by which new outbreaks can be described and managed better with information and they as you know raised the level of
concern from 3 to 4 to 5 finally, and I think that that's as far as they are going to go with this one.
All of you were out in the media, talking to a lot of folks. What were some of the biggest questions you got the most?
I know, obviously from a clinical perspective for Dr. Lichtenstein versus the campus response, and how did you feel?
You guys come out when things like this happen and in the community or out here on campus. How was that experience for all of you?
It was definately interesting. I've been interviewed on camera before for TV, but not on mass like we had at the end of Campanile walkway.
You did a great job on that by the way. So that was a little intimidating for me frankly. But I think overall the
press did a good job at getting the basic information out there. There was some interesting questions though,
Aljazeera interviewed me yesterday, which I thought was interesting, and one of their questions was,
"Isn't it true that this actually started here in San Diego as the first case, and wasn't really derived from any source cases in Mexico?"
So, that was over and over and over again-that question, and I checked with our county health department and the first case
was actually in Imperial County. Probably they got sick late March, which means that the virus had been circulating somewhere and
what we think had been circulating quite widely in Mexico. Perhaps you would have some more information on that, Professor Maloy.
You can trace the virus by looking at the genome of the virus. And if you do that tracing, you would estimate that it has been around
probably in Mexico for quite some time before we ever saw the first real case of disease. The first identified case,
and the first identified case in the U.S. was here in San Diego, and one of my students actually was working in a lab where they couldn't type
the virus, and then referred it for identification to the CDC, and they found it.
So, one question that this brings up in my mind and probably lots of other people-so, how did this virus get to San Diego?
Apparently, that first case had been to Texas within the incubation period prior to showing signs and symptoms.
It gets to San Diego because we have a globalized economy. People are traveling back and forth, there was spring break in April,
a lot of those students who got it in New York had been down to Mexico for a trip, so its global travel, contact, one person to another person
and perhaps even the objects in the environment are something that people had contact with.
But I think another point there is that not everybody who gets this virus gets seriously ill to come to the attention of a healthcare provider
There may be some people who just have cold-like symptoms and then they transmit it to the next person who's a lot more sick.
I think it's the deaths in Mexico that was really the trigger for concern that it was effecting young people and that's not something we usually
see with the normal, seasonal flu-it's the older, venerable folks or very young and so I think that was the other concern about this one.
Again, because it was novel and the immunity wasn't there. But this goes back to your question,
and I think what I heard the most from people was the question, "How much should I worry?"
"How severe is it going to be?" "Is this going to be like we heard about the 1918 influenza?"
And people just didn't know, because there was so much different information coming in from so many different places.
So, we had to respond in a very cautious way and that instilled fear in a lot of people. Especially the attitude that
this occurred over the last couple of days. And when you say people didn't know, you're referring to public health experts
just didn't know. From the expert on influenza, all the way to the person who has no expertise in this area at all.
That unfortunately, as he said, that does instill a sense of apprehension in the public because they see people who you expect would know
these things who don't know the answers and that's a lot of the time and medicine, that's the situation anyway,
we act on the information that we have.
I think you all bring up a good point. This might be a good way to kind of jump into some of the questions we've got submitted
in terms of, now that we've come to the point where it seems like we know that it's a milder strain, Amy Pino submitted a question,
"Is there a possibility this strain could mutate into something worse?" This is more of a Dean Maloy question.
I think that there is a real possibility. The difficulty is we don't know the probability, so it could happen, but will it happen?
The best experts on influenza and epidemiology always say you can never second-guess influenza.
Influenza changes so much, all the time. In contrast to most of us, it mutates very quickly, that's why we need a new
vaccine for seasonal flu on a regular basis. And all it would take is the right type of mutation to convert this relatively
mild influenza to something much more severe. And it's interesting to note too that even though it was intitally called the Swine Flu,
it carried genetic material from not only Swine Flu but Avian Flu, but other forms of human influenza and I think it's important to note that
we don't know where this is going. As far as H1N1 goes, even though it seems really mild, would it help to get the flu now
and let it run its course or develop immunity against a possibly more deadly strain later this fall, and that's a question from
Claire Rogers. It's a good question, but we don't really know. We have evidence from past flu epidemics, the seasonal ones
that there is some carry over in immunity from one year to another. Whether that is the same pattern that we would see here,
we don't know for sure. Professor Maloy was telling me that they've been having some flu parties in New York, where they
purposely get themselves exposed with this relatively benign disease so that maybe it won't knock them out later in the flu season.
People used to do that with chicken pox. Of course, I never did it, but chicken pox parties were also a way of getting people exposed
and immune, and that one had lasting immunity. This one we don't know about.
In terms of building immunity, we've talked about vaccine development, and how it's looking like if we do develop a vaccine against this
that it's going to be 2 booster shots and then you also have to get a separate vaccination for the other seasonal flus
that may come up in the fall. From a clinical point of view, is there an issue with having that many shots for people, Dr. Lichtenstein?
The main issue is what we call adherence, or used to be called compliance. We have a tough enough time as it is getting the people in for the
regular flu shot who are in high-risk groups like, for example, people with asthma, heart disease, diabetics. These are people that are at
higher risk for complicaions if they do get the flu and we'll send out notices to the campus communities. Sometimes we've even sent out
letters to students. We've developed a list of students from our database with certian conditions. Please come in this year for the flu.
And frankly, the response is pretty low campus-wide. We'll typically order 1,200 doses of flu vaccine each year. We're talking about a student
body with 34-35,000 and another 5,000 faculty and staff who we allow to get vaccinated and we won't even use up that 1,200 doses
and we know there's more than 1,200 high-risk people in that group. Basically, if you're over the age of 50, for flu vaccination,
its indicated and there's a lot of us in that age range on this campus here. It's very difficult to get people in for one shot.
Now, we're talking about a new vaccine which is going to require an initial primer dose and then a booster dose essentialy to get
the immunity levels up to where they should be. I just can't see people following through on the whole series.
The other thing too that we mentioned earlier is that was the concern with the Swine Flu vaccine that was implemented in 1976
the vaccine program that President Ford got behind in a big way and millions of people were vaccinated. And there was the
case of gambray syndrome, which was a pretty severe neurologic disease that may have been associated with that vaccine
because of the number of people vaccinated, the risk was still probably quite low and they never really figured out what the issue was
in terms of why it was associated. But it was still a very weak association, even then.
So that concern is likely to come back in people's minds-well there were complications and such but the fact of the matter is
that immunization against influenza is an extraordinarily important public health measure. The more people who are vaccinated
who don't get influenza means that the rest of the people who are not vaccinated have some protection because they're not
getting the contact with the people so easily who are able to spread the illness around. So, it has not just an individual value but
a population value. And so we really try to encourage everybody to get flu vaccines every year, especially those who are age 50
above, and also the very young. You could ask the question, "How come you can't combine them all into a single vaccine?"
And the problem is that because every time you make a new vaccine, you have to go through a lot of safety hoops. And so all
of the regulatory analysis has been done on the current tri-daily vaccine. And so if we added another influenza to it, it would demand
a lot of regulatory groups. It wouldn't be ready in a form that the government felt was safe in time to respond if next winter
we had a severe outbreak of it. Do you want to talk at all about the lead time that it takes to do a vaccine? The normal flu vaccine is 6 months.
Normally it takes about 6 months and there are people who think we could move that up a little bit. The timing is really
important for us because flu season is during the winter when its cold. For reasons we still don't know, but flu seems to dissapear
for the most part during the summer and come back in the winter. So we have between now and the winter to try to prepare
a vaccine that could be very effective. It is an enormus job though. Ensuring that the vaccine is safe and effective.
And that there is the capacity to produce it in the quantity that we expect. They're looking at new ways of recombinant vaccines
that can be constructed in the lab rather then grown in chicken embryos. It's a challenge to even get enough of those doses prepared.
We haven't really talked too much about the fact that even though flu season is almost over in the northern hemisphere,
in the southern hemisphere it will be winter very soon and so the flu could go down there, possibly mutate, and come back as a different
strain which the immunization may not protect against. Are there concerns against that in the medical community, the public health community?
Absolutley. I think this is a globalized environment. It doesn't take much to fly from one country to another.
The virus is good at accompanying people. It certainly is going to be an area of concern for WHO and the public health community to
do careful surveillance in the southern hemisphere in the summer here to see what comes of this epidemic.
I would like to ask both of my counterparts here. We talk about the virus may mutate into a more deadly form.
What's the usual chain of events with a flu virus. Do they mutate into less invasive forms?
Usually they don't mutate to something that's much more serious. The thing is though, in the United States every year
seasonal influenza is the run of the mill. 36,000 people die. Even if it was only as bad as seasonal influenza, we've got 72,000 people dying
of something that potentially we could protect against. And that doesn't count all of the people who are out ill
and unable to do their jobs. So the economic impact as well as the human impact is great even if if it doesn't become the real killer influenza.
This is a question I got from Rojelio Reyes, and looking at the political implications and looking at how the public health community,
the WHO, the CDC, the Mexican government who all work together, his question basicially, i'll read it word for word because its a little long
but he writes, "The Mexican newspaper, 'La Granada' and other sources have reported that as far back as earlier this year the
Mexican government was aware of the breakout of this new virus in Laguardia in the state of Vera Cruz but had kept it
quiet until after Obama's visit to Mexico in April. Furthermore, according to 'La Granada," others have raised health emergencies in
Mexico have been left unaddressed for decades. Could it be that the Mexican power structure was more interested in attracting
attraction from its own power?" His question looks at...we saw the impact. Hundreds of people in Mexico did die from this flu
but like you said, in the U.S. alone, 35,000 people died from the seasonal flu. I think that number is exaggerated,
in terms of the number of deaths. I don't think it was hundreds. I think confirmed deaths-they're still evaluating that.
There is still a lot of investigation to be done, as to when the bug was out there, how it was identified. But Mexico, like all
the other countries, members of the WHO, are obligated to report diseases as they appear that may have public health implications-
that's new, or that have widespread, possibities for spread, and also economic implications. They're members of this
aggreement, the International Health Regulations. So they did report it. I don't know the exact dates that they did that but all governments
have a sovereign responsibility to take care of their own population, so they did what they would normally do in terms of understanding
the epidemic at the beginning. I don't know that one could say that there was any sort of purposful obscuration of the facts.
They certainly did act agressively, to a very consrevative approach, by closing down businesses, gatherings, cinco de mayo, everything.
That was very conscientious and a costly kind of thing. A government has the responsibility not to over-react or to allow a major economic
impact from occurring as a result of this. There's been plenty of cases in the past when a single case of cholera, for instance,
has caused enormous panic. In India, 20 years ago was a huge over-reaction that caused billions in dollars of loss for something that
didn't need to be reacted to in such a way. I don't know the exact sequence, the dates that it happened, but I do know that
Mexico participated fully in terms of its responsibilities to its membership to the World Health Organization and to other countries.
I think there's been great international cooperation as a result of that. If I could add to that, before SARS, the level of international
cooperation wasn't so great. There were countries that thought, "If we keep this a secret, it will all blow over, it won't be a problem."
There were serious international reprucussions for that. There is a very strong political motive to respond to these diseases and quickly.
We have another submitted question from Claire Rogers that we want to touch on before we come to and end in a few more minutes.
Claire writes, "Because H1N1 is hybridized from swine, avian, and human flu strains, is there any liklihood that migratory birds might carry
and spread this virus?" I don't know who answers that question. Influenza is very interesting, because it's very common in the
avian population-in birds. In birds, it attaches to a certain receptor. That's how it gets inside of the cells of birds. In humans, it attaches
to a different receptor. That's how it gets in our cells. The bird virus typically won't affect humans. And vice versa. Pigs are in between.
They have receptors that the bird virus can attach to, and the human virus can attach to. So pigs are a melting pot that brings these
viruses together and then can redisseminate them into the different populations. It's unlikely that birds would the carriers of this.
Once it's transmitted human to human, it can move very quickly. On airplanes, as we've already discussed, and the worries of some other
mode of transmission decreases. The real question with avian influenza was, could it effectively develop the human to human
spread that would result in a worldwide pandemic? It's important to note that H1N1 is not all swine flu. There's been no reported connection
yet that we've seen from the first case, what I've seen anyways, of pig to human transmission. It's important to note because some countries
did have a little bit of an over-reaction it seems like, to the name of swine flu itself, hence the name change to H1N1.
Pigs got a bad name out of this, and they didn't quite deserve it. By the way, pigs can be immunized as well. That's right.
That's very important to note. Let me check here, I think those are all of our submitted questions. No actually I may be wrong.
Sue Johnsten writes, "It seems this flu strain has not confirmed the cold-weather flu theory as much as other strains. Should this be a concern?
Do you feel that this epidemic is on the wane?" It is springtime, technically. But in other parts of the country, it is still very cold.
Denver reported snow earlier last week. Any thoughts on that question? From a public health standpoint, it's easier when people are
closed indoors as a result of the cold to spread things around. The other thing that happens before the seasonal flu epidemic is
holiday travel in December, and I can't help but think that this is a factor in the beginning of the flu epidemic in the northern hemisphere.
We had spring break in April. At least some of these cases, I know, resulted from travel to Mexico-students in New York, for instance.
It may not be so much the confinement and cold spaces, but the mixing of people in large groups and surroundings that facilitate
the transmission during travel. I think that maybe had more to do with it. It is kind of conjecture from a public health standpoint but
it makes sense. Like you said, the investigation is still ongoing. Speaking of travel, we have questions submitted about summer travel.
Should people caution about going to the southern hemisphere, or should it just be standard practice of common sense
hygene-washing your hands,not touching extremely dirty things, I don't know if you have any advice in that regard for summer travel.
Essentially, since this strain of flu doesn't seem to be acting that much different than other strains of flu I don't think that we would
recommend avoiding certain countries as a result of their potential of having more H1N1 cases, just because they're in the southern
hemisphere. There are no recommendations coming out right now about any kind of travel restrictions, I myself am going to Brazil
in June, so I'll find out. Good to know. One last question, I know we had said that pigs got a bad rap, but just to re-emphasize it,
pork products are safe, are they not? Yes. I want to have one last comment. If people wash their hands regularly, as we've heard
over and over again, it not only will help thwart influenza, it will help prevent a whole bunch of other diseases. A very simple thing to do.
Wash your hands thoroughly, wash your hands often. And what better advice is that, to wash your hands. Something my mother,
also a microbiologist, says. Unfortunately we don't have any more time left today, although I think we could talk about this all afternoon.
Dr. Novotny, Dr. Lichtenstein, Dean Maloy, thank you all for being here today. I think it has been very informative for a lot of folks
here on campus and off, so thank you. You've been watching SDSU LIVE, a live streamed video production of San Diego State University,
thank you for clicking in, and I hope you join us again soon.