Flu may not have killed most in 1918 pandemic


An emergency hospital at Camp Funston, Kansas, for soldiers sickened by the 1918 flu.
REUTERS/National Museum of Health and Medicine/Armed Forces Institute of Pathology/Handout

WASHINGTON (Reuters) – Strep infections and not the flu virus itself may have killed most people during the 1918 influenza pandemic, which suggests some of the most dire predictions about a new pandemic may be exaggerated, U.S. researchers said on Thursday.

The findings suggest that amassing antibiotics to fight bacterial infections may be at least as important as stockpiling antiviral drugs to battle flu, they said.

Keith Klugman of Emory University in Atlanta and colleagues looked at what information is available about the 1918 flu pandemic, which killed anywhere between 50 million and 100 million people globally in the space of about 18 months.

Some research has shown that on average it took a week to 11 days for people to die — which fits in more with the known pattern of a bacterial infection than a viral infection, Klugman’s group wrote in a letter to the journal Emerging Infectious Diseases.

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Who should MDs let die in a pandemic? Report offers answers

Doctors know some patients needing lifesaving care won’t get it in a flu pandemic or other disaster. The gut-wrenching dilemma will be deciding who to let die.

Now, an influential group of physicians has drafted a grimly specific list of recommendations for which patients wouldn’t be treated. They include the very elderly, seriously hurt trauma victims, severely burned patients and those with severe dementia.

The suggested list was compiled by a task force whose members come from prestigious universities, medical groups, the military and government agencies. They include the Department of Homeland Security, the Centers for Disease Control and Prevention and the Department of Health and Human Services.

The proposed guidelines are designed to be a blueprint for hospitals “so that everybody will be thinking in the same way” when pandemic flu or another widespread health care disaster hits, said Dr. Asha Devereaux. She is a critical care specialist in San Diego and lead writer of the task force report.

The idea is to try to make sure that scarce resources – including ventilators, medicine and doctors and nurses – are used in a uniform, objective way, task force members said.

Their recommendations appear in a report appearing Monday in the May edition of Chest, the medical journal of the American College of Chest Physicians.

“If a mass casualty critical care event were to occur tomorrow, many people with clinical conditions that are survivable under usual health care system conditions may have to forgo life-sustaining interventions owing to deficiencies in supply or staffing,” the report states.

To prepare, hospitals should designate a triage team with the Godlike task of deciding who will and who won’t get lifesaving care, the task force wrote. Those out of luck are the people at high risk of death and a slim chance of long-term survival. But the recommendations get much more specific, and include:

– People older than 85.

– Those with severe trauma, which could include critical injuries from car crashes and shootings.

– Severely burned patients older than 60.

– Those with severe mental impairment, which could include advanced Alzheimer’s disease.

– Those with a severe chronic disease, such as advanced heart failure, lung disease or poorly controlled diabetes.

Dr. Kevin Yeskey, director of the preparedness and emergency operations office at the Department of Health and Human Services, was on the task force. He said the report would be among many the agency reviews as part of preparedness efforts.

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Pandemic fear over resistant superbug

Doctors have warned that if a superbug which is known to be even more resistant to antibiotics than clostridium difficile and MRSA takes hold in hospitals, the country could face a pandemic.

The acinetobacter bug is being treated with older antibiotics because newer ones do not work. There are fears that injured soldiers returning from Iraq and Afghanistan have passed the infection on in civilian hospitals.

Prof Matthew Falagas, an expert in hospital-acquired infections, said: “In some cases, we have simply run out of treatments and we could be facing a pandemic with public health implications.”
He warned delegates at the Society for General Microbiology conference in Edinburgh: “Doctors in many countries have gone back to using old antibiotics that were abandoned 20 years ago because their toxic side-effects were so frequent and so bad.

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Indonesia: Rampant bird flu raises pandemic risks

JAKARTA, Indonesia (AP) – Efforts to contain bird flu are failing in Indonesia, increasing the possibility that the virus may mutate into a deadlier form, the leading U.N. veterinary health body warned.The H5N1 bird flu virus is entrenched in 31 of the country’s 33 provinces and will cause more human deaths, the U.N. Food and Agriculture Organization said in a statement released late Tuesday.

“I am deeply concerned that the high level of virus circulation in birds in the country could create conditions for the virus to mutate and to finally cause a human influenza pandemic,” FAO Chief Veterinary Officer Joseph Domenech said.

Indonesia “has not succeeded in containing the spread of avian influenza,” Domenech said, adding that there must be “major human and financial resources, stronger political commitment and strengthened coordination.”

The H5N1 virus has killed at least 236 people in a dozen countries worldwide since it began ravaging poultry stocks across Asia in 2003. It has been found in birds in more than 60 countries, but Indonesia has recorded 105 deaths, almost half the global tally, according to the World Health Organization.

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