The global response to the swine flu outbreak
Donald McNeil, the New York Times: Thanks for having me.
John Hockenberry: And Keith Bradsher is the Hong Kong Bureau Chief for the New York Times, who joins us from Hong Kong, where of course that city and other places in Asia have had a lot of recent experience dealing with SARS and more recently with avian flu. Keith, thanks for being with us.
Keith Bradsher, the New York Times: Thank you.
John Hockenberry: Don, when you came into the studio, you literally said very shortly we’re not going to be shaking hands, we’re going to be doing elbow bumps when we meet each other. Do you think that’s really where this is headed?
Donald McNeil: Yeah, I do. I think public health officials are being very careful and very conservative. But I think the scenes we’re seeing in Mexico City now, we’ll be seeing in New York and other places. Maybe not as severe, but the flu is already here. It’s in Queens. We’re an epicenter of the epidemic now and it will spread.
John Hockenberry: And is the threat what flu can do? Or is there something that we know about this strain confirmed now that suggests this is the real deal?
Donald McNeil: Nobody has enough numbers to really understand what’s happening. That’s one of the reasons that the WHO is reluctant to raise a pandemic level alert. They are also reluctant for political reasons. But when you say 1,000 people infected, that’s not right. There’s probably tens of thousands of people infected. It’s about 1000 people seriously ill, and I think it’s about 100 people dead. You have to assume that there are many, many more cases in Mexico. They’ve been having a surge of flu in Mexico for about a month, and something like that presumably will happen here now that it’s going around the world.
John Hockenberry: How quickly can you figure out from a person that goes into a hospital and says “Boy, I feel lousy,” how long does it take before that person can be confirmed to be with the virus, and be put on a map, and decisions can be made about where this is headed?
Donald McNeil: There’s a whole serious of flu tests that you do. You do a test to see if it’s flu and not something else, not rhinovirus or coronavirus. Then you do a test to see if it’s flu A or flu B. Then you have to see, if it’s flu A, is it a previously known strain. If it’s not one of those, the best guess is that it’s swine flu. But to get that confirmed you have to send the sample to Atlanta, so it takes a couple of days. A couple of days at least.
John Hockenberry: A couple of days, at least. Keith, the people of China and in places around Asia are familiar with taking aggressive steps here. What are the sorts of infrastructure medically that are already in place in a city like Hong Kong, Keith?
Keith Bradsher: Hong Kong is the best prepared of all because this place is terrified and has been terrified for six years of having any repeat of SARS, which was a terrible lasting scar on the city. In fact, during SARS, we stopped shaking hands here. We, or many people, began going back to the traditional Chinese greeting where you clasp one hand over the other in sort of a double fist without actually shaking hands or making contact. It’s actually a very good way to avoid this type of contact. In terms of steps being taken now, for starters, they’ve already built a new Respiratory Diseases Isolation building here. So Hong Kong has 1400 beds for respiratory isolation in a city that only requires 80 to 100 beds on any given day. The city, by Thursday, will have six hospitals running immediate tests that will be able to identify swine flu as opposed to in the states everyone having to send samples to Atlanta. Hong Kong already today, has already taken the legal procedures to make, to specially identify swine flu so people can be quarantined. There have been extensive legal changes here in ways that the United States has not done, to establish exactly what sorts of legal powers there are to quarantine or detain or trace people that might be infected. The territory also keeps a very active database of everyone who has been trained as a nurse or a doctor, even if they’ve retired or moved on to other occupations, and can mobilize them. There are detailed contingency plans for keeping the trams, the subway, the busses, the food supplies, the telecommunications, the electricity, all of that running, even if large numbers of people get sick. In terms of alternate crews…
John Hockenberry: Are you even halfway through this list yet, Keith?
Keith Bradsher: No I’m not. It’s a very extensive thing that everybody has been preparing for here for years. And the question is has the rest the world taken the warnings that you could see coming from avian flu to heart. Hong Kong is an example of how that can be done.
John Hockenberry: Let’s put that to Don. I want to move to Hong Kong today. Should I be concerned about not having the sort of infrastructure that Keith Bradsher is talking about in Hong Kong?
Donald McNeil: We do have that kind of infrastructure, we’ve just never ramped it up the way they have in Hong Kong or in Taiwan or a few other places, because they faced SARS and they faced…but thanks to SARS and thanks to the fear over avian flu, we have an enormous strategic stockpile of tamiflu and masks and hospital ventilators and things like that that’s already prepositioned in warehouses around the country.
John Hockenberry: Let’s just be really, really clear here. Based on what you’re seeing here in the United States, is it premature to go to the levels that Keith is talking about or should we look for those switches to be tripped this week?
Donald McNeil: It’s certainly premature for Hong Kong to be going to the levels, they don’t have any cases. In New York, it’s premature, but we have cases. You should look at that school in Queens. It went from 75 cases to 100 cases in about a day or so, according to what Brother Francis said.
John Hockenberry: Let me put a question to you, Don, from one of our listeners. Does immunization matter? Have the people who have caught it, at least with those that we can obtain this information, been immunized or not with the seasonal flu vaccine?
Donald McNeil: The answer is nobody knows. They are testing this past year’s seasonal flu vaccine against the new virus. Samples were sent from people who took the new flu vaccine down to the CDC, but they haven’t got an answer yet. There is an H1N1 component in the seasonal flu vaccine.
John Hockenberry: Explain H1N1.
Donald McNeil: OK. There are lots of different kinds of flus, they’re each known by the H number and the N number. The H is the hemagglutin spike on the outside that lets it get into a cell. The N is the neuraminidase that lets it escape from the cell. Each one, N1, H3 and 2, H9 and 2, there are lots of different flu viruses around. There is a human H1N1, it is a distant, distant descendent of the 1918 pandemic flu and that’s been going around since 1918, it’s part of the seasonal flu. It’s mutated a lot since then, so it’s mild. But there’s something in the vaccine from that component. There might be a tiny amount of cross-protection, but nobody’s sure.
John Hockenberry: So it’s unclear if the virus, the specific strain that we’re vaccinated against, the swine flu this time around is relevant to what’s going on in this particular…
Donald McNeil: You’re actually vaccinated against three strains every time you get a flu shot, an H1N1, an H3N2 and a B. But there’s a number of problems. The H1N1 may get a little bit of cross-protection, but they haven’t proven that yet.
John Hockenberry: I actually understand that. Keith Bradsher… And I understand that just by listening to you, not because I did my homework this morning. Keith, are the measures that are in place in Hong Kong designed to stamp out an epidemic? It seems to me that a city the size of Hong Kong, it would be hard to stop something if things get moving with all the traffic inside and outside the city. Or is it designed to mitigate the health implications and try to save as many people as get infected?
Keith Bradsher: It is designed, in the case of influenza, to mitigate and slow down an outbreak. If it were something like SARS, something like SARS you can control and try to stamp out entirely, as Hong Kong did although at terrible human cost and lives and very, very sick people six years ago. But you could stamp it out because people didn’t become infectious until after they’d been sick for a week. And by then they were probably in the hospital because they were so ill. By contrast, with flu people become infectious right as symptoms are first appearing or even slightly before. So you cannot prevent it entirely, but the hope is that you can slow it down so you don’t have everyone hitting the hospitals at the same time, and so that you have longer in which to develop for example, ideally, a good vaccine, so that you can make a variety of these other preparations in terms of ensuring that vital services are maintained. All these things can be done if you can slow things down. So the goal is to slow things down so you can treat the patients as best as possible.
John Hockenberry: Alright Keith, thanks so much. He’s the Hong Kong bureau chief for the New York Times, talking about the infrastructure in place in Asia where they do have some recent experience with SARS and avian flu. Donald McNeil, here in the studio, last question for you, one of our listeners wants to know: No one that I know of has addressed the reason for fatalities in Mexico, and the swine flu seems to be so mild everywhere else. Are the people that died immune compromised, young, or old? What do we know at this point and what does it say to people in the United States?
Donald McNeil: They’re the opposite of immune compromised. First of all, you should assume that the best guess is that there are tens of thousands or hundreds of thousands of cases of the flu in Mexico and that what you’re seeing is the tiny tip of the iceberg that’s getting seriously ill, and the tinier tip of that iceberg that’s dying. And they’re probably dying, this is a guess, because of a cytokine storm, which is a hyperactive immune, a regular immune system in a strong healthy young person flooding the lungs with fluid and people basically drowning.
John Hockenberry: Donald McNeil, reporter for the New York Times covering the swine flu that is now, as you’ve described, an epicenter here in New York.
