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H1N1: Discussion of Iowa Swine Flu Risks and Safety Measures

posted on May 12, 2009 at 4:29 PM

Is it time to ratchet back on the panic over a flu pandemic or are we getting an early alert for bad things to come?  We'll take up that question next on this May 7, 2009 edition of The Iowa Journal.

Paul Yeager: Hello and welcome to The Iowa Journal.  We are live tonight and equipped with a corps of phone operators to take your calls about the flu bug known as H1N1.  The virus has claimed lives and its rapid spread has earned it the designation of pandemic from the World Health Organization.  There is no better analogy for H1N1 than the news of it.  Like the virus, the story has spread and mutated quickly and widely.

Mexico scrambled today to head off a deadly outbreak of swine flu.  Schools, museums, libraries and other public sites were closed in Mexico City.  In recent days more than 1000 people have fallen ill and officials say as many as 60 have died.

Ten Mexican states, including the capitol, have reported swine flu cases.  In the United States, state health officials in New York, California, Kansas, Ohio and Texas have all reported confirmed swine flu cases.

The economic fallout from the flu also has begun to come into focus.  Cuba today became the first nation to impose a travel ban on flights to and from Mexico.

My thoughts and prayers and deepest condolences go out to the family as well as those who are ill and recovering from this flu.

Now that we believe the virus has been introduced to the state we anticipate it will spread across Iowa.  Given the two probable cases in Iowa, I have asked the Department of Public Health to activate their emergency coordinating center.

Two H1N1 cases here in Iowa are being investigated by the Centers for Disease Control in Atlanta.

Those probable cases showed up in Clinton County and Des Moines County.

The illness continued its spread as the number of U.S. cases passed 100 and more schools closed.

11 states, 109 cases, the H1N1 virus continues to spread coast to coast.  A back log at the CDC means that Iowa will not know until tomorrow about what were called two probable cases of H1N1.

Obviously this is a rapidly changing situation.

The number of probable cases of H1N1 flu has grown in the state of Iowa but no cases have yet been confirmed.

Iowans are in a sort of limbo tonight as the state awaits results from what officials call three probable cases of H1N1 flu.

The first confirmed case of the H1N1 virus uncovered in Iowa today and now the state says up to ten more cases could be on the way.

Marshalltown schools will be closed all week.

Six likely cases of H1N1 led to that shutdown.

Sixty more cases today.  The Centers for Disease Control and Prevention confirms there are now more than 226 confirmed cases of H1N1 in 30 U.S. states.  That is up from 160 cases in 21 states.  In all, the Iowa Department of Public Health has conducted 548 tests for that H1N1 flu.

Swine flu continued its creep around the world.  The number of cases went to over 1000 spanning 20 countries according to the World Health Organization.

H1N1 continues to spread across Iowa, still only one case confirmed, that in Des Moines County in eastern Iowa but new tonight one probable case in Polk County and two more probable cases in Marshall County bringing the total number of probable cases there to ten.

What a difference eight hours made today in Marshalltown.  This morning the school district superintendent defended the decision to close schools all week as a necessary measure to fight the spread of the H1N1 flu.  This afternoon that closure order was cancelled.

Paul Yeager: So, the question tonight, where are we now?  Has the danger ebbed?  Are pandemics more the product of media coverage than actual biothreats?  Or did the world just get a free preview of how quickly a virus can spread?  Should officials and citizens be processing some serious what-ifs?  We hope to answer some of these questions and also give you an opportunity to call in your questions tonight.  We have operators to take your calls.  You can also send an e-mail to iowajournal@iptv.org.  With us tonight to address these inquiries are Dr. Patricia Quinlisk, she is Medical Director and also the State Epidemiologist at the Iowa Department of Public Health.  Also from that department is Thomas Newton, he is the director of the Iowa Department of Public Health.  Also on our panel tonight and at the table is Charles Sukup, he is President of Sukup Manufacturing in Sheffield.  He is also Chairman of the Board of Directors for the Iowa Association of Business and Industry.  And also on the program tonight is Iowa State University's Dr. Butch Baker.  He is Senior Clinician with the Veterinary Diagnostic Production Medicine at Iowa State University.  Thank you all for joining us tonight on this topic that has been evolving. 

Paul Yeager: Tom Newton, I want to start with you.  What is our biggest concern tonight?

Tom Newton: Well, our biggest concern is that people are going to get complacent and we've spent the last week trying to explain to the public what the risk is associated with H1N1 and now that we're seeing that the disease is less severe than it was anticipated it could be certainly people are kind of scaling back the response at the federal level and also at the state level.  But this is still an illness that is causing people to get pretty sick and it does pose a risk as a new virus.

Paul Yeager: So, Dr. Quinlisk from the same department here, does that make you concerned when you hear that people are getting complacent?

Dr. Patricia Quinlisk: Yes, it does because we want people to continue doing the things that they need to do to stop this virus from spreading because we still don't want anybody to get sick with it so we still need people to cover their mouth and nose when they cough and sneeze, to stay home when they're ill and keep their hands clean by washing them.

Paul Yeager: So, if we're starting to see things table off and I'm at home thinking it wasn’t as bad, if I'm at home thinking wow the media hype did it again to me is that a concern as well when they think or even officials from communicable diseases?  How do you answer that question?

Dr. Patricia Quinlisk: Well, I think we just need to keep our message that we need to use the media and work with the media to make sure that the message gets out and we have to achieve that balance, that balance of yes, be concerned but don't panic because it's not that bad but yet wash your hands.

Paul Yeager: I can understand that, we'll get into many more of those questions, our phones are ringing tonight.  Charles Sukup, I want to ask from a business standpoint what is the biggest concern for those that are doing business travel?

Charles Sukup: Well, it's taking proper safety measures and before the flu virus came up you were hearing about kidnappings in places and just personal safety so it's a matter of being street smart from all sorts of different aspects and where you travel and what you do and how you handle yourself and what situations you let yourself be in.

Paul Yeager: Go with your personal business, Sukup Manufacturing, you had an employee that was in Mexico.  Tell us that story.

Charles Sukup: Well, he was there, he left a week ago last Sunday or so just at the time that news really got heavy about what was going on in Mexico.  The news we had heard was it was primarily centered and concerned with Mexico City.  Where he was at was a more rural area and actually he was twice as close to the U.S. border as he was to Mexico City.  The people there, it was a rural area, they had no illness, they thought it was overblown at least from their standpoint.  When he went to leave, he just got back this Saturday evening...

Paul Yeager: You put him back to work, you didn't make him stay at home or anything?

Charles Sukup: No, we put him back to work.  He said there had been no signs of it down there.  Before he left at the airport there in Mexico they had taken him, he said, to a small room and took his temperature and then gave him a mask, a face mask and said nearly all the people on the plane were wearing the face masks that they had been getting but once he got to LA airport nobody around there was wearing it so the people all went on their way.  I just spoke to him a few hours ago and he's doing fine.

Paul Yeager: I want to talk about the mask and if they are worthwhile in a minute.  But Charles, what about some of these companies?  Have you banned travel to Mexico?  Other companies, have they done the same thing or travel bans to hot zones?

Charles Sukup: No, we haven't.  We look at it individually and some of the bigger companies that have more steady travel down there, this was a particular case where our dealer had requested some assistance and because of some operation things it was timely to get him down there.  If you've got a large sales force, I understand Deere and some others have put a moratorium on it and that may be the wise thing to do if you've got the luxury of postponing the travel. 

Paul Yeager: Some of it is necessary and some of it needs to be done.  From your ABI standpoint do you know of companies, has there been a policy set in to say you really should look at postponing travel or cancelling it all together?

Charles Sukup: Well, I've heard of a few companies that have put a moratorium on it.

Paul Yeager: Right, you mentioned Deere.

Charles Sukup: Right, and I guess that business, an Iowa business in particular, this is where this whole discussion really meets the moderation of putting the risk analysis together.  I have a feeling we may be hearing about this from John Stossel and his list of what the risks are of things and it reminds me of what the President said about the economy, things are never as good as what they seem at one time or as bad as what they seem in trying to keep the middle road and that's where business is really based is to put the practical risk.

Paul Yeager: Let's get back to the face mask or the mask, Dr. Quinlisk, is that something that -- is that mask doing any of those employees or any of those travelers, is that doing them any good?

Dr. Patricia Quinlisk: Well, most of the time the people on the street that you see wearing the masks what it really is, is protecting the other person because it's basically stopping them from coughing on somebody.  But certainly in some circumstances, particularly in the healthcare area, it does protect the healthcare worker if they wear the right kind of mask and that it forms right around their face.  So, yes, you'd have to use it in the right place but for most people out in the community, again, just making sure that you cover your mouth when you cough and sneeze is probably about as good as the mask.

Paul Yeager: Very good.  Dr. Butch Baker, we need to hear from you, I need to bring you into this conversation.  You've got a full list of folks that deal in veterinary medicine at Iowa State.  We've called this, it started as swine flu, then it's become H1N1.  Specifically when it comes to the hogs and this virus what should we be calling it or what are you calling it in your lab?

Dr. Butch Baker: We're certainly calling it Influenza Type A, H1N1 2009 and some people are calling it human H1N1 2009 which I think is probably the proper terminology.

Paul Yeager: So, how did you get to there and how does this thing work then?

Dr. Butch Baker: Well, as far as probably the virus itself has some common ancestors with viruses that have been in pigs but this particular virus has never been isolated in pigs anywhere in the world until this past weekend and that was in Canada and there we think a worker that just returned from Mexico spread it to the pigs and then it was isolated from the pigs.  And we suspected it would infect pigs because of its genetic makeup and its history, somewhere it came perhaps from pig viruses and avian viruses and human viruses mixed together over the years.

Paul Yeager: I think you call that a triple threat?

Dr. Butch Baker: A triple reassortment and these viruses they change by two methods, one is by anogenic drift which is just simple point mutations in the genetic code and then we have a reassortment or anogenic shift and that is where the two different viruses infect the same organism or same cell or the same animal and when the virus puts itself back together it doesn't really care and it will mix and match these genetic components and we get this reassortment.

Paul Yeager: Do you call that reassortment or mutation?

Dr. Butch Baker: They're really two different things.  You could look at it as a mutation but a reassortment is really a genetic leap where a mutation is a much more gradual, maybe one nuclea or one piece of the genetic code at a time.  So, since the virus has never been isolated in pigs before and we've certainly looked in Iowa and we are certain it hasn't been in Iowa before and because the economic situation that it caused on our farmers calling it the swine flu sent a fear amongst the consumers and our fear was they would quit consuming pork and that certainly happened in Mexico City.  At one point the consumption of pork dropped by about 75% down there until the word got back out that the pork was safe and that the virus really wasn't a pig virus.

Paul Yeager: Meat consumption, was it 152 million tons in 1983 and by 1997 it was 233 million tons, by 2020 expected to be 386 million tons of meat.  That is an economic question that is maybe a little outside your realm but that's also very real to the producers that you have a relationship with, what is the conversation like with some of those folks right now?  Are they pretty nervous?  This market has kind of fallen hard on them.

Dr. Butch Baker: Well, they have definitely had tough economic times the last two years and this is just, we were really much in hopes that the market would improve.  This is the time of year we usually see the market conditions improve, people are getting their barbeque grills out, pork is a favorite on the barbeque grill so we see an increase in demand this time of year and market conditions usually improve for our farmers.  They were desperately hoping to see these improvements.  But right now the condition has gone just the opposite, pigs were off the limit on the board for several days during the early part of this.  Our pig farmers are probably losing an average of somewhere between $30 and $35 for every pig the market right now.  So, that's why we certainly don't want to call it swine flu anymore and because it isn't swine flu there's good reason not to call it that.

Paul Yeager: Tom Newton, you had been in briefings with the Governor last week daily, twice daily briefings and now that has kind of come back just a little bit.  Have any of those concerns that Dr. Baker is talking about when it comes to an economy in this state fallen into some of those briefings?  Have you heard that information?

Tom Newton: Well, I think you've seen that on the state level.  We have transitioned from calling it swine flu to H1N1 virus.  You've seen it on the national level, they have transitioned at CDC from calling it swine flu to H1N1 virus, Influenza A and so it's gone by a number of different names over the last couple of weeks and I think everyone is trying to find what is the right fit for this virus and we certainly want to protect our producers within the state and it became clear pretty early on that this was not a swine virus, this was a human virus.

Paul Yeager: A human virus, humans are some of the worst ones at carrying these things when it comes to viruses.  Let's talk about - on a state level - resources for anybody who is traveling abroad.  Is there going to be any relief that the state is going to be able to offer those companies whether it is a Deere or a Rockwell-Collins or something like that, that's traveling, that they need to get them back or bring them back because of this virus?

Tom Newton: We haven't discussed that at the state level and certainly there's no prohibition on people coming back into the country at this point, there's no prohibition on people going into Mexico.  I think our position from the State Health Department has always been if you have unnecessary travel to Mexico you may want to postpone that at this point.  But we are starting to see H1N1 virus within the state and I think that's probably what you're going to see is in the United States you'll have more and more cases coming up.  So, we may see this widespread enough here soon that whether you travel to Mexico or whether you travel anywhere within Iowa you could be equally at risk.

Paul Yeager: So, is there any worry or should there be any worry -- should there be anybody bringing their families back of the businesses that are traveling that might be on a longer stay, two to three months in some locations, should they bring their families back?

Tom Newton: I'm not sure I would advocate for that at this point.

Paul Yeager: That's interesting, that was one of our questions.  You can submit your questions online tonight at iowajournal@iptv.org.  Dr. Quinlisk, when we talk about a response or a reaction to something like this is it a little early to grade how we're doing in responding to this?

Dr. Patricia Quinlisk: Well, when we respond at the State Health Department, to be honest, we're sort of grading ourselves every day and we sort of at the end of the day say, well, could we have done better today?  What do we need to improve tomorrow?  But one of the things we do do is at the end of all of these kinds of episodes is we sit down with the people in the State Health Department but also all of our partners, the hospitals, the local health departments and sit down and say how did this go?  What can we learn from it so that the next time this happens, because we will have a next time, how can we make sure that we respond better?

Paul Yeager: How would you grade how business or, Butch, the ag community, the vet community, how has everybody responded to this?

Charles Sukup: Well, I think the Iowa Department of Public Health has done an outstanding job.  I know our safety person and our people in our plant have pulled things off the Web site and that and giving short, concise, very practical -- wash your hands, sing the Happy Birthday song twice to get it done, coughing into your elbow rather than into your hand, watching handshakes, just being cognoscente that if you're sick stay home and be precautionary there on it.  So, I would give them a very good A grade in how they're giving practical advice.

Tom Newton: I would add that local public health agencies at the county level are doing an outstanding job.  They're really on the front lines, they are the ones that are interacting with people that are showing up in the hospitals and then they're doing follow up with them to see what kind of contacts they have had.  I would give them an A grade as well.

Paul Yeager: They're like investigators, police investigators trying to figure out, pin this down where they went, where they traveled, that's an incredible thing.  Dr. Quinlisk, I've seen you do countless media interviews where you've said get the flu shot.  We had a call come in, will the flu shot they got in the fall, a standard flu shot, what was that flu shot for?  Will it protect them against H1N1?

Dr. Patricia Quinlisk: Well, that flu shot that they got last fall covered three different seasonal flu viruses and this one is a unique virus so this virus was not in last fall's.  Now, I've heard some people speculate that if you're somebody who gets the flu shot year after year after year you can sort of build up some immunity that might give you a little bit of protection when these new strains come up but you never know.  So, the best thing to do, of course, is just to make sure you always get your flu shot every fall.

Paul Yeager: Do we think there will be a study to find out if that's true?

Dr. Patricia Quinlisk: Well, there could be.  Right now we know that very few people over the age of 50 are getting sick with this particular virus and what that usually means is they have some kind of immunity.  Now, whether that immunity is from the flu that they had when they were a child or there's been some speculation about the flu shots that were given after the swine flu in the mid-70s, don't know exactly but for some reason older people are just not getting this nearly as much as the young people.

Paul Yeager: There was a reporter that said this is something that will be here for eight weeks, take eight weeks off or there is some timeframes in there and we really need to be worried about that second timeframe -- tell me what that is and is that something we need to be concerned about?

Dr. Patricia Quinlisk: Well, typically the flu when it comes, it comes usually to Iowa in like the end of November, December, comes through the winter and then it starts to go away in March, April and by May usually it's gone.  So, we're thinking that this virus is going to go away.  And right now we are seeing it in school age children and once the schools get out that should slow the transmission in that age group.  So, I think people are anticipating that this summer the virus will basically go away or get to be such low numbers that we just don't see it anymore.  But whatever we see at the end of the flu season is usually what comes back at the beginning of the next flu season so there's a lot of concern that this will come back.  So, we're watching the southern hemisphere very closely as they go into their winter and their flu season to see how this virus acts down there.

Paul Yeager: That's something we'll have to watch.  I need Dr. Baker to put his professor hat on.  Can you give us a little background?  What is a virus?  How does it work?  What are we talking about here?

Dr. Butch Baker: Well, there's a lot of different viruses but the influenza virus is unique in that we think all of these viruses come from water fowl and wild ducks and other avian species that are migratory and this virus there are two genetic components that are important to us and one of them is the hemoglutinin in our HA and the other is neuramidase and these are proteins that sit out on the surface of this virus and they are what give us immunity, especially the hemoglutinin and they are also what we design our tests for.  The antibodies are created against that.  But these hemoglutinins in wild ducks there's 16 of them and then there's nine of the neuramidase and these viruses are gut viruses in ducks and the virus survives best in wet, cold conditions where they happen to live and these ducks can easily have two or three of these viruses living in their gut.  It doesn't make them sick.  But when they fly back to the tundra for breeding season and nesting season that becomes a virus swap meet in the water and so these viruses are continually mixing and we see influenza viruses are unique in that they jump from the avian species into mammals and other animals very easily over time and we have them in horses, we have them in dogs, we have them in whales and porpoises, mice, ferrets, people and pigs and probably other species.  So, in the process of these viruses moving through the different species they continue to change, the virus has great ability to change and unfortunately as humans it's a serious disease for us in the seasonal influenza outbreaks.  We have seasonal influenza in the pigs too, it's the same way, the virus seems to like the cold, wet season of the year which is winter.

Paul Yeager: Now, you hit a couple of things there.  So, we've had the avian flu or at least the discussion about that, that's called H5N1.  There's been a lot of money put into that in research over time.  But is the H1N1, the Type A that we're dealing with now, is that something that has been getting as much attention and research both in humans and in animals, the pigs who are the, as we call them I guess, the perfect incubators?

Dr. Butch Baker: Well, for years and years we thought the pig was the mixing vessel for this virus for human pandemics and always thought that the Spanish flu or the pandemic from 1918 may have come from pigs because the virus was first isolated in pigs in 1930 here at Iowa State by a researcher many years ago.  So, it was the first virus that was isolated and characterized and it came from pigs and it was an H1N1.  But now we know that that virus was originally an avian virus.  Back around six, seven years ago they went to Alaska to an Indian village, they got permission and they exhumed some of the victims of the 1918 virus and they were able to piece this virus back together and we know that that originally was an avian virus so it probably went from people to pigs in that pandemic.  And then it basically remained unchanged in our pigs for about 75 years and then about 15 years ago we started picking up some human viruses in our pigs again and then we started seeing some change and re-assortment.

Paul Yeager: Any one thing that you can pin down 15 years ago?  Was it a different vaccine that's coming out?  Is it a different pig?  Is it we're putting pigs in different places?  We're confining pigs more?

Dr. Butch Baker: Well, one of the problems we've had with vaccines, the first vaccines we had was about 15 years ago and it was an H1N1 against our classic swine flu.  Shortly after that vaccine came on the market then we saw a triple re-assortment come in and H3N2, part of those genes came from human viruses into the pigs and so then the vaccine was behind and the vaccine companies have been in a mad scramble ever since trying to keep the vaccines current.  It's been a very difficult job for them to do and when the vaccines -- the fortunate thing we have is that our vaccines we have on the market today, the hemoglutinin that is in that virus that's in the vaccine is a fairly close match to this one even though the rest of the genetics in those viruses are significantly different.  But that is the part of the virus, remember, that confers immunity, especially with kill vaccines.  So, we think that we have vaccines that are ready to go, unlike what we have in human medicine, where they're in this six, seven month lag time to get it up and going.  We probably have some vaccines that will work fairly well in the interim until we get ours to a closer match assuming that this virus does jump into our pig population, so far it hasn't.

Paul Yeager: So far, that's the big question.  Tom Newton, did you ever think in this field that you'd be studying or monitoring so closely what goes on in birds and in pigs when we're talking about humans and flu?

Tom Newton: Well, it might surprise people but we actually have a state public health vet within our department because there are so many diseases that move back and forth between humans and animals.  And so we have made a concerted effort to work with the Department of Agriculture to work with our state public health vet through the years to try and keep track of what's going on within the animal population as well as what's going on within the human population.

Paul Yeager: Well, the human population. Dr. Quinlisk is always wondering, "what are the symptoms?"  From what I've read in reports about this flu is that the point that I'm the most able to spread it I don't have any symptoms.  Is that the case?

Dr. Patricia Quinlisk: Well, we think that people might become infectious with this virus, in other words be able to spread it to somebody else, about a day before they really start getting ill.  But the time at which you're most likely to spread it to other people is when you're coughing because that's when you're just pushing that virus out and spreading it out to other people in crowds and things like that.  So, probably the time at which you're most infectious is that first day or so of illness.  But you can spread it the day before and we think you can spread it up to about maybe seven to ten days after you become ill.

Paul Yeager: So, if I go to the library on a Monday and I'm going through some library books or a magazine or something and somebody coughed on that the day before am I going to get the virus from that?

Dr. Patricia Quinlisk: No, probably not.  But we do know that surfaces like doorknobs and rails, if somebody coughed into their hand and then grabbed it and you came right behind them and grabbed that doorknob and then rubbed your eye you can infect yourself.  But, to be honest, the way that most of this is spread is somebody coughs on somebody else.

Paul Yeager: A week ago tonight on Thursday in the morning Vice President Joe Biden made a comment where he talked about flying on an airplane where he says, why would I get on an airplane that re-circulates the air and I'm one cough away from spreading it around.  Was he correct?

Dr. Patricia Quinlisk: Well, theoretically you can spread it on an airplane but we find actually a lot of these viruses do not spread very well on airplanes.  Most airplanes have pretty good re-circulating air system and the air then goes through a filter that filters out these viruses.  If somebody sitting next to you coughed right on you, yes, but that's why, to be honest, we really need every single person whether they're feeling ill or well covers their mouth and nose when they cough and sneeze because you don't know what you're going to come down with in a couple hours or the next day.

Paul Yeager: Charles, we did talk about it a little bit earlier when we were talking about travel but how much -- we're really a plane ride and a good cough away it sounds like from traveling these things.  The business community really has to be putting pencils to numbers, is it really worth it for my employees to go travel?

Charles Sukup: Well, and if you take all of the risks that are out there you wouldn't go out your front door.  So, we have to put it in some balance and perspective and thinking to Vice President Biden's comment I think kind of the law of politicians they get in the most trouble when they say the truth about things or at least what many people are thinking in regards to it.  So, it's a balance and you just have to be street smart and practical and can't live your life in fear or your business in fear.

Paul Yeager: We don't know of anybody that's doing that.  The response has been fairly calm.  Is that right, Tom?

Tom Newton: I think it has.  I think we've seen a good response.  You asked earlier has the media hyped this and I think what you're seeing is there's a lot of unpredictability around flu virus and a lot of the information that was coming from Mexico talked about a lot of cases and a lot of potential deaths associated with this virus.  And so you saw CDC as well as national or federal health and human services taking every precaution to make sure that we identified cases, followed up on cases and make sure we protected health as much as possible and I think that was a lot of the action around school closings early on.  We wanted to try and minimize spread within communities but it became pretty apparent quickly that closing down schools may not have as big of an impact on spread within a community, this may have actually been within the community for a couple of weeks before we ever even determined that it was out there. 

Paul Yeager: The pig was out of the barn already, we won't say pig, but the horse was out of the barn.  Just thought I'd throw it in there.  You talked about schools, Marshalltown schools, were they the only ones in the state that went and closed?

Tom Newton: They were the only ones in the state.

Paul Yeager: So, what is the discussion that goes on with superintendents, principals, county officials there and with your department?

Tom Newton: On Saturday afternoon, we got indication from the laboratory that we were going to have some cases in school age students at Marshalltown community school district.  Our first call was the Department of Education because we don't have all the superintendents on speed dial at the Department of Public Health, that would be a big speed dial.  So, we worked through our Iowa Department of Education, brought them into the room, had Dr. Quinlisk there, other staff from the Department of Public Health, really sat down, called the superintendent as well as I think they had the board chair there, they had a number of people that would be in on this decision and sat down and really laid out what the situation is and at that time given the CDC guidance on what we should be doing when you have a probable case within a school district we worked with the locals and they made the decision to close the school district for a week.  Then comes Wednesday and CDC has kind of changed its tune as to what we need to do related to schools and we worked again with the school district, talked with them about what new guidance was coming down and then the decision was made to reopen the school today.

Paul Yeager: Is there a certain age group, Dr. Quinlisk?  Is it the school kids that are the most vulnerable or the most apt to get something like this?  Is it the elderly?  I know we talk about that with the traditional flu that it's the elderly that could be -- is there a demographic in there that really needs to be watching this?

Dr. Patricia Quinlisk: Well, we know in a lot of communities that the school age children are the ones that spread the virus the best.  In fact, there's been some studies showing that if you vaccinate all the school age kids that's almost as effective in preventing the elderly from getting ill than vaccinating the elderly.  So, we know that the schools are a great place for kids to spread around viruses.  So, I'm not surprised that that is the place where we first saw sort of this virus get up and get going.  But when we talk about seasonal flu it is usually the very old, the very young and people who have conditions that put them at risk, they are the ones who are probably at the greatest risk of having serious disease and dying.  In this one, though, it's been a little bit different.  We've seen basically it's the younger people who are getting sick and in Mexico it was the younger people who were getting very sick and dying.

Paul Yeager: So, what is the concern then?  That sounds like a mutation, a variation that has changed and maybe the old rules, traditional rules are out the window.  How concerning is that?

Dr. Patricia Quinlisk: Well, to be honest, we see that in our regular seasonal flu too.  Several years ago we had a particular virus that got into Iowa and it was hitting the younger school age children the hardest.  In fact, that year we had hardly anybody who was elderly get sick with it.  So, we know that this is one of those things the flu virus does.  Even though usually it's the very young and very old it can hit any age group.  So, that's one of the reasons why last year basically the recommendation for getting the flu shot has expanded and basically they're saying school age children as well as the very young, the very old and the people with medical conditions should get vaccinated every year.

Paul Yeager: In your notes, I know you've got a big stack of paper, what are we at for Iowa cases right now that have gone for treatment or possible, probable cases?  What are we at?

Dr. Patricia Quinlisk: Well, as of this morning I can tell you we've got five confirmed cases, we've got 35 probable cases and I'll just tell you that almost all of those, if not all of them will be confirmed and that is out of about 770 people that we've tested in the state.  So, that's not very many out of the total number of people we've tested.

Paul Yeager: So, how much higher could we have taken our healthcare system in getting these people tested whether it's at a health department -- is that double, is it 10,000 people would overwhelm our health system in this state?  How high if something like this would spread or come back in the fall?

Dr. Patricia Quinlisk: Well, I think you have to think about not only how many people are getting ill but how sick are they getting?  Fortunately most of the people who are getting ill with this virus are not getting that sick so they are being cared for at home.  What we are seeing, though, is the people at their homes are getting sick, they're spreading it to family members and then they're getting mom sick and the little sister is getting sick so that is of concern.  We do want to, again, help people to understand how to take care of somebody and not spread it to the rest of the family and if an adult gets sick how we can get sick stay at home and not spread it to our children.

Paul Yeager: Is this almost a dry run at something that might be worse or could be worse?  Are we just getting practiced and better at handling this and containing this?

Tom Newton: I think we have to look at this as a dry run.  Obviously we know that there are going to be more pandemics that come through the years.  There has been a pattern of them through the last century.  We'll continue to see flu pandemics.  It just depends upon how severe they get.  When we talk about mild disease in public health we're talking about people are getting sick, they're running fevers, they're having coughs and they're feeling pretty crummy.  When we talk about severe disease they're dying, they're being hospitalized and fortunately this has not been a severe disease.

Paul Yeager: So, Dr. Baker, I've got to give you a few minutes on this or at least you could go on for minutes about this ... we talk about variation and mutations in some of this.  We talk about things looking different, this is not the way it was.  There's reports that this specific swine flu H1N1 did start back in 2005, there's a report that says it was in 1990, it was in 1987, it's mutated, it's looked different, it's been variety.  How do we predict where this is going?  How do you as a scientist try to predict and inform public health folks and inform my family as well?

Dr. Butch Baker: I think our crystal ball is probably no better than on the human side.  We kind of look at the crystal balls surveillance and trying to understand these viruses and I think one thing about this, this number two practice run at the next pandemic, I guess SARS was first and now this, is the unique collaboration between the animal health side and the human health side and the directors of all the diagnostic -- I've been on a number of conference calls the last few days there somebody from the CDC, somebody from Iowa Public Health or maybe even Health and Human Services and then lab directors and veterinarians like myself are all listening in trying to find out some answers, what's the real information on this and what do we need to do next.  And so in the planning typically on the animal side we plan alone for our disease control and management strategies.  With this one, though, we're lock step with the CDC and the human medical side so I think that's going to help and I think we'll see more federal dollars come over to the animal side where we can do a better job of surveillance looking for these things trying to predict.  As far as this virus having been here before there is a lot of stuff on the Internet and most of it is misinformation but we have gone back and we have looked at viruses for the last five years, we have a freezer full of them when they come in and between our diagnostic lab and the University of Minnesota, Iowa State and Minnesota we probably we 70% of all the swine cases in the United States so it's not just in Iowa we're looking at, we've got North Carolina, Indiana, Nebraska, Minnesota and Minnesota has got the same situation.  We've had a couple of good scientists, K.J. Juhn at Iowa State has been sequencing these viruses for a long time and studying them.  Marie Gramer up in Minnesota, excellent young scientist and she sequenced a lot of them.  A lot of hers has gone to Richard Webby, St. Judy Children's Hospital in Memphis, he's done whole genome sequences, he's been monitoring our swine viruses for five, six, seven years now.  So, we've been looking.  This particular virus, though, hasn't been in North America before and I don't think it's been in any of the Americas before.  Honestly it has some ancient ancestor virus that is part of this that did come from North America but then the other one came from Asia and so where did this virus come together and create a new virus; where do most pandemics come from?

Paul Yeager: Charles, if you are a small business in business and industry and you don't have kids at school, you have to pay attention to the media and you have employees that you need to take care of, do you feel that they have been well informed?  Who do those people turn to for information to help their employees because in some places they might be the biggest employer in their town?  Do you feel that business and industry in Iowa has been well prepared or well informed of what's been going on and where have you been getting your information from?

Charles Sukup: Well, we've been getting our information from the Iowa Department of Public Health and in our specific company the safety director but it's easy to download with a Web site and that to get that together.  In looking at the overall thing I think one of the things people looking at balancing the risk is how many deaths.  We've had two deaths in the United States with it and what I hear in a typical year the seasonal flu is over 30,000.

Paul Yeager: 36,000 a year average death rate.  That's worldwide?

Dr. Patricia Quinlisk: That's in the United States.

Paul Yeager: That's in the United States alone and the traditional flu.  Okay.  So, do you feel that there needs to be -- is there a mandate at your company to have everybody get flu shots?

Charles Sukup: No, we don't mandate it but we offer it at a discounted rate and a high percentage of our people -- we keep track of those that do take it.

Paul Yeager: Now put on your business and industry hat, do we need to have a mandate for some type of vaccine for all those in business and industry?

Charles Sukup: My first reaction would say no, our organization and most businesses are usually pretty skeptical about mandates and fixed cookie cutter type plans.  It's better to be flexible and use some personal discretion and wisdom and experience to help fit it in.  The news media is certainly getting us information, the Department of Public Health, we see the various elements of risk that are involved there.  So, I don't think most businesses would support a mandate.  But what the information there people are going to be asking for it, they're going to be wanting it and the business will support it because obviously it's just common sense that employees are such an important asset, we want healthy employees.

Paul Yeager: Dr. Quinlisk, would you like to have a mandate for everybody?

Dr. Patricia Quinlisk: Well, I think there are some places where we should have some sort of almost a mandate and I think that's in the healthcare system.  When you go to the hospital or to see your doctor or the nurse you don't want to pick up something from them.  So, I do think that in that area to have a vast majority of people vaccinated is a very good idea.  And one of the things I was just going to mention with business is they have been doing some studies where they find out that if you vaccinate your employees against the flu that they find out that not only do people not get the flu, they stay in better health through the winter and they actually don't end up getting other respiratory viruses through the winter season and they actually have much better attendance through the winter and then, of course, they're not spreading it to their families and having to stay home with sick kids.  So, I think economically that the flu shot would probably be a very economically wise thing to do.

Charles Sukup: That's been a very popular thing and we had people in our company it was a couple of years ago when there wasn't enough flu vaccine they were upset and concerned and wanted to have it there in regards to it.

Dr. Butch Baker: I would just say in the swine production and in the pork production industry we've recommended influenza shots for all of our employees for a number of years now, no mandate although maybe some of the companies have, but generally we have recommended that because we've known for a number of years that on occasions human flu viruses have been getting into our pigs over the last fifteen years.  So, we recommend vaccination.  And I would add that when the CDC comes with their new vaccine, if it does have this virus in it, I think the veterinarians that are out there in the trenches with the pig farmers and the pigs and the people that work on the farm should certainly be on their priority list of people that should receive the vaccine this coming fall.

Paul Yeager: The workers that go from confinement to confinement, in some cases they are required by the corporation that might own that confinement to shower in, shower out.  What is the concern of how that employee might be transmitting it or the employee gets it from a confinement operation and then spreads it back to the family?

Dr. Butch Baker: Well, so far that hasn't happened and we hope it doesn't or at least not with this virus.  There have been cases where individuals in close contact with pigs have contracted the traditional H1N1, the one that we found in 1930 and has been in pigs since but that virus has never been a good human-to-human virus if at all.  So, our units are bird proof and we usually have showers and we have downtime rules usually from unit to unit where a person is working in one unit we would let them not work over a weekend or a holiday if we wanted to move them to another unit in the larger production systems.  And the family farms, you know, it's the family and a few employees that are there every day and we certainly, this virus if it does have the potential, we think it does, to infect pigs then this is going to be a big concern for us next fall who should be vaccinated and what additional steps.  The Pork Board and others are recommending don't force a sick employee to come to work, give them an incentive to stay at home if they are sick, give them plenty of incentive to get the flu shot this fall.

Paul Yeager: Don't make them feel like they have to tough it out which then makes it worse.

Dr. Butch Baker: It creates more risk for the pigs and it may create more risk for the other employees and certainly they're going to cough on the employee as well as the pig.

Charles Sukup: One other item in regards to mandates and I certainly agree with Dr. Quinlisk certain segments there and health ones, we were talking before the program started here the 1976 vaccination that actually in that one more people died from the vaccination than did from the flu and the flu didn't end up being as severe or we saw it years ago in states mandating asbestos, different unintended consequences that kind of caution us about broad mandates and being do no harm.

Paul Yeager: Dr. Quinlisk, please run down the symptoms of this H1N1.

Dr. Patricia Quinlisk: Well, actually it's almost identical to the regular seasonal flu, most people will have a day or so of not feeling too good, most people will develop a fever over 100, then a cough, sore throat, some of the children are having vomiting and diarrhea so basically you're getting the same symptoms that you do with seasonal flu which is causing a little bit of trouble because it's not like you can walk into your doctor's office and doctor goes, oh, you must have this flu rather than that flu, doesn't work that way.

Paul Yeager: And so it's hard to differentiate on what you've got and it's got to be testing?  Is there a timeframe when everybody who comes into a doctor's office is going to have their blood shipped off to the CDC?

Dr. Patricia Quinlisk: Well, actually what we do with this particular strain of flu and other strains is we do what's called a nasal pharyngeal swab which is they take this little thin wire down the nose, it's not very pleasant but it's the best way of finding this virus.  But no, we don't need to test everybody.  Once we know that this virus is in a community and we see people getting sick with the same syndrome we only need to test a few people and then we can basically say that's what all of these people have.  And the other thing, not everybody needs to be treated.  We do have antiviral medications but traditionally we only treat those people who are really at high risk of becoming seriously ill, of developing complications and an ordinary, healthy young person doesn't really need to be put on antiviral drugs.

Paul Yeager: There is a strain that's out there and you're going to probably have to tell me on exactly what strain that is that has become resistant to Tamiflu.  What is that one?  Is that a concern tied in at all to our discussion tonight?

Dr. Patricia Quinlisk: Well, fortunately it isn't tied in.  It was one of the seasonal strains that we saw this last year.  It was one of the predominant strains that we saw here in Iowa and it has developed antiviral resistance to Tamiflu.  The strain that we're seeing now, the H1N1 is sensitive to Tamiflu and the other drug that we've got which is Relenza.  So, those drugs can be used for that.  The problem comes in, of course, when somebody walks into their healthcare provider's office, they have flulike symptoms, you don't know which one they've got.  And so right now it's somewhat difficult to treat if you're not sure which one they have and they actually have guidelines right now to treat them with both just in case.  But, again, the bottom line is not everybody needs to be treated.

Paul Yeager: I'm going to let your boss handle this next one.  Let’s talk about some policies.  We always hear there is the conspiracy theorists out there the CDC is stockpiling this, all these vaccines that can go somewhere.  Does the CDC have a stockpile of vaccines that trickle down to states?  How does that relationship happen where there is a conversation we've got a big case, we need some help?  How does that conversation go from where your chair is?

Tom Newton: When you say stockpile of vaccines...

Paul Yeager: Is that a term that exists?

Tom Newton: No, well, they certainly have a vaccine program in which they distribute vaccines for everything from measles, mumps, rubella to flu to the states but in this case there is no vaccine for H1N1, the new influenza that we're dealing with right now.  Dr. Quinlisk talked a little bit about the antivirals and there is a stockpile of antivirals at the federal level.  This last week or maybe the week before, I think it was the week before, they're all running together at this point, the week before we did receive a shipment, in fact I think it was probably two or three shipments, of antivirals from the CDC.

Paul Yeager: And what are those used for?

Tom Newton: Those are used for any time we have a pandemic outbreak and there's specific guidelines on what they can be used for, the individuals who meet the criteria for treatment if they do have this new strain of flu.  Obviously we're not going to give them to everyone.  You've already talked about one strain of influenza that developed some resistance to Tamiflu.  The more you use Tamiflu on different strains of flu the more likely there is that they will develop resistance so we want to be very cautious about that.  But we did receive that stockpile, we also have a stockpile in state of resources of Tamiflu and Relenza and so we mix those two together and then as cases pop up across the state when we have probables we ship out a mini stockpile of antivirals that they can use on anyone within the population that meets the criteria we have.

Paul Yeager: Today is May 7th and if the time shifts and moves along forward with what we're talking about, how this flu could come back, this H1N1, is there enough time for companies to make another vaccine that would be able to fight this or to help us be resistant to this that we would give out in September or October that would protect us?

Tom Newton: As we understand it CDC does have the virus and they are working on a vaccine right now, CDC and NIH.  NIH will have to run all the trials on it to make sure that it's safe.  We don't want to get into a situation again like we had in '76 where people were being injured by the vaccine.  They are telling us six to eight months to get production.  So, we're optimistic that by October, November we will see a vaccine available for this strain of the flu.  Now, the seasonal flu vaccine is almost at the end of production so you may have a separate seasonal influenza shot and then you may have a separate H1N1 novel influenza shot.  And we don't know yet at this point but we think there will probably be two shots associated with the new flu vaccine.

Paul Yeager: Will we be getting those at the same time if it is in the fall or would they be staggered?

Tom Newton: It would be about the same time.

Paul Yeager: I've got about three minutes left in our discussion here so I want to quickly give everybody a chance for final comments.  Butch, from your end, what is the biggest challenge you have ahead here in the next few days?

Dr. Butch Baker: Well, one of our biggest challenges, two things, this surveillance is evolving and we're scrambling to test all of the new isolates that come in, we've looked back five years of isolates to make sure the virus hasn't been here in the past.  The other thing is there's been quite a bit of Internet traffic about the safety of consuming pork and I would say that there's been a lot of studies done, some at Iowa State, some over at the National Animal Disease Center, those studies will continue as we look at how this virus will infect pigs over in the HEPA filter unit they have over across town in Ames at the NVSL and NADC.  We want to make sure and we have every study supports the fact that pork is safe, this virus is not a systemic virus in pigs so, in other words, it just stays right in the lungs and it doesn't get in the blood or the meat and so pork is safe and we want to make sure that our audience understands that.

Paul Yeager: It sounds like you're talking directly to the Chinese to lift a ban of some kind.

Dr. Butch Baker: The World Health Organization has told them and it's not just the Chinese, it's a number of places that the bans are illegal.

Paul Yeager: Charles, biggest challenge for business right now?

Charles Sukup: Assessing the risk, protecting our employees, getting the message and word out particularly in our company the folks that are EMTs are that and we visited with the foreman and if somebody gets sick or vomiting, that sort of thing how you treat it and get them taken care of, the level is heightened very much there.  One other question that I had for our medical people as a non-medical person if they could define a little bit more what the pandemic is versus an epidemic versus being sick.

Dr. Patricia Quinlisk: Outbreak is somewhere like your church supper.  Epidemic is like everybody in your community is getting measles.  Pandemic is the flu is going all the way around the world.

Paul Yeager: One quick question I've got here, if I've got antibacterial that's been on the shelf for a year or two years is there a timetable on when I can keep using that?

Dr. Patricia Quinlisk: Well, as long as it still has alcohol in it and it's a 10% alcohol gel it should be fine.

Paul Yeager: Tom Newton, 30 seconds, biggest challenge the health department has?

Tom Newton: The biggest challenge we've had from the outset of this has been getting people educated, giving them enough information without pushing them to pushing the red panic button.  And that is some balance we've been trying to strike and hopefully we've been doing so.

Paul Yeager: Do you think the panic button was hit?

Tom Newton: I think there were cases where people were pushing a panic button but hopefully we've got that calmed down at this point and we're getting a good message out there on how they can protect themselves and their families.

Paul Yeager: Very good, that's Tom Newton, Director of the Iowa Department of Public Health.  Also with us tonight is Dr. Patricia Quinlisk, she's the Medical Director and the State Epidemiologist also at the Iowa Department of Public Health.  Charles Sukup is President of Sukup Manufacturing.  Dr. Butch Baker, Veterinary Diagnostic Production in Animal Medicine at Iowa State University.  I appreciate all of you coming in tonight for this discussion.  We hope we answered many of your questions tonight.  We know there's a bunch of them and they will continue.  We'll be back next week for The Iowa Journal.  This time we're going to be examining autism, a condition that seems to be afflicting a growing number of children.  Until then, I'm Paul Yeager.  For all of us here at Iowa Public Television, thank you for spending your evening with us.  Good night.

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Tags: flu germs H1N1 hospitals Iowa

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