ScienceInsider

Detailed preparedness plans drawn up in the past five years have been a boon for officials fighting the outbreak of swine flu. But not everyone is reading from the same page, as was clear at press conferences held today in the United States, Sweden, and Switzerland. In part, that’s because as helpful as preparedness plans can be, “microbes don’t read the plan, and you need to move away from the plan pretty soon after day one,” said Richard Besser, acting director of the U.S. Centers for Disease Control and Prevention.

As CDC, the World Health Organization in Geneva, and the European Centre for Disease Prevention and Control (ECDC) in Stockholm made clear, countries—and even states and cities within countries—are tailor-making responses to their outbreaks. Perspectives differ about containment strategies, including school closings, travel restrictions, and airport screenings. Decisions vary about when to report cases. And many locales still have only limited, if any, ability to test for the novel virus causing the outbreak. There’s even some debate about whether to call the outbreak “swine flu” or not, with WHO and others renaming it the less catchy "H1N1 virus," and some calling it the “Mexican flu.”

More countries will get to stick their fingers in this pie because the virus is spreading rapidly. Lab-confirmed cases are up to 236 from 148 yesterday; and three more European countries have joined the list: the Netherlands, France (with a probable case), and Switzerland. Peru and Costa Rica are now flu zones, too. Even a member of President Barack Obama’s security team is suspected of catching swine flu during a recent visit to Mexico with the president. Because of this spread, Angus Nicoll, head of ECDC’s influenza program, said today that it’s “inevitable” that WHO will raise the alert level from pandemic phase 5 to 6, and “it’s just a question of when that will happen.” But WHO said the situation hasn’t changed yet: “There is nothing that epidemiologically suggests today that we should be moving towards phase 6,” said Keiji Fukuda, WHO’s assistant director-general for health security and environment, in a briefing.

“There’s a backlog of several thousand specimens that need to be tested,” said Fukuda.

Over at The New Republic's health care blog, Jonathan Cohn is wondering why an apparently qualified expert on infectious disease—a member of the Institute of Medicine, no less—has yet to get a Senate confirmation vote to become commissioner of the Food and Drug Administration. Margaret Hamburg is President Barack Obama's nominee to run FDA, which has been working to prepare vaccines and develop diagnostic tools to understand swine flu.

—Eli Kintisch

The National Research Council stepped into the shadowy world of cyberwarfare this week, issuing a call for open discussion of the Pentagon's efforts to build computer viruses or other novel weapons to infect or destroy an adversary's computers. According to the NRC panel, the "cyberattack capabilities" of the United States are probably more powerful than "the most sophisticated cyberattacks perpetrated by cybercriminals."

This is a good thing, says Admiral William Owens, a former vice chair of the Joint Chiefs of Staff, who co-chaired the NRC panel. According to Owens, attacking foreign computers is "a very important capability." But he also warned of dangers stemming from widespread secrecy and ignorance surrounding the nation's cyberarsenal. Most civilian policymakers and senior military leaders, he says, don't fully understand how attacks on computers are carried out and probably don't understand the risks involved. In the early stages of a conflict, he says, "it may be considered just a little too easy" to sabotage an adversary's power grid or telecommunications with software, instead of with explosives. But the risks, in fact, may be similar: "Cyberattacks are not of lesser significance simply because they target computers."

Slate covers the Challenge Grant frenzy that's sweeping the biomedical nation:

The grant-writing mania is palpable across academic and medical institutions. At the University of Pennsylvania School of Medicine, for instance, faculty members normally spend about 50 percent of their time working on grants, according to Glen Gaulton, the school's Chief Scientific Officer. (This number rose substantially during the Bush years, he said, as NIH funding flattened out.) He estimates that in March and April, however, faculty members have spent more like 75 percent to 90 percent of their time going after stimulus dollars.

(Update: So does Stanford)

University researchers who work with dangerous pathogens should keep an eye on each other and report any signs of suspicious behavior to lab managers, says a panel of life scientists that was asked by the U.S. government to think of ways to tackle the threat of lab insiders carrying out a bioterrorist attack. However, in recommendations released yesterday, the panel rejected psychological screenings, drug tests, and medical monitoring as useful methods for enhancing personnel reliability in the academic setting.

The National Science Advisory Board for Biosecurity (NSABB) began looking into personnel reliability last fall after officials from the Federal Bureau of Investigation said that the 2001 anthrax letter attacks had been perpetrated by U.S. Army researcher Bruce Ivins. Although the case never went to trial because of Ivins’s suicide, it prompted federal agencies to review policies for screening and monitoring individuals with access to select agents. In considering strategies to prevent individuals with evil designs from misusing access to select agents, the board studied Personnel Reliability Programs in effect within the biological labs at the Department of Defense, the Department of Energy, and other organizations. Select agent researchers at these places undergo high-level security screenings including mental health assessments and monitoring procedures such as random drug tests and periodic credit checks.

In the end, NSABB members decided that such policies would not be effective in mitigating the insider threat.

Now a popular pet, ferrets have also become the animal model of choice for many influenza studies, as they can easily be infected with the virus and have similar respiratory tracts to humans'. But a report last October of an outbreak of influenza in a ferret colony has led to questions about whether this animal model can help sort out a critical question about the current swine flu outbreak: What allows this particular virus to transmit so well between humans?

No Few studies have ever tested swine flu viruses on ferrets, and little information exists about natural influenza outbreaks in the species. But at the annual conference of the American Association of Veterinary Laboratory Diagnosticians last October, researchers from Iowa State University reported (see page 101 of the conference proceedings) that an outbreak of influenza in a ferret colony on an Iowa farm infected 8% of about 1000 of the minklike animals.

The researchers, led by virologist Kyoung-Jin Yoon, discovered that the outbreak was caused by an H1N1 swine influenza virus. The ferrets lived about 0.4 kilometers from a swine farm.

The current human outbreak is also caused by an H1N1 virus of swine origin. Shortly after his team typed the strain causing the human outbreak, Ruben Donis, a virologist who heads the molecular virology and vaccines branch of the U.S. Centers for Disease Control and Prevention (see interview with ScienceInsider), noticed the ferret study. He immediately wondered whether the swine H1N1 spreading through ferrets might be the same as the one causing the human outbreak. “I thought, ah, a smoking gun,” he says.

The World Health Organization has raised the threat of the current outbreak of swine flu from phase 4 to 5, officials announced this evening in Geneva. Phase 6 is a full-scale pandemic. “Influenza pandemics must be taken seriously precisely because of their capacity to spread rapidly to every country in the world,” said Margaret Chan, WHO’s director-general, at a press conference.

As Chan and other officials explained, WHO made the decision to move from phase 4 to 5 because of evidence that the virus had spread from humans to humans in both Mexico and the United States, two countries in the same region. “All countries should immediately now activate their pandemic preparedness plans,” said Chan. “Countries should remain on high alert for unusual outbreaks of influenza-like illness and severe pneumonia.”

If human-to-human transmission is confirmed in another region—which now seems likely—WHO will raise the threat level to phase 6.

Chan explained that she has been in touch with leaders from several countries, the pharmaceutical industry, and the head of the World Bank to discuss appropriate health measures, potentially ramping up production of antivirals and a vaccine, and finding money to help developing countries combat their outbreaks. The change to a phase 5 alert, she said, should signal that “certain actions now should be taken with increased urgency and accelerated pace.”

As severe cases of disease still have not been seen outside of Mexico and the United States, Chan says it’s still unclear just how aggressively countries should respond. But she said countries should step up surveillance and consider measures such as closing schools and delaying public meetings to stem local outbreaks.

Virologist Ruben Donis, chief of the molecular virology and vaccines branch at the U.S. Centers for Disease Control and Prevention, spoke with ScienceInsider at length last night about the swine flu virus causing the current outbreak. CDC’s early analyses raise several provocative possibilities. The stage appears to have been set for this human outbreak by an outbreak over the past decade of flu viruses in swine that combine strains from several species. The first infected human may not even have been in North America, let alone Mexico. Patient samples from Mexico taken over the past several months reveal that this swine flu clearly exploded in late March, suggesting that it was not rapidly spreading in that country, undetected, for very long.

Donis discussed the genetics of the virus—the clues in this mystery—in detail. These include several of its eight genes, which code for surface proteins hemagglutinin (H) and neuraminidase (N), the matrix that surrounds the nucleus, the nucleoprotein itself, and three polymerase enzymes called PA, PB1, and PB2.

—Jon Cohen

Q: What do you know about this swine flu virus?

R.D.: We know it’s quite similar to viruses that were circulating in the United States and are still circulating in the United States and that are self-limiting, and they usually only are found in Midwestern states where there is swine farming. There’s only one well-documented case where the infection spread from one human to another. What we know is that it is not common that there is sustained transmission in people.

Q: Christopher Olsen published a paper that looked at the literature back to 1958 and only found 50 cases of humans infected with a swine influenza.

R.D.: If we have two documented cases a year, maybe that’s just the tip of iceberg. Maybe there are 10 times more or 50 times more. But still, it’s only swine to human, and it stops there.

Q: Have you completely sequenced this virus?

R.D.: Yes, 2 weeks ago. Very soon after we received specimens from California and Texas. Hemagglutinin, neuraminidase, and matrix, the three genes that have the most public health interest, were sequenced, and then the whole genome was completed.

The American Chemical Society has cut 56 employees or 3% of its work force, eliminated select retirement benefits, and reduced general expenses across the organization to cope with declining ad revenues for Chemical & Engineering News, print subscription cancellations, and investment losses.

—Jackie Grom

Racing to keep up with swine flu’s spread, health agencies warned this morning that the number infected is changing hourly, and the World Health Organization is eyeing an upgrade to pandemic level 5 if it sees sustained person-to-person transmission in at least two countries. Mexico is there already, WHO says, and it’s keeping a close watch on New York City, where the swine flu has spread through at least one school. The WHO alert level was raised from 3 to 4 on Monday.

Even as cases of the disease are confirmed in more and more countries—Germany and Austria have just been added to the list—the flu’s severity is in question. “We don’t have a handle on this right now,” said Keiji Fukuda, WHO’s assistant director-general for health security and environment, at a conference call with journalists this morning.

But at the European Centre for Disease Prevention and Control, which held its own briefing an hour before WHO, Angus Nicoll, head of the agency’s influenza program, said he was seeing “something that looks more like an ordinary influenza, with a lot of people infected, but very few people being sick enough to end up in hospital or die.” Mexico, he noted, has reclassified some deaths attributed to swine flu as due to other causes.

The first death outside Mexico, in a Mexican toddler who traveled to Texas several weeks ago, was reported this morning. Outside the United States and Mexico, most cases so far are in individuals who recently traveled to Mexico. As of today, the United States has 91 confirmed cases in 10 states. Six of these people, including the child who died, have been hospitalized. Richard Besser, acting director of the U.S. Centers for Disease Control and Prevention, said at a press conference today that “we have a number of suspect cases that have been hospitalized.”

Questions remain about whether the flu in Mexico, the nexus of all flu-related deaths except the toddler’s, is really more severe, or whether, as health officials increasingly seem to believe, there were simply many undiagnosed flu cases there, making the death rate much smaller than it seems at first glance.