Rear Admiral Steven K. Galson, M.D.
Acting Surgeon General
Tuesday, May 5, 2009 11:00 AM
The swine flu virus has spread to 36 states and infected at least 286 people, but the outbreak at this point appears to be milder than initially feared, U.S. officials said Monday, and Mexico declared that the epidemic is "slowing."
Rear Admiral Steven K. Galson, M.D., acting Surgeon General and the nation's top public health physician, was online Tuesday, May 5, at 11 a.m. ET to discuss this latest news about the H1N1 flu virus and answer questions about reader's concerns.
Washington, D.C.: Thanks for taking questions today. Did the media blow this out of proportion? Reported numbers of a couple hundred does not seem that big -- even if only 1 in 10 reports being sick, is 2-3,000 people being sick with a strain of flu really that big of a deal?
Steven K. Galson: I'm Rear Admiral Steven Galson, Acting Surgeon General and I am very pleased to be here.
The press has conveyed a lot of extremely valuable information to the public, covering the data and recomendations coming out of the Department of Health and Human Services and getting it to people all over the country.
Our concern about this strain of flu is based on the fact that it is new and that there is no vaccine available yet, so we don't have immunity. Considering the 36,000 deaths that occur in the US every year, your're right, 3000 sick people with 1 death may not be cause for alarm, but preparations and precautions are needed until we're really sure that spread is slowing and the level of illness is not severe.
CDC is evaluating the data on a real-time basis and will be modifying guidance documents without delay, as indicated by the medical and public health information coming in.
South Riding, Va.: Do other viruses such as chicken pox have as many strains as the flu? Was there more fear that this new form of the flu would mutate or combine with another flu virus to form an even more unique strain? The precautions and school closings seemed more extreme than normal. Cases of measles or the norovirus don't close schools or businesses for two weeks.
Steven K. Galson: Flu viruses DO mutate faster than other viruses. The precautions and recommendations in place are based on the potential severity of infection with a new influenza virus to which we have no immunity.
Richmond, Va.: I don't feel any sense of panic about this flu any more -- and while I do know the media contributed greatly to the panickiness when the CDC and other agencies were rightly cautious, can I feel confident that things have really slowed and we've passed the worst of it?
Steven K. Galson: You can be confident in the daily updates on cases coming out of the CDC. The best way to keep yourself calm is to stay informed!
NYC: Do you have enough data currently to determine what H1N1 will look like in the fall and how aggressive it may be?
Also, what is any is the current evidence from the Southern Hemisphere regarding H1N1 and its mutation?
Steven K. Galson: It is not possible to predict what the virus will look like in the fall because of the potential for mutation. We are monitoring international reports carefully and we're in daily contact with our colleagues in the Southern Hemisphere.
Potomac, Md.: As a pandemic flu planner, I am concerned that all the talk by public health officials about the good news of a mild strain presenting in the current outbreak will cause institutions to slack off planning before what could be a more virulent outbreak in the fall. How do we balance descriptions of the current phase in such a way that we neither lull people into false optimism nor discourage them from making proper preparations for something more serious?
Steven K. Galson: It is always a challenge to keep the correct balance but we start with a reliance on the surveillance data and it does, so far, give us reason for cautious optimism that this may be a relatively mild epidemic. However, we're mindful that it's still very early in the epidemic and our assessment could change.
Philadelphia, Pa.: How does this flu compare to others in terms of numbers, especially at this point, during the spring season?
Steven K. Galson: The severity of the epidemic is actually more important than the numbers, and so far this virus is causing relatively mild illness.
Washington, D.C.: Are people recovering from Swine flu without antiviral medicines? My concern is that I will get the flu, but not realize that the symptoms are just allergies until it is too late for the antiviral medicines to be effective?
Steven K. Galson: So far, most people have recovered uneventfully and without antiviral medication.
Harrisburg, Pa.: If the fear is there will be a fall outbreak of the swine flu, are we taking enough steps to see that a vaccine, and that enough of the vaccine, is being made in time for distribution before the fall flu season? Also, while there are fears the flu may mutate, may much mutation is required before a vaccine is rendered useless against it?
Steven K. Galson: We have agressively begun the process of developing a vaccine and are in active discussion with our partners nationally about recommendations for it's use in the fall.
Chiapas, Mexico: Mexicans here seem obsessed with face masks and those with colds wore them on the street and in public before this panic, but are they really that effective?
It seems to me they could stop the airborne spread of the virus by containing coughing and sneezing but are otherwise useless against picking the virus up from surfaces.
Are they not, if fact, harmful in holding the humid, infected byproducts of breathing, coughing and sneezing close to the wearer's nose and mouth?
Steven K. Galson: The CDC has not recommended the use of face masks by the public. They are recommended in certain settings such as healthcare. Instead, we focus on actions that have been proven to reduce spread of the virus:
Wash your hands often. You can also use alcohol-based hand disinfectants.
Keep your hands away from your eyes, nose and mouth.
If you get sick, stay home from work and keep your kids home from school.
And stay tuned to the latest recommendations on the CDC web site. It's updated frequently.
Rockville, Md.: Dr. Galson - Say this particular virus goes underground only to re-emerge in the fall, like the Spanish flu of 1918. Wouldn't we be better equipped to provide some sort of vaccine to it than our descendants of 90 years ago were?
Steven K. Galson: Yes! A lot better equipped! As I mentioned above, we are agressively working on a vaccine should we need it.
Toronto, Canada: Why do we have to wait so long for flu vaccine? We have been using virus growing in eggs for many years now. Does science have something better and faster for us?
Steven K. Galson: The process of developing a vaccine takes several months under the best of circumstances. We are developing new technologies of producing vaccines without using eggs, but it will still take several months from discovery of a new virus to having a vaccine ready. All the pandemic influenza planning has resulted in a more efficient vaccine development process.
Rockville, Md.: Dr. Galson -- One question I have that puzzles me is why is warmer weather necessarily a bad time for viruses to spread? I guess I am just confused as to why they seem to thrive in cooler months and go dormant in the warmer ones?
Steven K. Galson: Great question, but frankly we really don't have a good understanding of why viruses thrive in cooler months. This is an area of intense research.
Northern Virginia: Sorry to ask a dumb question, but I notice you are wearing a military uniform, as are some, but not all, of the other doctors we have seen speaking for the CDC or similar offices.
Are these people (are you) in the armed forces? Or does the Public Health Service or the CDC also wear uniforms, at both the regular-employee and executive level?
I honor your service and am impressed by those ribbons, but I am not as familiar with these uniforms and would like to understand.
Steven K. Galson: As the Acting Surgeon General, I am the commanding officer of a force of 6200 uniformed officers of the Commissioned Corps of the Public Health Service.
We are a uniformed service distinct from the other uniformed services like the Navy, but our uniforms do look like Navy uniforms.
At CDC, other agencies of the Department of Health and Human Services and across the government at places like the EPA and Bureau of Prisons, in fact at 800 worksites in the US and around the world, officers work alongside civilian government employees to protect public health and promote wellness.
US Public Health Service officers have special training to enable them to be deployed on short notice for public health emergencies like this epidemic.
Of the HHS employees deployed for this epidemic, currently 30 of them are Commissioned Officers.
If you want more information about the Commissioned Corps, go to www.usphs.gov
Evanston, Ill.: I have been rather dismayed at the government's echoing and reinforcing the media's panic. If tens of thousands die annually because of the regular flu why should we panic because of a new strain that has killed tens of people? The media is profit driven and can't resist hyping a story. Shouldn't government balance and resist that as opposed to feeding it?
Steven K. Galson: We have repeatedly said that there is no reason for panic. Our recommendations are based on case reports and our understanding that any new virus can cause a severe epidemic. Stay informed of the latest recommendations by checking the CDC web site daily.
Washington, D.C.: How do you distinguish between a "mild" case of the flu and the symptoms of another illness?
Steven K. Galson: Yes, it can be very difficult or impossible to distinguish because the symptoms do overlap. The CDC web site has algorithms for the public and health care professionals to help make these distinctions.
San Diego, Calif.: Good morning, and thanks for the chat. As a child in the mid- to late-80s, I had what was known as Taiwan Flu, which I understand was another A-H1N1 virus. How similar was that flu to this one? Also, am I more or less likely to contract this H1N1 virus because of the other one?
Steven K. Galson: This H1N1 virus is very different from the Taiwan strain. Whether previous exposure to this virus may impact catching the current one is actively being investigated. We just don't have the answer yet.
Washignton, D.C.: Hi,
Thanks for answering our questions.
Can flu be transmitted by money (coins and paper)?
Steven K. Galson: We don't have any evidence that flu can be transmitted by money.
Wokingham, U.K.: Have we in the West been quick and conscientious enough in helping Mexico in the hour of need?
Steven K. Galson: We have deployed staff to Mexico to help and we have been in daily communication with the Mexican and other governments.
Bloomfield, Mich.: How many vaccine manufacturers are in this country? And if there is only one vaccine manufacturer left, how much vaccine will they be able to produce?
Steven K. Galson: There are 4 manufactures that currently make seasonal influenza vaccine for the US. We are in active discussions with the industy about how to maximize vaccine production.
Toronto, Canada: Does the altitude of Mexico City have anything to do with the increased death rate there?
Steven K. Galson: Investigations are underway in Mexico to try to understand the risk for serious illness related to this infection.
Illinois: Is there any influence of pollution effect and global warming in generating of new type of species and viruses?
Steven K. Galson: I am not aware of any evidence of a link between global warming and generation of new viruses.
Anonymous: Is the World Health Organization still considering raising its pandemic level to its highest alert 6, signifying a swine flu pandemic?
Steven K. Galson: They continue to monitor the situation whether the spread of the epidemic warrants a level 6 designation.
Oakton, Va.: Dr. Galson Could you give us an idea of how much longer it will take for CDC to formally state the level of severity of the current version of swine flu outbreak in the U.S.?
Steven K. Galson: Our information on severity is becoming clearer as the days go by, so stay tuned.
Rockville, Md.: Under what circumstances would the U.S. government act in a similar manner to Mexico: shutting down restaurants, churches, and schools? Do you think the Mexican government over-reacted?
Steven K. Galson: As part of our pandemic plan, we use information on severity and spread to decide on recommendations for public gatherings and facilities.
Arlington, Va.: My children will be attending college in the fall. Are there any recommendations for such children? If a vaccine is available; should they get it?
Steven K. Galson: We have current recommendations for higher education on the CDC web site but it's too early to know what the situation will bring in the fall. Stay tuned.
San Jose, Calif.: Is it of great concern that this particular flu virus is born in Mexico? As I understand it, the seasonal flu generally comes out of the Asian continent, giving us time to prepare a vaccine for it. Can we expect this region to become more active in terms of emerging viruses?
Steven K. Galson: The initial source of the virus has still not been definitively identified. A new virus can arise anywhere in the world.
Washington, D.C.: How long should a school close if there is a suspected case of swine flu at the school?
Steven K. Galson: The current guidelines say UP TO 14 days but we are reevaluating this recommendation based on case reports. Again, stay tuned!
Moberly, Mo.: Is it possible that H1N1 could encounter a strain of H5N1 bird flue somewhere in the Asiatic regions and somehow become a deadlier hybrid cross strain?
Steven K. Galson: It is difficult to predict the behavior of influenza virus. This is why a robust global surveillance system to identify new viruses is so very important. We are actively working with global partners on just such a system.
Thanks very much for all your great questions this morning!
RADM Steven Galson, MD, MPH
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