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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 38. This is the beginning of the thread.
Posted by Phillipa on April 28, 2009, at 2:42:46
Anyone else confused about this swine flue and meds and what and where it came from is it pigs, flies, birds. Says variant of A to C or something like that any scientists aboard to clear up this mystery? Phillipa
Swine influenza
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This pathology is related to a current event: 2009 swine flu outbreak. Information may change rapidly as the event progresses.
This article may require cleanup to meet Wikipedia's quality standards. Please improve this article if you can. (April 2009)
Flu
Influenza
Virus
Avian influenza
Swine influenza
Flu season
Research
Vaccine
Treatment
Genome project
H5N1 strain
H1N1 strain
Pandemic
Pigs can harbor influenza viruses adapted to humans and others that are adapted to birds, allowing the viruses to exchange genes and create a pandemic strain.Swine influenza virus (referred to as SIV) refers to influenza cases that are caused by Orthomyxoviruses that are endemic to pig populations. SIV strains isolated to date have been classified either as Influenzavirus C or one of the various subtypes of the genus Influenzavirus A.[1]Swine influenza is known to be caused by influenza A subtypes H1N1,[2] H1N2,[2] H3N1,[3] H3N2,[2] and H2N3.[4]
In swine, three influenza A virus subtypes (H1N1, H3N2, and H1N2) are circulating throughout the world. In the United States, the H1N1 subtype was exclusively prevalent among swine populations before 1998; however, since late August 1998, H3N2 subtypes have been isolated from pigs. As of 2004, H3N2 virus isolates in US swine and turkey stocks were triple reassortants, containing genes from human (HA, NA, and PB1), swine (NS, NP, and M), and avian (PB2 and PA) lineages.[5]
Contents [hide]
1 Classification
2 Signs and symptoms
3 Causes
3.1 H5N1
4 Pathophysiology
4.1 Swine flu in humans
5 Prevention
6 Treatment
7 Epidemiology
7.1 Outbreaks in swine
7.1.1 2007 Philippine outbreak
7.2 Outbreaks in humans
7.2.1 1918 Influenza
7.2.2 1976 U.S. outbreak
7.2.3 2009 swine flu outbreak
8 Veterinary vaccines
9 See also
10 References
11 Further reading
12 External links
Classification
SIV strains isolated to date have been classified either as Influenzavirus C or one of the various subtypes of the genus Influenzavirus A.[6]
Signs and symptoms
The CDC have stated that the symptoms of swine flu are similar to those of other strains of human flu, including fever, cough, sore throat, body aches, headache, chills and fatigue. A few patients have reported that they also suffered from diarrhea and vomiting.[7]
CausesH5N1
Avian influenza virus H3N2 is endemic in pigs in China and has been detected in pigs in Vietnam, increasing fears of the emergence of new variant strains.[8] Health experts[who?] say pigs can carry human influenza viruses, which can combine (i.e. exchange homologous genome sub-units by genetic reassortment) with H5N1, passing genes and mutating into a form which can pass easily among humans.[9] H3N2 evolved from H2N2 by antigenic shift.[10] In August 2004, researchers in China found H5N1 in pigs.[11] Measured resistance to the standard antiviral drugs amantadine and rimantadine in H3N2 in humans has increased[12] to 92% in 2005.[13]Chairul Nidom, a virologist at Airlangga University's tropical disease center in Surabaya, East Java, conducted an independent research; he tested the blood of 10 apparently healthy pigs housed near poultry farms in West Java where avian flu had broken out, Nature reported. Five of the pig samples contained the H5N1 virus. The Indonesian government has since found similar results in the same region. Additional tests of 150 pigs outside the area were negative.[14][15]
Pathophysiology
Influenza viruses bind through hemagglutinin onto sialic acid sugars on the surfaces of epithelial cells; typically in the nose, throat and lungs of mammals and intestines of birds (Stage 1 in infection figure).[16]
Swine flu in humans
People who work with poultry and swine, especially people with intense exposures, are at increased risk of zoonotic infection with influenza virus endemic in these animals, and constitute a population of human hosts in which zoonosis and reassortment can co-occur.[17] Transmission of influenza from swine to humans who work with swine was documented in a small surveillance study performed in 2004 at the University of Iowa.[18] This study among others forms the basis of a recommendation that people whose jobs involve handling poultry and swine be the focus of increased public health surveillance.[17] The 2009 swine flu outbreak appears to be a result of co-occurring zoonosis and reassortment.[citation needed]The Centers for Disease Control and Prevention (CDC) reports that the symptoms and transmission of the swine flu from human to human is much like seasonal flu, commonly fever, lethargy, lack of appetite and coughing. Some people with swine flu also have reported runny nose, sore throat, nausea, vomiting and diarrhea.[19] It is believed to be spread between humans through coughing or sneezing of infected people and touching something with the virus on it and then touching their own nose or mouth.[20] The swine flu in humans is most contagious during the first five days of the illness although some people, most commonly children, can remain contagious for up to ten days. Diagnosis can be made by sending a specimen, collected during the first five days, to the CDC for analysis.[21]
The swine flu is susceptible to four drugs licensed in the United States, amantadine, rimantadine, oseltamivir and zanamivir, however, for the 2009 outbreak it is recommended it be treated with oseltamivir and zanamivir.[22] The vaccine for the human seasonal H1N1 flu does not protect against the swine H1N1 flu, even if the virus strains are the same specific variety, as they are antigenically very different.[23]
Prevention
Recommendations to prevent infection by the virus consist of the standard personal precautions against influenza. This includes frequent washing of hands with soap and water or with alcohol-based hand sanitizers, especially after being out in-public. People should avoid touching their mouth, nose or eyes with their hands unless they've washed their hands. If people do cough, they should either cough into a tissue and throw it in the garbage immediately, cough into their elbow, or, if they cough in their hand, they should wash their hands immediately.[24]
Treatment
The Centers for Disease Control and Prevention recommends the use of Tamiflu(oseltamivir phosphate) or Relenza(zanamivir) for the treatment and/or prevention of infection with swine influenza viruses. If you get sick, antiviral drugs can make your illness milder and make you feel better faster. They may also prevent serious flu complications. For treatment, antiviral drugs work best if started soon after getting sick (within 2 days of symptoms). [25]
EpidemiologyOutbreaks in swine
2007 Philippine outbreak
On August 20, 2007 Department of Agriculture officers investigated the outbreak of swine flu in Nueva Ecija and Central Luzon, Philippines. The mortality rate is less than 10% for swine flu, if there are no complications like hog cholera. On July 27, 2007, the Philippine National Meat Inspection Service (NMIS) raised a hog cholera "red alert" warning over Metro Manila and 5 regions of Luzon after the disease spread to backyard pig farms in Bulacan and Pampanga, even if these tested negative for the swine flu virus.[26][27]
Outbreaks in humans1918 Influenza
The "Spanish" influenza pandemic of 19181919 infected one third of the world's population (or ≈500 million persons at that time) and caused ≈50 million deaths.[28] The impact of this pandemic was not limited to 19181919. All influenza A pandemics since that time, and indeed almost all cases of influenza A worldwide (excepting human infections from avian viruses such as H5N1 and H7N7), have been caused by descendants of the 1918 virus, including "drifted" H1N1 viruses and reassorted H2N2 and H3N2 viruses. The latter are composed of key genes from the 1918 virus, updated by subsequently incorporated avian influenza genes that code for novel surface proteins, making the 1918 virus indeed the "mother" of all pandemics.Before and after 1918, most influenza pandemics developed in Asia and spread from there to the rest of the world. Confounding definite assignment of a geographic point of origin, the 1918 pandemic spread more or less simultaneously in 3 distinct waves during an ≈12-month period in 19181919, in Europe, Asia, and North America (the first wave was best described in the United States in March 1918).[29]
1976 U.S. outbreak
On February 5, 1976, an army recruit at Fort Dix said he felt tired and weak. He died the next day and four of his fellow soldiers were later hospitalized. Two weeks after his death, health officials announced that swine flu was the cause of death and that this strain of flu appeared to be closely related to the strain involved in the 1918 flu pandemic. Alarmed public-health officials decided that action must be taken to head off another major pandemic, and they urged President Gerald Ford that every person in the U.S. be vaccinated for the disease. The vaccination program was plagued by delays and public relations problems, but about 24% of the population had been vaccinated by the time the program was canceled.About 500 cases of Guillain-Barré syndrome, resulting in death from severe pulmonary complications for 25 people, were probably caused by an immunopathological reaction to the 1976 vaccine. Other influenza vaccines have not been linked to Guillain-Barré syndrome, though caution is advised for certain individuals, particularly those with a history of GBS.[30][31]
2009 swine flu outbreak
Confirmed cases followed by death
Confirmed cases
Unconfirmed or suspected cases
See also: H1N1 Swine Flu cases tagged on Google MapsMain article: 2009 swine flu outbreak
The new strain of influenza involved in the 2009 swine flu outbreak strain is a reassortment of several strains of influenza A virus subtype H1N1 that are, separately, endemic in humans and in swine. Preliminary genetic characterization found that the hemagglutinin (HA) gene was similar to that of swine flu viruses present in U.S. pigs since 1999, but the neuraminidase (NA) and matrix protein (M) genes resembled versions present in European swine flu isolates. Viruses with this genetic makeup had not previously been found to be circulating in humans or pigs, but there is no formal national surveillance system to determine what viruses are circulating in pigs in the U.S.[12]The origins of this new strain remain unknown. One theory is that Asian and European strains traveled to Mexico in migratory birds or in people, then combined with North American strains in Mexican pig factory farms before jumping over to farm workers.[32] The Mexican health agency acknowledged that the original disease vector of the virus may have been flies multiplying in manure lagoons of pig farms near Perote, Veracruz, owned by Granjas Carroll,[33] a subsidiary of Smithfield Foods.[34]
Veterinary vaccines
Please help improve this article or section by expanding it. Further information might be found on the talk page.Swine influenza has become a greater problem in recent decades as the evolution of the virus has resulted in inconsistent responses to traditional vaccines. Standard commercial swine flu vaccines are effective in controlling the infection when the virus strains match enough to have significant cross-protection, and custom (autogenous) vaccines made from the specific viruses isolated are created and used in the more difficult cases.[35][36]
Present vaccination strategies for SIV control and prevention in swine farms, typically include the use of one of several bivalent SIV vaccines commercially available in the United States. Of the 97 recent H3N2 isolates examined, only 41 isolates had strong serologic cross-reactions with antiserum to three commercial SIV vaccines. Since the protective ability of influenza vaccines depends primarily on the closeness of the match between the vaccine virus and the epidemic virus, the presence of nonreactive H3N2 SIV variants suggests that current commercial vaccines might not effectively protect pigs from infection with a majority of H3N2 viruses.[37][38]
Posted by desolationrower on April 28, 2009, at 2:42:46
In reply to Confused about What Swine Flu Is And Meds To Treat, posted by Phillipa on April 27, 2009, at 13:42:22
read also cytokine storm; at least if you're a young healthy person, thats teh danger
-d/r
Posted by sowhysosad on April 28, 2009, at 2:42:46
In reply to Confused about What Swine Flu Is And Meds To Treat, posted by Phillipa on April 27, 2009, at 13:42:22
Does amantadine work as it's supposed to for Avian Flu?
Posted by Zana on April 28, 2009, at 2:42:46
In reply to Re: Confused about What Swine Flu Is And Meds To Treat, posted by sowhysosad on April 27, 2009, at 14:31:50
DK about amantidine but tamiflu works. NPR had a program on this afternoon. There's probably a pod cast available on their website.
Zana
Posted by Larry Hoover on April 28, 2009, at 2:42:46
In reply to Re: Confused about What Swine Flu Is And Meds To Treat, posted by sowhysosad on April 27, 2009, at 14:31:50
No, it's resistant to amantadine. Susceptible to both Tamiflu and Relenza, though.
Lar
Posted by Larry Hoover on April 28, 2009, at 2:42:46
In reply to Confused about What Swine Flu Is And Meds To Treat, posted by Phillipa on April 27, 2009, at 13:42:22
Don't worry about the details. Influenza infects birds, pigs, and humans. The influenza virus can swap parts of its genetic structure with other influenza virus particles, to create a kind of hybrid. This hybrid started out being a pig influenza, but it has components from human influenza and bird influenza. Whatever, it's the flu.
It's this ability to mutate that necessitates new vaccines every year. The virus is constantly changing, and once in a while, a new version causes nasty symptoms.
Tamiflu and Relenza are effective, and governments around the world have stockpiles of these drugs for just such an occurrence.
Lar
Posted by sowhysosad on April 28, 2009, at 2:42:46
In reply to Re: Confused about What Swine Flu Is And Meds To Treat » sowhysosad, posted by Larry Hoover on April 27, 2009, at 16:49:15
> No, it's resistant to amantadine. Susceptible to both Tamiflu and Relenza, though.
Ouch! Good that there's still a couple of viable options though.
Posted by Phillipa on April 28, 2009, at 2:42:46
In reply to Re: Confused about What Swine Flu Is And Meds To Treat » Phillipa, posted by Larry Hoover on April 27, 2009, at 16:54:02
Lar just got an update on my webmd that the tamiflu doesn't work???? Phillipa also said the young and old not affected how strange is that???
Posted by 10derHeart on April 28, 2009, at 2:42:46
In reply to Re: Confused about What Swine Flu Is And Meds To Treat » Larry Hoover, posted by Phillipa on April 27, 2009, at 20:57:32
Are they contradicting themselves over there?
"The new swine flu virus is sensitive to the antiviral drugs Tamiflu and Relenza. The CDC recommends those drugs to prevent or treat swine flu; the drugs are most effective when taken within 48 hours of the start of flu symptoms. But not everyone needs those drugs; many of the first people in the U.S. with lab-confirmed swine flu recovered without treatment. The Department of Homeland Security has released 25% of its stockpile of Tamiflu and Relenza to states. Health officials have asked people not to hoard Tamiflu or Relenza."
http://www.webmd.com/cold-and-flu/news/20090421/swine-flu-faq?page=2#treated
Remain calm. Wash your hands a few more times than usual. Pay attention to the news. Be extra cautions around folks who may be coughing or sneezing all over the place. Live your life as usual.
Those are some things I hope to do re: swine flu.
Posted by Phillipa on April 28, 2009, at 2:42:46
In reply to WebMD » Phillipa, posted by 10derHeart on April 27, 2009, at 21:11:52
I got an audio update on it but don't think I could copy and paste that. I'm not worried at all. I can try and find it in deleted and post but doubt if it will work. Love Phillipa
Posted by Phillipa on April 28, 2009, at 2:42:47
In reply to Re: WebMD » 10derHeart, posted by Phillipa on April 27, 2009, at 22:15:14
Tried to copy the audio no dice. Another thread but no mention of meds. I don't feel it's to fear. Phillipa ps there are about five articles on the update. Didn't read but will.
From Reuters Health Information
Seven People in U.S. Hit by Strange New Swine Flu
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By Maggie FoxWASHINGTON (Reuters) Apr 24 - Seven people have been diagnosed with a new kind of swine flu in California and Texas, the U.S. Centers for Disease Control and Prevention reported on Thursday.
All seven people have recovered but the virus itself is a never-before-seen mixture of genetic components typical for human, swine and avian influenza viruses, the CDC said.
"We are likely to find more cases," the CDC's Dr. Anne Schuchat told a telephone briefing. "We don't think this is time for major concern around the country."
Only one of the seven cases was sick enough to be hospitalized and all have recovered, Schuchat said.
CDC officials are unsure whether the cases are related to an unusually late and severe flu season in Mexico in which 20 people have died.
"Generally the period of infection ends during the last week of February and the first week of March, but this year there was an atypical situation where the transmission period was prolonged until April," Mexico's Ministry of Health said in a statement.
Canadian officials have asked doctors to keep an eye out for cases of respiratory illness among travelers from Mexico.
"Symptoms from those seriously ill in Mexico include high fever, headache, eye pain, shortness of breath and extreme fatigue with rapid progression of symptoms to severe respiratory distress in about five days," the British Columbia Centre for Disease Control said in a statement.
In the United States, the CDC reported the new strain of swine flu on Tuesday in a boy and a girl from California's two southernmost counties.
Now, five more cases have been found via normal surveillance for seasonal influenza. None of the patients, whose symptoms closely resembled seasonal flu, had any direct contact with pigs.
Two of the new cases were among 16-year-olds at the same school in San Antonio "and there's a father-daughter pair in California," Schuchat said. The boy whose case was reported on Tuesday had flown to Dallas, but the CDC has found no links to the other Texas cases.
The agency will issue daily updates at http://www.cdc.gov/flu/swine/investigation.htm.
HUMAN TO HUMAN
"We believe at this point that human-to-human spread is occurring," Schuchat said. "That's unusual. We don't know yet how widely it is spreading... We are also working with international partners to understand what is occurring in other parts of the world."
The CDC's Dr. Nancy Cox said virus samples from the seven appear to carry genes from swine flu, avian flu and human flu viruses from North America, Europe and Asia.
"We haven't seen this strain before, but we hadn't been looking as intensively as we have," Schuchat said. "It's very possible that this is something new that hasn't been happening before."
The influenza A strain is an H1N1, the same subtype as one of the seasonal flu viruses now circulating. Now that the normal influenza season is waning, it may be easier to spot cases of the new swine flu, Schuchat said.
The CDC is asking doctors to think about the possibility of swine flu when patients appear with flu-like symptoms, to take a sample and send it to state health officials or the CDC for testing.
Cox said the CDC is already preparing a vaccine against the new strain, just in case.
"This is standard operating procedure," he said.
Posted by Phillipa on April 28, 2009, at 2:42:47
In reply to Re: WebMD, posted by Phillipa on April 27, 2009, at 22:23:24
I'm afraid only the topics will be accessible. Phillipa not to worry as Mexico seems to be fairing the worse.
From Medscape Infectious Diseases
Swine Flu Alert Center
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Stay up to date and be prepared with the latest news, clinical perspectives, and reference material for clinicians on the swine influenza outbreak from Medscape and eMedicine.ALSO ON THIS PAGE: News Expert Video Commentary
News
WHO Raises Pandemic Level for Swine Flu, Mexican Death Toll Mounts
Medscape Medical News, April 27, 2009
Swine Flu Cases Rising in US, World
WebMD Health News, April 27, 2009
US Declares Swine Flu Emergency
WebMD Health News, April 26, 2009
3rd Possible Swine Flu Outbreak in Mexico: WHO
Reuters Health Information, April 24, 2009
New, Deadly Swine Flu Hits Mexico, May Spread
Reuters Health Information, April 24, 2009
WHO Concerned at New Swine Flu in U.S., Flu in Mexico
Reuters Health Information, April 24, 2009
Seven People in U.S. Hit by Strange New Swine Flu
Reuters Health Information, April 24, 2009
Swine Flu Detected in 2 Children; Human-to-Human Spread Possible
Medscape Medical News, April 22, 2009
Back to Top Δ
Expert Video Commentary
Swine Flu A Fast-Moving New Flu
Paul G. Auwaerter, MD, MBA, April 27, 2009
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Posted by Larry Hoover on April 28, 2009, at 4:55:47
In reply to Re: Confused about What Swine Flu Is And Meds To Treat » Larry Hoover, posted by Phillipa on April 28, 2009, at 2:42:46
Here's the link from the Centers for Disease Control: http://www.cdc.gov/swineflu/antiviral_swine.htm
Lots of other stuff available in the menu to the left. Consumer information, and technical info.
Lar
Posted by Dinah on April 28, 2009, at 8:04:16
In reply to Re: Confused about What Swine Flu Is And Meds To Treat » Larry Hoover, posted by Phillipa on April 28, 2009, at 2:42:46
Our local medical expert, an infectious diseases doc, was on the news saying that the young seem to be harder hit.
He said it's similar to viruses that have been around since the thirties, and older people might have built up some amounts of immunity to it.
What I wonder is if it's been around that long, why won't the vaccine take care of it?
He said not to panic, to take regular precautions, and to make sure to contact your doctor if you come down with the flu.
He also showed a nasopharyngsomething or another swab, which perhaps worked against his urgings to contact your doctor.
Posted by Phil on April 28, 2009, at 9:54:11
In reply to Re: Confused about What Swine Flu Is And Meds To Treat » Phillipa, posted by Larry Hoover on April 28, 2009, at 4:55:47
There are no cases reported in Austin but I've already seen some people(a few) already wearing masks. They were in a bank and had shotguns.
Posted by 10derHeart on April 28, 2009, at 11:46:18
In reply to Re: Confused about What Swine Flu Is And Meds To Treat, posted by Phil on April 28, 2009, at 9:54:11
Posted by obsidian on April 28, 2009, at 18:59:48
In reply to Lol. Vintage Phil :-) (nm), posted by 10derHeart on April 28, 2009, at 11:46:18
I drove by the school the other day where hundreds of high school students have come down with it. I only noticed because of the TV cameras!
I'm not worried about it though, they said a lot of those kids were already feeling better when they went on TV with the announcements.
funny how everything adapts in order to survive.
Posted by Phillipa on April 28, 2009, at 20:30:44
In reply to it's in my neighborhood...., posted by obsidian on April 28, 2009, at 18:59:48
Lar yes tamiflu is approved and the update I received today says if it gets bad that even unprofessionals volunteers can administer the IM injection I don't think that is tamiflu though. Posted on meds hope redireted to here more continuity. And today two here in Charlotte seriously. And some school in NY had quite a few come down with it. They were then testing those at a nearby public or was it private school? I didn't take it seriously until today. I think the injection is available for those over l year old. Seems to be targeting those above 7 why who knows and adults to age 40? Strange. Phillipa
Posted by obsidian on April 28, 2009, at 20:51:21
In reply to Re: Update Seriously, posted by Phillipa on April 28, 2009, at 20:30:44
there are about 300 people at a catholic high school near me (about 5 miles away) that came down with it (they only confirmed about 45?)- its seems that some had gone down to Mexico on spring break.
I think there are about 2700? total in the high school.then it went down the road to a public school for autistic children where about 80 have called in sick out of 380
I got a lot of this info from yahoo news, it also says they're checking another school in Manhattan.
Does the flu usually spread this fast??
Posted by Dinah on April 28, 2009, at 21:00:46
In reply to Re: Update Seriously » Phillipa, posted by obsidian on April 28, 2009, at 20:51:21
They are saying that the cases in the US are recovering more quickly than they had expected, based on what happened elsewhere. Some have been hospitalized, but most released. Maybe the flu shot is at least working well enough to give the body a head start in producing antibodies?
Flu does spread pretty rapidly. It's astonishing really how it used to move around the world even in the days before jumbo jets and easy travel. But even so, almost everything runs quickly through a school. They're always sending notices home with my son. A few a year, at least. And my mother caught ever single virus that came near her school. Yet oddly, we didn't catch nearly as many as she did, even though we shared a house with her. Schools must be special breeding grounds for viruses. Lots of people spreading them, lots of sneezed on surfaces.
Does it ever occur to anyone but me that it is insane to have magazines in doctor's offices? I thought about it a few years ago, and have been bringing my own reading material since.
Posted by Dinah on April 28, 2009, at 21:03:22
In reply to Re: Update Seriously » obsidian, posted by Dinah on April 28, 2009, at 21:00:46
Oooh. And public buses. I used to ride public transit part of the year. I caught *everything*.
Of course, I have a habit of rubbing my eyes. That's a huge no-no in disease prevention.
Posted by obsidian on April 28, 2009, at 21:09:52
In reply to Re: Update Seriously, posted by Dinah on April 28, 2009, at 21:03:22
and planes!! those flying petri dishes!
they say there is a 1-2 day day incubation period with the flu
the last time I took a plane (to New Orleans) a day or two later...bam! sick with the flu, it's bad enough being sick with the flu at home, in a hotel room it sucks even more
Posted by Dinah on April 28, 2009, at 21:19:21
In reply to Re: Update Seriously » Dinah, posted by obsidian on April 28, 2009, at 21:09:52
I remember that! I think...
Weren't we talking about getting together while you were here?
You're right. When I'm sick, I'd much rather be at home to be miserable.
Stuff spreads like wildfire in cruise ships too. That's one of many reasons this emetophobe has refused to ever take one.
Posted by obsidian on April 28, 2009, at 21:25:50
In reply to Re: Update Seriously » obsidian, posted by Dinah on April 28, 2009, at 21:19:21
yup, I was sick, sick, sick!!
one night I just sat on the cold floor in the bathroom just because it helped me feel better :-(
I remember heading toward the french quarter and thinking..."what is this sneezing about?"
Posted by Phillipa on April 28, 2009, at 21:58:33
In reply to Re: Update Seriously » Dinah, posted by obsidian on April 28, 2009, at 21:25:50
Well from what I've heard on the news today and newsletters the flu vaccine is useless as different strain. The CDC keeps changing things now they want to change the name as it has nothing to do with birds or pigs. There was a blog by nurses I read now some think it's manmade. Like chemical warfare. Others say that we the people and health care workers should be notified much sooner. Maybe we will all become addicted to the internet and be quaranteened at home. Sigi where are you. Humor please. Phillipa bearer of great news But wash your hands, stay out of crowds, a lot are cancelling travel plans. That's horrible about the schools and NY of all places.
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