The microbiology of zombies, part II: ineffective treatments and how not to survive the apocalypse

(Spoilers. And things.)

After the start of season 4 of the Walking Dead and the introduction of a new nemesis: a fast-spreading, deadly infectious disease that seems to be a strain of influenza, I was looking forward to the plot arc of this season.

And then episode 3, “Isolation”, happened. From an infectious disease standpoint, I say, bah.

At the end of the previous episode, “Infected”, the group had decided to lock up anyone who was showing signs of the infectious disease within the death row cellblock, so that they would not further spread the disease, and to put the children and elderly (as the most vulnerable population) in another area to keep them safe from the infection. Quickly it was seen that this wasn’t working well, as people were becoming sick all over and more and more were moving into the isolation cellblock.

So, a council meeting was called of the leaders of the group. One of the decisions which was made, on the advice of Hershel the veterinarian, was to try to scavenge supplies from a college of veterinary medicine approximately 50 miles away from their location at the prison. What supplies?

ANTIBIOTICS.

For the micro people reading, you’ll see why my rage started boiling a bit at this point. Hershel was the one who’d suggested this was an influenza outbreak (and therefore, caused by a virus) in the prior episode. He is familiar with the disease (and there is another physician, Dr. Subramanian, who has been treating the ill and has seen the rapid course of the disease–of course, he is now sick himself). It is true that influenza can be complicated by a secondary bacterial infection: that those sick with the flu could develop pneumonia due to Staphylococcus aureus or other bacteria, and that these bacterial infections would respond to antibiotic treatment. But, when the course of disease is as rapid as it appears to be during this outbreak, it’s more likely that people are dying from primary influenza infections, which are most certainly NOT treatable with antibiotics. There are antiviral drugs that can treat influenza infections if given early in the disease course (such as oseltamivir or zanamivir ), but I think the odds of those being stocked at a veterinary school would be pretty slim.

So, rather than at least try for some kind of medically plausible scenario (is that really too much to ask?), Daryl, Michonne, Tyreese and Bob the medic take off in search of completely ineffective antibiotics,and run into an enormous zombie horde on the way. Hershel, in the interim, leaves the relative safety of the prison (he was ensconced with the children as a “high risk” individual) and wanders out into the woods to pick berries and leaves to brew elderberry tea. A folk remedy, there are a few peer-reviewed publications which suggest that elderberries or elder flower might have some properties that do work to treat influenza, so at least here Hershel is, well, sucking somewhat less here when it comes to proposing medical interventions to help those suffering than he did with his terrible antibiotics idea.

Hershel does end up with his tea, taking it into the isolation cell block and distributing it to the infected. This includes Dr. Subramanian, who repays the favor by coughing bloody sputum all over Hershel’s face. (Seriously, he doesn’t even know how to cough into his elbow? Even the little girl talking to Carol did that correctly).

From the previews of next week’s episode, “Indifference”, it appears there will be more searches for drugs, while presumably the horde advances toward the prison. I anticipate a miracle cure of some kind for Glenn at the least, but remain annoyed that the writers are touting antibiotics for a viral infection when flu season is upon us.

See also:

Part I: the microbiology of zombies

Part III: “We’re all infected”

Part IV: hidden infections

Why are the schools closing and other good H1N1 links…

Over at DailyKos, DemfromCT has an excellent post explaining why it may be beneficial for schools to close temporarily, even if they only have one confirmed case of swine influenza: H1N1: Why Do Schools Close, And When Do They Open?

DarkSyde also has one up on the basic biology and evolution of the flu.

Nick Kristof discusses our lack of attention to public health and what it means in the event of a pandemic in today’s NY Times.

[Updated: and via the comment theads, this post which further discusses what I mentioned here regarding testing–and how the confirmed cases are only the tip of the iceberg (complete with diagram!).

What does the WHO’s pandemic scale mean? And why is anyone worried about this?

I’ve been seeing a lot of comments mocking the current outbreak of H1N1, and a lot of people (and journalists) who don’t understand what “big deal” is about the “snoutbreak” of swine influenza, or don’t get what the raising of the World Health Organization’s pandemic alert phase up to 5 means. I noted here what the alert level meant, but wanted to discuss it a bit more in a full post; after the jump.
Continue reading “What does the WHO’s pandemic scale mean? And why is anyone worried about this?”

Swine influenza–older posts

While there’s interest and some new readers, I figured I’d link some of my older posts on swine influenza and pandemic influenza in general for some additional background information and history. Keep in mind that these are unrelated to the current outbreak.

Pandemic influenza series (a bit dated, but still some good information in there, including an overview of 20th century pandemics).

Asymptomatic swine flu infections in farmers

Swine flu in Ohio fairgoers

Iowan has swine flu

New swine influenza virus detected

Masks and influenza

Masks and influenza part II

Swine flu: 20 US cases now identified [UPDATED–6 Canadian cases also confirmed]

According to new information from the CDC, in addition to the 2 cases in Texas, 7 in California, and 2 in Kansas, the 8 in New York have now been confirmed, and an additional case has also been confirmed in Ohio (I’ve not seen any info on that case)–UPDATED below. Investigations are apparently ongoing in at least 2 Canadian provinces, also (British Columbia and Nova Scotia). An investigation is also ongoing in New Zealand after teenagers took a trip to Mexico and have shown flu-like symptoms.

Concerning to say the least, but crof and revere both have some excellent posts to keep things in perspective. I’ve hated the screaming headlines at many of the MSM sites, and Crawford has a great post encouraging calm. revere, meanwhile, has a nice overview of influenza and world travel, and what we should be focusing on now that it seems the genie is already out of the bottle.

Again, this is a fast-developing story; some of this information will probably be out of date by a few hours after I post this, so stay tuned…

UPDATED: found some information on the Ohio case, from the Toledo Blade:

The Ohio Department of Health says a 9-year-old boy who recently traveled to Mexico on vacation with his family has a confirmed case of swine flu.

Health department spokesman Robert Jennings said Sunday the boy is recovering at his home in Elyria, in northern Ohio’s Lorain County. The child’s name was not released.

Jennings says the Centers for Disease Control confirmed the case, but officials do not know if the child has the same deadly strain of swine flu that has killed up to 81 people in Mexico.

Jennings says the boy displayed typical symptoms of the flu, including a sore throat and body aches. Jennings says the child returned from Mexico within the past two weeks.

Jennings says the boy’s relatives are being tested for the disease, but they currently do not have any symptoms.

Nova Scotia cases have also been confirmed:

Nova Scotia’s chief public health officer says the east coast Canadian province has four confirmed cases of swine flu.

Chief Public Health officer Dr. Robert Strang says Sunday four students from King’s-Edgehill School in Nova Scotia ranging in age from 12 to 17 or 18 are recovering. All of them had what he describes as “very mild” cases of the flu.

2 cases in British Columbia also confirmed:

B.C.’s Centre for Disease Control on Sunday confirmed cases of swine flu involving two people from the province who recently returned from Mexico.

Swine flu: a quick overview–and new New York and Kansas cases

Sorry for the radio silence–I’ve been working on grants and manuscripts like a fiend, and so have tried to limit as many distractions as possible (which, unfortunately, includes blogging). However, the swine flu news is right up my alley, so I do just want to say a few words about it, and point you to some excellent stories already up elsewhere.

First, in case you’ve not been paying attention to the news in the last few days, there have been 8 reported cases of swine influenza infections in humans (6 in California and 2 in Texas, with additional suspected cases) and reports from Mexico suggesting as many as 1000 ill and 68 dead from influenza in the past month or so. Of the Mexican cases, a dozen thus far have been confirmed to be the same strain as the US swine flu strain from California/Texas.

What does all this mean? Much more after the jump.
Continue reading “Swine flu: a quick overview–and new New York and Kansas cases”