User:Medanth/CulturalFactorsH1N1

New article name is Cultural Factors that may Increase or Inhibit the Spread of the H1N1 Flu Virus.

Origin and Evolution of H1N1 Virus in 2009

While the loss of life as a result of military actions in World War I was immense, estimated from 9.5 to 16 million, more people around the globe lost their lives as a result of an influenza pandemic of 1918-1919. In the United States alone, 675,000 people are estimated to have been killed by influenza, while 28% of the population had been infected. This Avian influenza was called Spanish Flu, although the first known case was not in Spain, but in Canton.

At its most virulent the disease infected and killed its victims swiftly. The nature of the disease can be reflected in many oral and written stories of the time, in which a person would be infected en route to work and die later the same day, for example.

Unlike other strains of influenza, including the 2009 H1N1 strain, whose largest victim age groups are the elderly and infants or small children, this flu claimed the lives of adults aged 20 to 40 years. This may be partly explained by the Great War, whose soldiers both lived in close contact with each other, and were also deployed through various parts of Europe, allowing for faster spread of the disease. In addition, global patterns of infection seemed to have followed trade routes.

Another strain, which did conform to the general patterns of infection and death in youths and the elderly, emerged in the late 1970s and was called “Russian Flu.” Unlike the Spanish Flu, whose name may be misleading, this strain did emerge from Russia, but also China.

While the origin of the current influenza strain is debated, the first confirmed case of infection was in the town of La Gloria, in Mexico. “Patient Zero” Edgar Hernandez, a five-year-old child, was taken to a clinic by his mother despite assurances that her son’s illness was simply a cold. After an official investigation by state health workers, nearly half of the residents were discovered to be experiencing similar symptoms, however of 35 total mucus tests only Edgar’s had returned positive.

It is not surprising to some scientists that the first known case emerged from Mexico. A recent study using computer modeling identified Mexico as a potential area of origin for disease. Other potential areas were China and other parts of Southeast Asia, as well as both Europe and the United States.

However debate still rages as to the ultimate cause of this strain of influenza. While some point the finger at large-scale farming, others claim the virus was kept secret by the Russian or Chinese governments, then accidentally leaked, and other still simply say the cause is perhaps evolution, or an increasingly smaller world.

Factory Farming

Although the WHO, in an effort to distance the disease from the animal, has advocated the disuse of the name “swine flu” in favor of “H1N1,” many people still associate the flu with the common farm animal. While pork producers strive to persuade the public of the safety of consuming pork, others affirm that people’s fear of the animal may not be completely unwarranted. While debates to indeed continue, the Center for Disease Control has concluded that the virus did originate in a pig, not in some far-flung Third-World country, as some would suspect, but in the United States. In this scenario, the disease emerged in North Carolina in 1998.

What is it about American farms that would have caused this? The Humane Society points to extreme overcrowding of the pigs. In North Carolina, for example, in 1998, while the pig population increased from 2 million to 10 million, the number of farms simultaneously decreased. This led to the overcrowding which may have aided the spread and emergence of the virus. More pigs in close contact would increase the rate of infection, which is a wind borne infection spread by contact with respiratory droplets.

Some farmers and producers, in an effort to combat negative perceptions of their products, refute the claim that industrial farming caused H1N1. Devon Schott, a farmer in Iowa, says that although the pigs may appear unsanitary, covered in mud or feces, they are healthy, moreso than pigs outside of pathogen-cleared farms. This is because the pigs he raises are never exposed to many of the sicknesses and infections in the wild. He takes efforts to maintain viral safety inside his complex. All workers entering must have showers. Specific clothing is worn only inside the building, and remains inside the building. He also purchases all of his pigs from the same source. In further defense of pork veterinarian Liz Wagstrom, speaking on behalf of the National Pork Board, says the claim that H1N1 originated from pig farms is not only false, but a scare tactic used to vilify the pork industry.

Still, the debate rages, and, for the first time, came to court. In Texas in the spring of 2009, charges were brought against a large pork producer based in Virginia, Smithfield Foods, by the husband of a woman who died as a result of H1N1. Judy Dominguez Trunnell, a healthy 33-year-old pregnant woman, died of H1N1 on the fourth of May. Her daughter was delivered via caesarean section. She was the first casualty in the United States. Her husband filled a petition, claiming that the company was responsible for her death because of their own neglectful behavior, which led to conditions in their farms ripe for development of the virus.

Travel

Travel is a major factor involved in the spread and transmission of diseases and illness. There are an average of 3,000,000 airline passengers traveling via plane each day. Travel by air is such an important factor in disease and illness that a group of researchers actually acurately predicted how the h1n1 virus would spread around the world. St. Michael's Hospital scientist and infectious disease physician Dr. Kamran Khan and colleagues analyzed the flight itineraries of the more than 2.3 million passengers departing Mexico on commercial flights during the months of March and April to predict the spread of H1N1. The findings show the international destinations of air travelers leaving Mexico were strongly associated with confirmed importations of the H1N1 virus around the world. Another factor is the fact that many people use multiple flights instead of direct flights to reach destinations providing many more opportunities to transmit and spread disease. Sixty percent of all passengers traveling to Canada from developing areas of the world use multiple flights to reach their destination. About half of these passengers – or 1.4 million people every year – make flight connections into Canada through just nine cities: London (UK), Hong Kong, Tokyo, Frankfurt, Paris, Miami, Amsterdam, New York City and Chicago. Every single citiy visited or traveled through is a potential point of transmission for the h1n1 virus.

H1N1 and the Media

The swine flu epidemic, now referred to as H1N1, grabbed media attention in late April of 2009. The frequency at which H1N1 was discussed throughout the world wide web increased from 0% to over 5% of total "buzz volume" in English language blog discussion during just the last week of April through the first of May. The Wikipedia "Swine Flu" page was updated hundreds of times that week, 100+ Facebook groups popped up the month of May, and Twitter was experiencing 10,000+ tweets per hour. On December 2, 2009, a simple Facebook search of the terms H1N1 or Swine Flu and alternative misspellings (i.e. swine flue) results in over 12,000 groups and approximately 1,200 pages to follow. This increasing trend of disseminating important health and epidemic information via social networking cites and blogs is a cause for concern, however. These cites serve as a medium through which misinformed and/or panicking people may broadcast and likely perpetuate their fears. Many of the most loaded statements that have been shared by those active on social networking cites have equated H1N1 to Mexico, pork consumption, danger, the 1918 Spanish Influenza epidemic, and death, ultimately contributing the creation of fear surrounding Novel H1N1 virus.

In response to the surge of information about the disease, the CDC made itself available to the public via these social networking sites and others, stating the need for a "voice of reason" in the midst of an abundance of unsubstantiated or untrustworthy information. The CDC is spreading its information by making available ads for people to place on websites, e-cards, Twitter updates, email alerts and updates, Youtube videos, Podcasts, RSS Feeds, Facebook, Myspace, and many more, according to their website.[26]

Some organizations argue that the response to the H1N1 epidemic underscores the power of the media and corporations. These players constantly subjected the American public to coverage of the disease, yet offered little information about the true epidemiology of the disease, i.e. the underlying public, social, and personal issues that largely influence the potential human toll a disease may take. The result is a sensationalized lack of useful information, which has been thought to be detrimental to adequate national response to H1N1. For example, on April 30, 2009, the World Health Organization's (WHO) director-general Margaret Chan cited, upon H1N1's designation as a full pandemic (a level 6 on a scale of 6), that "all of humanity is under threat during a pandemic." At the time, the WHO's official count was 787 instances of swine flu, 506 occurring in Mexico. At the same time, Mexico reduced the number of deaths linked to swine flu from 176 to 100, with 19 deaths being confirmed. Another example cited is that the news often sensationalized news coverage by linking the current influenza outbreak to the Spanish Influenza outbreak of 1918, in which a third of the world's population became infected and arguably 50-100 million died. [27] The coverage, however, most often failed to point out that the victims of 1918 lacked medical technologies and infrastructures that combat widespread infectious diseases, like anti-viral drugs, DNA-analysis, disease tracking methods, and modern sanitation. In addition to these issues, news coverage also fails to mention the role the circumstances of poverty have in the course of H1N1. On May 3, 2009, on NBC's "Meet the Press," officials did not mention poverty and lack of access to medical care as potential reasons to why Mexico was experiencing a higher mortality rate than the United States.

Fear-Mongering and H1N1

A fear-monger is defined in the Merriam-Webster dictionary as one inclined to raise or excite alarms especially needlessly[28]. Politically speaking, governments have been blamed for using fear-mongering to provoke fear amongst the general public in order to accomplish their own goals. The general public has placed great importance on the advice and opinions of experts, yielding them immense power in producing the culture of fear. The authority of science and the power of the expertise of health professionals is unique, however, in that their power rests on influencing "ordinary peoples'" perceptions of their health and capitalizing on the existential fears of disease and death.

There are many negative implications of eliciting such fear regarding H1N1. Fear-mongering has generated not only fear about the possible number of those getting ill and those dying, but also about the treatment and prevention measures the field of public health have promoted since the outbreak of the disease. President Barack Obama declared the H1N1 pandemic a national emergency on October 24, 2009. Beginning late that same month, a vaccine to prevent against H1N1 was released to the public on a group by group basis, targeting the most susceptible groups first. The actions of the WHO in recommending vaccines for the H1N1 outbreak and the declaration of H1N1 as a national emergency has increased the fear of contracting H1N1.

Meanwhile, fear of getting the H1N1 vaccine is also being generated. In the popular media, figures including Glenn Beck and Rush Limbaugh have been accused of perpetuating public fear in getting inoculated. Beck has been quoted suggesting that the vaccine could be deadly, that the public should do the opposite of what the administration advises, and that it is possible that the vaccine could cause neurological damage like vaccines in the 1970's did. Limbaugh has been quoted saying you'll be healthier if you don't listen to the government and that he would not take the vaccine precisely because the government is saying he should.

Population Density

World population is increasing at an exponential rate. With the current population at 6.8 billion international borders are becoming increasingly transparent. This population growth also increases the rates of urbanization. Within an urban setting, people are more likely to engage in interpersonal contact which in effect puts these people at a higher risk of infection. It is estimated by the year 2030 that 65% of the global populace will reside in an urban setting. Correlative with the rise in urbanization is an increase in the number of epidemics and pandemics. Living within an urban community also has been shown to increase stress levels which can in turn have negative effects on physical health. Also within the urban setting, higher levels of pollution may weaken the immune systems of residents. Urbanization has been steadily increasing throughout time. In 1994 alone, 30 million people chose to leave their villages in order to pursue a life in the city. This current cultural trend of urbanization will increase the number of pandemics and epidemics. When great numbers of people are living in close proximity to each other, contagious diseases are able to be be spread more easily and faster.

Increased Use of Long-Term Care Facilities

Daycare

The typical American family would be the nuclear model. In most other countries, this is the exact opposite reality. The extended family is the dominant type of family. The citizens in United States think in an individualistic way rather than a collective. In this respect, the elderly are expected to deal with their own problems, and if they can not the family has the option to have them put in long-term care--a nursing home. The elderly's immune systems, due to normal biological functions, start to weaken as age sets in and as other processes slow down. This makes this age group at risk for viral and bacterial infection, and due to the mass grouping of the elderly in group homes, infection possibilities increase. The nursing homes provide much interpersonal contact to people that are already at risk for H1N1 and other viruses. If current trends continue, it is estimated that 43% of Americans will need to stay in a long-term care facility. Also related are the younger generations. Similarly due to biological factors, youth under about three years of age are also at risk because of their developing immune systems. The fact that more women have entered the work force since the women's rights movement has increased the need for daycare or preschool facilities. 3/4 of U.S. children need some form of care whether it be daycare or preschool. This fraction adds up to about 13 million preschoolers and about 6 million babies. These children are also in very close contact with each other, and they are learning the rules of socialization which is putting them in circumstances of great amounts of personal interaction. One issue within the daycare system that increases the health risks for the children is the fact that 39 states in the U.S. do not require daycare workers to go through training. The act of daycare licensing would reduce risks of infection due to the hygiene training that would be enforced. Another factor that puts children at risk for infection is that they have not totally mastered the actions of cleanliness and sanitation. One sick child could spread H1N1 or any other virus in a very short amount of time to a great number of other children and adults due to lack of hand-washing/covering mouth or nose when sneezing or coughing.

Immunosuppression

One factor that can increase the instance of H1N1 morbidity is Immunosuppression. Immunosuppression is the state of having an immune system that is weakened. Some immunosuppressed people are in this state due to organ transplantation medications that weaken the body’s immune system in order to decrease the risks of rejection, AIDS, an autoimmune disease, or if they are undergoing chemotherapy. People that are immunosuppressed are often looked at as prime recipients of vaccines, but complications can arise. People that have had lung transplants are typically the most at risk when it comes to immunosuppression due to organ transplantation when it comes to the H1N1 virus due to the risk of contracting pneumonia and other lung ailments. Kidney recipients also have a higher instance of rejection when it comes to receiving vaccines. Also the use of the live attenuated intranasal monovalent H1N1 influenza vaccine(LAIV) is not recommended to be given to people who are immunosuppressed, pregnant women, and people with underlying conditions. It is also recommended to be administered to healthy individuals between the ages of 2 and 49. Some individuals within the immunosuppressed group could be in this condition due to cultural factors. Many lifestyle factors in the United States contribute to bad health even a weakened immune response. Smoking tobacco has been shown to increase further lung complications while subjected to the H1N1 virus. Smoking can increase the possibility of contracting H1N1, and it may also increase the chances of mortality.

Hygiene

The h1n1 virus has had various socio-cultural effects since it's arrival on the global germ scene. One of which would be the heightening of our awareness of diseases, and emphasis on hygiene. American culture is on that is known for it's emphasis on hygiene, and the h1n1 scare has certainly elevated our hygenic practices. The H1N1 virus has created a social hygiene culture aimed at eliminating or minimizing the spread of the flu virus. People are changing habits and being more cautious about germs than they were before the 2009 H1N1 virus. The evidence for this newly empasized culture of hygiene is everywhere. Grocery stores have disinfecting wipes for shopping carts. Hand sanitizer stations are in office buildings, college campus buildings, schools and stores. Sales for hand sanitizer have skyrocketed. Some health officials recommend bumping elbows, waving or smiling at people instead of a handshake. Even places where human contact is normally expected and accepted are starting to cut back on such practices. For example The Simeon Baptist Church in Antioch is offering prepackaged communion to parishioners since September to cut down on the spread of viruses. Worshippers have to break a seal to get to their individually packaged wafer and juice, said Rev. John Rollins, minister of education at the church. The CDC has also responded to the h1n1 scare. The CDC website has a whole section dedicated to the h1n1 virus. The site provides suggestions for avoiding the virus including, washing hands several times throughout the day, avoiding touching the eyes, nose or mouth,, and spraying and wiping down doorknobs, handles, keyboards, or anything else that endures regular use by one or many individuals, with a disinfectant daily. Even President Barrack Obama has admitted that "[the h1n1 virus] is obviously a cause for concern and requires a heightened state of alert..."

Illness Experience

The experiences of the 2009 H1N1 pandemic are highly variable between the groups of people that constitute affected areas. In the United States, the virus has caused the highest suffering and deaths among those with pre-existing deaths, evident in controlled administration of the H1N1 vaccine to at-risk groups who received the vaccine prior to the general public. Approximately 70% of those hospitalized with this year's strain of H1N1 have had at least one of the pre-existing chronic health issues that are recognized as placing individuals at higher risk. Those conditions include pregnancy, diabetes, heart disease, asthma, and kidney disease

The 2009 H1N1 virus spreads like other flu viruses- person to person through the coughing and sneezing of those with the virus. It can also be contracted by touching a surface with the virus, then touching one's mouth or nose. According to the CDC, the virus has been mild to severe in nature. Symptoms include fever, cough, runny or stuffy nose, fatigue, chills, headache, and sometimes nausea, vomiting, and diarrhea. The site states that most H1N1 cases have been mild and most people infected have recovered without medical attention. This is corroborated by the recent H1N1 death and illness statistics:

Current numbers reported by CNN Health indicate that in the US, as of November 12, 2009 there have been 3900 deaths, 98,000 hospitalizations, and 22 million infected. Among children, there have been 8 million infected, 36,000 deaths, and 540 deaths. Among adults ages 18-64, 12 million have been ill, 53,000 hospitalized, and 2900 deaths. In the 65 and older age group, 2 million have been ill, 9,000 have been hospitalized, and 440 have died On a global scale, WHO has reported that as of late November 2009, 207 countries and overseas territories have confirmed cases of the Novel H1N1 virus. The global death count has reached 8768. They also report that it has peaked and is declining in North America, and has or is peaking in western and northern Europe. Disease activity has yet to peak in Central Europe and most of Asia.

Cultural Consequences of the H1N1 Pandemic

Migrant workers, Latinos in particular, are more likely to have low-incomes, lack health insurance, and face intense job pressure, placing them in a demographic facing extreme risk from H1N1. Prevalent in southern California, migrant workers have come to clinics only once their flu symptoms are severe, specifically because of their lack of resources and because they receive no sick time and will lose days worth of pay, all while possibly losing their job. In addition, most Latinos and migrant workers working for a low income live in high-density quarters, increasing the likelihood of spreading infection, and have a limited access to health care, so getting treated for the flu and obtaining the H1N1 vaccine is especially difficult.

In the UK, Chief Medical Officer Sir Liam Donaldson has ordered children not to bully or shun classmates who have contracted the virus. This came in response to cases of bullying, especially through the use of texts, phone, and social networking cites.

Around the world, displays of affection and greetings have been altered temporarily to stem the spread of the disease. Hugging, kissing, hand shaking, and now, "fist pumps" have been avoided as a means of social distancing. In Lebanon, the traditional practice of kissing someone three times to greet them has been discouraged, even though H1N1 has not appeared in the country.

Racism and H1N1

Upon the first outbreak of H1N1, racism against immigrants and Mexicans has gathered steam. It is not rare for an infectious disease to unleash previous prejudices against "the other." Dr. Howard Markel wrote about about this phenomenon in his book “When Germs Travel: Six Major Epidemics That Have Invaded America Since 1900 and the Fears They Have Unleashed.” Upon the emergence of the disease in America, statements have been issued by talk radio hosts, websites, and the like, blaming illegal immigrants and Mexicans for spreading the contagious disease. Syndicated columnist Michelle Malkin has openly stated that the spread of H1N1 to the United States from Mexico is the result of "uncontrolled borders." Furthermore, conservative channel FOX news has eluded numerous times to the spread of the disease from Mexico to the US as a "border crisis" and a reason to be more concerned about border control. Countless others, including radio talk show hosts Michael Savage, Jay Severin, and Alex Jones, are accused of using H1N1 to promote their own agendas, generating racism, fear, and hatred toward Mexicans, Hispanics, and immigrants. Michael Savage called to question the hygeine of Mexican workers and has also wondered aloud the possibility of H1N1 as a bio-terroristic act against the US. The spread of thoughts like these are taking an unjust toll on Mexican-Americans, who are experiencing a new wave of prejudice: coworkers are wary, Mexican business owners are seeing declines in sales, and the stigmatized that are suffering from the flu feel discouraged from seeking medical help.

References

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2. http://en.wikipedia.org/wiki/World_population

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6. Before the H1N1 Pandemic: A Brief History of H1N1, Testcountry.org, http://www.testcountry.org/before-the-h1n1-pandemic-a-brief-history-of-h1n1.htm

7. Dr. W. David Parsons, The Spanish Lady and the Newfoundland Regiment, WWI: The Medical Front, Updated May 2006, http://www.vlib.us/medical/parsons.htm

8. The Influenza Pandemic of 1918

9. Before the H1N1 Pandemic

10. Vincent Racaniello, Origin of Current Influenza H1N1 Virus, Virology Blog, March 2009, http://www.virology.ws/2009/03/02/origin-of-current-influenza-h1n1-virus/

11. Elizabeth Landau, Swine Flu Origins Mysterious in ‘Genetic Arms Race,’ CNN.com, May 6, 2009, http://www.cnn.com/2009/HEALTH/05/06/swine.flu.origins/

12. Olga R. Rodriguez, La Gloria: Swine Flu’s Ground Zero?, The Huffington Post, April 28, 2009, http://www.huffingtonpost.com/2009/04/28/la-gloria-swine-flus-grou_n_192145.html

13. Swine Flu Origins Mysterious in ‘Genetic Arms Race’

14. Micheal Gregor, M.D., CDC Confirms Ties to Virus First Discovered in U.S. Pig Factories, August 26, 2009, The Humane Society of the United States, http://www.humanesociety.org/news/news/2009/04/swine_flu_virus_origin_1998_042909.html,

15. David Brown, Back Where Virus Started, New Scrutiny of Pig Farming, The Washington Post, October 25, 2009, http://www.washingtonpost.com/wp-dyn/content/article/2009/10/24/AR2009102402280.html

16. Leora Broydo Vestel, Debate: Modern Pork Production and H1N1, New York Times, November 9, 2009, http://greeninc.blogs.nytimes.com/2009/11/09/debate-modern-pork-production-and-h1n1/

17. Bryan Walsh, H1N1 Virus: The First Legal Action Targets a Pig Farm, Time.com, May 15, 2009, http://www.time.com/time/health/article/0,8599,1898977,00.html

18. http://www.chacha.com

19. http://www.sciencedaily.com/releases/2009/06/090629200838.htm

20. http://www.sciencedaily.com/releases/2009/06/090629200838.htm

21. Davies, Melissa. (2009.) Swine Flu as Social Media Epidemic. [29]

22. Morozov, Evgeny. (2009.) Swine Flu: Twitter's Power to Misinform. [30]

23. Lantier, Alex. (2009.) Media Sensationalism, corporate power and the swine flu outbreak. [31]

24. [32]

25. Furedi, Frank. (2009.) What swine flu reveals about the culture of fear. [33]

26. http://www.washingtonpost.com/wp-dyn/content/article/2009/10/24/AR2009102401061.html

27. Pleat, Zachary. (2009.) Beck, Limbaugh formenting fear about H1N1 vaccine. [34]

28.http://www.nhs.uk/news/2009/07July/Pages/Swinefluandimmunosuppression.aspx

29. http://www.health.state.ny.us/diseases/communicable/influenza/h1n1/health_care_providers/guidance/2009-09-30_health_advisory_use_of_laiv.htm

30. http://www.ncbi.nlm.nih.gov/pubmed/7121513

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