The Progressive Review


The WHO has confirmed 16,226 deaths attributable to the H1N1 pandemic virus 2/10

Reuters - As many as 80 million Americans have been infected with H1N1 swine flu, up to 16,000 have been killed and more than 360,000 hospitalized, the U.S. Centers for Disease Control and Prevention 1/10

An August report by the President's Council of Advisors on Science and Technology proposed a "plausible" death toll that could fall anywhere between 30,000 and 90,000. - USA Today

Boston Globe - If someone in your home has swine flu, your odds of catching it are about 1 in 8, although children are twice as susceptible as adults. The study was done by outbreak specialists from Imperial College London and from the US Centers for Disease Control and Prevention. Results are in today's New England Journal of Medicine.

Latest WHO figures indicate swine flu has killed at least 12,799 people whose cases were laboratory confirmed, but the real toll will take several years to establish. - Irish Times . . . Note that CDC previously listed about 10,000 dead in U.S. alone

Scientific Blogging - At this point, the CDC says there has been no seasonal flu - almost all flu cases have been H1N1.

CDC estimates that between 34 million and 67 million cases of 2009 H1N1 occurred between April and November 14.

CDC estimates that between about 154,000 and 303,000 2009 H1N1-related hospitalizations occurred between April and November 14.

CDC estimates that between about 7,070 and 13,930 2009 H1N1-related deaths occurred between April and November 14, 2009. The mid-level in this range is about 9,820 2009 H1N1-related deaths.

The CDC offers some comparisons with seasonal flu:

- Seasonal flu causes an average of 200,000 hospitalizations per year, with 60% of those occurring in those 65 and older. With H1N1, only about 10% of the hospitalizations have been for patients over 65.

- Seasonal flu causes about 36,000 deaths per year on average, with 90% of those occurring in people over 65.

The upside of H1N1 primarily affecting those under 65 is that there are fewer deaths compared with seasonal flu: taking the H1N1 mid-level estimates, there have been 10,000 deaths for 213,000 hospitalizations, compared with an average of 36,000 deaths and 200,000 hospitalizations for seasonal flu.

July: British health projection of flu deaths: 65,000

Nov: British health projection of flu deaths: 1,000

New data reveal that there were 26 deaths out of every 100,000 cases of swine flu in England (a fatality rate of 0.026%). The authors conclude that "the first influenza pandemic of the 21 st century is considerably less lethal than was feared in advance.". . . The researchers say their fatality rate estimate compares well with the other three 20 th century influenza pandemics - the rate for the 1918 Spanish flu was 2-3% and subsequent pandemics (1957-8 and 1967-8) had rates of around 0.2%. -British Medical Journal





















This May 29, 1919 photograph shows rows of tents that had been set up on a lawn at Emery Hill in Lawrence, Mass., where victims of the 1918 influenza pandemic were treated. (CDC/ProPublica)




NPR - Fewer than half of Americans say that they are planning to receive the new H1N1 swine flu vaccine, according to recent polls - a trend that is leaving many health professionals at a loss.

"I'm genuinely baffled," says Arthur Kellermann, an emergency medicine physician at the Emory University School of Medicine who has treated swine flu cases. "The public has developed this odd sense of complacency. The only thing that comes to my mind is photos of people standing on the seawall of Galveston hours before the hurricane hit."

The public's skepticism over the vaccine has persisted despite health experts' warning that the unpredictable H1N1 virus, which can cause very severe complications even in healthy young adults and children, has reached pandemic proportions.

The Centers for Disease Control and Prevention says an unusually high number of children have died since it first arose last spring. "There are now a total of 86 children under 18 who have died from the 2009 H1N1 influenza virus," the CDC's Dr. Anne Schuchat told reporters in a briefing Friday. Eleven of those deaths were reported in the past week, the CDC says.

Public health officials and the medical community are scrambling to figure out how to convince more Americans to get vaccinated when supplies of the vaccine become more widely available, but it won't be easy.

For one thing, there are many different reasons why people say they are unlikely to get vaccinated. Nearly a third are worried about side effects, according to a Harvard School of Public Health survey in September. Twenty-eight percent said they don't believe they are at risk for a serious case of the flu, while another quarter say they can get medication to treat the flu if they do get sick.

That last statistic is the one that really worries Kellermann, who is also an associate dean for health policy at Emory's medical school. He says that even a mild flu outbreak could overwhelm the nation's emergency rooms, which already have a limited supply of the high-tech equipment that is needed to fight the most virulent cases of the H1N1 virus.

"This flu, seemingly by random, occasionally picks out the healthy child or young adult and puts them in the intensive care unit, hanging on by a thread," he says. "We don't have thousands and thousands of ICU beds and high-frequency jet ventilators standing by to care for those people."

For now, government officials are trying to walk a fine line with their message: They're touting the safety of the vaccine and warning about the risks of swine flu, but stopping well short of creating a panic.

"They really can lose public credibility for decades if what they do is threaten that thousands are going to die and be hospitalized, and it doesn't occur," says Robert Blendon, a professor of health policy and political analysis at the Harvard University School of Health. "They feel confident there's going to an outbreak, but they don't know how many severe cases there will be.". . .

It is still very early in the fall flu season. As skeptics see more and more people getting vaccinated, experts expect others to change their minds. Reports of swine flu deaths, particularly in people's own communities and schools, could end up being the most powerful motivator.

But this year, officials are also fighting some high-profile counterweights to their message. First, an unusual set of high-profile personalities - including conservative media commentators like Rush Limbaugh and Glenn Beck, and more liberal ones like Bill Maher - is publicly opposing the vaccination effort.

Their opposition appears to be part of the larger anti-government movement that has been vocal during the debate over the Obama administration's efforts to overhaul the nation's health care system. Beck told his viewers on Fox News that he would do "the exact opposite" of whatever the government recommends. Maher echoed that on his HBO talk show, saying, "I don't trust the government, especially with my health."

It's not yet clear how persuasive their opinions will be. "There's no question that the anti-government feeling and fears are playing a role," says Blendon. "We just don't know the magnitude of the impact."

Public opinion surveys show that doctors and nurses are seen as the most credible sources of information on these kinds of medical decisions, but there has also been a flurry of media reports about some health professionals resisting mandatory vaccination campaigns at certain hospitals.

Washington Post, Sep 9 - With the H1N1 pandemic spreading rapidly, hundreds of thousands of doctors, nurses, orderlies and other U.S. health-care workers for the first time are being required to get flu shots, drawing praise from many public-health authorities but condemnation from some employees, unions and other critics who object to mandatory vaccination.

One of the nation's most populous states, the country's largest hospital chain and the Washington area's biggest private health-care system are among those ordering influenza inoculation for health-care employees this year, along with a growing list of medical centers and clinics coast to coast.

The trend is being fueled by frustration at the stubbornly low proportion of health-care workers who get vaccinated each year despite years of coaxing, urging and incentives to do so voluntarily, combined with trepidation that the swine flu pandemic could overwhelm the health-care system, especially if many caregivers get sick, too.

Critics, however, say the decision to get vaccinated should remain individual, especially for the swine flu vaccine, which was rushed into production to try to blunt the pandemic's second wave. . . A survey of 1,500 British nurses conducted in August by the Nursing Times found that one-third would not get the vaccine because of safety concerns. . .

Only about half of health-care workers get flu shots during a typical flu season, even though their patients tend to be more vulnerable to infection and potentially life-threatening complications. Concern is spiking this year because of the new swine flu virus, known as H1N1.

New York this year became the first state to require all health-care workers with direct patient contact at hospitals, health centers, hospices and private homes to get flu shots -- both the seasonal flu vaccine, which is already available, and the swine flu vaccine, which will start to arrive next month. . .

MedStar, the state of New York, HCA and other entities requiring vaccination are allowing exemptions for employees who have medical reasons for not getting vaccinated, such as egg allergies or risk factors for a rare complication known as Guilliame-Barre syndrome. MedStar and HCA and others also allow workers with religious objections to be exempted.

In New York, however, where the policy affects about 522,000 employees, no religious exemptions are allowed. Workers who refuse would be assigned to duties that do not involve patient contact, and they could face further disciplinary action. . .

HCA employees who do not get vaccinated will have to wear surgical masks during the flu season or be dismissed. MedStar workers who refuse would face disciplinary action, including possibly being fired. . .

"As a general rule, medicine should be a voluntary occupation," said George Annas, a Boston University bioethicist. "Once you start requiring doctors to get it, doctors are going to think it's reasonable to make patients get it. It starts you down that mandatory route, and I don't think we want to go there."

Some unions also object, saying mandatory vaccination diverts attention from other more effective infection-control methods, such as providing workers with state-of-the-art, well-fitting masks.

LA Times - In a poll of 1,678 U.S. parents conducted by the University of Michigan's C.S. Mott Children's Hospital, 40% said they would get their children immunized against the H1N1 virus -- even as 54% indicated they would get their kids vaccinated against regular seasonal flu.

Among those who said they do not intend to have their kids vaccinated against H1N1, almost half -- 46% -- indicated they're not worried about their children becoming ill with the pandemic virus. Twenty percent said they do not believe the H1N1 flu is a serious disease. . .

More than half of Latino parents said they would bring their kids to get vaccinated against H1N1. Among white parents, 38% said they would do so. African American parents were the least inclined to vaccinate: 30% said they planned to do so.

About half of the parents who said they'd pass on the H1N1 flu shot for their kids expressed concern about possible side effects of the vaccine.


Shannon Brownlee and Jeanne Lenzer, Atlantic - What if flu vaccines do not protect people from dying-particularly the elderly, who account for 90 percent of deaths from seasonal flu? And what if the expensive antiviral drugs that the government has stockpiled over the past few years also have little, if any, power to reduce the number of people who die or are hospitalized? The U.S. government-with the support of leaders in the public-health and medical communities-has put its faith in the power of vaccines and antiviral drugs to limit the spread and lethality of swine flu. Other plans to contain the pandemic seem anemic by comparison. Yet some top flu researchers are deeply skeptical of both flu vaccines and antivirals. Like the engineers who warned for years about the levees of New Orleans, these experts caution that our defenses may be flawed, and quite possibly useless against a truly lethal flu. And that unless we are willing to ask fundamental questions about the science behind flu vaccines and antiviral drugs, we could find ourselves, in a bad epidemic, as helpless as the citizens of New Orleans during Hurricane Katrina. . .

While vaccines for, say, whooping cough and polio clearly and dramatically reduced death rates from those diseases, the impact of flu vaccine has been harder to determine. Flu comes and goes with the seasons, and often it does not kill people directly, but rather contributes to death by making the body more susceptible to secondary infections like pneumonia or bronchitis. For this reason, researchers studying the impact of flu vaccination typically look at deaths from all causes during flu season, and compare the vaccinated and unvaccinated populations.

Such comparisons have shown a dramatic difference in mortality between these two groups: study after study has found that people who get a flu shot in the fall are about half as likely to die that winter-from any cause-as people who do not. Get your flu shot each year, the literature suggests, and you will dramatically reduce your chance of dying during flu season.

Yet in the view of several vaccine skeptics, this claim is suspicious on its face. Influenza causes only a small minority of all deaths in the U.S., even among senior citizens, and even after adding in the deaths to which flu might have contributed indirectly. When researchers from the National Institute of Allergy and Infectious Diseases included all deaths from illnesses that flu aggravates, like lung disease or chronic heart failure, they found that flu accounts for, at most, 10 percent of winter deaths among the elderly. So how could flu vaccine possibly reduce total deaths by half? . . .

When Lisa Jackson, a physician and senior investigator with the Group Health Research Center, in Seattle, began wondering aloud to colleagues if maybe something was amiss with the estimate of 50 percent mortality reduction for people who get flu vaccine, the response she got sounded more like doctrine than science. "People told me, 'No good can come of [asking] this,'" she says. "'Potentially a lot of bad could happen' for me professionally by raising any criticism that might dissuade people from getting vaccinated, because of course, 'We know that vaccine works.' This was the prevailing wisdom."

Nonetheless, in 2004, Jackson and three colleagues set out to determine whether the mortality difference between the vaccinated and the unvaccinated might be caused by a phenomenon known as the "healthy user effect." . . . Jackson's findings showed that outside of flu season, the baseline risk of death among people who did not get vaccinated was approximately 60 percent higher than among those who did, lending support to the hypothesis that on average, healthy people chose to get the vaccine, while the "frail elderly" didn't or couldn't. In fact, the healthy-user effect explained the entire benefit that other researchers were attributing to flu vaccine, suggesting that the vaccine itself might not reduce mortality at all. Jackson's papers "are beautiful," says Lone Simonsen, who is a professor of global health at George Washington University, in Washington, D.C., and an internationally recognized expert in influenza and vaccine epidemiology. "They are classic studies in epidemiology, they are so carefully done." MORE


Globe & Mail, Canada - A "perplexing" Canadian study linking H1N1 to seasonal flu shots is throwing national influenza plans into disarray and testing public faith in the government agencies responsible for protecting the nation's health.

Distributed for peer review last week, the study confounded infectious-disease experts in suggesting that people vaccinated against seasonal flu are twice as likely to catch swine flu.

The paper is under peer review, and lead researchers Danuta Skowronski of the British Columbia Centre for Disease Control and Gaston De Serres of Laval University must stay mum until it's published.

Met with intense early skepticism both in Canada and abroad, the paper has since convinced several provincial health agencies to announce hasty suspensions of seasonal flu vaccinations, long-held fixtures of public-health planning.


LA Times - Swine flu's tendency to strike the young is causing confusion Even as health officials anticipate a new onslaught of H1N1 cases, the pattern of the pandemic influenza strain -- which tends to be fatal for the middle-aged but not the elderly -- remains a mystery. . . The initial explanation was that the elderly, who are usually most vulnerable to the flu, have built-in immunity as a result of their exposure more than 50 years ago to ancestors of today's pandemic strain. But the limits of the theory are becoming more clear. For starters, only a third actually have antibodies to the new H1N1. . . Further, the flu's two key genes came directly from pigs and are new to everyone. That means all age groups should be equally vulnerable since no one has encountered the genes before. Yet infants seem to be in less danger than older children and most adults. Unraveling these mysteries will be crucial to designing a strong defense against this tenacious virus. Tests in animals strongly suggest that H1N1 will be with us for the foreseeable future, supplanting the strains that cause seasonal flu within a year or two.


Progressive Review - Once again, the prozac press is attempting to squash an issue by concentrating on an aspect easy to dismiss while ignoring underlying problems. In this case, while indeed no quarantine orders have been issued, a number of states have quarantine orders prepared and ready to go. These have been formulated without legislative or media discussion and could prove extremely controversial if ever put into effect. For example, Here's how one Iowa broadcast station handled the story:

KIMT - Health leaders in Iowa are reassuring people that there are no H1N1 related quarantines being ordered. Rumors started swirling after a quarantine form was found by someone on the internet. Polly Carver-Kimm from the state health department says that it's simply a template that was made months ago. She says folks shouldn't expect to see it used anytime soon."

The story ended with the soothing advice to wash your hands. Now here is a more informative story:

Lynda Waddington, Iowa Independent - A quarantine template created by the Iowa Department of Public Health and accessible through the Centers for Disease Control Web site should not be of great concern, according to a press release from health department officials. . . Many public health departments prepare such templates "in preparation for public health emergencies," the agency said, but "isolation and quarantine orders are only very rarely used in very specific situations.". . . The template, which, as expected, contains several fill-in-the-blank information areas, is dated May 1, 2009 and reads as follows. . .

[][][] The Iowa Department of Public Health has determined that you have had contact with a person with Novel Influenza A H1N1. Novel Influenza A H1N1 is a disease which is spread from person to person and is associated with fever (greater than 100.0 F), cough, sore throat, rhinorrhea (runny nose), nasal congestion, body aches, headache, chills and fatigue. Novel Influenza A H1N1 presents a risk of serious harm to public health and if it spreads in the community severe public health consequences may result.

The Department has determined that it is necessary to quarantine your movement to a specific facility to prevent further spread of this disease. The Department has determined that quarantine in your home and other less restrictive alternatives are not acceptable because [insert the reason home quarantine is not acceptable, the person violated a previously issued home quarantine order, the person does not have an appropriate home setting conducive to home quarantine, etc.] The Department is therefore ordering you to comply with the following provisions during the entire period of quarantine:

1. Terms of confinement. You are ordered to remain at the quarantine facility, [insert name and address of facility], from [insert dates of quarantine].

2. Requirements during confinement. During the period of quarantine:

a. You must not leave the quarantine facility at any time unless you have received prior written authorization from the Department to do so. b. You must not come into contact with anyone except the following persons: (i) other persons who are also under similar quarantine order at the quarantine facility; (ii) authorized healthcare providers and other staff at the quarantine facility; (iii) authorized Department staff or other persons acting on behalf of the Department; and (iv) such other persons as are authorized by the Department. c. Your daily needs, including food, shelter, and medical care, will be provided for you during the period of quarantine at the quarantine facility. You should bring clothing, toiletries, and other personal items with you to the quarantine facility. You will have limited access to a telephone at the quarantine facility. You may bring your cell phone with you should you desire to have greater access to a means of communication. d. You should inform your employer that you are under quarantine order and are not authorized to physically come to the work place, although you may work from the facility via electronic or other means if appropriate. You should be aware that Iowa law prohibits an employer from firing, demoting, or otherwise discriminating against an employee due to the compliance of an employee with a quarantine order issued by the Department. . .

Violations of order. If you fail to comply with this Quarantine Order you may be ordered to be quarantined in a more restrictive facility. In addition, failure to comply with this order is a simple misdemeanor for which you may be arrested, fined, and imprisoned. [][][]

Other states have similar laws in waiting. Some are written in a way that essentially gives the state martial law status. In North Carolina, , failure to comply with an isolation order can result in a jail sentence. In Massachusetts, officials can enter homes without a warrant, and gives the state power over "routes of transportation and over materials and facilities including but not limited to communication devices, carriers, public utilities, fuels, food, clothing, and shelter."

There are a number of problems with all this such as who determines whether the swine flue situation deserves quarantines? The record of past flu analysis is not reassuring. The predictions, after all, are being made by politicians and bureaucrats who want to make sure they are not caught underestimating the problem. While there is little harm in this at the advisory level, it becomes a whole other matter when it results in martial law. Further, neither the media nor the legislatures involved have had anything close to adequate public discussion of the issue.


Mike Davis, Guardian, UK - Since its identification during the Great Depression, H1N1 swine flu had only drifted slightly from its original genome. Then in 1998 a highly pathogenic strain began to decimate sows on a farm in North Carolina and new, more virulent versions began to appear almost yearly, including a variant of H1N1 that contained the internal genes of H3N2 (the other type-A flu circulating among humans).

What caused this acceleration of swine flu evolution? Virologists have long believed that the intensive agricultural system of southern China is the principal engine of influenza mutation: both seasonal "drift" and episodic genomic "shift". But the corporate industrialization of livestock production has broken China's natural monopoly on influenza evolution. Animal husbandry in recent decades has been transformed into something that more closely resembles the petrochemical industry than the happy family farm depicted in school readers.

In 1965, for instance, there were 53m US hogs on more than 1m farms; today, 65m hogs are concentrated in 65,000 facilities. This has been a transition from old-fashioned pig pens to vast excremental hells, containing tens of thousands of animals with weakened immune systems suffocating in heat and manure while exchanging pathogens at blinding velocity with their fellow inmates.

Last year a commission convened by the Pew Research Center issued a report on "industrial farm animal production" that underscored the acute danger that "the continual cycling of viruses … in large herds or flocks [will] increase opportunities for the generation of novel virus through mutation or recombinant events that could result in more efficient human to human transmission." . . .

Scientific American - New evidence indicates that our agricultural practices are leading directly to the spread of human disease. Much has been made in recent years of MRSA, the antibiotic-resistant strain of Staphylococcus bacteria, and for good reason. In 2005, the most recent year for which figures are available, about 95,000 MRSA infections caused the deaths of nearly 19,000 Americans. . . .

Perhaps we should not be surprised. Modern factory farms keep so many animals in such a small space that the animals must be given low doses of antibiotics to shield them from the fetid conditions. The drug-resistant bacteria that emerge have now entered our food supply. The first study to investigate farm-bred MRSA in the U.S. amazingly, the Food and Drug Administration has shown little interest in testing the nation's livestock for this disease recently found that 49 percent of pigs and 45 percent of pig workers in the survey harbored the bacteria. Unfortunately, these infections can spread. According to a report published in Emerging Infectious Diseases, MRSA from animals is now thought to be responsible for more than 20 percent of all human MRSA cases in the Netherlands.

James Ridgeway, Unsilent Generation - One of the unusual things about the current H1N1 virus, compared with the strains that cause our yearly seasonal flu outbreaks, is that it doesn't seem to discriminate on the basis of age. That may change as the pandemic develops, but it may not: The massive 1918 Spanish Flu pandemic is also known for killing across all age groups.

There is, nonetheless, an age angle here, and it has to do with those garden-variety annual influenza outbreaks, and how the medical, political, and media establishments have handled them. Because the great majority of the deaths caused each and every year by these "ordinary" flu viruses –some 36,000 on average in the United States alone, according to the CDC – are of people over 65 years old. Some years it's more, and some years it's fewer: During the 1990s, the number of deaths ranged from 17,000 to 54,000. But every year, tens of thousands of old folk succumb, with little fanfare and minimal media attention, to flu-related deaths.

One major public health initiative has been launched in response to these deaths, and that is to increase the number of older Americans who are vaccinated against the flu each year. The percentage of elders who are vaccinated has grown about four-fold in the last 30 years. But there's just one problem: The vaccine apparently doesn't work very well, if at all. . .

A study published in September 2008 in Britain's most respected medical journal, the Lancet, found no correlation at all between flu vaccination and a reduced risk of illness and death. . . .

Part of the problem, as AMNews notes, is "the nature of influenza vaccine, which aims at a constantly moving target. The viral strains it includes change every year. Circulating viruses shift constantly. And every season is different in regard to severity and spread." But it appears there's another problem with the vaccine, as well, when it comes to older people. Yet another recent study found that old folk might be better protected by a vaccine containing four times the usual dose. As Reuters reported, researchers concluded that "this is likely because their immune systems are not as active as those of younger people". . .

The excellent public health blog Effect Measure had some other ideas on how to protect older people, since the vaccine seems to be proving ineffective. But this would involve shifting the focus of national public health efforts. . .

It makes perfect sense, when you think about it: Young people are more likely to infect their elders than vice versa, and since the vaccine apparently works better on them, why not push them to have it? But frankly, I can't see this working. I can't see young people, who know they aren't likely to die from the flu, going out and getting vaccinated just to protect older folk.

I can't see this, any more than I can see the newspapers running headlines every winter proclaiming: "30,000 Geezers Dead in Seasonal Flu Outbreak," or the president going on TV to say that the government would stop at nothing to protect granny from this dangerous virus. The fact that these things don't happen, I think, is proof that the older we get, the less our lives are worth in this society.

Johann Hari, Independent, UK - A swelling number of scientists believe swine flu has not happened by accident. No: they argue that this global pandemic – and all the deaths we are about to see – is the direct result of our demand for cheap meat. . .

To understand how this might happen, you have to compare two farms. My grandparents had a pig farm in the Swiss mountains, with around 20 swine at any one time. What happened there if, in the bowels of one of their pigs, a virus mutated and took on a deadlier form? At every stage, the virus would meet stiff resistance from the pigs' immune systems. They were living in fresh air, on the diet they evolved with, and without stress – so they had a robust ability to fight back. If the virus did take hold, it would travel only as far as the sick hog could walk. So if the virus would then have around 20 other pigs to spread and mutate in – before it would hit the end of its own evolutionary path, and die off. If it was a really lucky, plucky virus, it might make it to market – where it would come up against more healthy pigs living in small herds. It had little opportunity to fan out across a large population of pigs or evolve a strain that could be transmitted to humans.

Now compare this to what happens when a virus evolves in a modern factory farm. In most swine farms today, 6,000 pigs are crammed snout-to-snout in tiny cages where they can barely move, and are fed for life on an artificial pulp, while living on top of cess-pools of their own stale faeces.

Instead of having just 20 pigs to experiment and evolve in, the virus now has a pool of thousands, constantly infecting and reinfecting each other. The virus can combine and recombine again and again. . .

As Dr Michael Greger, director of Public Health and Animal Agriculture at the Humane Society of the United States, explains: "Put all this together, and you have a perfect storm environment for these super-strains. If you wanted to create global pandemics, you'd build as many of these factory farms as possible. That's why the development of swine flu isn't a surprise to those in the public health community. In 2003, the American Public Health Association – the oldest and largest in world – called for a moratorium of factory farming because they saw something like this would happen. It may take something as serious as a pandemic to make us realise the real cost of factory farming.". . .

It's no coincidence that we have seen a sudden surge of new viruses in the past decade at precisely the moment when factory farming has intensified so dramatically. For example, between 1994 and 2001, the number of American pigs that live and die in vast industrial farms in the US spiked from 10 per cent to 72 per cent. Swine flu had been stable since 1918 – and then suddenly, in this period, went super-charged. . .

We always knew that factory farms were a scar on humanity's conscience – but now we fear they are a scar on our health. If we carry on like this, bird flu and swine flu will be just the beginning of a century of viral outbreaks. As we witness a global pandemic washing across the world, we need to shut down these virus factories – before they shut down even more human lives.